Social Rhythm Research Articles

Implementing Interpersonal and Social Rhythm Therapy for Mood Disorders Across a Continuum of Care

Interpersonal and social rhythm therapy (IPSRT) is an evidence-based psychotherapy for mood disorders. The goal of this quality improvement initiative was to demonstrate feasibility of implementing IPSRT across the continuum of outpatient and inpatient care within an academic medical center. A multidisciplinary work group was convened to implement IPSRT in outpatient (N=48), inpatient (N=602), and intensive outpatient (N=68) programs of an academic medical center. Quality improvement performance markers (including symptoms and group attendance rates) were collected. Institutional preference for group treatments required adaptation of IPSRT from an individual to group psychotherapy format. Iterative problem solving and protocol development resulted in models of group IPSRT appropriate for each level of care. Performance outcome markers were favorable, indicating feasibility of implementation. At a single, multisite, urban, academic medical center, IPSRT proved a feasible evidence-based psychotherapy for implementation across levels of care in routine practice.

Implementing Interpersonal and Social Rhythm Therapy for Mood Disorders Across a Continuum of Care

Implementing Interpersonal and Social Rhythm Therapy for Mood Disorders Across a Continuum of Care

Cronotipo e implicações para sua utilização na fisioterapia em pacientes com acidente vascular encefálico

Na prática clínica, frequentemente o fisioterapeuta avalia e programa o tratamento do paciente sem levar em consideração a variação temporal de funções e comportamentos. O objetivo do estudo foi analisar a influência do cronotipo, padrão vigília-sono (qualidade do sono e sonolência excessiva) e regularidade do estilo de vida na determinação do horário de preferência para a prática de atividades física e mental em pacientes com acidente vascular encefálico (AVE). Participaram 42 pacientes (61±9 anos) no estágio crônico do AVE (18±21 meses) e 12 indivíduos saudáveis (53±6 anos) que responderam ao Questionário de Horne e Östberg (QHO), Índice de Qualidade do Sono de Pittsburgh (IQSP), Sonolência Excessiva de Epworth (SEE) e o Social Rhythm Metric (SRM). Foi questionado em qual horário os participantes preferiam realizar atividade física (exercícios) e mental (tarefas de raciocínio), considerando apenas seu bem-estar pessoal. Os dados foram analisados através do teste do χ2 e regressão múltipla. Dos pacientes avaliados, 93% eram matutinos, 64% apresentavam qualidade ruim do sono, 43% sonolência excessiva e 57% padrão irregular da rotina diária. Ao final da análise de regressão verificou-se que o cronotipo foi o único fator que teve influência no horário preferencial das atividades. Esses achados sugerem a necessidade da avaliação do cronotipo dos pacientes antes de se estabelecer um horário de atendimento na Fisioterapia.

Time as a Mode of Bio-politics

There is a paradigm shift in human approach to time. Time, which was so far considered as an entity beyond human control is being used as an effective bio-political tool. Time as a social construct (social rhythm) has completely marginalized the time as natural or biological rhythm. The ‘greatness’ of the rulers including the political and intellectual was based on their ability to use time effectively to control, manipulate and maneuver their respective subjects at various times in the past, and introduced their own time schedule in the form of calendars, time tables and clocks etc. In the name of scientific and technological advancements, human have succeeded in getting access to the biological clocks of every organism and using the same for value generation and profit maximization and ultimately creating new colonies.

Social rhythms and vulnerability to bipolar disorder

Reduced social rhythmicity is a commonly reported feature of bipolar disorder which may extend to non-clinical populations at risk of bipolar disorder. The aim of the current study was to investigate social rhythms across three groups of participants; a clinical group of bipolar disorder outpatients, and two non-clinical groups with high- and low-vulnerability to bipolar disorder, respectively. It was expected that reduced social rhythmicity would differentiate the clinical group from the low-vulnerability group, but not the high vulnerability group. Non-clinical participants were selected on the basis of scores derived from the General Behaviour Inventory and allocated to groups of high (n=36) and low (n=36) trait vulnerability to bipolar disorder. The clinical group (n=15) were volunteers recruited from an outpatient clinic. Participants completed a self-report social rhythmicity measure daily for seven consecutive days. One-way analysis of covariance (age) showed a significant overall effect for group, F (2,83)=4.67, p<.05. Post hoc comparisons revealed significant differences in social rhythms between the two nonclinical groups only. The cross-sectional design of the study limits the strength of conclusions that can be drawn. The hypothesis was only partially supported. Consistent with expectations, the non-clinical group with higher vulnerability to bipolar disorder recorded lower social rhythmicity than the non-clinical group with lower vulnerability to bipolar disorder. The clinical group however, did not differ in social rhythmicity from the lower vulnerability group. The findings may have consequences for the way in which vulnerability to bipolar disorder is managed.

