Analysis of circadian rhythms from online communities of individuals with affective disorders

The circadian system regulates 24 hour rhythms in biological creatures. It impacts mood regulation. The disruptions of circadian rhythms cause destabilization in individuals with affective disorders, such as depression and bipolar disorders. Previous work has examined the role of the circadian system on effects of light interactions on mood-related systems, the effects of light manipulation on brain, the impact of chronic stress on rhythms. However, such studies have been conducted in small, preselected populations. The deluge of data is now changing the landscape of research practice. The unprecedented growth of social media data allows one to study individual behavior across large and diverse populations. In particular, individuals with affective disorders from online communities have not been examined rigorously. In this paper, we aim to use social media as a sensor to identify circadian patterns for individuals with affective disorders in online communities.We use a large scale study cohort of data collecting from online affective disorder communities. We analyze changes in hourly, daily, weekly and seasonal affect of these clinical groups in contrast with control groups of general communities. By comparing the behaviors between the clinical groups and the control groups, our findings show that individuals with affective disorders show a significant distinction in their circadian rhythms across the online activity. The results shed light on the potential of using social media for identifying diurnal individual variation in affective state, providing key indicators and risk factors for noninvasive wellbeing monitoring and prediction

Longitudinal Assessment of Seasonal Impacts and Depression Associations on Circadian Rhythm Using Multimodal Wearable Sensing

Objective: This study aimed to explore the associations between depression severity and wearable-measured circadian rhythms, accounting for seasonal impacts and quantifying seasonal changes in circadian rhythms.Materials and Methods: Data used in this study came from a large longitudinal mobile health study. Depression severity (measured biweekly using the 8-item Patient Health Questionnaire [PHQ-8]) and behaviors (monitored by Fitbit) were tracked for up to two years. Twelve features were extracted from Fitbit recordings to approximate circadian rhythms. Three nested linear mixed-effects models were employed for each feature: (1) incorporating the PHQ-8 score as an independent variable; (2) adding the season variable; and (3) adding an interaction term between season and the PHQ-8 score. Results: This study analyzed 10,018 PHQ-8 records with Fitbit data from 543 participants. Upon adjusting for seasonal effects, higher PHQ-8 scores were associated with reduced activity, irregular behaviors, and delayed rhythms. Notably, the negative association with daily step counts was stronger in summer and spring than in winter, and the positive association with the onset of the most active continuous 10-hour period was significant only during summer. Furthermore, participants had shorter and later sleep, more activity, and delayed circadian rhythms in summer compared to winter. Discussion and Conclusions: Our findings underscore the significant seasonal impacts on human circadian rhythms and their associations with depression and indicate that wearable-measured circadian rhythms have the potential to be the digital biomarkers of depression

Circadian strain, light exposure, and depressive symptoms in rural communities of Southern Brazil

Irregular light–dark cycles and circadian/sleep disturbances have been suggested as risk or co-occurring factors in depression. Among a set of metrics developed to quantify strain on the circadian system, social jetlag (SJL) has been put forward as a measure of the discrepancy between biological and social clocks. Here, we approached the question on whether light exposure and SJL would also be associated with depressive symptoms in Quilombola communities in Southern Brazil. These rural communities are void of potential confounders of modern lifestyles and show low levels of SJL. 210 Quilombolas (age range 16–92; 56% women) were asked about their sleep times and light exposure using the Munich ChronoType Questionnaire (MCTQ). The Beck Depression Inventory (BDI) was used to assess depressive symptoms. Additionally, we analyzed 7-day actimetry recordings in 124 subjects. BDI scores higher than 10 (having clinically significant depressive symptoms; controlled for age and sex in the multivariate analysis) were positively associated with SJL >1 h and negatively associated with median light exposure during the day, especially in the morning from 8:00 to 10:00. Our results suggest that low light exposure during the day, and higher levels of SJL are associated with depressive symptoms; longitudinal and experimental studies are needed to understand the underlying mechanisms. Nevertheless, we highlight the potential of treatment strategies aimed at decreasing circadian strain and insufficient light exposure, which are suggested as areas of further research in Psychiatry

