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Sleep and Related Disorders / Treatment of Major Depression · Journal article
BMC Psychiatry · July 31, 2026
Early or partial results. Treat as a signal, not a conclusion.
This cross-sectional exploratory study of 110 outpatient depression patients found moderate-to-strong correlations between poor sleep quality and reduced social functioning, lower medication adherence, circadian rhythm disruption, and greater depressive severity. Biological rhythm disruption was the sole independent predictor of sleep quality in adjusted analysis. The study design and single-center setting preclude causal inference and generalization.
Descriptive correlational cross-sectional study. Adult outpatients with confirmed diagnosis of major depressive disorder at a single university psychiatry outpatient clinic.. n = 110. Adult Psychiatry Outpatient Clinic of Maltepe University Faculty of Medicine Hospital (Turkey)..
46.4% of participants reported moderate sleep quality; 31.8% reported poor sleep quality (mean PSQI 8.31, SD 4.21) Poorer sleep quality correlated moderately with lower social functioning (r = −0.300, p < 0.01) and lower medication adherence (r = −0.350, p < 0.01) Sleep quality strongly correlated with biological rhythm disruption (r = 0.621, p < 0.01) and depression severity (r = 0.494, p < 0.01)
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The findings suggest clinicians should screen for sleep disturbance and circadian rhythm dysfunction in depression treatment, and consider integrated approaches addressing both sleep and circadian regulation alongside functional recovery. However, the cross-sectional design cannot establish whether improving sleep improves adherence or functioning, limiting evidence for intervention.
Cross-sectional exploratory study demonstrating associations among sleep, circadian rhythm, functioning, and adherence in depression, but lacking causal evidence, control group, or intervention testing to support practice change.
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Quoted from the source exactly as published.
The findings suggest clinicians should screen for sleep disturbance and circadian rhythm dysfunction in depression treatment, and consider integrated approaches addressing both sleep and circadian regulation alongside functional recovery. However, the cross-sectional design cannot establish whether improving sleep improves adherence or functioning, limiting evidence for intervention.
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Sleep disturbances and circadian rhythm disruption are highly prevalent in major depressive disorder (MDD) and may contribute to poorer functioning and reduced treatment adherence. However, few studies have examined sleep quality, biological rhythm disruption, functioning, and medication adherence concurrently in an outpatient depression sample. This study investigated the relationships among sleep quality, biological rhythm, functional status, medication adherence, and depression severity in patients diagnosed with depression. A descriptive, correlational cross-sectional study was conducted in the Adult Psychiatry Outpatient Clinic of Maltepe University Faculty of Medicine Hospital between 16 December 2024 and 15 March 2025. A total of 110 patients with a confirmed diagnosis of depression were included. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), biological rhythm disruption using the Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN), functional status using the Social Functioning Scale (SFS-T), medication adherence using the Medication Adherence Rating Scale (MARS), and depression severity using the Beck Depression Inventory (BDI). Pearson correlation analyses were used to examine associations among variables, and multiple linear regression analyses were conducted to identify independent factors associated with sleep quality. Sleep impairment was common: 46.4% of participants reported moderate sleep quality and 31.8% reported poor sleep quality. Mean PSQI score was 8.31 (SD = 4.21). Poorer sleep quality (higher PSQI scores) was moderately associated with lower social functioning ( r = − 0.300, p < 0.01) and lower medication adherence ( r = − 0.350, p < 0.01), and strongly associated with greater biological rhythm disruption ( r = 0.621, p < 0.01). Sleep quality was also positively correlated with depression severity ( r = 0.494, p < 0.01). Sleep impairment was common: 46.4% of participants reported moderate sleep quality and 31.8% reported poor sleep quality. Poorer sleep quality (higher PSQI scores) was moderately associated with lower social functioning ( r = − 0.300, p < 0.01) and lower medication adherence ( r = − 0.350, p < 0.01), and positively associated with biological rhythm disruption ( r = 0.621, p < 0.01) and depressive symptom severity ( r = 0.494, p < 0.01). In the multiple linear regression analysis, the overall model was statistically significant (R² = 0.429, p < 0.001), explaining 42.9% of the variance in sleep quality. After adjustment for the other variables, biological rhythm disruption remained the only independent predictor of sleep quality (β = 0.445, p < 0.001). In this outpatient depression sample, poor sleep quality was significantly associated with circadian rhythm disruption, reduced functioning, lower medication adherence, and greater depressive symptom severity. These findings support the clinical value of early sleep screening and integrated approaches that address sleep–circadian regulation alongside functional recovery, with possible benefits for treatment engagement in outpatient mental health care. Not applicable.
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