Sonntagsarbeit — Auswirkungen auf Sicherheit, Gesundheit und Work-Life-Balance der Beschäftigten

During the last decades the number of employees working in flexible and/or unsocial hours (e.g., on evenings and weekends) has substantially increased. However, working on weekends can reduce both recovery time and interfere with the social rhythm in our society, thus reducing the amount of socially valuable hours available. According to the social rhythm, the utility of time for social and leisure activities is usually rated higher in the evenings and on weekends, with the highest values on Sundays. Thus, working on Sundays should lead to severe impairments to psychosocial well-being, to a reduction in the quality of and time for recovery from work-related strain, as well as to a reduction of social commitments. However, only very few studies have addressed possible safety, health, and social effects of work on Sundays yet. Furthermore, the effects of working on Sundays and working in shifts, which often includes work on Sundays, have not been separated yet. The objectives of our study were therefore to investigate in two large and representative samples of the European workforce, whether working on Sundays increases the risk of impairments to (1) occupational safety, e.g. as expressed in the incidence of accidents, (2) general health, and (3) work-life balance, while controlling for different important confounders. Two representative samples of employed workers in the 15 original member states of the European Union served as the data base for a cross-sectional analysis. The samples were collected via face-to-face interviews in the year 2000 (EU 2000) and 2005 (EU 2005) and contained data of n=17,910 and n=12,288 individuals in 2000 and 2005, respectively. The surveys included questions on working conditions, several work schedule characteristics, and the individual personal situation (e.g., demographic information, time lost due to an occupational accident in the last 12 months, subjective health impairments, subjective compatibility between working hours and private/ leisure commitments as an indicator of the work-life balance (WLB)). The increases in the risks of occupational accidents, health impairments, and decreases in WLB due to work on Sundays (coded in “no Sunday work” and “at least 1 Sunday/ month”) were calculated using analysis of variance and logistic regression models, controlling for potential confounders: demographic characteristics, work load intensity, autonomy, shift work, and other work schedule components (working on at least 1 Saturday, evening, and/or night per month, and the usual number of weekly working hours).

Sleep quality and daily lifestyle regularity in workers with different working hours

The objective of this study was to assess subjective sleep quality and lifestyle regularity in daytime workers and shift workers. Studies concluding that sleep quality improved with greater regularity. However, there are no data in the literature related to workers. The sample was composed of 141 male workers (42 daytime workers and 99 shift workers) with 42.56 ± 5.66 years of age. Protocols: informed consent form; identification record; Pittsburgh Sleep Quality Index (PSQI), and a shortened 5-item version of the Social Rhythm Metric (SRM-5). Student's t-test for independent samples and Spearman's nonparametric correlation test were used. There was bad sleep quality (6.23 ± 3.3) and daily lifestyle irregularity (2.36 ± 0.8) for 141 workers. There was good sleep quality for daytime workers (4.74 ± 2.68) and bad sleep quality for shift workers (6.86 ± 3.31). There are daily lifestyle irregularities for both groups (for daytime workers 2.23 ± 0.55 and for shift workers 2.41 ± 0.94). There was no significant correlation between the SRM-5 and overall PSQI scores. In shift work, the regularity of daily activities does not seem to be the main factor in determining sleep quality.

Adaptação transcultural da versão brasileira da escala Social Rhythm Metric-17 (SRM-17) para a população angolana