Self-monitoring Practices, Attitudes, and Needs of Individuals with Bipolar Disorder: Implications for the Design of Technologies to Manage Mental Health

Objective To understand self-monitoring strategies used independently of clinical treatment by individuals with bipolar disorder (BD), in order to recommend technology design principles to support mental health management. Materials and Methods Participants with BD (N = 552) were recruited through the Depression and Bipolar Support Alliance, the International Bipolar Foundation, and WeSearchTogether.org to complete a survey of closed- and open-ended questions. In this study, we focus on descriptive results and qualitative analyses. Results Individuals reported primarily self-monitoring items related to their bipolar disorder (mood, sleep, finances, exercise, and social interactions), with an increasing trend towards the use of digital tracking methods observed. Most participants reported having positive experiences with technology-based tracking because it enables self-reflection and agency regarding health management and also enhances lines of communication with treatment teams. Reported challenges stem from poor usability or difficulty interpreting self-tracked data. Discussion Two major implications for technology-based self-monitoring emerged from our results. First, technologies can be designed to be more condition-oriented, intuitive, and proactive. Second, more automated forms of digital symptom tracking and intervention are desired, and our results suggest the feasibility of detecting and predicting emotional states from patterns of technology usage. However, we also uncovered tension points, namely that technology designed to support mental health can also be a disruptor. Conclusion This study provides increased understanding of self-monitoring practices, attitudes, and needs of individuals with bipolar disorder. This knowledge bears implications for clinical researchers and practitioners seeking insight into how individuals independently self-manage their condition as well as for researchers designing monitoring technologies to support mental health management

An evidence map of psychosocial interventions for the earliest stages of bipolar disorder.

Depression, schizophrenia, and bipolar disorder are three of the four most burdensome problems in people aged under 25 years. In psychosis and depression, psychological interventions are effective, low-risk, and high-benefit approaches for patients at high risk of first-episode or early-onset disorders. We review the use of psychological interventions for early-stage bipolar disorder in patients aged 15-25 years. Because previous systematic reviews had struggled to identify information about this emerging sphere of research, we used evidence mapping to help us identify the extent, distribution, and methodological quality of evidence because the gold standard approaches were only slightly informative or appropriate. This strategy identified 29 studies in three target groups: ten studies in populations at high risk for bipolar disorder, five studies in patients with a first episode, and 14 studies in patients with early-onset bipolar disorder. Of the 20 completed studies, eight studies were randomised trials, but only two had sample sizes of more than 100 individuals. The main interventions used were family, cognitive behavioural, and interpersonal therapies. Only behavioural family therapies were tested across all of our three target groups. Although the available interventions were well adapted to the level of maturity and social environment of young people, few interventions target specific developmental psychological or physiological processes (eg, ruminative response style or delayed sleep phase), or offer detailed strategies for the management of substance use or physical health

The effect of bright light on rest-activity rhythms and behavioural and psychological symptoms of dementia

