Social zeitgebers and circadian dysrhythmia are associated with severity of symptoms of PTSD and depression in trauma-affected refugees

Abstract

The relation of aspects of rest–activity patterns, i.e., social zeitgebers, physical activity and circadian rhythm, to the severity of PTSD and depressive symptoms has not previously been studied. Doing so could provide valuable insight into possible targets for treatment. Our study explored these links in a population of 219 trauma-affected refugees diagnosed with PTSD who were seeking treatment. Data regarding social zeitgebers, such as affiliation with the labor market and contact with social network, and symptoms of PTSD and depression were collected from them. Furthermore, their levels of physical activity and circadian rest–activity parameters were calculated from actigraphy data. Bivariate correlation analyses and multiple linear regression analyses were performed to examine various aspects of rest–activity regarding relation to severity of PTSD and depressive symptoms. Several social zeitgebers were associated with severity of PTSD and depressive symptoms. The level of physical activity was unrelated to symptom severity, whereas a rest–activity pattern, with early onset of the most active 10 h, was associated with severity of PTSD, and a circadian rhythm with a large difference between periods of rest and activity was associated with severity of depression. Social zeitgebers, levels of physical activity and circadian rhythm parameters were all associated with each other. Social zeitgebers and circadian rhythm parameters were significantly related to the severity of PTSD and depressive symptoms—a relationship indicating that interventions targeting regularity of daily routines have a potential role in treating PTSD and depression in trauma-affected refugees.

Trial registration: ClinicalTrials.gov, ID: NCT02761161, April 27, 2016.

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Data availability

The data that support the findings of this study are available from the corresponding author upon request.

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Acknowledgements

The authors wish to thank the participants and staff at the Competence Centre for Transcultural Psychiatry. In particular, we are grateful to Henriette Laugesen and Joakim Friis for managing the data.

Funding

This work was supported by TrygFonden (Grant number 120354) and Fonden til Lægevidenskabens fremme (Foundation for Promotion of Medicine, Grant number 16–319). Treatment facilities were provided by the Mental Health Services of the Capital Region, Denmark. The design, management of the study and interpretation of the data were entirely independent of funding.

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All authors contributed to the study conception and design. Material preparation, data collection and analyses were performed by Hinuga Sandahl and Jessica Carlsson. The first draft of the manuscript was written by Hinuga Sandahl and the other authors commented on subsequent versions. All authors read and approved the final manuscript.

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Correspondence to Hinuga Sandahl.

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The authors have no relevant financial or non-financial interests to disclose.

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The authors assert that all procedures were carried out in accordance with the ethical standards of the National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol and amendments were approved by the Ethics Committee of the Capital Region of Denmark (H-15014503), the Danish Medicines Agency (EudraCT: 2015–004153-40) and the Danish Data Protection Agency (2012–58-0004).

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Sandahl, H., Baandrup, L., Vindbjerg, E. et al. Social zeitgebers and circadian dysrhythmia are associated with severity of symptoms of PTSD and depression in trauma-affected refugees. Eur Arch Psychiatry Clin Neurosci (2021). https://doi.org/10.1007/s00406-021-01266-8

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Keywords

  • Circadian rhythm
  • Social zeitgebers
  • Physical activity
  • Sleep
  • Employment
  • Social relationships