Zhao XF, Bi YX, Xiao S, Lou ML, Zhu WL, Xing YR. Chronotype as a risk factor for adolescent depression and anxiety: The mediating roles of sleep and social functioning. World J Psychiatry 2025; 15(11): 111593 [DOI: 10.5498/wjp.v15.i11.111593]
Corresponding Author of This Article
Yu-Rong Xing, Department of International Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou 450000, Henan Province, China. fccxyr@zzu.edu.cn
Research Domain of This Article
Psychiatry
Article-Type of This Article
Observational Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 19, 2025 (publication date) through Nov 4, 2025
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Journal Information of This Article
Publication Name
World Journal of Psychiatry
ISSN
2220-3206
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Zhao XF, Bi YX, Xiao S, Lou ML, Zhu WL, Xing YR. Chronotype as a risk factor for adolescent depression and anxiety: The mediating roles of sleep and social functioning. World J Psychiatry 2025; 15(11): 111593 [DOI: 10.5498/wjp.v15.i11.111593]
Xiao-Feng Zhao, Yu-Xiao Bi, Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
Sa Xiao, Ming-Li Lou, Yu-Rong Xing, Department of International Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
Wen-Li Zhu, Department of Psychiatry, The Fourth People’s Hospital of Wuhu, Wuhu 241002, Anhui Province, China
Co-corresponding authors: Wen-Li Zhu and Yu-Rong Xing.
Author contributions: Zhao XF and Bi YX contributed equally to the conception and design of the study and drafted the initial manuscript; Xiao S and Lou ML contributed to data collection; Xiao S contributed to assisting in study design and interpretation of findings; Lou ML contributed to data analysis; Zhu WL and Xing YR supervised the project, critically revised the manuscript, and contributed equally as co-corresponding authors. All authors read and approved the final manuscript.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of The First Affiliated Hospital of Zhengzhou University, No. 2024-KY-0528-001.
Informed consent statement: Written informed consent was obtained from all participants and their legal guardians after providing a detailed explanation of the study objectives, procedures, potential risks, and benefits. Participation was voluntary, and withdrawal was allowed at any stage without consequence.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Rong Xing, Department of International Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou 450000, Henan Province, China. fccxyr@zzu.edu.cn
Received: July 4, 2025 Revised: July 13, 2025 Accepted: August 25, 2025 Published online: November 19, 2025 Processing time: 123 Days and 18 Hours
Abstract
BACKGROUND
Adolescents with an evening chronotype are at higher risk for mental health problems, such as depression and anxiety. However, the mechanisms underlying this relationship are not well understood. Sleep disturbances and impaired social functioning may mediate this association.
AIM
To examine the mediating roles of sleep quality and social functioning in the relationship between chronotype and mental health in adolescents.
METHODS
A cross-sectional survey was conducted among 381 adolescents (mean age 14.3 years; 61.9% male) using the Morningness-Eveningness Questionnaire, Hamilton Depression Rating Scale, Hamilton Anxiety Scale, Pittsburgh Sleep Quality Index, and Social Disability Screening Schedule. Descriptive statistics, Pearson correlation analyses, and chain mediation analysis using the bootstrap method were performed.
RESULTS
Chronotype was significantly associated with both depression and anxiety. Sleep quality and social functioning significantly mediated these relationships. The indirect effect on depression was -0.52, accounting for 69.3% of the total effect. For anxiety, the indirect effect was -0.39, accounting for 79.3%. No significant direct effect of chronotype on depression or anxiety was found after accounting for the mediators.
CONCLUSION
Sleep quality and social functioning mediate the association between chronotype and adolescent mental health. These findings highlight the importance of addressing sleep disturbances and social functioning impairments in interventions aimed at improving mental well-being among adolescents with evening chronotypes.
Core Tip: This cross-sectional observational study investigated the indirect pathways linking chronotype to adolescent mental health. Using validated measures in 381 adolescents, we found that the relationship between evening chronotype and higher levels of depression and anxiety was fully mediated by poor sleep quality and impaired social functioning. This is the first study to establish a chain mediation model incorporating both sleep and social factors, emphasizing the importance of targeting sleep hygiene and social adjustment in interventions for youth mental health.