INTRODUÇÃO: O ritmo social é um conceito que integra a relação entre Zeitgebers (sincronizadores) sociais e os marcadores de tempo endógenos, e pode ser avaliado com a Escala de Ritmo Social (Social Rhythm Metric-17, SRM-17). O objetivo deste estudo foi realizar a adaptação da versão brasileira da SRM-17 para o português angolano, comparando as duas escalas em populações que utilizam o mesmo idioma mas apresentam diferenças culturais. MÉTODOS: A versão brasileira da SRM-17 foi submetida à avaliação de 10 estudantes universitários angolanos, que analisaram o grau de clareza de cada um dos 15 itens do instrumento usando uma escala visual analógica de 10 cm e propuseram modificações ao texto. Foi realizada revisão dos resultados para a elaboração da versão final, bem como prova de leitura e relatório final. RESULTADOS: A versão final angolana manteve uma equivalência de itens com relação à versão em português brasileiro. A versão avaliada demonstrou um grau satisfatório de clareza e equivalência semântica na maioria dos itens. Porém, alguns itens apresentaram um escore na clareza inferior à média aritmética de compreensão global do instrumento (8,38±1,0). CONCLUSÃO: Apesar de o português ser o idioma oficial nos dois países, há diferenças culturais significativas nas duas populações. Este trabalho apresenta uma versão adaptada à realidade angolana de um instrumento específico para aferir ritmo social. O processo de adaptação transcultural deve efetivar-se com estudos de validação do instrumento final em uma amostra maior da população, onde também poderão ser avaliadas as equivalências operacional, de medida e funcional.

S35-01 - Chronobiological issues of sleep and circadian rhythms

Progress in unravelling the cellular and molecular basis of mammalian circadian regulation over the past decade has provided us with data that deteriorations in measurable circadian output parameters, such as sleep/wake deficits and dysregulation of circulating hormone levels, are common features of most central nervous system disorders.At the core of the mammalian circadian system is a complex of molecular oscillations within the hypothalamic suprachiasmatic nucleus. These oscillations are modifiable by afferent signals from the environment, and integrated signals are subsequently conveyed to remote central neural circuits where specific output rhythms are regulated. Usually our sleep/wake cycle, temperature and melatonin rhythms are internally synchronized with a stable phase relationship. When there is a desynchrony between the sleep/wake cycle and circadian rhythm, sleep disorders such as advanced and delayed sleep phase syndrome can arise as well as transient chronobiologic disturbances, for example from jet lag and shift work.Increasing evidence suggests that disrupted temporal organization of biological functions impairs behaviour, cognition, affect, and emotion. Furthermore, disruption of circadian clock genes impairs the sleep-wake cycle and social rhythms, which may be implicated in particular in mental disorders. An increasing number of journal publications point to a crucial role of circadian rhythm dysregulations in particular for affective disorders, which should e addressed specifically in modern psychiatry.

S35-04 - Clock genes and mood disorders: Which role?

The Circadian Locomotor Output Cycles Kaput (CLOCK) gene is thought to be involved in the regulation of circadian rhythms, with its protein products driving transcription of other genetic components of the molecular oscillator. The possible role of 3111T/C CLOCK gene polymorphism and a number of other variants in psychiatry is currently under investigation. A polymorphism in the 3’ flanking region of the CLOCK gene have been shown to affect mRNA stability and half-life, with possible significant effects on the level of protein finally being translated. In mice, a mutation of CLOCK gene, called “C” variant, has been shown to lead to a lengthened circadian period and in healthy humans the CLOCK*C allele has been investigated as a predictor of “eveningness.” Finally, a significantly higher recurrence rate of illness episodes has been found in bipolar patients homozygous for the C variant. In a series of studies, we investigated the possible effect of CLOCK variants in mood disorders and drug response.Taken together, this evidence suggests that CLOCK gene variants modulate mood disorders in a subtle but consistent way, causing liability to a shorter and disrupted sleep, which is reflected in poorer sleep improvement during antidepressant therapy and eventually in a higher frequency of episodes. This also suggests the clinical usefulness of social rhythm therapy particularly in this subgroup of patients.

W08-02 - Effective strategies for health information, self-help and psychoeducation in bipolar disorder

