The hidden clock: how chronotype is related to depression, anxiety, and stress in adolescents – insights from the EHDLA study

May 22, 2025International journal of mental health systems

How Sleep Timing Patterns Relate to Depression, Anxiety, and Stress in Teenagers

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Abstract

The highest probability of depression (27.4%), anxiety (28.5%), and stress (47.6%) was found in adolescents with an preference.

Adolescents with an eveningness chronotype showed significantly higher symptoms of depression, anxiety, and stress compared to those with morningness or intermediate .
The lowest probabilities for these symptoms were observed in adolescents preferring a morningness chronotype, with rates of 11.9% for depression, 15.4% for anxiety, and 19.5% for stress.
Adjustments for various factors such as age, sex, and physical activity were made to ensure the accuracy of these associations.
Significant statistical differences were found when comparing the eveningness chronotype to other chronotypes (p < 0.05).

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BACKGROUND: Depression, anxiety, and stress symptoms are common among adolescents; however, studies exploring their relationship with in European youth populations is scarce. This study aimed to evaluate the association between chronotype status and depression, anxiety, and stress symptoms in adolescents.

METHODS: A secondary analysis of the Eating Healthy and Daily Life Activities (EHDLA) cross-sectional study was performed in 703 adolescents (56.3% girls) between 12 and 17 years from the Valle de Ricote, Spain. Chronotype preference was assessed using the Morningness/Eveningness Scale in Children (MESC), while symptoms were evaluated using the Depression, Anxiety, and Stress Scale (DASS-21). A robust generalized linear regression model was used to evaluate the associations between chronotype prefernces and symptoms of depression, anxiety and stress in adolescents.

RESULTS: After adjusting for potential covariates (sex, age, socioeconomic status, body mass index, sleep duration, physical activity, sedentary behavior, and energy intake), the highest probability of having depression, anxiety, and stress was identified in those with an preference (depression: 27.4%, 95% confidence interval [CI] 17.5-40.1%; anxiety: 28.5%, 95% CI 18.6-41.0%; stress: 47.6%, 95% CI 34.1-61.5%). Conversely, the lowest probability was observed in adolescents with a morningness chronotype preference (depression: 11.9%, 95% CI 8.3-16.8%; anxiety: 15.4%, 95% CI 11.2-28.9%; stress: 19.5%, 95% CI 14.7-25.5%). Significant differences were found when comparing participants with the eveningness chronotype to those with a morningness or intermediate chronotype preference (p < 0.05 for all comparisons).

CONCLUSIONS: Depression, anxiety, and stress symptoms were more likely in adolescents with an eveningness chronotype preference than in those with morningness or intermediate chronotypes. Chronotype preferences should be taken into account for developing interventions that promote better mental health and healthy sleep habits in adolescents.

Key numbers

27.4%

Probability of Depression Increase

Among adolescents with evening preference

28.5%

Probability of Anxiety Increase

Among adolescents with evening preference

47.6%

Probability of Stress Increase

Among adolescents with evening preference

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The hidden clock: how chronotype is related to depression, anxiety, and stress in adolescents – insights from the EHDLA study

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