De fleste som lever med demens har også atferdsmessige- og psykologiske symptomer ved demens (APSD) som for eksempel depresjon, angst, agitasjon, og søvnforstyrrelser. APSD påvirker livskvalitet og pleiebehov. Aktivitetsrytmen er ofte endret hos personer med demens. For eksempel kan søvn og våkenhet forekomme uregelmessig, med rastløshet og atferdsforstyrrelser på kvelds- og nattestid, og søvn på dagtid. Forstyrrelser i søvn og våkenhet har negative konsekvenser for daglig fungering, kognisjon, og affekt. I tillegg er det trolig at denne typen problemer gjenspeiler forstyrrelse av den endogene cirkadiane rytmen. APSD, inkludert søvnproblemer, behandles ofte medikamentelt, på tross av at slik behandling har begrenset effekt og kan medføre alvorlige bivirkninger. Lys påvirker den cirkadiane rytmen, og kan i tillegg ha en innvirkning på våkenhet og humør. Disse omtales som ikke-visuelle effekter av lys. Lysterapi er en ikke-medikamentell behandling som ifølge noen tidligere studier kan ha en positiv effekt på affekt, agitasjon, søvnforstyrrelser og aktivitetsrytmer hos personer med demens, men resultatene fra ulike studier har ikke vært entydige. Målet med denne avhandlingen var å undersøke effekten av lysterapi på APSD og aktivitetsrytmer, gjennom en klynge-randomisert placebo-kontrollert studie over 24 uker – DEM.LIGHT studien. Et sekundært mål, og et forarbeid til hovedstudien, var å undersøke lysforholdene ved demensenheter på sykehjem. Artikkel 1 presenterte en undersøkelse av lys på 15 demensenheter i Bergen kommune, gjennomført ved to årstider og med lysmålinger i ulike retninger. Lysmålingene ble sammenlignet med grenseverdier basert på anbefalinger og tidligere forskning. Lysverdiene ble oppgitt i måleenheter som er relevante for ikkevisuelle effekter av lys. Artikkel 2 og 3 rapporterte resultater fra DEM.LIGHTstudien, gjennomført på 8 sykehjem med 69 deltagere. Intervensjonen besto av takmonterte LED-lys i fellesstuen på 4 demensenheter, som gav lys av ulik styrke og fargetemperatur gjennom dagen. Maksimalt nivå for intervensjonen var ~1000 lx og 6000 K, mellom kl. 10:00 og 15:00, målt vertikalt 1.2 m over gulvet. Kontrollgruppen (4 demensenheter) hadde standard innendørsbelysning (~150–300 lx, 3000 K). Data ble innhentet ved baseline, og etter 8, 16 og 24 uker. Artikkel 2 undersøkte effekten av lysbehandlingen på aktivitetsrytmer registrert med aktigrafi, og artikkel 3 undersøkte effekten på proxy-vurderte APSD-mål (Cornell Scale for Depression in Dementia, CSDD og Neuropsychiatric Inventory – Nursing Home Version, NPI-NH). Effekten av behandlingen ble analysert ved bruk av blandede regresjonsmodeller (multilevel models), med demensstadium (Functional Assessment Staging Tool, FAST skåre) ved baseline som en a priori bestemt kovariat. I tillegg ble baselineskårer på utfallsmålene inkludert som kovariater i analysene til artikkel 3. I artikkel 1 fant vi at de fleste målingene av lyset på demensenhetene var under terskelverdiene, uavhengig av årstid og måleretning. I artikkel 2 fant vi ingen forbedring av aktivitetsrytmen etter BLT hos personer med demens når vi korrigerte for multippel testing. Uten slik korreksjon var akrofasen (tidspunktet for aktivitetrytmens makspunkt) signifikant mindre forsinket (med en time) i uke 16 i intervensjonsgruppen sammenlignet med kontrollgruppen. Artikkel 3 rapporterte blandede resultater for effekten av lysintervensjonen på APSD. Det var en signifikant effekt på underskalaer som måler affektive symptomer i uke 16, men ikke i uke 8 eller 24, etter korreksjon for multippel testing. Det var en signifikant effekt på CSDD og NPI-NH total-skårer i uke 16 før, men ikke etter, korreksjon for multippel testing. Det var ingen signifikant effekt på andre underskalaer. Oppsummert peker funnene fra artikkel 1 mot at lyset på demensenheter er utilstrekkelig sett opp mot terskelverdier for ikke-visuelle effekter av lys. Likevel var resultatene fra DEM.LIGHT-studien, som økte belysningen på demensenheter, blandede. Basert på disse resultatene kan vi ikke anbefale takmontert lysterapi ved demensenheter. Det er imidlertid flere metodologiske utfordringer og karakteristikker ved utvalget som begrenser generaliserbarheten til disse funnene.Most people living with dementia have behavioural and psychological symptoms of dementia (BPSD), such as depression, anxiety, agitation, and disturbed sleep, that strongly affect well-being and care needs. The rest-activity rhythm (RAR), i.e., the diurnal pattern of activity, is often altered in individuals with dementia. Sleep and wakefulness may, for instance, occur at irregular intervals, characterised by restlessness and behavioural disturbances at night, and napping during the day. This disruption of the sleep-wake pattern is detrimental to functioning and well-being. It is also thought to reflect deterioration of the endogenous circadian rhythm. Pharmacotherapy is often used to treat BPSD, including sleep disturbances, but has limited efficacy and is associated with severe side effects. Light influences the circadian rhythm, and can also have effects on alertness and mood. These are collectively referred to as non-image forming (NIF) effects of light. Bright light treatment (BLT) is a non-pharmacological intervention that has been found to improve affective symptoms, agitation, sleep disorders, and RARs in people with dementia in some studies, but results have been mixed. The main aim of this thesis was to investigate the effect of BLT on RARs and BPSD in a 24-week cluster randomised controlled trial - the DEM.LIGHT trial (ClinicalTrials.gov identifier: NCT03357328). A secondary aim, and preparation for the trial, was to investigate the illumination in nursing home dementia units. Paper 1 was a field study investigating nursing home illumination in 15 dementia units across seasons and gaze directions. Measured illuminances were compared to thresholds suggested by industry standards and research, and measurement units relevant to NIF effects of light were used. Paper 2 and 3 reported results from the DEM.LIGHT trial, conducted at 8 dementia units, with 69 participants. In the intervention group (4 units), ceiling mounted LED-panels provided ambient light of varying illuminance and correlated colour temperature throughout the day, with a peak of ~1000 lx and 6000 K (measured vertically at 1.2 m) between 10:00 and 15:00. In the control group (4 units), standard indoor light of ~150–300 lx, 3000 K was used. Data were collected at baseline and at 8, 16, and 24 weeks. Paper 2 investigated the effect of the intervention on actigraphy-measured RARs, and paper 3 investigated the effect on proxy-rated BPSD measures: the Cornell Scale for Depression in Dementia (CSDD) and the Neuropsychiatric Inventory - Nursing Home Version (NPI-NH). Treatment effects were analysed using multilevel regression models, with dementia stage (score on the Functional Assessment Staging Tool, FAST) at baseline as a pre-determined covariate. In addition, baseline scores on the outcome measures were included as covariates in the models in paper 3. In paper 1 we found that, regardless of season and gaze direction, nearly all measured illuminances in dementia units fell below the thresholds. In paper 2, we found that there was no effect of BLT on RAR outcomes in people with dementia when controlling for multiple testing. Without controlling for multiple testing, the acrophase (i.e., timing of the activity peak) was significantly less delayed (by one hour) in the intervention group compared to the control group, in week 16. Paper 3 found mixed results for the effect of BLT on BPSD. There was a significant reduction of scores on affective subscales in the intervention group in week 16, but not at other follow-ups, after controlling for multiple testing. There was a significant effect on the NPI-NH and CSDD total scores in week 16 before, but not after, controlling for multiple testing. There were no significant effects on other subscales. In conclusion, the findings in paper 1 suggest that illumination in dementia units is inadequate compared to thresholds suggested for NIF effects of light. However, the results of the DEM.LIGHT trial, which increased the indoor illumination in dementia units, were mixed. Based on our results, we cannot make clear recommendations regarding the use of ambient BLT in dementia units. Several methodological challenges and sample characteristics may limit the generalisability of these results.Doktorgradsavhandlin

