Table 5.
Sleep-wake and circadian biology studies evaluating the five functional domains in young people (12-30 yrs) with a mood and/or anxiety disorder
| Outcome measure | Study | Age (mean ± SD) | Sample (N) | Aims | Key measures | Key findings |
|---|---|---|---|---|---|---|
| Social and economic participation | [103] | PD: 30.6 ± 6.1 | PD (8M; 12F) | Determine whether HPA activity can predict FUP functional status. | SWC: 24-hour cortisol samples, ACTH profiles, CRH stimulation test | PD: ↑ cortisol secretion pre-treatment ~ ↓ social and economic participation (better than pre-treatment clinical severity) |
| Functional: SDS | ||||||
| [102]* | MDD (M): 12.8 ± 2.6, MDD (F): 13.6 ± 1.9 | MDD (22M; 33F) | Investigate whether diurnal changes in cortisol and DHEA levels are associated with the occurrence of undesirable life events. | SWC: Cortisol/DHEA ratio, | MDD: ↑ cortisol/DHEA ratios at BL ~ ↓ social and economic participation at FUP. | |
| Functional: Semi-structured interview | ||||||
| [104] | MHP: 12.1 (7 – 17.9 years) | MHP (62M; 40F) | Investigate whether cortisol reactivity is associated with internalizing problem behaviour | SWC: Cortisol level | MHP: ↑ cortisol secretion during the social interaction task ~ ↓ social and economic participation | |
| Functional: CBCL, SASC, CDI | ||||||
| Suicide and self-harm | [105]* | MDD: 25.19 ± 2.42 | MDD (33M; 23F) | Examine baseline neuroendocrine predictors of follow up clinical features | SWC: Sleep EEG, GH secretion, blood cortisol | MDD: ↑ BL GH secretion during first 4 hours of sleep ~ a suicide attempt during FUP |
| HC: 25.92 ± 2.16 | HC (10M; 11F) | |||||
| Functional: Clinical interview | ||||||
| [106] | MDD: 25.19 ± 2.42 | MDD (33M; 23F) | Assess whether any premorbid cortisol abnormalities were associated with depressive course of illness | SWC: Sleep EEG, GH secretion, blood cortisol | MDD: ↑ BL cortisol secretion in the late evening hours ~ suicide attempts during FUP | |
| HC: 25.92 ± 2.16 | HC (10M; 11F) | |||||
| Functional: Clinical interview | ||||||
| [107]* | MDD: 16 ± 0.3 | MDD (6M; 14F) | Compare sleep EEG profiles of a sample of outpatient adolescents | SWC: Sleep EEG, blood samples | MDD: ↓ Delta sleep variable ~ ↑ suicidality (and depression severity). | |
| HC: 15.6 ± 0.6 | HC (7M; 6F) | |||||
| Functional: HDRS | ||||||
| Clinical syndrome | [108] | CS: 17.04 ± 0.36 | CS (57M; 173F) | Examine whether individual differences in the CAR serve as a premorbid risk factor for MDD | SWC: Salivary cortisol | CS: ↑ cortisol after waking at BL ~ ↑ risk of developing MDD at FUP |
| Clinical: SCID, LSI | ||||||
| [118] | HYP: 20.91 ± 3.72 | HYP (8M; 23F) | Assess circadian activity and sleep in individuals at behavioral high-risk of hypomania/bipolar disorders | SWC: Actigraphy | HYP: ↑ variability in duration, fragmentation and efficiency of sleep, ↓ sleep duration and later more variable be times. | |
| HC: 22.12 ± 2.83 | HC (8M; 16F) | Clinical: SCID, HPS, HIQ, ISS | ||||
| [120] | MDD: 12 ± 1.9 | MDD (2M; 4F) | Explore the effects of fluoxetine on sleep EEG | SWC: Sleep EEG | MDD: ↑ stage 1 sleep, arousals and REM density ~ fluoxetine treatment | |
| Clinical: K-SADS, CDRS, BDI, WSAS | ||||||
| [105]* | MDD: 25.19 ± 2.42 | MDD (33M; 23F) | Examine baseline neuroendocrine predictors of follow up clinical features | SWC: Sleep EEG, GH secretion, blood cortisol | MDD: Premorbidly, earlier and more steep GH secretion at sleep onset | |
