Alcoholism and seasonal affective disorder

Emergency Department Visits for Alcohol-Associated Falls Among Older Adults in the United States, 2011 to 2020

STUDY OBJECTIVE

The aim of this study was to examine the epidemiology of alcohol-associated fall injuries among older adults aged ≥65 years in the United States.

METHODS

We included emergency department (ED) visits for unintentional fall injuries by adults from the National Electronic Injury Surveillance System-All Injury Program during 2011 to 2020. We estimated the annual national rate of ED visits for alcohol-associated falls and the proportion of these falls among older adults' fall-related ED visits using demographic and clinical characteristics. Joinpoint regression was performed to examine trends in alcohol-associated ED fall visits between 2011 and 2019 among older adult age subgroups and to compare these trends with those of younger adults.

RESULTS

There were 9,657 (weighted national estimate: 618,099) ED visits for alcohol-associated falls, representing 2.2% of ED fall visits during 2011 to 2020 among older adults. The proportion of fall-related ED visits that were alcohol-associated was higher among men than among women (adjusted prevalence ratio [aPR]=3.6, 95% confidence interval [CI] 2.9 to 4.5). The head and face were the most commonly injured body parts, and internal injury was the most common diagnosis for alcohol-associated falls. From 2011 to 2019, the annual rate of ED visits for alcohol-associated falls increased (annual percent change 7.5, 95% CI 6.1 to 8.9) among older adults. Adults aged 55 to 64 years had a similar increase; a sustained increase was not detected in younger age groups.

CONCLUSION

Our findings highlight the rising rates of ED visits for alcohol-associated falls among older adults during the study period. Health care providers in the ED can screen older adults for fall risk and assess for modifiable risk factors such as alcohol use to help identify those who could benefit from interventions to reduce their risk.

Photoperiod Impacts Nucleus Accumbens Dopamine Dynamics

Circadian photoperiod, or day length, changes with the seasons and influences behavior to allow animals to adapt to their environment. Photoperiod is also associated with seasonal rhythms of affective state, as evidenced by seasonality of several neuropsychiatric disorders. Interestingly, seasonality tends to be more prevalent in women for affective disorders such as major depressive disorder and bipolar disorder (BD). However, the underlying neurobiological processes contributing to sex-linked seasonality of affective behaviors are largely unknown. Mesolimbic dopamine input to the nucleus accumbens (NAc) contributes to the regulation of affective state and behaviors. Additionally, sex differences in the mesolimbic dopamine pathway are well established. Therefore, we hypothesize that photoperiod may drive differential modulation of NAc dopamine in males and females. Here, we used fast-scan cyclic voltammetry (FSCV) to explore whether photoperiod can modulate subsecond dopamine signaling dynamics in the NAc core of male and female mice raised in seasonally relevant photoperiods. We found that photoperiod modulates dopamine signaling in the NAc core, and that this effect is sex-specific to females. Both release and uptake of dopamine were enhanced in the NAc core of female mice raised in long, summer-like photoperiods, whereas we did not find photoperiodic effects on NAc core dopamine in males. These findings uncover a potential neural circuit basis for sex-linked seasonality in affective behaviors.

Seasonality contributes to depressive, anxiety and alcohol use disorders in the Finnish general adult population

BACKGROUND

Earlier evidence suggests that the seasonal changes in mood and behavior are associated with mental disorders, especially with mood disorders. However, the extent of these associations has not been analyzed by using large samples of the general population.

METHODS

A random sample of adults, aged 29 to 97 years and representative of the general population living in Finland, attended a nationwide health examination survey. Mental disorders were assessed with the Munich version of the Composite International Diagnostic Interview (M-CIDI, n = 4554). Of them, the seasonal variations in mood and behavior (seasonality) were assessed with the six items of the Global Seasonality Score (GSS, n = 4004) as well as with the experienced problem due to these variations.

RESULTS

After adjusting for age, gender, level of education, and region of residence, the GSS was associated with depressive, anxiety and alcohol use disorders (all p < 0.001). Of the GSS items, mood was associated with depressive disorders (p < 0.001), anxiety disorders (p = 0.003) and alcohol use disorders (p = 0.008), whereas appetite was associated only with depressive disorders (p = 0.012), and energy level only with anxiety disorders (p = 0.025).

