Department of Psychiatry and Behavioral Science, University of California, San Francisco, San Francisco, California, USA.
Department of Psychiatry and Behavioral Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
J Child Psychol Psychiatry. 2023 Dec;64(12):1652-1664. doi: 10.1111/jcpp.13880. Epub 2023 Aug 17.
An evening circadian preference is common among adolescents. It is characterized by a behavioral predilection for later sleep and wake timing and is associated with higher rates of Major Depressive Disorder (MDD). The present study aims to (a) test the effectiveness of a cognitive behavioral sleep intervention (Transdiagnostic Sleep and Circadian Intervention; TranS-C) in a sample of adolescents with an evening circadian preference and clinically significant depressive symptoms and (b) evaluate improved alignment between circadian biology and sleep-wake behavior as a potential mechanism in the relationship between sleep and depression symptom improvement.
Adolescents with an evening circadian preference and clinically significant depressive symptoms were randomized to receive TranS-C (n = 24) or a psychoeducation condition (PE; n = 18). Alignment between circadian biology and sleep-wake behavior was measured using objective biological measurement. Measures of sleep and circadian rhythm were taken at pre- and posttreatment, and depression symptoms were measured at pre- and posttreatment and 6- and 12-month follow-up.
Mixed effects modeling revealed that compared with an active control condition, TranS-C resulted in a significant reduction in MDD severity at 12-month follow-up. A MacArthur mediation analysis conducted to explore alignment between circadian biology and sleep-wake behavior as a mediator of depression severity reduction through 12-month follow-up revealed a significant interaction between change in alignment between circadian biology and sleep-wake behavior and treatment arm, indicating that improved alignment between circadian biology and sleep-wake behavior at posttreatment was associated with improvements in depression outcomes at 12-month follow-up under the treatment condition.
These results provide novel evidence for improved alignment between circadian biology and sleep-wake behavior as a specific mechanism of depression improvement, provide key clues into the complex relationship between sleep and depression, and have significant clinical implications for adolescents with depression.
青少年中常见的夜间昼夜偏好。其特点是行为上倾向于晚睡晚起，并与更高的重度抑郁症（MDD）发生率相关。本研究旨在：（a）在有夜间昼夜偏好和临床显著抑郁症状的青少年样本中测试认知行为睡眠干预（Transdiagnostic Sleep and Circadian Intervention；TranS-C）的有效性，以及（b）评估昼夜生物节律和睡眠-觉醒行为之间的改善一致性作为睡眠与抑郁症状改善之间关系的潜在机制。
有夜间昼夜偏好和临床显著抑郁症状的青少年被随机分为接受 TranS-C（n=24）或心理教育条件（PE；n=18）。使用客观的生物测量来测量昼夜生物节律和睡眠-觉醒行为之间的一致性。在治疗前和治疗后测量睡眠和昼夜节律的测量值，并在治疗前和治疗后以及 6 个月和 12 个月随访时测量抑郁症状。
混合效应模型显示，与积极对照条件相比，TranS-C 在 12 个月随访时显著降低 MDD 严重程度。为探索昼夜生物节律和睡眠-觉醒行为之间的一致性作为通过 12 个月随访降低抑郁严重程度的中介，进行了 MacArthur 中介分析，结果显示昼夜生物节律和睡眠-觉醒行为之间的一致性变化与治疗手臂之间存在显著的相互作用，表明治疗后昼夜生物节律和睡眠-觉醒行为之间的一致性改善与治疗条件下 12 个月随访时抑郁结果的改善相关。
这些结果为昼夜生物节律和睡眠-觉醒行为之间的改善一致性作为抑郁改善的特定机制提供了新的证据，为睡眠与抑郁之间的复杂关系提供了关键线索，并对抑郁青少年具有重要的临床意义。
