Commonalities in frailty and psychopathology predict chronotype across severe mental disorders from a comorbidity perspective

May 12, 2026Psychological medicine

Shared frailty and mental health symptoms are linked to sleep timing in severe mental disorders

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Abstract

Neurocognitive and functional impairments were greater in severe mental illness (SMI) groups than in healthy controls with differences ranging from 10.3 to 31.4.

SMI with comorbidities (SMI-C) exhibited worse frailty compared to healthy controls and SMI without comorbidities at different time points.
Elevated mean corpuscular volume/mean corpuscular hemoglobin (MCV/MCH) was observed in the SMI-C group.
Frailty and psychopathology were predictors of evening chronotype in individuals with SMI.
In healthy controls, frailty and functional performance were predictors of chronotype.

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BACKGROUND: Individuals with severe mental illness (SMI) have increased risk of physical comorbidities, linked to worse outcomes such as greater psychopathology, frailty, and neurocognitive impairment. Mechanisms underlying this burden remain unclear. This study examined whether frailty and psychopathology predict evening chronotype, especially in SMI with comorbidities.

METHODS: A longitudinal study assessed 165 participants at two time points over one year: schizophrenia (= 30), bipolar disorder (= 42), major depressive disorder (= 35), and healthy controls (= 58). The SMI group (= 107) was divided into SMI with comorbidities (SMI-C;= 47) and without (SMI;= 60). Measures included psychopathology, frailty, chronotype, neurocognitive and functional performance, and hematological biomarkers. n n n n n n n

RESULTS: Neurocognitive and functional impairments were greater in SMI groups than controls (= 10.3-31.4;< 0.0001; η²= 0.12-0.34). The SMI-C group showed worse frailty than controls at T1 (= 4.3;< 0.01; η²= 0.05) and than SMI at T2 (= 8.5;< 0.0001; η²= 0.12), and elevated MCV/MCH (= 3.8-9.4;< 0.05-0.0001; η²= 0.04-0.11). Chronotype distribution did not differ. Frailty and psychopathology predicted chronotype in SMI (< 0.05-0.01); in controls, frailty and performance did so (p < 0.05). F p p F p p F p p F p p p

CONCLUSIONS: Psychopathological and hematological profiles are associated with chronotype and may help identify subgroups for chronobiology-informed interventions. These findings support more personalized treatment approaches.

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Commonalities in frailty and psychopathology predict chronotype across severe mental disorders from a comorbidity perspective

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