LIMITATIONS

This cross-sectional study was based on self-reported data on the seasonal pattern.

CONCLUSIONS

Seasonality had significant associations with depressive, anxiety and alcohol use disorders among the general adult population. This needs attention in clinical practice.

Relationship between ambient temperature and severe acute poisoning by alcohol and drugs

AIM

To test the hypothesis that severe acute poisoning by alcohol and drugs is more frequent at higher rather than at lower ambient temperatures.

METHOD

This was a prospective observational study performed in a prehospital setting under marine west coast climate conditions. Data from the Emergency Medical Service in Hamburg (Germany) and data from the local weather station were evaluated over a 5-year period. Temperature data were obtained and matched with the associated rescue mission data, which were divided into the following groups: 1) alcohol poisoning, 2) opioid poisoning, 3) poisoning by sedatives/hypnotics, multiple drugs, volatile solvents, and other psychoactive substances. Lowess-Regression analysis was performed to assess the relationship between ambient temperature and frequency of severe acute poisoning. Additionally, three temperature ranges were defined in order to compare them with each other with regard to frequency of severe poisoning (<10 °C vs. 10-20 °C vs. >20 °C). The severity of emergencies was assessed using the National Advisory Committee for Aeronautics (NACA) scoring system.

RESULTS

In 1535 patients, severe acute alcohol or drug poisoning associated with loss of consciousness, hypotension, and impaired respiratory function was treated (alcohol: n = 604; opioids: n = 295; sedatives/hypnotics/multiple drugs: n = 636). Compared to mild temperatures (10-20 °C), the frequency of poisoning increased in all three groups at higher temperatures and decreased at lower temperatures (p < 0.01). No significant correlation was found between severity of emergencies and temperature.

CONCLUSIONS

Our results suggest a continuously increasing probability of occurrence of severe acute poisoning by alcohol and drugs with rising temperature.

Perceptions of alcohol misuse among Alaska native health care system stakeholders: A qualitative exploration

Although alcohol misuse is a priority for health care systems serving Alaska Native and American Indian (ANAI) people, stakeholders' perceptions of misuse are understudied. Patients (n = 34), providers (n = 20), and leaders (n = 16) at a Tribally owned and operated health care system reported that alcohol misuse results from the interaction of factors, including colonization, structural factors, social alienation, social norms about overdrinking introduced at the time of colonizing contact, coping with emotions, and beliefs about ANAI people and alcohol. Childhood exposure to alcohol misuse leads some ANAI people to avoid alcohol altogether, shedding light on the high levels of abstinence observed in ANAI communities.

Seasonality of mood and affect in a large general population sample

Mood and behaviour are thought to be under considerable influence of the seasons, but evidence is not unequivocal. The purpose of this study was to investigate whether mood and affect are related to the seasons, and what is the role of neuroticism in this association. In a national internet-based crowdsourcing project in the Dutch general population, individuals were invited to assess themselves on several domains of mental health. ANCOVA was used to test for differences between the seasons in mean scores on the Positive and Negative Affect Schedule (PANAS) and Quick Inventory of Depressive Symptomatology (QIDS). Within-subject seasonal differences were tested as well, in a subgroup that completed the PANAS twice. The role of neuroticism as a potential moderator of seasonality was examined. Participants (n = 5,282) scored significantly higher on positive affect (PANAS) and lower on depressive symptoms (QIDS) in spring compared to summer, autumn and winter. They also scored significantly lower on negative affect in spring compared to autumn. Effect sizes were small or very small. Neuroticism moderated the effect of the seasons, with only participants higher on neuroticism showing seasonality. There was no within-subject seasonal effect for participants who completed the questionnaires twice (n = 503), nor was neuroticism a significant moderator of this within-subjects effect. The findings of this study in a general population sample participating in an online crowdsourcing study do not support the widespread belief that seasons influence mood to a great extent. For, as far as the seasons did influence mood, this only applied to highly neurotic participants and not to low-neurotic participants. The underlying mechanism of cognitive attribution may explain the perceived relation between seasonality and neuroticism.

