The Modifying Role of Cortisol in the Sex-Specific Associations of Social Jetlag with Neurobehavioral Problems Among Adolescents: The Shanghai Adolescent Cohort Study

Purpose

Social-jetlag is linked to adverse mental health outcomes, though longitudinal evidence in adolescents remains insufficient. The neuroendocrine mechanism underlying this association, particularly the modifying role of cortisol and sex difference, remains uncharacterized. Patients and methods: Data were collected from the Shanghai Adolescent Cohort Study (2017-2021), involving 609 students investigated from grade 6 to 9. Levels of neurobehavioral symptoms were evaluated using the Youth Self-Report (YSR). Social-jetlag was assessed using structured questionnaire. Cortisol levels in fingernail samples were measured using liquid-chromatography-tandem-mass-spectrometry (LC-MS/MS). Two distinct social-jetlag trajectories (the consistently low-level and relatively high-level social-jetlag trajectories across 4 years) were identified by the Latent-class-mixture-modeling (LCMM). Negative binomial generalized linear models were employed to analyze the longitudinal associations between social-jetlag trajectories with adolescent neurobehavioral problems under low and high cortisol levels.