Short- and long-term health consequences of sleep disruption

Sleep plays a vital role in brain function and systemic physiology across many body systems. Problems with sleep are widely prevalent and include deficits in quantity and quality of sleep; sleep problems that impact the continuity of sleep are collectively referred to as sleep disruptions. Numerous factors contribute to sleep disruption, ranging from lifestyle and environmental factors to sleep disorders and other medical conditions. Sleep disruptions have substantial adverse short-and long-term health consequences. A literature search was conducted to provide a nonsystematic review of these health consequences (this review was designed to be nonsystematic to better focus on the topics of interest due to the myriad parameters affected by sleep). Sleep disruption is associated with increased activity of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis, metabolic effects, changes in circadian rhythms, and proinflammatory responses. In otherwise healthy adults, short-term consequences of sleep disruption include increased stress responsivity, somatic pain, reduced quality of life, emotional distress and mood disorders, and cognitive, memory, and performance deficits. For adolescents, psychosocial health, school performance, and risk-taking behaviors are impacted by sleep disruption. Behavioral problems and cognitive functioning are associated with sleep disruption in children. Long-term consequences of sleep disruption in otherwise healthy individuals include hypertension, dyslipidemia, cardiovascular disease, weight-related issues, metabolic syndrome, type 2 diabetes mellitus, and colorectal cancer. All-cause mortality is also increased in men with sleep disturbances. For those with underlying medical conditions, sleep disruption may diminish the health-related quality of life of children and adolescents and may worsen the severity of common gastrointestinal disorders. As a result of the potential consequences of sleep disruption, health care professionals should be cognizant of how managing underlying medical conditions may help to optimize sleep continuity and consider prescribing interventions that minimize sleep disruption

