Each spring, the clock change nudges our daily routines out of sync, even if only for a few days. Humans have evolved alongside the predictable rising and setting of the sun. To adapt to these daily light-dark changes, we have developed an internal “body clock,” known as circadian rhythms. Our body clock regulates many functions over a 24-hour period, including sleep, hormones, body temperature, appetite, and mood. For example, you might feel hungry at the same time each morning because your body clock is anticipating breakfast.
However, modern life has changed our exposure to light. Artificial lighting and indoor lifestyles mean our light exposure is less consistent than it once was. We might turn on bright lights in the middle of the night or spend most of the day indoors away from natural sunlight. As a result, the body clock can become confused about what is day and what is night, leading to disruption. You may have experienced this yourself; staying up late and sleeping in on weekends, then feeling sluggish and fatigued on Monday. This is your body clock being out of sync.
Disruptions to the body clock are linked to certain mental health conditions (Walker W. et al., 2020), such as depression and bipolar disorder. Some researchers suggest this may be due to differences in circadian sensitivity to light (Swope C. et al., 2023); meaning light affects the body clock differently in certain individuals. However, much remains unknown about these relationships. Importantly, people with lived experience, as well as carers and clinicians, are often underrepresented in research. This raises an important question:
Are researchers focusing on the aspects of circadian rhythms and mental health that truly matter to those affected?
To address this, it is essential to identify the top research priorities from the perspectives of people with lived experience. In this new study, Ferguson and colleagues (2026) used a gold-standard approach (the James Lind Alliance) to bring together patients, carers, and healthcare professionals to establish the first set of research priorities on the body clock and mental health.
Disruptions in the body clock are associated with mental health conditions, including depression and bipolar disorder.
Methods
There were several stages involved in identifying the top research priorities in circadian science and mental health. First, a steering group was formed by inviting key stakeholders. The group of 14 members included people with lived experience of mental health and/or circadian rhythm disruption, carers, and clinicians in relevant fields (some members fit multiple roles).
Surveys were co-designed with input from the steering group and included and initial survey (Survey 1) with four open-ended questions:
- What would you like to know about how a disrupted body clock impacts mental health?
- What would you like to know about how mental health difficulties impact the body clock?
- What questions do you feel research needs to answer about mental health and the body clock?
- Do you have any further thoughts or experiences you would like to share?
Responses were analysed and grouped into 69 themes. These themes were then reviewed using a traffic light system to assess existing evidence:
- Red = not answered
- Yellow = partially answered
- Green = already answered (these questions were ultimately excluded)
In the next stage, participants were organised into focus groups where they selected the most important questions. The top 15 questions from each group were identified. This resulted in 28 unique questions, which the steering group refined to 25. Finally, a new group of participants (including some of the original steering group members) ranked these 25 questions (Survey 2) and worked together to reach a consensus on the top 10 research priorities.
Results
Initial survey (Survey 1)
The initial survey was completed by 247 participants across the UK, aged between 12 and 95 years (M = 43.6, SD = 15.2). The sample was predominantly female (69.2%) and Caucasian (85.8%). Most participants reported lived experience of mental health or circadian rhythm difficulties (91.9%), alongside smaller proportions of carers (17.8%) and clinicians (16.6%).
This stage generated a total of 964 responses, of which 546 were deemed to be within the scope of the study. These responses were refined and synthesised into a set of research questions.
Ranking survey (Survey 2)
The second survey, used to prioritise these questions, included 222 participants (aged 12-82 years; M = 43.2, SD = 14.2), again drawn from across the UK. The majority of the sample were again female (54.2%), Caucasian (71.6%), and individuals with lived experience (90.1%). Participants ranked the importance of the refined questions, which informed the final prioritisation process.
Top 10 Research Priorities
The resulting Top 10 research priorities reflect a broad range of themes across mental health and circadian science. These include:
- Whether the interaction between mental health and the body clock varies across different life stages.
- Effective strategies, including medications, for managing disrupted body clocks alongside mental health conditions.
- The relationship between circadian rhythms and mental health in neurodivergent individuals.
- Mechanistic links between circadian disruption and conditions such as bipolar disorder and psychosis.
- The role of societal and policy changes in supporting individuals with extreme chronotypes and reducing stigma.
- The relationship between menopause, mental health, and circadian rhythms.
- The impact of trauma (e.g., grief) on the body clock and how this can be managed.
- Whether aligning with natural rhythms or social schedules is more beneficial for mental health.
- The relationship between seasonal changes, circadian rhythms, and mental wellbeing.
- Whether mental health difficulties can disrupt the body clock at a molecular level, or whether these effects are primarily behavioural.
Overall, the priorities span mechanistic, clinical, and societal domains, reflecting the diverse unmet needs of stakeholders.
Individuals with lived experience, carers, and clinicians came together to rank the top priorities for mental health and circadian rhythms.
Conclusions
In a sample of individuals with lived experience, carers and clinicians, 10 important research questions in the area of mental health and circadian rhythms were identified. This study is the first to identify research priorities to inform researchers and funding bodies. Overall, this should lead to greater understanding of the relationships between circadian rhythms and mental health conditions.
The authors concluded by recommending that:
funding bodies (should) consider translating these questions into direct funding calls.
Without this, even the most well-defined research question risk remaining unanswered.
Top research priorities will remain unanswered if they are not backed by meaningful funding and action.
