{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:16:38Z","timestamp":1786115798672,"version":"build-2736575974"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Sleep disturbance and circadian rhythm dysregulation are common in mental disorders and may contribute to depressive symptoms and functional impairment. This systematic review and meta-analysis assessed the impact of non-pharmacological interventions targeting sleep and circadian rhythms on depressive symptoms and sleep-related outcomes in adults experiencing mental disorders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive search was conducted across several databases, including PubMed, Embase, Web of Science, the Cochrane Library, CNKI, VIP, and Wanfang, covering the period from their inception until April 12, 2026. Eligible studies were randomized controlled trials (RCTs) of adults with clinically diagnosed mental disorders receiving combined sleep\u2013circadian interventions. The included populations covered depressive disorders, bipolar disorder, severe mental illness, attention-deficit\/hyperactivity disorder, and mixed psychiatric samples. Risk of bias was assessed using the Cochrane RoB 2 tool, and evidence certainty was rated using the GRADE approach. Meta-analyses were carried out with the aid of Review Manager version 5.4. Depending on the context, standardized mean differences (SMDs), mean differences (MDs), or risk ratios (RRs) along with 95% confidence intervals (CIs) were computed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eleven RCTs were included. Sleep\u2013circadian interventions were associated with reduced depressive symptom severity (SMD = -0.51, 95% CI: -0.72 to -0.30) and higher treatment response (RR\u00a0=\u00a01.68, 95% CI: 1.25 to 2.27). Remission also favored the intervention groups, but this estimate was based on only two trials (RR\u00a0=\u00a02.06, 95% CI: 1.09 to 3.90). Improvements were observed in insomnia severity (MD = -5.23, 95% CI: -6.41 to -4.04), sleep disturbance or sleep quality (SMD = -0.92, 95% CI: -1.19 to -0.65), sleep-related impairment (MD = -7.91, 95% CI: -9.89 to -5.93), and functional impairment (MD = -4.78, 95% CI: -6.42 to -3.15). Evidence certainty ranged from very low to moderate, and several outcomes were supported by few trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Sleep\u2013circadian interventions may improve depressive symptoms, selected sleep outcomes, and functioning in adults with mental disorders. Given the heterogeneity of diagnoses and interventions, these findings should be viewed as promising transdiagnostic evidence. Larger trials with longer follow-up are needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO<\/jats:ext-link>\n                      , identifier CRD420261412965.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1901978","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T05:33:59Z","timestamp":1785994439000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Transdiagnostic effects of combined sleep\u2013circadian interventions on depressive symptoms and sleep outcomes in adults with mental disorders: a systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.3389","volume":"17","author":[{"given":"Jingyu","family":"Xu","sequence":"first","affiliation":[{"name":"Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baojuan","family":"Wang","sequence":"additional","affiliation":[{"name":"First Teaching Hospital of Tianjin University of Traditional Chinese Medicine (National Clinical Research Center for Chinese Medicine)","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenbin","family":"Zhu","sequence":"additional","affiliation":[{"name":"The Third Affiliated Hospital of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peixin","family":"Song","sequence":"additional","affiliation":[{"name":"Beijing Maikesipu Biotechnology Company Limited","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiqing","family":"Ao","sequence":"additional","affiliation":[{"name":"Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/s2215-0366(21)00395-3","article-title":"Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"9","year":"2022","journal-title":"Lancet Psychiatry"},{"key":"B2","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1038\/s41398-020-0694-0","article-title":"Circadian rhythm disruption and mental health","volume":"10","author":"Walker","year":"2020","journal-title":"Transl Psychiatry"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2214756121","article-title":"The sleep-circadian interface: A window into mental disorders","volume":"121","author":"Meyer","year":"2024","journal-title":"PNAS"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1111\/eip.70160","article-title":"Sleep in early psychosis and bipolar disorder: Preliminary results on actigraphic and self-reported markers of vulnerability","volume":"20","author":"Baldini","year":"2026","journal-title":"Early Intervention Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2011.01.011","article-title":"Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies","volume":"135","author":"Baglioni","year":"2011","journal-title":"J Affect Disord"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.14035","article-title":"The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023","volume":"32","author":"Riemann","year":"2023","journal-title":"J Sleep Res"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.yfrne.2022.100978","article-title":"Timing is everything: Circadian rhythms and their role in the control of sleep","volume":"66","author":"Pandi-Perumal","year":"2022","journal-title":"Front Neuroendocrinol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1111\/pcn.12688","article-title":"Circadian rhythm in bipolar disorder: A review of the literature","volume":"72","author":"Takaesu","year":"2018","journal-title":"Psychiatry Clin Neurosci"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbaa024","article-title":"Sleep and circadian rhythm disturbance in remitted schizophrenia and bipolar disorder: A systematic review and meta-analysis","volume":"46","author":"Meyer","year":"2020","journal-title":"Schizophr