JMIR Publications

ABSTRACT

Background:

Disturbances in wearable-measured circadian rhythms have been linked with depression severity. However, the real-world associations between circadian rhythms and depression may be biased if seasonal effects are not appropriately considered.

Objective:

This study aimed to explore the associations between depression severity and wearable-measured circadian rhythms, accounting for seasonal impacts and quantifying seasonal changes in circadian rhythms.

Methods:

Data used in this study came from a large longitudinal mobile health study. Participants’ depression severity (measured biweekly using the 8-item Patient Health Questionnaire [PHQ-8]) and behaviors (monitored by Fitbit) were tracked for up to two years. Twelve features were extracted from Fitbit recordings to approximate circadian rhythms. Three nested linear mixed-effects models were employed for each feature: (1) incorporating the PHQ-8 score as an independent variable; (2) adding the season variable; and (3) adding an interaction term between season and the PHQ-8 score.

Results:

This study analyzed 10,018 PHQ-8 records with Fitbit data from 543 participants. Upon adjusting for seasonal effects, higher PHQ-8 scores were associated with reduced activity, irregular behaviors, and delayed rhythms. Notably, the negative association with daily step counts was stronger in summer and spring than in winter, and the positive association with the onset of the most active continuous 10-hour period was significant only during summer. Furthermore, participants had shorter and later sleep, more activity, and delayed circadian rhythms in summer compared to winter.

Conclusions:

Our findings underscore the significant seasonal impacts on human circadian rhythms and their associations with depression and indicate that wearable-measured circadian rhythms have the potential to be the digital biomarkers of depression.