Circadian activity rhythms and psychopathology during depressive episodes

Paola Salvatore, MD

McLean Hospital – Research Associate
Salvatore_Paola poster

Scientific Abstract

Background: In assessing suicidal risk is challenging to identify suicidal ideation. A wish-to-die can be minimized, concealed, or denied, fluctuates, and can seem stigmatizing if divulged. In contrast, vitality is a core component of the subjective life of the self for it is immediately conscious, before reflection, as an experience of energetic momentum. Probing vitality as well as evaluating suicidal thinking may improve identification of early warning signs of suicidal risk, whereas suicidal ideation assessment alone may not capture suicidal status. This proposal arises from the idea that loss of vitality is associated with the dawning of any illness, and objective motility measures would be associated with vitality. 

Methods: We conducted actigraphy measurements and subjective psychopathology assessments among 83 adult psychiatric outpatients at Parma University, diagnosed with a DSM-5 major affective disorder (BD-I [n=48], BD-II [20], and MDD [15]) during clinical depression. Participants were monitored with actigraphy at home for 72 hours during non-holiday weekdays, and self-rated their emotional and vital states at regular intervals. We applied cosinor analysis to actigraphic data and analyzed associations of subjective measures with circadian activity parameters. 

Results: In bivariable analyses, self-rated vitality was significantly lower, self-rated suicidality significantly higher, and their difference smaller, with BD vs. UD.  No significant diagnostic differences were found in actigraphic sleep parameters, or in self-rated depression, dysphoria or anxiety. Linear regression found that the difference between self-reported vitality and wish-to-die was significantly positively correlated with: circadian activity mesor, daytime activity, amplitude, and night activity (respectively: t=4.19, p<0.0001; t=4.09, p<0.0001; t=3.44, p=0.001; t=2.37, p=0.02).

Conclusions: Significant changes of objective measures of circadian activity can signal relative predominance of subjective vitality over suicidal ideation. Current paradigms of suicide risk assessment, which center on negative affects and suicidal ideation, might usefully evaluate motility and vitality.

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research Areas


Paola Salvatore, MD, Premananda Indic, PhD, Hari-Mandir K. Khalsa, MS, Mauricio Tohen, MD, MPH, MBA, Carlo Maggini, MD, Ross J. Baldessarini, MD

Principal Investigator

Paola Salvatore, MD