Bull"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2022.101597","article-title":"Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis","volume":"62","author":"Hertenstein","year":"2022","journal-title":"Sleep Med Rev"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2021.101556","article-title":"Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials","volume":"60","author":"Scott","year":"2021","journal-title":"Sleep Med Rev"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2014.08.015","article-title":"Adjunctive triple chronotherapy (combined total sleep deprivation, sleep phase advance, and bright light therapy) rapidly improves mood and suicidality in suicidal depressed inpatients: An open label pilot study","volume":"59","author":"Sahlem","year":"2014","journal-title":"J Psychiatr Res"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2022.114686","article-title":"A critical overview of systematic reviews and meta-analyses of light therapy for non-seasonal depression","volume":"314","author":"Dong","year":"2022","journal-title":"Psychiatry Res"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2022.12.079","article-title":"Critically-timed sleep+light interventions differentially improve mood in pregnancy vs. postpartum depression by shifting melatonin rhythms","volume":"324","author":"Parry","year":"2023","journal-title":"J Affect Disord"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1234","DOI":"10.4088\/jcp.11m07625","article-title":"A 9-week randomized trial comparing a chronotherapeutic intervention (wake and light therapy) to exercise in major depressive disorder patients treated with duloxetine","volume":"73","author":"Martiny","year":"2012"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12741","article-title":"Wake and light therapy for moderate-to-severe depression - a randomized controlled trial","volume":"136","author":"Kragh","year":"2017","journal-title":"Acta Psychiatrica Scandinavica"},{"key":"B17","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1016\/j.biopsych.2009.02.018","article-title":"Rapid and sustained antidepressant response with sleep deprivation and chronotherapy in bipolar disorder","volume":"66","author":"Wu","year":"2009","journal-title":"Biol Psychiatry"},{"key":"B18","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1080\/16506070903033825","article-title":"A transdiagnostic approach to treating sleep disturbance in psychiatric disorders","volume":"38","author":"Harvey","year":"2009","journal-title":"Cogn Behav Ther"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1037\/ccp0000650","article-title":"A randomized controlled trial of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) to improve serious mental illness outcomes in a community setting","volume":"89","author":"Harvey","year":"2021","journal-title":"J Consulting Clin Psychol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1037\/ccp0000869","article-title":"A group-based transdiagnostic sleep and circadian treatment for major depressive disorder: A randomized controlled trial","volume":"92","author":"Yau","year":"2024","journal-title":"J Consulting Clin Psychol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.70088","article-title":"Efficacy of a transdiagnostic sleep and circadian intervention for outpatients with sleep problems and depression, attention deficit disorder, or bipolar disorder: A randomised controlled trial","volume":"35","author":"Kragh","year":"2026","journal-title":"J Sleep Res"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ (Clinical Res Ed)"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ (Clinical Res Ed)"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.07.015","article-title":"GRADE guidelines: 3. Rating the quality of evidence","volume":"64","author":"Balshem","year":"2011","journal-title":"J Clin Epidemiol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12402","article-title":"Maintained superiority of chronotherapeutics vs. exercise in a 20-week randomized follow-up trial in major depression","volume":"131","author":"Martiny","year":"2015","journal-title":"Acta Psychiatr Scand"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.2196\/50072","article-title":"Circadian reinforcement therapy in combination with electronic self-monitoring to facilitate a safe postdischarge period for patients with major depression: Randomized controlled trial","volume":"10","author":"Aggestrup","year":"2023","journal-title":"JMIR Ment Health"},{"key":"B27","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/s13012-025-01440-9","article-title":"A randomized trial of adapted versus standard versions of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction implemented via facilitation and delivered by community mental health providers: Improving the \"fit\" of psychological treatments by adapting to context","volume":"20","author":"Harvey","year":"2025","journal-title":"Implementation Sci IS"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2020.12.174","article-title":"A randomized, controlled trial assessing the acute efficacy of triple chronotherapy in unipolar depression","volume":"282","author":"Yuen","year":"2021","journal-title":"J Affect Disord"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-025-01467-y","article-title":"A randomized trial of adapted versus standard versions the transdiagnostic intervention for sleep and circadian dysfunction (TSC) implemented via facilitation and delivered by community mental health providers using train-the-trainer","volume":"21","author":"Harvey","year":"2026","journal-title":"Implementation Sci IS"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2021.705090","article-title":"Total sleep deprivation followed by bright light therapy as rapid relief for depression: A pragmatic randomized controlled trial","volume":"12","author":"Ioannou","year":"2021","journal-title":"Front Psychiatry"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/s2215-0366(21)00034-1","article-title":"Circadian rhythm sleep-wake disturbances and depression in young people: Implications for