3 research outputs found
Konsequenzen einer Diskrepanz zwischen tatsÀchlichen Schlafzeiten und Chronotyp auf die psychische Gesundheit
Einleitung: Die Abweichung tatsĂ€chlicher Schlafzeiten von der individuell unterschiedlichen inneren Uhr, dem Chronotyp, durch die ErfĂŒllung sozialer Zeitvorgaben, fĂŒhrt zum PhĂ€nomen des Sozialen Jetlags (SJL). Dieser wird in der Literatur verknĂŒpft mit negativen gesundheitlichen Auswirkungen auf psychischer, kognitiver (Depressionen, Substanzkonsum und schlechtere akademische Leistungen) sowie psychosomatischer Ebene (höherer BMI und metabolisches Risiko). Dabei ist unklar, inwieweit gesundheitliche Folgen des SJL vom gleichzeitig auftretenden Schlafdefizit getrennt werden können. In dieser Arbeit wird der Einfluss des SJL und zusĂ€tzlich des Schlafdefizits mittels subjektiver Fragebögen auf mehrere Parameter der psychischen Gesundheit ĂŒberprĂŒft.
Methoden: Mit dem âMunich Chronotype Questionnaire (MCTQ)â wurden in Phase I SJL, Chronotyp, Schlafdefizit, BMI und Substanzkonsum an 1308 Probanden erhoben. In Phase II wurden weitere Gesundheitsparameter mittels eines Stress- (PSS), Depressions- (PHQ9) und SchlafqualitĂ€ts- (PSQI) Fragebogens an 688 verbliebenen Probanden erfasst und die geographische Verbreitung des SJL mithilfe eines UrbanitĂ€tsindex ermittelt. Es wurde auf Normalverteilung der Variablen getestet und Analysen mit nichtparametrischen Verfahren durchgefĂŒhrt. Mit Mann-Whitney-U-Tests bzw. Kruskal-Wallis-Tests wurde auf geschlechts- beziehungsweise altersspezifische Unterschiede getestet sowie Gruppenvergleiche zwischen SJL-Kategorien durchgefĂŒhrt. Mögliche Assoziationen des SJL und des Schlafdefizits mit psychischen Auswirkungen wurden mittels Spearman-Rangkorrelationskoeffizienten und partiellen Korrelationen berechnet.
Ergebnisse: Der SJL wurde geringer mit zunehmendem Alter. Ein Einfluss des Geschlechts konnte nicht gefunden werden. Bei gröĂerem SJL zeigten sich ein spĂ€terer Chronotyp und ein stĂ€rker ausgeprĂ€gtes Schlafdefizit. Es konnte ein schwach signifikanter positiver Zusammenhang zwischen SJL und UrbanitĂ€tsscore festgestellt werden. Tendenziell konnten bei steigendem SJL höhere Werte der untersuchten psychischen Parameter gefunden werden, die mit Ausnahme eines höheren SJL bei Rauchern statistisch nicht signifikant waren. Zwischen Schlafdefizit und PHQ9, PSQI und BMI zeigten sich statistisch signifikante geringe positive ZusammenhĂ€nge.
Schlussfolgerung: Die MCTQ-Daten unserer Stichprobe sind mit denen anderer Studien vergleichbar. Je urbaner unsere Probanden aufwuchsen, desto mehr SJL hatten sie. Die Relevanz des SJL zeigt sich unter Anderem in dieser gefundenen Assoziation zur UrbanitĂ€t, da die Urbanisierung ein zunehmendes PhĂ€nomen der Gesellschaft darstellt. Probanden mit hohem SJL neigten zu Nikotinkonsum. Zudem sahen wir Trends zu weiteren psychischen BeeintrĂ€chtigungen bei höherem SJL, die jedoch keine Signifikanz erreichten. Grund dafĂŒr könnte das unausgereifte Konzept des SJL sein. Vor allem die Berechnungsmethode des SJL wird kontrovers diskutiert. AuĂerdem muss die eingeschrĂ€nkte ReprĂ€sentativitĂ€t unserer Stichprobe und die Nutzung subjektiver Fragebögen anstatt objektiver Untersuchungsmethoden kritisiert werden. Weitere Studien mit gut geplanten Designs zur Erstellung einer reprĂ€sentativen Stichprobe und alternativen Erhebungsmethoden des SJL sind wichtig, um mehr Klarheit zu schaffen, ob der SJL mit psychischen EinschrĂ€nkungen zusammenhĂ€ngt.Background: The discrepancy between actual sleep times and the individual inner clock, the chronotype, results in a phenomenon called social jetlag (SJL), related to social obligations such as working hours. SJL is associated with negative health effects on a psychological, cognitive (depression, substance use, low academic performance) and psychosomatic level (obesity, metabolic risk). The question is raised if potential negative effects can be separated from sleep loss that often accompanies SJL. This work studies effects of SJL and sleep loss on parameters of mental health tested by subjective questionnaires.