Suppression of voluntary ethanol intake in mice under constant light and constant darkness

Seasonal variations in photoperiod are associated with alterations in human mood and behavior. Similarly, manipulation of the environmental lighting regimen can exert pronounced effects on affective behavior in experimental animals. These observations may be due, in part, to light-induced alterations in circadian rhythms, but it seems likely that other, non-circadian factors also contribute. Several studies have shown that voluntary alcohol (ethanol) consumption can be affected by lighting conditions in rodents, suggesting that photoperiodic variation may account for seasonal and geographic patterns of human alcohol consumption. Nevertheless, the existing animal data are somewhat inconsistent, and little work in this area has been performed in mice. In the present study, we monitored circadian activity rhythms and voluntary ethanol consumption under standard 12:12 light-dark (LD) cycles, and in constant light (LL) and constant darkness (DD). Experiment 1 employed male C3H/He inbred mice, while Experiment 2 employed males and females from a genetically heterogeneous line (WSC). Relative to LD conditions, ethanol intake and ethanol preference were reduced under both LL and DD in both experiments. Because similar effects were seen in both LL and DD, neither circadian disruption nor a classical photoperiodic mechanism are likely to account fully for these findings. Instead, we suggest that the absence of circadian entrainment may function as a mild stressor, resulting in reduced ethanol consumption.

Colder Weather and Fewer Sunlight Hours Increase Alcohol Consumption and Alcoholic Cirrhosis Worldwide

Risk of alcoholic cirrhosis is determined by genetic and environmental factors. We aimed to investigate if climate has a causal effect on alcohol consumption and its weight on alcoholic cirrhosis. We collected extensive data from 193 sovereign countries as well as 50 states and 3,144 counties in the United States. Data sources included World Health Organization, World Meteorological Organization, and the Institute on Health Metrics and Evaluation. Climate parameters comprised Koppen-Geiger classification, average annual sunshine hours, and average annual temperature. Alcohol consumption data, pattern of drinking, health indicators, and alcohol-attributable fraction (AAF) of cirrhosis were obtained. The global cohort revealed an inverse correlation between mean average temperature and average annual sunshine hours with liters of annual alcohol consumption per capita (Spearman's rho -0.5 and -0.57, respectively). Moreover, the percentage of heavy episodic drinking and total drinkers among population inversely correlated with temperature -0.45 and -0.49 (P < 0.001) and sunshine hours -0.39 and -0.57 (P < 0.001). Importantly, AAF was inversely correlated with temperature -0.45 (P < 0.001) and sunshine hours -0.6 (P < 0.001). At a global level, all included parameters in the univariable and multivariable analysis showed an association with liters of alcohol consumption and drinkers among population once adjusted by potential confounders. In the multivariate analysis, liters of alcohol consumption associated with AAF. In the United States, colder climates showed a positive correlation with the age-standardized prevalence of heavy and binge drinkers. Conclusion: These results suggest that colder climates may play a causal role on AAF mediated by alcohol consumption.

The effects of seasonal affective disorder and alcohol abuse on sleep and snoring functions in a population-based study in Finland

Seasonal affective disorder (SAD) is a recurrent depressive disorder with a seasonal pattern. In addition to some specific symptoms such as sad mood, low energy or carbohydrate craving, this mood disorder is also characterized by the presence of sleeping problems and alcohol disorders. Interestingly, there is a strong link between alcohol use and sleeping deficits. Although previous studies have focused extensively on the sleep patterns in SAD patients and patients with alcohol use disorder (AUD), no research has yet been conducted on subjects with comorbid SAD and AUD. The aim of this study was to examine the differences in sleep functioning between subjects with SAD, AUD and SAD+AUD. A total of 4554 Finnish subjects from the population-based Health 2011 survey were interviewed, and of these 2430 individuals completed all the questionnaires. We selected those participants who fulfilled the criteria for SAD (n = 298), AUD (n = 359), SAD+AUD (n = 69), controls 1 (no current alcohol use, n = 226) and controls 2 (current alcohol use but not AUD, n = 1445). Controls with a history of alcohol abuse were excluded (n = 33). All the participants completed the EuroQoL five-dimensions questionnaire (EQ-5), the Seasonal Pattern Assessment Questionnaire (SPAQ), the Alcohol Use Disorders Identification Test (AUDIT) and several questions about sleeping, based on the Basic Nordic Sleep Questionnaire (BNSQ). Our results showed that those subjects with SAD+AUD reported the highest levels of subjective sleeping problems compared to controls, SAD and AUD. These findings suggest the relevance of examining the comorbidity of SAD and AUD when studying sleep functioning in these groups of patients.

