Association of sleep and circadian rhythm disruption with co-occurring depressive and anxiety symptoms among primary and secondary school students

YE Sheng; YANG Yue; LU Xuelei; JIN Heyue; LI Juntong; LIU Hui; LIU Li

doi:10.16835/j.cnki.1000-9817.2025287

Volume 46 Issue 10

Oct. 2025

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YE Sheng, YANG Yue, LU Xuelei, JIN Heyue, LI Juntong, LIU Hui, LIU Li. Association of sleep and circadian rhythm disruption with co-occurring depressive and anxiety symptoms among primary and secondary school students[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2025, 46(10): 1478-1483. doi: 10.16835/j.cnki.1000-9817.2025287

Citation:

YE Sheng, YANG Yue, LU Xuelei, JIN Heyue, LI Juntong, LIU Hui, LIU Li. Association of sleep and circadian rhythm disruption with co-occurring depressive and anxiety symptoms among primary and secondary school students[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2025, 46(10): 1478-1483. doi: 10.16835/j.cnki.1000-9817.2025287

Citation:

YE Sheng, YANG Yue, LU Xuelei, JIN Heyue, LI Juntong, LIU Hui, LIU Li. Association of sleep and circadian rhythm disruption with co-occurring depressive and anxiety symptoms among primary and secondary school students[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2025, 46(10): 1478-1483. doi: 10.16835/j.cnki.1000-9817.2025287

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Association of sleep and circadian rhythm disruption with co-occurring depressive and anxiety symptoms among primary and secondary school students

doi: 10.16835/j.cnki.1000-9817.2025287

Section of School Health, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, Jiangsu Province, China

Received Date: 2025-05-12
Rev Recd Date: 2025-07-23
Publish Date: 2025-10-25

Abstract

Abstract

Objective To investigate the association of sleep and circadian rhythm disruption indicators (including chronotype, sleep duration, and social jetlag) with co-occurring depressive and anxiety symptoms among primary and secondary school students, so as to provide a reference for promoting their mental health. Methods In October 2023, a total of 15 944 primary and secondary school students were recruited from Nanjing, using a stratified cluster random sampling method. The Morning and Evening Questionnaire-5, Center for Epidemiological Studies Depression, and Generalized Anxiety Disorder-7 were used for the survey. Chi-square test was employed for intergroup comparisons, and Logistic regression model was applied to analyze the independent and joint effects of sleep-related factors on comorbid symptoms of depressive and anxiety among primary and middle school students. Results The prevalence of co-occurring depressive and anxiety symptoms among primary and secondary school students in Nanjing was 16.9%. After adjusting for covariates, Logistic regression analysis revealed significant independent associations between evening chronotype (OR=6.55, 95%CI=5.59-7.68), insufficient sleep duration (OR=3.05, 95%CI=2.60-3.59), and social jetlag ≥2 h (OR=2.09, 95%CI=1.85-2.37) with comorbid symptoms of depressive and anxiety among students (all P < 0.05). Concurrent of evening chronotype and insufficient sleep (OR=7.54, 95%CI=3.55-16.01), as well as evening chronotype and social jetlag ≥2 h (OR=4.18, 95%CI=3.01-5.81), were associated with an increased risk of co-occurring depressive and anxiety symptoms (both P < 0.05). In the female and high school student subgroups, the combination of evening chronotype and insufficient sleep or social jetlag ≥2 h showed stronger joint effects on co-occurring depressive and anxiety symptoms [OR(95%CI)=8.46(3.25-22.04) and 15.90(3.66-69.08); 7.87(4.90-12.65) and 4.85(3.10-7.59), respectively; all P < 0.05]. Conclusions Evening chronotype, insufficient sleep, and social jetlag≥2 h may serve as risk factors for comorbid symptoms of depressive and anxiety in school-aged populations. Paying attention to the coexistence of multiple sleep-related risk factors may help mitigate the occurrence of emotional disorders in this demographic.
- Sleep,
- Circadian rhythm,
- Anxiety,
- Depression,
- Regression analysis,
- Students

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References(27)

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