Methods: In Phase I SJL, chronotype, sleep loss, substance use and BMI are assessed in 1308 participants, using the âMunich Chronotype Questionnaire (MCTQ)â. In Phase II parameters of mental health are measured using stress (PSS), depression (PHQ9) and sleep quality (PSQI) questionnaires in 688 remaining participants. Distribution of SJL is assessed by an urbanity score. The variables were tested for normal distribution and non parametric tests were applied. The Mann-Whitney-U-Test and Kruskal-Wallis-Test were used to assess gender and age differences and to test for group differences in SJL categories. Spearman and partial correlations were computed to analyze associations between SJL, sleep loss and mental health.
Results: SJL decreased with age. No sex differences were found. Later chronotypes and participants with more sleep loss presented a higher SJL. A significant association could be detected between SJL and urbanity score. Tendencies of more psychological impairments in participants with higher SJL were observed. However, they did not reach statistical significance except for SJL and smoking. Small positive significant associations between sleep loss and PHQ9, PSQI and BMI were detected.
Conclusions: Our sample corresponded well with previous MCTQ studies. The more urban participants grew up, the higher was their SJL. This association underlines the relevance of SJL as urbanization is a growing phenomenon in our society. In this study participants with higher SJL tended to be smokers. Although trends were detected, no other significant association between higher SJL and mental health impairments was found. One reason could be the unformed concept of SJL. Especially the calculation method seems to be controversal. The limited representativity of our sample and assessment of parameters by subjective questionnaires can be criticised. More studies with well planned designs and alternative objective assessment methods are needed to assure better representativity of the sample and to further answer the question if SJL causes impairments of mental health
Chronotype is associated with psychological well-being depending on the composition of the study sample
Past studies examining the effect of chronotype and social jetlag on psychological well-being have been inconsistent so far. Here, we recruited participants from the general population and enquired about their natural sleeping behavior, sleep quality, depressive symptoms, and perceived stress. Partial correlations were computed between sleep variables and indicators of psychological well-being, controlling for age and sex. Less sleep during work days was found a good indicator for impairments in psychological well-being. In exploratory follow-up analyses, the same correlations were calculated within groups of early, intermediate, and late chronotype. We observed that the composition of the sample in terms of chronotype influenced whether associations between sleep variables and psychological well-being could be observed, a finding that is advised to be taken into account in future studies.Peer Reviewe
Efficacy of off-label augmentation in unipolar depression: A systematic review of the evidence
Treatment of unipolar depression with currently available antidepressants is still unsatisfactory. Augmentation with lithium or second generation antipsychotics is an established practice in non-responders to antidepressant monotherapy, but is also associated with a substantial non response rate and with non-tolerance. Based on a systematic review of the literature, including meta-analyses, randomized controlled trials (RCTs), non-randomized comparative studies and case studies, off-label augmentation agents (administered in addition to an antidepressant, without FDA approval for treatment of MDD) were identified and evaluated regarding their efficacy using levels of evidence. The agents had to be added to an existing antidepressant regime with the aim of achieving an improved clinical response to an ongoing antidepressant treatment (augmentation) or an earlier onset of effect when starting antidepressant and augmentation agent simultaneously (acceleration). Five substances, modafinil, ketamine, pindolol, testosterone and estrogen (the latter two in hormone-deficient patients) were shown to be clinically effective in high evidence studies. For the six drugs dexamethasone, mecamylamine, riluzole, amantadine, pramipexole and yohimbine clear proof of efficacy was not possible due to low levels of evidence, small sample sizes or discordant results. For the two agents methylphenidate and memantine only studies with negative outcomes could be found. Overall, the quality of study designs was low and results were often contradictory. However, the use of pindolol, ketamine, modafinil, estrogen and testosterone might be an option for depressed patients who are not responding to antidepressant monotherapy or established augmentation strategies. Further high quality studies are necessary and warranted. (C) 2017 Elsevier B.V. and ECNP. All rights reserved