The interplay between subjective time perspective, circadian rhythms, and social functioning in schizophrenia spectrum disorders: Insights from the DiAPASon study

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BACKGROUND AND HYPOTHESIS: This study aims to understand how subjective temporal experience interacts with behavioral patterns by investigating the relationships between Time Perspective (TP), circadian rhythms, and social functioning in individuals with Schizophrenia Spectrum Disorders (SSDs). Building on the hypothesis that a pessimistic and helpless view of the present (Present-Fatalistic), a negatively biased view of the past (Past-Negative), and a reduced ability to flexibly balance different temporal perspectives (Deviation from Balanced Time Perspecitve-Revisited; DBTP-R) are maladaptive, we test whether these characteristics align with disrupted sleep-wake regulation and worse functioning. STUDY DESIGN: The study included 122 participants diagnosed with SSD. Assessments included the Zimbardo Time Perspective Inventory (ZTPI), 7-day actigraphy recordings, and the Specific Levels of Functioning scale (SLOF). Distributional analyses were conducted to assess differences between outpatients and residential patients across socio-demographic and clinical variables. Associations between time perspective, actigraphy, and functioning were examined using correlation analyses stratified by treatment setting. STUDY RESULTS: No significant differences emerged in ZTPI scores between groups. In contrast, significant differences were observed across multiple SLOF domains, with residential patients showing poorer overall functioning compared to outpatients (FDR-corrected p < 0.01). In residential patients, Past-Positive was associated with less sleep fragmentation (r = -0.27, uncorrected p = 0.02), while Present-Fatalistic (r = -0.26, uncorrected p = 0.03) and a more unbalanced TP (r = -0.4, uncorrected p < 0.01) were both negatively correlated with overall functioning. Among outpatients, Past-Negative was linked to lower total sleep time (r = -0.3, uncorrected p = 0.03), whereas Present-Hedonistic was positively correlated with interpersonal relationships (r = 0.34, uncorrected p = 0.01) and overall functioning (r = 0.28, uncorrected p = 0.04). CONCLUSIONS: By integrating ZTPI with actigraphy across outpatient and residential settings, we established that altered time perception in SSD is associated with circadian rhythms fragmentation and reduced sleep duration in outpatients, and with reduced functioning in residential patients. Interventions targeting temporal imbalances and circadian regulation may therefore enhance functioning and quality of life, particularly in community-based settings.

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