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: 30Â % had delayed sleep | ||||||
HC: 10Â % 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) |