Variation of psychiatric emergencies across seasons in San Diego county

A Systematic Review on the Impact of Seasonality on Severe Mental Illness Admissions: Does Seasonal Variation Affect Coercion?

Coercion in psychiatry is associated mainly with involuntary admissions. The purpose of this study was to investigate the associations between hospital admissions of patients suffering from affective and schizophrenic disorders and seasonality. A systematic literature search using PubMed, Scopus and Google Scholar was conducted, including studies with affective and schizophrenia disorder admissions, published from October 1992 to August 2020. A total of 31 studies were included in the review. Four broad severe mental illness admission categories were identified regarding seasonality: affective disorders, schizophrenia disorders, involuntary admission affective disorders and involuntary admission schizophrenia disorders. There was clear and strong evidence for spring and summer peaks for severe mental illness admissions; data provided for age, gender and involuntary admissions was limited. Seasonality may have a significant effect on the onset and exacerbation of psychopathology of severe mental illness and should be considered as a risk factor in psychiatric admissions, violence and the risk of mental health coercion. A better understanding of the impact of seasonality on severe mental illness will help professionals to provide the best practices in mental health services in order to reduce and prevent psychiatric hospitalizations (especially involuntary admissions) resulting in further coercive measures.

Cross-sectional and within-subject seasonality and regularity of hospitalizations: A population study in mood disorders and schizophrenia

BACKGROUND

Seasonal peaks in hospitalizations for mood disorders and schizophrenia are well recognized and often replicated. The within-subject tendency to experience illness episodes in the same season, that is, seasonal course, is much less established, as certain individuals may temporarily meet criteria for seasonal course purely by chance.

AIMS

In this population, prospective cohort study, we investigated whether between and within-subject seasonal patterns of hospitalizations occurred more frequently than would be expected by chance.

METHODS

Using a compulsory, standardized national register of hospitalizations, we analyzed all admissions for mood disorders and schizophrenia in the Czech Republic between 1994 and 2013. We used bootstrap tests to compare the observed numbers of (a) participants with seasonal/regular course and (b) hospitalizations in individual months against empirical distributions obtained by simulations.

RESULTS

Among 87 184 participants, we found uneven distribution of hospitalizations, with hospitalization peaks for depression in April and November (X² (11) = 363.66, P < .001), for mania in August (X² (11) = 50.36, P < .001) and for schizophrenia in June (X² (11) = 70.34, P < .001). Significantly more participants than would be expected by chance, had two subsequent rehospitalizations in the same 90 days in different years (7.36%, bootstrap P < .01) or after a regular, but non-seasonal interval (6.07%, bootstrap P < .001). The proportion of participants with two consecutive hospitalizations in the same season was below chance level (7.06%).

CONCLUSIONS

Psychiatric hospitalizations were unevenly distributed throughout the year (cross-sectional seasonality), with evidence for regularity, but not seasonality of hospitalizations within subjects. Our data do not support the validity of seasonal pattern specifier. Season may be a general risk factor, which increases the risk of hospitalizations across psychiatric participants.

Seasonality and symptoms of depression: A systematic review of the literature

AIMS

Lay opinions and published papers alike suggest mood varies with the seasons, commonly framed as higher rates of depression mood in winter. Memory and confirmation bias may have influenced previous studies. We therefore systematically searched for and reviewed studies on the topic, but excluded study designs where explicit referrals to seasonality were included in questions, interviews or data collection.

METHODS

Systematic literature search in Cochrane database, DARE, Medline, Embase, PsychINFO and CINAHL, reporting according to the PRISMA framework, and study quality assessment using the Newcastle-Ottawa scale. Two authors independently assessed each study for inclusion and quality assessment. Due to large heterogeneity, we used a descriptive review of the studies.

RESULTS

Among the 41 included studies, there was great heterogeneity in regards to included symptoms and disorder definitions, operationalisation and measurement. We also observed important heterogeneity in how definitions of 'seasons' as well as study design, reporting and quality. This heterogeneity precluded meta-analysis and publication bias analysis. Thirteen of the studies suggested more depression in winter. The remaining studies suggested no seasonal pattern, seasonality outside winter, or inconclusive results.

CONCLUSIONS

The results of this review suggest that the research field of seasonal variations in mood disorders is fragmented, and important questions remain unanswered. There is some support for seasonal variation in clinical depression, but our results contest a general population shift towards lower mood and more sub-threshold symptoms at regular intervals throughout the year. We suggest future research on this issue should be aware of potential bias by design and take into account other biological and behavioural seasonal changes that may nullify or exacerbate any impact on mood.

Psychiatric emergency "surge capacity" following acts of terrorism and mass violence with high media impact: what is required?

OBJECTIVE

Adequate preparedness for acts of terrorism and mass violence requires a thorough understanding of the postdisaster mental health needs of all exposed groups, including those watching such events from a distance. This study examined emergency psychiatric treatment-seeking patterns following media exposure to four national terrorist or mass casualty events.

METHOD

An event was selected for study if (a) it precipitated local front-page headlines for >5 consecutive days and (b) emergency service psychiatrists identified it as specifically precipitating help-seeking in the study hospital. Four events qualified: the Oklahoma City bombing (1995), the Columbine High School (1999) and Wedgewood Baptist Church (1999) shootings and the terrorist attacks of September 11, 2001. Time-series analyses were used to correct for autocorrelation in visit patterns during the postdisaster week, and equivalent time periods from years before and after each event were used as control years.

RESULTS

Overall, disaster week census did not differ significantly from predisaster weeks, although 3-day nonsignificant decreases in visit rate were observed following each disaster. Treatment-seeking for anxiety-related issues showed a nonsignificant increase following each disaster, which became significant in the "all disaster" model (t=5.17; P=.006). Intensity of media coverage did not impact rate of help-seeking in any analysis.

CONCLUSIONS

Although these sentinel US disasters varied in scope, method, geographic proximity to the study site, perpetrator characteristics, public response, sequelae and degree of media coverage, the extent to which they impacted emergency department treatment-seeking was minimal. Geographically distant mass violence and disaster events of the type and scope studied here may require only minimal mental health "surge capacity" in the days following the event.