Sleep, circadian rhythm, and physical activity patterns in depressive and anxiety disorders: A 2-week ambulatory assessment study

Sonia Difrancesco; Femke Lamers; Harriëtte Riese; Kathleen R Merikangas; Aartjan T F Beekman; Albert M van Hemert; Robert A Schoevers; Brenda W J H Penninx

doi:10.1002/da.22949

Sleep, circadian rhythm, and physical activity patterns in depressive and anxiety disorders: A 2-week ambulatory assessment study

Depress Anxiety. 2019 Oct;36(10):975-986. doi: 10.1002/da.22949. Epub 2019 Jul 26.

Authors

Sonia Difrancesco¹, Femke Lamers¹, Harriëtte Riese², Kathleen R Merikangas³, Aartjan T F Beekman¹, Albert M van Hemert⁴, Robert A Schoevers², Brenda W J H Penninx¹

Affiliations

¹ Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
² University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center for Psychopathology and Emotion Regulation, Groningen, The Netherlands.
³ Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland.
⁴ Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.

Abstract

Background: Actigraphy may provide a more valid assessment of sleep, circadian rhythm (CR), and physical activity (PA) than self-reported questionnaires, but has not been used widely to study the association with depression/anxiety and their clinical characteristics.

Methods: Fourteen-day actigraphy data of 359 participants with current (n = 93), remitted (n = 176), or no (n = 90) composite international diagnostic interview depression/anxiety diagnoses were obtained from the Netherlands Study of Depression and Anxiety. Objective estimates included sleep duration (SD), sleep efficiency, relative amplitude (RA) between day-time and night-time activity, mid sleep on free days (MSF), gross motor activity (GMA), and moderate-to-vigorous PA (MVPA). Self-reported measures included insomnia rating scale, SD, MSF, metabolic equivalent total, and MVPA.

Results: Compared to controls, individuals with current depression/anxiety had a significantly different objective, but not self-reported, PA and CR: lower GMA (23.83 vs. 27.4 milli-gravity/day, p = .022), lower MVPA (35.32 vs. 47.64 min/day, p = .023), lower RA (0.82 vs. 0.83, p = .033). In contrast, self-reported, but not objective, sleep differed between people with current depression/anxiety compared to those without current disorders; people with current depression/anxiety reported both shorter and longer SD and more insomnia. More depressive/anxiety symptoms and number of depressive/anxiety diagnoses were associated with larger disturbances of the actigraphy measures.

Conclusion: Actigraphy provides ecologically valid information on sleep, CR, and PA that enhances data from self-reported questionnaires. As those with more severe or comorbid forms showed the lowest PA and most CR disruptions, the potential for adjunctive behavioral and chronotherapy interventions should be explored, as well as the potential of actigraphy to monitor treatment response to such interventions.

Keywords: actigraphy; anxiety disorders; circadian rhythm; comorbidity; depressive disorder; dysthymic disorder; exercise; sleep.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Actigraphy*
Anxiety / complications
Anxiety / physiopathology
Anxiety Disorders / complications
Anxiety Disorders / physiopathology*
Circadian Rhythm*
Comorbidity
Depression / complications
Depression / physiopathology
Depressive Disorder / complications
Depressive Disorder / physiopathology*
Exercise*
Female
Humans
Male
Middle Aged
Netherlands
Self Report
Sleep Initiation and Maintenance Disorders / complications*
Sleep Initiation and Maintenance Disorders / physiopathology
Sleep*
Surveys and Questionnaires
Time Factors