IntroductionMany patients with bipolar disorders do not achieve clinical and functional recovery, even with good pharmacotherapy compliance. The influence of patients’ attitudes, behavior, subjective state and interpersonal environment on course of the disorder points out the importance of psychosocial interventions and patients’ active role to improve outcome.MethodsA survey of recent guidelines, systematic reviews and clinical trials of psychosocial interventions for bipolar disorders was performed.ResultsResearch evidence supports the efficacy and likely effectiveness of a number of psychosocial treatments: Individual and group psychoeducation, family-focused therapy, interpersonal and social rhythm therapy, cognitive behavior therapy. The lower cost and potential ease of dissemination of group psychoeducation suggest that this should be the first-line approach, with more complex interventions reserved to selected subgroups of patients. The following elements should be included in a basic psychoeducation package: information about the disorder and available treatment options, identification of early warning signs, encouragement of structured routines and healthy lifestyles, use of a mood diary and life-event charting to monitor mood patterns and effectiveness of intervention, improvement of communication skills, emotional self-regulation and social skills, reduction of self-stigmatization, stabilization of sleep/wake cycles, awareness of medication effects and improvement of decision-making skills on drug treatment in a collaborative way, acquisition of balanced attitudes towards the self in relation to the illness.ConclusionThe introduction of psychoeducation interventions with a focus on self-help strategies and patients empowerment and the adaptation of research models to everyday practice, can improve the outcome of bipolar disorders in real world.

Bipolar Phenomenology: Have We Learned All We Can Learn?

Bipolar Phenomenology: Have We Learned All We Can Learn?

Adjunctive Psychotherapy for Bipolar Disorder

Whereas pharmacotherapy often forms the foundation of a treatment plan for bipolar disorder, increasing evidence suggests that psychosocial interventions as adjuncts to pharmacological treatment may improve medication adherence as well as bolster cognitive and interpersonal coping skills, ultimately lengthening intervals between episodes and improving overall quality of life. This article will advocate the use of adjunctive psychosocial interventions for adults and youth with bipolar disorder by first providing a general overview of options for psychotherapy and reviewing the evidence base for psychoeducation, cognitive behavior therapy, interpersonal and social rhythm therapy, and family-focused therapy. Specific applications for youth and issues concerning the effectiveness and availability of specialized psychotherapies for bipolar disorder will be discussed. Finally, recommendations for clinicians will be provided.

Approaches to Preventing Relapse in Bipolar Disorder

The goals of maintenance treatment for euthymic patients with bipolar disorder are to prevent recurrence of acute episodes and to optimize the patient's adaptive functioning. Although medications are the primary treatment for preventing relapse, patient outcomes can be enhanced through the use of psychosocial interventions that address barriers to treatment success such as nonadherence to medication and lack of patient or caregiver understanding of the illness. Patients can learn to take an active and responsible role in managing their illness, including monitoring their symptoms to recognize prodromal signs of relapse, protecting daily social rhythms and routines, and maintaining healthy activities.

An investigation of the relationship between subjective sleep quality, loneliness and mood in an Australian sample: Can daily routine explain the links?

Loneliness and low mood are associated with significant negative health outcomes including poor sleep, but the strength of the evidence underlying these associations varies. There is strong evidence that poor sleep quality and low mood are linked, but only emerging evidence that loneliness and poor sleep are associated. To independently replicate the finding that loneliness and poor subjective sleep quality are associated and to extend past research by investigating lifestyle regularity as a possible mediator of relationships, since lifestyle regularity has been linked to loneliness and poor sleep. Using a cross-sectional design, 97 adults completed standardized measures of loneliness, lifestyle regularity, subjective sleep quality and mood. Loneliness was a significant predictor of sleep quality. Lifestyle regularity was not a predictor of, nor associated with, mood, sleep quality or loneliness. This study provides an important independent replication of the association between poor sleep and loneliness. However, the mechanism underlying this link remains unclear. A theoretically plausible mechanism for this link, lifestyle regularity, does not explain the relationship between loneliness and poor sleep. The nexus between loneliness and poor sleep is unlikely to be broken by altering the social rhythm of patients who present with poor sleep and loneliness.

A review of empirically supported psychological therapies for mood disorders in adults.

The mood disorders are prevalent and problematic. We review randomized controlled psychotherapy trials to find those that are empirically supported with respect to acute symptom reduction and the prevention of subsequent relapse and recurrence. We searched the PsycINFO and PubMed databases and the reference sections of chapters and journal articles to identify appropriate articles. One hundred twenty-five studies were found evaluating treatment efficacy for the various mood disorders. With respect to the treatment of major depressive disorder (MDD), interpersonal psychotherapy (IPT), cognitive behavior therapy (CBT), and behavior therapy (BT) are efficacious and specific and brief dynamic therapy (BDT) and emotion-focused therapy (EFT) are possibly efficacious. CBT is efficacious and specific, mindfulness-based cognitive therapy (MBCT) efficacious, and BDT and EFT possibly efficacious in the prevention of relapse/recurrence following treatment termination and IPT and CBT are each possibly efficacious in the prevention of relapse/recurrence if continued or maintained. IPT is possibly efficacious in the treatment of dysthymic disorder. With respect to bipolar disorder (BD), CBT and family-focused therapy (FFT) are efficacious and interpersonal social rhythm therapy (IPSRT) possibly efficacious as adjuncts to medication in the treatment of depression. Psychoeducation (PE) is efficacious in the prevention of mania/hypomania (and possibly depression) and FFT is efficacious and IPSRT and CBT possibly efficacious in preventing bipolar episodes. The newer psychological interventions are as efficacious as and more enduring than medications in the treatment of MDD and may enhance the efficacy of medications in the treatment of BD.