Clinical Associations of Chronotypes in Adolescents and Young Adults with Mental Disorders

Youth represents a sensitive period for the onset of both circadian disturbances and mental disorders. There are some suggestions that circadian disturbances may be an early feature or may directly contribute to the emergence, perpetuation, and recurrence of some mental disorders, particularly affective disorders. A person’s ‘chronotype’ characterises their circadian preferences for early or late bed and wake times and their peak cognitive and physical activities across the 24-hour period. In this thesis, the chronotype of young persons with various mental disorders is examined. Study 1 evaluated chronotypes, as assessed with the Horne-Östberg questionnaire, in young people with emerging anxiety, depression, bipolar, or psychotic disorders and healthy controls. Associations between Morningness-Eveningness preference and the severity of various psychiatric symptoms were assessed. Four hundred and ninety-six individuals aged 12-30 years (mean age + SD: 19.5 + 4.2) were divided according to primary diagnosis and were assessed with the Social and Occupational Functioning Scale (SOFAS), the Hamilton Depression Rating Scale (HDRS), the Brief Psychiatric Rating Scale (BPRS), the Kessler Psychological Distress Scale (K10) and the Horne-Östberg Morningness-Eveningness questionnaire (ME). A significant diagnostic group effect was found for the ME (ANOVA: F (4, 491) = 9.1, p < 0.001) and remained significant after controlling for age and gender (ANCOVA: F (4, 489) = 8.2, p < 0.001). Post hoc tests showed that the anxiety (p < 0.001), depression (p < 0.001), bipolar (p < 0.001) and psychosis (p = 0.045) groups had significantly lower ME scores (i.e. higher eveningness) compared to the control group. Significant negative correlations were found between clinical scales (i.e. HDRS, BPRS, SOFAS, K10) and ME for all diagnostic groups, suggesting that participants with more pronounced eveningness had worse symptom severity than those with more pronounced morningness. 8 Study 2 examined temporal variations in chronotypes and investigated longitudinal associations between changes in Morningness-Eveningness preference and changes in symptom profiles in 133 young people (12-35 years) with primary depression or bipolar disorder. From a categorical perspective, 33% of all participants shifted to a later chronotype from baseline to follow-up (F (1, 105) = 7.5, p = 0.007). After controlling for age, gender and longitudinal period length, significant interactions showed that participants who shifted to earlier chronotypes showed more prominent longitudinal improvements in depressive (F (1, 108) = 4.6, p = 0.035) and negative (F (1, 115) = 6.6, p = 0.011) symptoms on the BPRS than participants who remained in the same chronotype category or shifted to later chronotypes. The results obtained from these studies suggest that many young persons with emerging mental disorders present with a strong eveningness preference, which is in turn associated with worse clinical profiles. Longitudinally, those persons with depression or bipolar disorder who shift towards more morningness also showed the strongest clinical improvements. Overall, these findings suggest that evening chronotypes are associated with worse psychiatric symptom severity and highly likely to be reflective of state changes across the course of mental illnesses. These findings have implications for clinical practice in young persons with emerging mental disorders. Morningness-Eveningness preference is unlikely to be a static trait in the context of youth and mental disorders. Treatment strategies targeting the circadian system are highly likely to be relevant for patients presenting with affective disorders and late chronotypes