The Relationship Between Indicators of Behavior Rhythmicity With Depression, Anxiety, and Stress Among Youths

Chronotype, social jetlag (SJL), eating jetlag (EJL), eating windows, and breakfast skipping are important and commonly used indicators for behavior rhythmicity. The present study comprehensively examined the behavior rhythmicity and depression, anxiety, and stress among university students.

A cross-sectional study of a total of 734 college students was conducted. The questionnaire included investigation of sociodemographic characteristics and lifestyle information. Behavior rhythmicity was measured by the Munich Chronotype Questionnaire (MCTQ), the Reduced Morningness-Eveningness Questionnaire (rMEQ), and the Chrononutrition Profile-Questionnaire (CP-Q). Depression, anxiety, and stress were measured by the Depression, Anxiety, and Stress Scale-21 Items (DASS-21).

A total of 734 participants with completed data were included in this study. After adjustment of age, sex, exercise time, screen time, being the only child, and family's monthly per capita income, higher sleep-corrected SJL (SJLsc) was significantly associated with increased risks of depression (OR = 1.527 per 1-h increase; 95% CI: 1.129-2.066), anxiety (OR = 1.324 per 1-h increase; 95% CI: 1.029-1.703), and stress (OR = 1.524 per 1-h increase; 95% CI: 1.112-2.088). Compared with the non-evening type group, evening chronotype participants had a significantly higher risk of depression (OR = 1.856, 95% CI: 1.228-2.803), anxiety (OR = 1.598, 95% CI: 1.159-2.202), and stress (OR = 1.945, 95% CI: 1.261-2.999). Further stratified analysis by sex showed that the associations were sex-specific. SJL_sc was associated with depression only in males (OR = 2.014, 95% CI: 1.213-3.345), but not in females. Evening chronotype was related to a higher risk of depression (OR = 1.853, 95% CI: 1.130-3.037) and stress (OR = 2.031, 95% CI: 1.227-3.363) only in females. The last eating occasion jet lag was associated with stress in males (OR = 1.383, 95% CI: 1.035-1.846), but not in females. Eating window jet lag was associated with stress in females (OR = 1.155, 95% CI: 1.015-1.315) but not in males.

SJLsc and evening chronotype are significantly associated with higher risk of depression, anxiety, and stress. Sex-specific associations between last eating occasion jet lag, eating window jet lag, and chronotype with depression, anxiety, and stress existed in young adults.