Behavioral Regularity in Infancy Predicts Lower Anxiety Years Later

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessBehavioral Regularity in Infancy Predicts Lower Anxiety Years LaterMark MoranMark MoranSearch for more papers by this authorPublished Online:3 Sep 2010https://doi.org/10.1176/pn.45.17.psychnews_45_17_030AbstractLack of regularity in sleeping, eating, and play routines in infancy appears to be associated with risk for anxiety in childhood.Infants with irregular patterns of sleeping, eating, and playing were significantly more likely to experience symptoms of anxiety more than a decade later, according to a prospective study of 59 children followed for 13 years beginning at age 1 month. The report was published online in the July Psychiatry Research.“The study indicates there are long-term implications for early behavioral regularity,” co-author Linnea Burk, Ph.D., of the Wisconsin Psychiatric Institute and Clinics, told Psychiatric News. “Clinicians have long advocated for predictable care and sleep schedules for children, and this study provides clear support that these steps are not only important in the short run, while the children are young, but also to long-term outcomes in adolescence.”Beginning in 1990 and 1991 as part of the Wisconsin Study of Families and Work, parents of 59 infants completed a diary tool called the Baby Social Rhythm Metric (Baby SRM), devised by the researchers to document lifestyle routines and sleep patterns a week at a time. The diary was a structured instrument that required parents to write down the starting time for each of four other major daily events in the infant's life—feeding, playing, diaper changing, and receiving comfort. There were 30 baby girls and 29 baby boys.(The Wisconsin Study of Families and Work is a much larger prospective study of child development that has yielded a number of published papers. Information about the study is posted at <www.wsfw.us>.)Follow-up information was collected on “sociability” at ages 4 months and 12 months as measured by the Infant Behavior Questionnaire, and on symptoms of depression and anxiety in children up to age 13. A measure of children's “directed attention”—reflecting the ability to focus attention on specific tasks and environmental exploration—was obtained from videotaped observations of a two-hour home visit when children were 4.5 years of age.Separately, and only after follow-up data were gathered, an algorithm was developed that cast the four specified events measured in the Baby SRM into 12 two-hour segments covering the 24-hour day. The resulting metric related to how spread out around the clock the events were (reflecting a low SRM score and a high degree of irregularity) or the extent to which particular times of day predominated for each of the events (reflecting a high SRM score and a high degree of regularity).The Baby SRM score ranged from 0 (least regular) to 7 (most regular).The researchers found that a higher SRM score was associated with lower overall levels of anxiety symptoms in childhood. There was no significant correlation of Baby SRM with childhood depression.Timothy Monk, Ph.D., a professor of psychiatry and director of the human chronobiology research program at the University of Pittsburgh, noted that an extensive body of research in adults has shown circadian rhythm is associated with mental health.“These new findings in infants reinforce this view,” he said. “In terms of treating patients both young and old, it is worth encouraging patients to adopt, to the extent that they can, a highly regular daily life style with predictable timing of bedtime, rise time, meals, and work.”Moreover, sociability and directed attention were both correlated with Baby SRM scores and with school-age anxiety and may serve as mediating factors.“Greater regularity to daily activities may increase the predictability of infant demands, leading to enhanced parental perception of need cues and increased parental confidence, which further strengthens caretaking routines,” the researchers stated. “Thus, greater regularity in daily activities may enhance early parent–infant relationships, improve infant regulatory capacity, and promote environmental exploration as internal resources are available.”This study was supported in part by funding from the National Institute of Mental Health, the National Institutes of Health, and the John D. and Catherine T. MacArthur Foundation.Child psychiatrist and APA Treasurer David Fassler, M.D., said the results of the study are consistent with previous reports and with general clinical experience. “We're well aware that young infants display a range of distinct temperaments,” he said. “We also know that many of these early characteristics persist throughout childhood and into adulthood. The present study demonstrates that anxiety in childhood correlates with specific behavior patterns observed during infancy.“The behavior of infants clearly affects and alters the nature of their interaction with their parents and other caregivers, which could easily influence emotional development from an early age,” Fassler said. “We also know that the expression of anxiety has a significant genetic component, elements of which could conceivably influence behavioral regularity during infancy.”“Behavioral Circadian Regularity at Age 1 Month Predicts Anxiety Levels During School-Age Years” is posted at <www.sciencedirect.com/science/journal/01651781>. ISSUES NewArchived

