Zhang, Y. orcid.org/0000-0003-4817-3835, Folarin, A.A. orcid.org/0000-0002-0333-1927, Sun, S. orcid.org/0000-0003-3652-5266 et al. (23 more authors) (2024) Longitudinal assessment of seasonal impacts and depression associations on circadian rhythm using multimodal wearable sensing: retrospective analysis. Journal of Medical Internet Research, 26 (1). e55302. ISSN 1439-4456
Abstract
Background: Previous mobile health (mHealth) studies have revealed significant links between depression and circadian rhythm features measured via wearables. However, the comprehensive impact of seasonal variations was not fully considered in these studies, potentially biasing interpretations in real-world settings.
Objective: This study aims to explore the associations between depression severity and wearable-measured circadian rhythms while accounting for seasonal impacts.
Methods: Data were sourced from a large longitudinal mHealth study, wherein participants’ depression severity was assessed biweekly using the 8-item Patient Health Questionnaire (PHQ-8), and participants’ behaviors, including sleep, step count, and heart rate (HR), were tracked via Fitbit devices for up to 2 years. We extracted 12 circadian rhythm features from the 14-day Fitbit data preceding each PHQ-8 assessment, including cosinor variables, such as HR peak timing (HR acrophase), and nonparametric features, such as the onset of the most active continuous 10-hour period (M10 onset). To investigate the association between depression severity and circadian rhythms while also assessing the seasonal impacts, we used three nested linear mixed-effects models for each circadian rhythm feature: (1) incorporating the PHQ-8 score as an independent variable, (2) adding seasonality, and (3) adding an interaction term between season and the PHQ-8 score.
Results: Analyzing 10,018 PHQ-8 records alongside Fitbit data from 543 participants (n=414, 76.2% female; median age 48, IQR 32-58 years), we found that after adjusting for seasonal effects, higher PHQ-8 scores were associated with reduced daily steps (β=–93.61, P<.001), increased sleep variability (β=0.96, P<.001), and delayed circadian rhythms (ie, sleep onset: β=0.55, P=.001; sleep offset: β=1.12, P<.001; M10 onset: β=0.73, P=.003; HR acrophase: β=0.71, P=.001). Notably, the negative association with daily steps was more pronounced in spring (β of PHQ-8 × spring = –31.51, P=.002) and summer (β of PHQ-8 × summer = –42.61, P<.001) compared with winter. Additionally, the significant correlation with delayed M10 onset was observed solely in summer (β of PHQ-8 × summer = 1.06, P=.008). Moreover, compared with winter, participants experienced a shorter sleep duration by 16.6 minutes, an increase in daily steps by 394.5, a delay in M10 onset by 20.5 minutes, and a delay in HR peak time by 67.9 minutes during summer.
Conclusions: Our findings highlight significant seasonal influences on human circadian rhythms and their associations with depression, underscoring the importance of considering seasonal variations in mHealth research for real-world applications. This study also indicates the potential of wearable-measured circadian rhythms as digital biomarkers for depression.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © Yuezhou Zhang, Amos A Folarin, Shaoxiong Sun, Nicholas Cummins, Yatharth Ranjan, Zulqarnain Rashid, Callum Stewart, Pauline Conde, Heet Sankesara, Petroula Laiou, Faith Matcham, Katie M White, Carolin Oetzmann, Femke Lamers, Sara Siddi, Sara Simblett, Srinivasan Vairavan, Inez Myin-Germeys, David C Mohr, Til Wykes, Josep Maria Haro, Peter Annas, Brenda WJH Penninx, Vaibhav A Narayan, Matthew Hotopf, Richard JB Dobson, RADAR-CNS consortium. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 28.06.2024. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research (ISSN 1438-8871), is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included. |
Keywords: | MDD; biological rhythms; circadian rhythm; digital health; mHealth; major depressive disorder; mental health; mobile health; monitoring; wearable; Humans; Seasons; Female; Circadian Rhythm; Male; Wearable Electronic Devices; Adult; Longitudinal Studies; Depression; Middle Aged; Retrospective Studies; Telemedicine |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Engineering (Sheffield) > Department of Computer Science (Sheffield) |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 31 Jan 2025 10:36 |
Last Modified: | 31 Jan 2025 10:36 |
Status: | Published |
Publisher: | JMIR Publications Inc. |
Refereed: | Yes |
Identification Number: | 10.2196/55302 |
Related URLs: | |
Sustainable Development Goals: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:222456 |