Seasonal affective disorder and alcohol abuse disorder in a population-based study

Seasonal affective disorder (SAD) is a recurrent major depressive disorder with a seasonal pattern, which is characterized by sad mood, low energy, longer sleep duration and carbohydrate craving. Furthermore, seasonal changes in mood and behavior may be closely related to alcohol use disorder (AUD). Nevertheless, there is scarce research on the study of cognitive impairments in SAD and AUD. We aimed to examine the relationship between the prevalence between SAD and AUD patients, and how cognitive functioning might be related to these variables. To do this, a sample of 8135 Finnish subjects was invited to take part in the population-based Health 2011 Survey, of whom 5903 did participate and 4554 were interviewed for mental health status with the Munich version of Composite International Diagnostic Interview. They also completed the modified Seasonal Pattern Assessment Questionnaire, the Mini-Mental State Examination, the category (animals) verbal fluency test, and the Rey Auditory Verbal Learning Test. Our results reveal the existence of a strong link between SAD and AUD in a large sample of Finnish population, as well as association between SAD and short-term memory problems.

Photoperiodic modulation of voluntary ethanol intake in C57BL/6 mice

Seasonal and geographic variations in light exposure influence human mood and behavior, including alcohol consumption. Similarly, manipulation of the environmental lighting regimen modulates voluntary ethanol intake in experimental animals. Nevertheless, previous studies in rats and hamsters have been somewhat inconsistent, and little is known concerning such effects in mice. In the present study, we maintained male C57Bl/6 mice in running-wheel cages under either short- or long-photoperiod light-dark cycles (LD 6:18 vs. LD 18:6); subsequently, the same animals were maintained under short or long "skeleton photoperiods", consisting of two daily 15-min light pulses signaling dusk and dawn (SP 6:18 vs. SP 18:6). Running wheels were locked mechanically for half the animals under each photoperiod. Analysis of running wheel patterns showed that mice displayed stable circadian adaptation to both standard LD cycles and skeleton photoperiods. Mice consumed more ethanol and less water, and thus showed higher ethanol preference, under LD 6:18 and SP 6:18 relative to the corresponding long-photoperiod regimens. While running-wheel access increased water intake, ethanol intake was unaffected by this manipulation. These effects are consistent with previous studies showing that short photoperiods or constant darkness increases ethanol intake in rodents. Further, the similarity of the effects of complete and skeleton photoperiods suggests that these effects are mediated by photoperiod-induced alterations in the circadian entrainment pattern, rather than by light exposure per se.

Eye color: A potential indicator of alcohol dependence risk in European Americans

In archival samples of European-ancestry subjects, light-eyed individuals have been found to consume more alcohol than dark-eyed individuals. No published population-based studies have directly tested the association between alcohol dependence (AD) and eye color. We hypothesized that light-eyed individuals have a higher prevalence of AD than dark-eyed individuals. A mixture model was used to select a homogeneous sample of 1,263 European-Americans and control for population stratification. After quality control, we conducted an association study using logistic regression, adjusting for confounders (age, sex, and genetic ancestry). We found evidence of association between AD and blue eye color (P = 0.0005 and odds ratio = 1.83 (1.31-2.57)), supporting light eye color as a risk factor relative to brown eye color. Network-based analyses revealed a statistically significant (P = 0.02) number of genetic interactions between eye color genes and AD-associated genes. We found evidence of linkage disequilibrium between an AD-associated GABA receptor gene cluster, GABRB3/GABRG3, and eye color genes, OCA2/HERC2, as well as between AD-associated GRM5 and pigmentation-associated TYR. Our population-phenotype, network, and linkage disequilibrium analyses support association between blue eye color and AD. Although we controlled for stratification we cannot exclude underlying occult stratification as a contributor to this observation. Although replication is needed, our findings suggest that eye pigmentation information may be useful in research on AD. Further characterization of this association may unravel new AD etiological factors. © 2015 Wiley Periodicals, Inc.