| HC: 25.92 ± 2.16 | HC (10M; 11F) | |||||
| Clinical: Clinical interview | ||||||
| [114] | MDD: 17.04 ± 0.35 | MDD (4M; 7F) | Examine the associations between MDD and anxiety disorders, and HPA- axis functioning | SWC: Salivary cortisol | P-MDD & MDD/ANX: flatter diurnal cortisol slopes | |
| ANX: 17.04 ± 0.37 | ANX (8M; 21F) | Clinical: MASQ, LSI | ||||
| MDD/ANX: 16.85 ± 0.21 | MDD-ANX (4M; 8F) | |||||
| P-MDD: 17.13 ± 0.37 | P-MDD (11M; 45F) | |||||
| P-ANX: 17.02 ± 0.38 | P-ANX (6M; 2F) | |||||
| [109] | HR: 16.8 ± 1.7 | HR (14M; 15F) | Examine the cortisol increase after awakening and basal cortisol levels hypothesis that high-risk offspring are more reactive to psychosocial stress than low-risk offspring | SWC: Salivary cortisol | HR: ↑ daytime cortisol in their natural environment. | |
| LR: 16.6 ± 2.1 | LR (14M; 15F) | Clinical: CDI, CBCL, PANAS | ||||
| [110] | HR: 18.3 ± 2.6 | HR (12M; 12F) | Determine whether HR individuals exhibit elevated cortisol levels relative to LR individuals during two weeks of daily sampling | SWC: Salivary cortisol | HR: ↑ afternoon cortisol levels in their natural environment | |
| LR: 18.0 ± 2.3 | LR (11M; 11F) | Clinical: BDI, CDI, PSWQ, CBCL, RLEQ | ||||
| [102]* | MDD (M): 12.8 ± 2.6 | MDD (22M; 33F) | Investigate whether diurnal changes in cortisol and DHEA levels are associated with the occurrence of undesirable life events. | SWC: Cortisol/DHEA ratio, | MDD: ↑ cortisol/DHEA ratios at BL ~ persistent major depression at FUP | |
| MDD (F): 13.6 ± 1.9 | Clinical: Semi-structured interview | |||||
| [113] | Mild: 14.73 ± 2.30 Moderate: 15.69 ± 1.58 | Mild (10M; 20F) Moderate (7M; 9F) | Examine cortisol reactivity to a psychological stress challenge in depressed adolescents. | SWC: Salivary cortisol | Moderate/severe depression: ↓ cortisol response regardless of child maltreatment history | |
| Clinical: CECA, BDI-II, K-SADS | ||||||
| Severe: 16.00 ± 2.00 | Severe (6M; 19F) | |||||
| [119] | MDD: 23.94 ± 2.31 | MDD (8M; 9F) | Investigate the effect of reducing slow waves during sleep on depression symptomology | SWC: Sleep EEG | MDD: ↑ overnight dissipation of SWA predicted ↓ in depressive symptoms. | |
| Clinical: QIDS, HDRS | ||||||
| [107]* | MDD: 16 ± 0.3 | MDD (6M; 14F) | Compare sleep EEG profiles of a sample of outpatient adolescents | SWC: Sleep EEG, blood samples | MDD: ↓ Delta sleep variable ~ ↑ depression severity. | |
| HC: 15.6 ± 0.6 | HC (7M; 6F) | |||||
| Clinical: HDRS | ||||||
| [117] | DD: 15.35 ± 1.85 | DD (18M; 28F) | Assess sleep disturbances pain and pubertal development in adolescent depressive disorders | SWC: Actigraphy | DD: ↓ sleep efficiency and total time asleep, ↑ time awake after sleep onset. ↑ pain intensity and depressive symptoms predicted worse sleep quality | |
| HC: 14.83 ± 1.76 | HC (17M; 43F) | Clinical: K-SADS, PDS, CES-D, BPD | ||||
| [111] | MDD: 22.4 ± 1.5 | MDD (9M; 17F) | Examine the relationship between longitudinal clinical course, sleep and cortisol in adolescent depression | SWC: Sleep EEG | MDD: recurrent illness ~ ↑ plasma cortisol near sleep onset at BL. | |
| HC: 21.9 ± 1.7 | HC (13M; 20F) | Clinical: K-SADS | ||||
| HC: high density REM and ↓ REM latency at BL ~ the development of depression a FUP | ||||||
| [112] | MDD: 15.6 ± 1.4 | MDD (6M; 10F) | Examine EEG sleep and HPA changes during MDD episodes and recovery | SWC: NUFC, sleep EEG | MDD: ↓ NUFC excretion during remission | |