prevention and early intervention","volume":"8","author":"Crouse","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2022.104585","article-title":"A systematic review and meta-analysis of sleep and circadian rhythms disturbances in individuals at high-risk of developing or with early onset of bipolar disorders","volume":"135","author":"Scott","year":"2022","journal-title":"Neurosci Biobehav Rev"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1002\/jcp.30815","article-title":"Circadian rhythm and disease: Relationship, new insights, and future perspectives","volume":"237","author":"Neves","year":"2022","journal-title":"J Cell Physiol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.jad.2019.09.078","article-title":"Chronotherapy for the rapid treatment of depression: A meta-analysis","volume":"261","author":"Humpston","year":"2020","journal-title":"J Affect Disord"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.8986","article-title":"Behavioral and psychological treatments for chronic insomnia disorder in adults: An American Academy of Sleep Medicine clinical practice guideline","volume":"17","author":"Edinger","year":"2021","journal-title":"J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2023.5060","article-title":"Components and delivery formats of cognitive behavioral therapy for chronic insomnia in adults: A systematic review and component network meta-analysis","volume":"81","author":"Furukawa","year":"2024","journal-title":"JAMA Psychiatry"},{"key":"B37","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.neures.2023.04.006","article-title":"Bidirectional relationship between sleep and depression","volume":"211","author":"Yasugaki","year":"2025","journal-title":"Neurosci Res"},{"key":"B38","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1176\/appi.ajp.2021.21080821","article-title":"The evolving nexus of sleep and depression","volume":"178","author":"Plante","year":"2021","journal-title":"Am J Psychiatry"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2022.104532","article-title":"Sleep disorders and non-sleep circadian disorders predict depression: A systematic review and meta-analysis of longitudinal studies","volume":"134","author":"Zhang","year":"2022","journal-title":"Neurosci Biobehav Rev"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2025.102149","article-title":"Genetic association between sleep quality, insomnia, and psychological distress: A systematic review and meta-analysis","volume":"83","author":"Blanco-Garc\u00eda","year":"2025","journal-title":"Sleep Med Rev"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2025.108735","article-title":"Association between sleep disturbances and circulating inflammatory markers in depressive and bipolar disorders: A systematic review and meta-analysis","volume":"139","author":"Fiori","year":"2026","journal-title":"Sleep Med"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1093\/geroni\/igae098.3728","article-title":"Symptom overlap between sleep disorder and depressive symptoms","volume":"8","author":"Gaba","year":"2024","journal-title":"Innov Aging"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2020.101873","article-title":"The efficacy of cognitive and behavior therapies for insomnia on daytime symptoms: A systematic review and network meta-analysis","volume":"80","author":"Benz","year":"2020","journal-title":"Clin Psychol Rev"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.7326\/m15-2175","article-title":"Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians","volume":"165","author":"Qaseem","year":"2016","journal-title":"Ann Internal Med"},{"key":"B45","doi-asserted-by":"publisher","first-page":"101208","DOI":"10.1016\/j.smrv.2019.08.002","article-title":"Cognitive behavioral therapy for insomnia: A meta-analysis of long-term effects in controlled studies","volume":"48","author":"van der Zweerde","year":"2019","journal-title":"Sleep Med Rev"},{"key":"B46","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1177\/0706743719892471","article-title":"Light therapy for patients with bipolar depression: Systematic review and meta-analysis of randomized controlled trials","volume":"65","author":"Lam","year":"2020","journal-title":"Can J Psychiatry Rev Can Psychiatr"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1002\/brb3.1876","article-title":"Adjunctive bright light therapy for treating bipolar depression: A systematic review and meta-analysis of randomized controlled trials","volume":"10","author":"Hirakawa","year":"2020","journal-title":"Brain Behav"},{"key":"B48","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1111\/acps.13253","article-title":"Sleep deprivation as treatment for depression: Systematic review and meta-analysis","volume":"143","author":"Ioannou","year":"2021","journal-title":"Acta Psychiatrica Scandinavica"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2020.00070","article-title":"Effectiveness of sleep deprivation in treating acute bipolar depression as augmentation strategy: A systematic review and meta-analysis","volume":"11","author":"Ramirez-Mahaluf","year":"2020","journal-title":"Front Psychiatry"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d4002","article-title":"Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials","volume":"343","author":"Sterne","year":"2011","journal-title":"BMJ (Clinical Res Ed)"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa065779","article-title":"Selective publication of antidepressant trials and its influence on apparent efficacy","volume":"358","author":"Turner","year":"2008","journal-title":"N Engl J Med"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ (Clinical Res Ed)"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1901978\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T05:34:00Z","timestamp":1785994440000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1901978\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":52,"alternative-id":["10.3389\/fpsyt.2026.1901978"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1901978","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]},"article-number":"1901978"}}