Relationship between chronotype and mental behavioural health among adolescents: a cross-sectional study based on the social ecological system

Authors：Zhang Y, Jin Z, Li S, Xu H, Wan Y, Tao F.

Source：BMC Psychiatry. 2023;23(1):404.

DOI: 10.1186/s12888-023-04879-6 

Abstract：

Background: Health risk behaviors (HRBs) is a kind of phenomenon behavior that often occurs in adolescence, and also often appears in clusters. Previous studies suggested an association between social ecological risk factors (SERFs) and HRBs. This study explored 1) whether chronotype moderates the risk of HRBs associated with SERFs and 2) whether mental health is a mediator in this relationship.

Methods: Adolescents were recruited from 39 junior or senior schools (three cities, 13 schools per city) using a multistage cluster sampling method conducted between October, 2020 and June, 2021. The Social Ecological System, Morningness-Eveningness Questionnaire, Brief Instrument on Psychological Health Youths, and Youth Risk Behavior Surveillance questionnaires were used to measure the SERFs, chronotype, mental health and HRBs. Latent category analysis was used to explore the clustering mode of HRBs. The primary exposure was SERFs, and the primary outcome was HRBs; chronotype was a moderator, and mental health was a mediator. The multivariable logistic regression model was used to determine the relationship between SERFs and chronotype and mental behavioral health status. Mediation moderate analysis using the PROCESS method was used to explore the relationship between these variables. Sensitivity analysis was conducted to evaluate the robustness of the model.

Results: In total, 17,800 individuals were initially enrolled. After excluding 947 individuals with invalid questionnaires, 16,853 participants were finally included in the analysis. The mean age of participants was 15.33 ± 1.08 years. After adjusting for covariates, multivariable logistic regression found that high levels of SERFs (odds ratio [OR] = 10.10, 95% confidence interval [CI]: 8.88-11.43, P < 0.01), intermediate chronotype (OR = 5.24, 95% CI: 4.57-6.01, P < 0.01), and eveningness (OR = 1.83, 95% CI: 1.64-2.05, P < 0.01) were associated with higher HRBs frequency. This study also assessed the interaction between chronotype, SERFs and HRBs (OR = 27.84, 95% CI: 22.03-35.19, P < 0.01) and mental health (OR = 18.46, 95% CI: 13.16-25.88, P < 0.01). The moderated mediation analyses examined the relationship between chronotype, SERFs, mental health and HRBs.

 Conclusions: SERFs may be important variables in measuring the effect of the adolescent psychosocial environment on HRBs; this effect is mediated by mental health and moderated by chronotype.

 Keywords: Adolescents; Chronotype; Health risk behavior; Mental health; Social ecological risk factor.

中文摘要：

背景：健康风险行为（HRBs）是一种经常发生在青少年时期的现象行为，也经常以集群的方式出现。以前的研究表明，社会生态风险因素（SERFs）和HRBs之间存在关联。本研究探讨了1）睡眠类型是否调节了与SERFs相关的HRBs的风险；2）心理健康是否是这种关系的中介因素。

方法：于2020年10月至2021年6月，采用多阶段整群抽样的方法，从39所初中或高中(3个城市，每个城市13所学校)招募青少年。采用社会生态系统量表、早晚问卷、青少年心理健康简易量表和青少年危险行为监测问卷来测量SERFs、时间型、心理健康和HRBs。采用潜类分析探讨 HRBs的聚类模式。主要暴露者为SERFs，主要结局为HRBs; 睡眠类型是调节因素，心理健康是中介。采用多变量logistic回归模型确定睡眠类型和心理行为健康状况与SERFs的关系。采用PROCESS方法进行中介调节分析，探讨各变量之间的关系。通过敏感性分析来评价模型的稳健性。

结果：最初总共有17,800人被招募。在排除了947份无效问卷后，最终纳入了16853名参与者。参与者平均年龄15.33±1.08岁。调整协变量后，多变量logistic回归发现，高水平的SERFs(比值比[OR] = 10.10, 95%可信区间[CI]: 8.88-11.43, P < 0.01)、中间型睡眠(OR = 5.24, 95% CI: 4.57-6.01, P < 0.01)和夜晚型睡眠(OR = 1.83, 95% CI: 1.64-2.05, P < 0.01)与较高的HRBs频率相关。本研究还评估了睡眠类型、SERFs和HRBs (OR = 27.84, 95% CI: 22.03-35.19, P < 0.01)与心理健康(OR = 18.46, 95% CI: 13.16-25.88, P < 0.01)之间的相互作用。中介分析检验了睡眠类型、SERFs、心理健康和HRBs之间的关系。

结论：在衡量青少年心理社会环境对HRBs的影响时，SERFs可能是一个重要的变量;这种效应是由心理健康介导的，并受睡眠类型的调节。

关键词：青少年；睡眠类型；危害健康行为；心理健康；社会生态风险因子。