| HC: 15.8 ± 1.9 | HC (7M; 9F) | Clinical: PRS, HDRS, K-SADS | ||||
| [115] | UPD: 21.8 ± 4.3 | UPD (5M; 13F) | Evaluate the potential of circadian measures as early markers of mood disorders subtypes | SWC: Actigraphy, DLMO | BPD:↓ and later onset of melatonin secretion | |
| BPD: 22.8 ± 4.8 | BPD (3M; 11F) | Clinical: Psychiatric interview (DSM-IV criteria), BDI | ||||
| [116] | HC: 24.8 ± 2.5 | HC (8M; 12F) | Investigate objectively the 24-h sleep–wake cycle in adolescents and young adults with mood disorders | SWC: Actigraphy | BPD: 62 % had delayed sleep (during a depressive phase), and later sleep offset compared to UPD and HC | |
| UPD: 20.1 ± 4.7 | UPD and BPD (28M; 47F) | Clinical: Psychiatric interview (DSM-IV criteria) | ||||
| BPD: 23.2 ± 4.3 | ||||||
| UPD: 30 % had delayed sleep | ||||||
| HC: 10 % had delayed sleep | ||||||
| [121] | Stage 1a: 17.6 ± 4.0 | Stage 1a (7M; 11F) | Determine if disturbed sleep–wake cycle patterns in young people with emerging mental disorder are associated with stages of illness | SWC: Actigraphy | Stage 1b & 2: ↑ delayed sleep schedule, especially on weeknights | |
| Stage 1b: 19.1 ± 4.1 | Stage 1b (44M; 38F) | Clinical: Psychiatric interview (DSM-IV criteria) | ||||
| Stage 2+: 22.4 ± 4.3 | Stage 2+ (27M; 27F) | Stage 1a & 2+: ↓ sleep efficiency | ||||
| HC: 24.4 ± 3.1 | HC (11M; 12F) |
Note. Sample: ANX anxiety disorder, BPD bipolar disorder, CS community sample, DD depressive disorder, HC healthy controls, HR high risk participants (offspring of parents with bipolar disorder), HYP hypomanic participants, LR low risk participants (offspring of parents without a mental disorder), MDD-ANX comorbid Major depressive disorder and anxiety disorder, MDD major depression disorder, MHP mental health patients (mixed diagnosis sample), P-MDD past major depressive disorder, P-ANX past anxiety disorder, PD panic disorder
Measures: ACTH adrenocorticotropic hormone, BDI beck depression inventory, BPD body pain diagram, CBCL child behaviour checklist, CDI children’s depression inventory, CDRS children’s depression rating scale, CECA childhood experience of case and abuse contextual semi-structured interview and rating system, CES-D Center for Epidemiologic Studies Depression, CRH corticotropin-releasing hormone, DHEA dehydroepiandrosterone, DLMO dim light melatonin onset, DSM-IV diagnostic and statistical manual of mental disorders IV, EEG electroencephalography, GH growth hormone, HDRS Hamilton depression rating scale, HPS hypomanic personality scale, HIQ hypomanic interpretations questionnaire, ISS internal state scale, K-SADS schedule for affective disorders and schizophrenia for school age children, LSI life stress interview, MASQ mood and anxiety symptom questionnaire, NUFC nocturnal urinary free cortisol, PANAS positive and negative affect scale, PDS pubertal developmental scale, PRS Pfeffer rating scale, PSWQ Penn state worry questionnaire, QIDS quick inventory of depressive symptomatology, RLEQ recent life events questionnaire, SASC social anxiety scale for children, SCID structured clinical interview for DSM, SDS Sheehan disability scale, SWC sleep-wake and circadian biology, WSAS work and social adjustment scale
Findings: ↑ = Increased, Improved or Higher, ↓ = Decreased, Reduced or Lower, ~ = ‘is associated with’, BL baseline, FUP follow-up, NUFC nocturnal urinary free cortisol, REM rapid eye movement, SWA slow wave activity
*indicates that the study features more than once in the data synthesis