大学生昼夜节律类型与抑郁情绪相关性的纵向研究

A longitudinal study on the correlation between circadian rhythm and depression in college students

摘要:

目的： 探索大学生昼夜节律类型稳定性及其与大学生抑郁情绪及纵向变化的相关性。方法： 分别于2018至2020年秋季学期的9~11月，通过网络发放调查问卷，评定本科新生的昼夜节律类型、抑郁情绪、睡眠质量情况、躯体症状及生活事件压力，并对其进行连续2年的随访及重复测评。构建logistic回归模型分析基线测评中抑郁情绪的独立相关因素及不同昼夜节律的影响；构建混合效应模型分析大学生昼夜节律类型的稳定性、抑郁情绪的纵向变化规律及抑郁情绪变化的影响因素。结果： 基线测评中大学生抑郁情绪检出率为24.2%，夜晚型昼夜节律类型的大学生最多，占52.1%（4 301/8 244）；中间型次之，为45.0%（3 708/8 244）；清晨型最少，仅2.9%（235/8 244）；二元logistic回归分析提示，夜晚型昼夜节律类型者（OR=1.526）、睡眠质量更差者（OR=1.540）、躯体症状更严重者（OR=1.115）、生活事件压力更大者（OR=1.046）更易有抑郁情绪。混合效应模型对随访数据的分析结果提示，虽然清晨型-夜晚型问卷得分以平均每年1.948分的趋势下降，昼夜节律类型仍是一种较为稳定的个体特征；而抑郁情绪的标准得分以平均每年0.104分的趋势上涨，第二水平模型固定效应部分的分析结果提示，基线水平的夜晚型昼夜节律（β₀₁=0.028）、睡眠质量（β₀₂=0.052）、躯体症状（β₀₃=0.017）、生活事件压力（β₀₄=0.007）对抑郁情绪标准得分的增加有正向预测作用；且睡眠质量更差者（β₁₂=-0.012）、生活事件压力更大者（β₁₄=-0.002）抑郁情绪标准得分增加速率更快。结论： 尽管昼夜节律类型是较为稳定的个体特质，但在大学生中仍会随着时间发生变化，且夜晚型昼夜节律是抑郁情绪产生及增加的重要预测因子之一，提示大学生的昼夜节律类型是大学生心理健康教育及危机干预中值得关注的一大因素。

Abstract:

Objective: To explore the stability of circadian rhythm and its correlation with depression and the longitudinal effects in college students. Methods: From September to November, 2018 to 2020, an online questionnaire was issued to assess the circadian rhythm, depression, sleep quality, physical symptoms and life event stress of the freshmen, and they were followed and repeatedly evaluated for two years. Logistic regression model was established to analyze the independent correlation factors of depression in baseline assessment. Mixed effect model was established to analyze the stability of circadian rhythm, longitudinal change of depression and the influencing factors of depression. Results: The detection rate of depression was 24.2%, 52.1% (4 301/8 244) of college students were eveningness, 45.0% (3 708/8 244) were intermedia circadian rhythm, and 2.9% (235/8 244) were morningness. Binary Logistic regression analysis suggested that eveningness (OR=1.526), worse sleep quality (OR=1.540), more serious physical symptoms (OR=1.115), and more stressful life events (OR=1.046) were more likely to have depression mood. The results of mixed effect model suggest that circadian rhythm was still a stable individual characteristic, although the score of morningness-eveningness questionnaire decreases by 1.948 points per year on average. While the standard score for depression increased by an average of 0.104 points per year, analysis of the fixed effects of the model suggested that baseline eveningness (β₀₁=0.028), sleep quality (β₀₂=0.052), physical symptoms (β₀₃=0.017), and life event stress (β₀₄=0.007) positively predicted the increase of standard depression scores. Moreover, students with poorer sleep quality (β₁₂=-0.012) and more stressful life events (β₁₄=-0.002) had a faster increase rate of standard depression score. Conclusion: Although the circadian rhythm is a stable individual characteristic, it will change over time in the college students, and eveningness is one of the important predictors of depression, prompting that circadian rhythm is a crisis intervention for college students’mental health.