Strengths and limitations
The main strength of this study is its use of a gold-standard, structured method to decide what research to focus on. Instead of researchers deciding everything, it asks patients and carers what matters most to them. By focusing on unanswered questions and cross-checking these against existing evidence, the study ensures that the resulting priorities reflect genuine gaps in knowledge rather than duplicating established findings.
Another strength of the study is its strong emphasis on inclusivity and co-production. By bringing together patients, carers, and healthcare professionals, the study enables a collaborative approach to defining research priorities. The researchers made an effort to use simple, easy-to-understand language including clearly defining terms such as the “body clock”, to ensure that participants without a research background could meaningfully engage. Feedback from participants suggests this worked well, with individuals reporting that “the process felt like genuine co-production and co-design”.
The study also clearly presents its results by creating a “top 10” list of research priorities. This list makes it easy for future researchers and funders to know what to focus on. The list covers a broad range of topics, from understanding the underlying mechanisms to improving management and public health policies, making findings practical and relevant to real life.
Despite its strengths, this study also has several limitations. One main issue is that not all groups of people were equally represented. Fewer young people, men, clinicians, and individuals from ethnic and sexual minority groups took part. These groups may have different or greater unmet needs, so their absence could mean some important research topics were missed. For example, since many mental health conditions begin in adolescence (Solmi M. et al., 2021), a period also association with significant changes in body clock timing (Crowley S. et al., 2007), not including enough young people might mean missing priorities related to early intervention. Similarly, having more women than men respond to the survey may have led to a greater focus on women’s health issues, such as menopause. Clinicians were also underrepresented, which may have reduced the focus on what is realistically achievable and important in day-to-day practice.
The authors further highlight limitations of their study methods. In particular, feedback suggested that the open-ended nature of the initial survey questions was too vague, making it difficult to suggest research ideas. This may have affected how useful or consistent the responses were.
Overall, while the study is well-designed and provides useful insights, these limitations suggest that the final list of research priorities may not fully reflect the needs of all groups.
Key perspectives in this study were underrepresented, including, youth, men, minorities communities, and clinicians.
Implications for practice
There is still a lot that is not understood about mental health and circadian science. By involving individuals with lived experience, carers, and clinicians, this study helps highlight the most important unanswered questions that reflect real-world needs. The findings from this study have several implications for practice.
Should this change policy?
Not yet. This study does not test interventions or provide evidence for specific changes in healthcare. However, it does support a growing move towards more personalised care. The wide range of priorities, covering different stages of life, trauma, neurodiversity, and treatment types, shows that the problems with circadian rhythms are not the same for everyone.
For clinicians, this means it may be helpful to pay more attention to patients’ daily routines, sleep patterns, and environments, even though clear treatment guidelines are still developing.
What does this mean for policy?
Some of the findings raise interesting questions about how society is structured. For example, fixed work and school schedules may not suit the large variability in the timing of circadian rhythms between individuals. However, the study does not provide evidence to recommend changing these systems yet. Instead, it highlights that we need a better understanding of whether more flexible schedules would actually improve mental health.
What new research does this suggest?
One key takeaway is just how much we still do not know about mental health and the body clock. The top research priorities cover a wide range of areas, including:
- How the body clock works
- Different life stages
- Social and environmental factors
- Treatments
- Groups that are overlooked
Ideally, future research would consider these issues together, rather than treating them as separate issues, as these factors are likely connected and influenced by one another.
Final thoughts
In my opinion, what stands out most from this study is the shift in whose voices are shaping research. Rather than researchers deciding what matters, this approach centres the experiences of those living with mental health difficulties and circadian disturbances every day. This shift makes research feel less like something done to people, and more like something built with them.
Rather than researchers deciding what matters, this approach centres the experiences of those living with mental health difficulties and circadian disturbances every day.
Statement of interests
Bec (Rebecca Fitton) is particularly interested in this topic. Her research primarily focuses on circadian rhythms and psychiatric treatment in mental health conditions, such as depression and bipolar disorder. She has no conflicts of interests to declare.
Editor
Edited by Éimear Foley. AI tools assisted with language refinement and formatting during the editorial phase.
Links
Primary paper
Ferguson, Amy C., Kamenska, Ivana, Ahmad, Nahid, Needham, Nicole, Farquhar, Michael, Stephens, Candida, Abid, Usayd, Perry, Dylan, Gardani, Maria, et al. (2026). Research priorities for mental health and circadian science: a priority setting partnership of individuals with lived experience, carers, clinicians and researchers. BMJ Mental Health, 29(1).
Other references
Crowley, S. J., Acebo, C., & Carskadon, M. A. (2007). Sleep, circadian rhythms, and delayed phase in adolescence. Sleep medicine, 8(6), 602–612.
Solmi, M., Radua, J., Olivola, M. et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry 27, 281–295 (2022).
Swope, C. B., Rong, S., Campanella, C., Vaicekonyte, R., Phillips, A. J., Cain, S. W., & McGlashan, E. M. (2023). Factors associated with variability in the melatonin suppression response to light: A narrative review. Chronobiology International, 40(4), 542–556.
Walker, W. H., Walton, J. C., DeVries, A. C., & Nelson, R. J. (2020). Circadian rhythm disruption and mental health. Translational Psychiatry, 10(1), 1-13.
