Circadian Functioning and Quality of Life in Substance Use Disorder Patients With and Without Comorbid Major Depressive Disorder.

Iman Hashemzadeh,Julia E Marquez-Arrico,Ana Adan,Kosar Hashemzadeh,José Francisco Navarro

doi:10.3389/fpsyt.2021.750500

Abstract

Aim: Although a relationship between circadian disruption and development of several psychiatric disorders, such as major depressive disorder (MDD) and substance use disorder (SUD), has been observed, knowledge on this area is scarce yet. Therefore, this study aims to analyze the circadian functioning and quality of life (QOL) in SUD patients with and without comorbid MDD, two highly prevalent clinical entities with difficult therapeutic management.Methods: One hundred sixty-three male patients under treatment, 81 with SUD and 82 with SUD comorbid major depressive disorder (SUD + MDD), were evaluated. For the circadian functioning assessment, we calculated Social Jet Lag (SJL) and used the reduced Morningness–Eveningness Questionnaire (rMEQ) and the Pittsburgh Sleep Quality Index (PSQI). QOL was measured using the shortened version of the World Health Organization's Quality of Life Questionnaire (WHOQOL-BREF). We collected sociodemographic and clinical variables to evaluate their possible influence on the circadian functioning. Intergroup differences among the variables were examined by different analyses of covariance (ANCOVA and MANCOVA). The possible relationships of quantitative clinical variables with rMEQ, PSQI, and WHOQOL-BREF were explored using bivariate correlation analysis.Results: Lower SJL appears in the SUD + MDD group compared with SUD. The intermediate-type was more prevalent in the SUD group, while a higher percentage of morning-type patients was found in the SUD + MDD. Sleep quality (including latency and daytime dysfunction) was worse for SUD + MDD patients than for SUD even after controlling age and age of SUD onset variables. Last, QOL was poorer in patients with SUD + MDD and, for them, psychological health had a negative relationship with SJL and severity of depression.Conclusions: Our data support and extend previous findings indicating that SUD + MDD is associated with worse clinical characteristics, more sleep problems, and poorer QOL than SUD patients. These results underline the importance of a precise assessment of these measurements in future studies conducted in SUD patients with/without MDD comorbidity that could be considered from a therapeutic point of view.

Highlights

Most of the psychological and behavioral processes reveal circadian rhythms, with the sleep–wake cycle as one of their biological markers [1]
The only difference in sociodemographic variables was observed for the academic studies, in which the substance use disorder (SUD) + major depressive disorder (MDD) group reported more illiterate patients compared with SUD ones
Lower Social jet lag (SJL) appears in the SUD + MDD group compared with the SUD one

Summary

Introduction

Most of the psychological and behavioral processes reveal circadian rhythms, with the sleep–wake cycle as one of their biological markers [1]. With the initiation of using electrical lights and increased social demands, human sleep forms have been changed significantly. Social signals such as the timing of social interplays, mealtime, and exercise as non-photic synchronizers [3] can influence our biological clock. The nature of human social interactions leads to the addition of social time to the circadian clock, which plays an important role in our vast daily habits [2] The relationship between this social time and the endogenous rhythms is a personal differential trait, known as chronotype or circadian typology [10]. Morning types prefer to wake up early in the morning and find it hard to remain awake outside their usual bedtime, evening types desire to fall asleep late and have difficulty waking up in the morning, whereas intermediate types tend to do their tasks between morning- and evening-type times [10]

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