Frequency and characteristics of individuals with seasonal pattern among depressive patients attending primary care in France

OBJECTIVE

High rates of bipolar disorder (BD) have been found among major depressives with seasonal pattern (SP) consulting in psychiatric departments, as well as among patients seeking primary care. As SP was reported to be common in the latter, the current study was designed to assess (a) the frequency and characteristics of SP among major depressives attending primary care and (b) the prevalence and aspects of BD in this population.

METHODS

Among 400 patients who consulted French general practitioners (GPs) for major depression between February and December 2010, 390 could be included in the study: 167 (42.8%) met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for seasonal pattern [SP(+)], whereas 223 (57.2%) did not meet these criteria [SP(-)]. The two groups were compared on demographic, clinical, family history and temperamental characteristics.

RESULTS

Compared to SP(-), SP(+) patients were more frequently female, married and with a later age at first depressive episode, and showed more atypical vegetative symptoms, comorbid bulimia and stimulant abuse. They also exhibited more lifetime depressive episodes, were more often diagnosed as having BD II and met more often bipolarity specifier criteria, with higher rates of bipolar temperaments and a higher BD family loading. Among SP(+) patients, 68.9% met the bipolarity specifier criteria, whereas 31.1% did not. Seasonality was not influenced by climatic conditions. The following independent variables were associated with SP: BD according to bipolarity specifier, female gender, comorbid bulimia nervosa, hypersomnia, number of depressive episodes and family history of substance abuse.

CONCLUSIONS

Seasonal pattern is frequent among depressive patients attending primary care in France and may be indicative of hidden bipolarity. Given the risks associated with both SP and bipolarity, GPs are likely to have a major role in regard to prevention.

A narrative review of binge eating and addictive behaviors: shared associations with seasonality and personality factors

Binge-eating disorder and seasonal affective disorder were first described as clinically relevant conditions in very close temporal proximity a few decades ago. Both disorders have a higher prevalence rate in woman than in men, are characterized by a high proneness-to-stress and manifest heightened responsiveness to high-calorie, hyper-palatable foods. In recent years, a compelling body of evidence suggests that foods high in sugar and fat have the potential to alter brain reward circuitry in a manner similar to that seen when addictive drugs like alcohol and heroin are consumed in excess. These findings have led to suggestions that some cases of compulsive overeating may be understood as an addiction to sweet, fatty, and salty foods. In this paper, it is proposed that high seasonality is a risk factor for binge eating, especially in those characterized by anxious and impulsive personality traits - associations that could only occur in an environment with a superfluity of, and easy access to, rich and tasty foods. Given the well-established links between binge eating and addiction disorders [Ref. (1-3) for reviews], it is also suggested that seasonality, together with the same high-risk psychological profile, exacerbates the likelihood of engaging in a broad range of addictive behaviors. Data from a community sample (n = 412) of adults tested these models using linear regression procedures. Results confirmed that symptoms of binge eating and other addictive behaviors were significantly inter-correlated, and that seasonality, gender, and addictive personality traits were strong statistical predictors of the variance in binge-eating scores. Seasonality and addictive personality traits also accounted for a significant proportion of the variance in the measure of addictive behaviors. Conclusions are discussed in the context of brain reward mechanisms, motivational alternations in response to chronic over-consumption, and their relevance for the treatment of excessive appetitive behaviors.

Seasonality patterns of mood and behavior in the Old Order Amish

BACKGROUND

Although humans have become partially isolated from physical seasonal environmental changes through artificial lighting and temperature control, seasonal changes in mood and behavior have been described across hemispheres, continents, ethnicities and occupations. The Old Order Amish are more exposed than the general population to environmental seasonal changes both occupationally as well as through their limited use of electric light in the winter and air conditioning in the summer; yet, their seasonal changes in mood and behavior have not been previously studied.

METHODS

The aim of this study was to analyze seasonal patterns in mood and behavior in the Old Order Amish of Lancaster County, Pennsylvania, who returned completed Seasonal Pattern Assessment Questionnaires (SPAQ). Monthly seasonal patterns were analyzed with repeated measures ANOVAs, followed by a post hoc t-test if significant. The χ² was used for presence or absence of seasonal patterns for each item.

RESULTS

More than 75% of the participants reported at least one seasonal change. More than 75 % endorsed seasonality in "feeling best" but only <25% did so for "feeling worst". Mood-wise, the best month was May, and the worst months were January and February.

