Domino effect of evening chronotype: How chronotype topples adolescent mental health through sleep and social functioning

Abstract

This commentary elucidates the novel sequential mediation pathway (evening chronotype - sleep quality - social functioning - mental health) identified by Zhao et al, framing it as a coherent “domino effect” that links biological predisposition to psychosocial outcomes in adolescents. The analysis extends beyond summary to critically examine how this model advances the theoretical understanding of circadian-related psychopathology by specifying previously understudied mechanisms. The findings necessitate a paradigm shift in intervention design - away from correcting chronotype itself and toward targeting the malleable mediators of sleep and social functioning. A “chrono-health” approach is proposed, integrating sleep hygiene with social-skills training within ecologically valid settings such as schools and communities. Finally, the implications of these results are discussed for future longitudinal and experimental research, as well as for policy-making aimed at creating supportive, timing-friendly environments for neurodiverse adolescents.

Keywords: Evening chronotype; Domino effect; Sleep; Social functionging; Mental health; Adolescents

Core Tip: Zhao et al identified a mediating mechanism through which an evening-type circadian preference affects mental health via a sequential pathway involving sleep quality and social functioning. Their findings indicate that intervention strategies should focus on modifiable factors such as sleep hygiene and social competence, rather than enforcing conformity to rigid sleep-wake schedules. Further longitudinal research is warranted to corroborate these causal pathways and to develop evidence-based interventions integrating sleep management with social skills training.