Sex differences in the association between chronotype and anxiety: A nationwide population study

Abstract

Backgrounds: This study aimed to investigate potential sex differences in the association between anxiety and chronotype. Methods: Nationwide population-based data were analyzed from 2838 individuals aged 20-59 years who participated in the Circannual Change in Headache and Sleep Study. The chronotype was scored using the Morningness-Eveningness Questionnaire, and anxiety levels were assessed using the Generalized Anxiety Disorder-7 scale. Covariates included sociodemographic factors, depression, employment status, alcohol consumption, current smoker, body mass index, insomnia severity, and average sleep duration. Results: In this cohort (mean age = 40.5 +/- 11.1 years, 1424 women [50.2 %]. 1414 men [49.8 %]), anxiety was more commonly reported by women (12.2 %) than men (7.4 %), with the evening chronotype group showing the highest anxiety prevalence (15.3 %). After adjusting for covariates, men with a morning chronotype showed a significantly lower risk of anxiety than did those with an intermediate chronotype, however, no significant difference in anxiety risk was observed for evening-type men. Among women, chronotype was not significantly associated with anxiety. Conclusions: Differences in the chronotype-anxiety association were observed between men and women. Specifically, having a morning chronotype may reduce the risk of anxiety in men, whereas this protective effect was not observed in women. These findings suggest the need for sex-specific chronotype-targeted approaches for the prevention and management of anxiety.