CONCLUSIONS

There were significant seasonal patterns for all mood and behavior items reported by the majority of participants. The results were consistent with an overall winter pattern of seasonality previously consistently reported in predominantly Caucasian populations.

Circadian clock gene polymorphisms in alcohol use disorders and alcohol consumption

AIMS

Circadian clock genes are involved in the development of drug-induced behaviors and regulate neurotransmission pathways in addiction. Our aim was to study whether circadian clock gene polymorphisms predispose to alcohol dependence or abuse or other alcohol-related characteristics.

METHODS

The study sample comprised of 512 individuals having alcohol dependence or alcohol abuse (according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)) and their 511 age- and sex-matched controls. This population-based sample was drawn from a cohort (n = 7415), representative of the Finnish general population aged 30 and over. Altogether 42 single-nucleotide polymorphisms of 19 genes related to the circadian pacemaker system were genotyped.

RESULTS

ARNTL rs6486120 T(+) allelic status (P = 0.0007, q = 0.17), ADCYAP1 rs2856966 GG genotype (P = 0.0006, q = 0.17) and VIP CC haplotype (rs3823082-rs688136) (P = 0.0006) were suggestively associated with alcohol consumption in socially drinking controls. ARNTL2 GT haplotype (rs7958822-rs4964057) associated suggestively with alcohol abuse diagnosis (P = 0.0013). Earlier findings on the associations of DRD2 and NPY with alcohol dependence were supported: DRD2/ANKK1 Taq1A(1) increased (P = 0.04) and NPY Pro7 decreased (P = 0.01) the risk of alcohol dependence.

CONCLUSIONS

ARNTL, ARNTL2, VIP and ADCYAP1 were indicated as having influence on alcohol use or abuse. The role of DRD2 and NPY on alcohol dependence was also supported.

CLOCK is suggested to associate with comorbid alcohol use and depressive disorders

Background

Depression and alcohol abuse or dependence (AUD) co-occur in the general population more frequently than expected by chance. Alcohol use influences the circadian rhythms generated by the central pacemaker in the suprachiasmatic nucleus, and circadian rhythm alterations in turn are common in depressive disorders as well as among persons addicted to alcohol.

Methods

32 SNPs in 19 circadian clockwork related genes were analyzed using DNA from 76 individuals with comorbid depression and AUD, 446 individuals with AUD and 517 healthy controls with no psychiatric diagnosis. The individuals participated in a nationwide health examination study, representative of the general population aged 30 and over in Finland.

Results

The CLOCK haplotype TTGC formed by SNPs rs3805151, rs2412648, rs11240 and rs2412646, was associated with increased risk for comorbidity (OR = 1.65, 95% CI = 1.14-2.28, P = 0.0077). The SNPs of importance for this suggestive association were rs2412646 and rs11240 indicating location of the functional variation in the block downstream rs2412648. There was no indication for association between CLOCK and AUD.

Conclusion

Our findings suggest an association between the CLOCK gene and the comorbid condition of alcohol use and depressive disorders. Together with previous reports it indicates that the CLOCK variations we found here may be a vulnerability factor to depression given the exposure to alcohol in individuals having AUD.

Alcoholism and suicidal behavior: a clinical overview

OBJECTIVE

The purpose of this paper was to provide a clinical review of the literature on the relation of alcoholism to suicidal behavior.

METHOD

Studies of alcoholism and suicidal behavior available in MEDLINE, Institute for Scientific Information Databases (Science Citation Index Expanded, Social Sciences Citation Index, and Arts & Humanities Citation Index), EMBASE, and Cochrane Library were identified and reviewed.

RESULTS

Alcoholism is associated with a considerable risk of suicidal behavior. Individuals with alcoholism who attempt or complete suicide are characterized by major depressive episodes, stressful life events, particularly interpersonal difficulties, poor social support, living alone, high aggression/impulsivity, negative affect, hopelessness, severe alcoholism, comorbid substance, especially cocaine abuse, serious medical illness, suicidal communication, and prior suicidal behavior. Partner-relationship disruptions are strongly associated with suicidal behavior in individuals with alcoholism.

CONCLUSION

All individuals with alcoholism should receive a suicide risk assessment based on known risk factors.