The role of psychotherapy in bipolar disorder

Adjunctive psychosocial interventions for bipolar disorder target many of the issues that are not addressed by medication alone, including non-adherence, efficacy-effectiveness gap and functionality. Psychosocial interventions have been found to reduce relapse, particularly for the depressive pole, and improve functionality. Approaches such as psychoeducation, cognitive behaviour therapy, interpersonal and social rhythm therapy, and family therapy have shown benefits as adjunctive treatments. Each of the various psychosocial interventions has a unique emphasis, but they share common elements. These include: providing information and education; developing a personal understanding of the illness, such as triggers and early warning signs; having prepared strategies in place for early intervention, should symptoms of illness develop; and promoting a collaborative approach. Evidence to date supports the use of adjunctive psychosocial interventions in the management of bipolar disorder.

DEPRESSED MOOD IN THE WORKING POPULATION: ASSOCIATIONS WITH WORK SCHEDULES AND WORKING HOURS

The impact of working time arrangements (WTA) on health has been studied extensively. Still, little is known about the interrelation between work schedules, working hours, and depressed mood. For work schedules, the underlying assumptions regarding depressed mood refer to a disturbance of social and biological rhythms, whereas for working hours, the assumptions relate to workload and work capacity. Conversely, depressed mood may urge an employee to adjust his/her work schedule and/or number of working hours/week (h/wk). The aim of this study was to assess the association between work schedule and working hours with depressed mood. Using baseline data from the Maastricht Cohort Study, depressed mood in day work was compared with depressed mood in different shiftwork schedules (n = 8843). Within day work, several categories of working h/wk were studied in association with depressed mood (n = 7217). The association between depressed mood and several aspects of overtime was assessed separately. Depressed mood was measured with a dichotomous item: “Did you feel down every day over the last two weeks?” Separate logistic regression analyses were conducted for men and women, with adjustments for potential confounders. The odds ratio (OR) for depressed mood was greater for men involved in shiftwork than for men only involved in day work (three-shift OR = 2.05 [95% confidence interval, CI 1.52–2.77]; five-shift OR = 1.34 [95% CI 1.00–1.80]; irregular-shift OR = 1.79 [95% CI 1.27–2.53]). In female employees, five-shift work was associated with a higher prevalence of depressed mood (OR = 5.96 [95% CI 2.83–12.56]). Regarding the number of working h/wk, men working <26 h/wk had a higher prevalence of depressed mood than men working 36–40 h/wk (OR = 2.73 [95% CI 1.35–5.52]). After conducting trend analyses, a significant decreasing trend was found in men, whereas an increasing trend was found in women working a high number of hours. Furthermore, a dose-response relationship was present in men regarding the number of overtime h/wk. This study showed that different work schedules and working hours are associated with depressed mood. Shiftwork was related to a higher prevalence of depressed mood than day work. The association was more pronounced for male employees. Regarding the number of working h/wk, male and female employees showed an opposite trend in depressed mood. Because of the possibility of a healthy worker effect and the possibility of a reciprocal relationship between WTA and depressed mood, the reported relation might be underestimated. This study has illustrated that occupational physicians, who deal with depressed mood among workers, should carefully consider the impact of WTA. (Author coorespondence: Karolien.Driesen@epid.unimaas.nl)

Behavioral circadian regularity at age 1 month predicts anxiety levels during school-age years

Daily lifestyle regularity is measured using the Social Rhythm Metric (SRM). We developed a Baby SRM, with 59 babies followed for ~13years. Baby SRM score at age 1 month significantly predicted the child's school (K-9, 5 time points) anxiety level (more regular=less anxious), and may be mediated through sociability and directed-attention pathways.