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Legenbauer T, Kirschbaum-Lesch I, Jörke C, Kölch M, Reis O, Berger C, Dück A, Schulte-Markwort M, Becker-Hebly I, Bienioschek S, Schroth J, Ruckes C, Deuster O, Holtmann M. Bright Light Therapy as Add-On to Inpatient Treatment in Youth With Moderate to Severe Depression: A Randomized Clinical Trial. JAMA Psychiatry 2024; 81:655-662. [PMID: 38477894 PMCID: PMC10938243 DOI: 10.1001/jamapsychiatry.2024.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/18/2024] [Indexed: 03/14/2024]
Abstract
Importance Major depressive disorder is one of the most common mental disorders among adolescents, entailing severe, long-term psychosocial impairment and a high risk of chronicity. In view of the large number of patients requiring treatment, along with insufficient treatment responses with small effect sizes, innovative adjunctive treatment strategies are urgently needed. Objective To investigate whether the effect of adolescent psychiatric inpatient treatment as usual for major depressive disorder can be enhanced by simultaneous use of morning bright light therapy. Design, Setting, and Participants This was a double-blind, placebo-controlled randomized parallel-group trial with enrollment between March 2018 and November 2020 and follow-up completed in May 2021. The study took place among inpatients at 4 university hospitals for child and adolescent psychiatry across Germany. Of 248 eligible youth aged 12 to 18 years fulfilling ICD-10 criteria for major depressive disorder, 227 were randomized to bright light therapy (n = 116) or placebo red light (n = 111); 151 participants completed the study. Interventions Up to 20 sessions of either morning bright light therapy with an intensity of 10 000 lux or placebo red light (100 lux) in addition to multimodal inpatient treatment as usual over 4 weeks. Main Outcomes and Measures The primary outcome was the change in Beck Depression Inventory-II (BDI-II) score from baseline to posttreatment in the intention-to-treat sample. Results Among the 224 patients included in the intention-to-treat analyses (192 girls and 32 boys; mean [SD] age, 15.5 [1.4] years), the mean (SD) BDI-II score at baseline was 37.3 (8.7). BDI-II scores were significantly reduced after 4 weeks (postassessment) by a mean of -7.5 (95% CI, -9.0 to -6.0; Hedges g = 0.71). Bright light therapy had no impact on this change (no significant group × time effect). Loss to follow-up was 31% (n = 69) at 16 weeks and 49% (n = 110) at 28 weeks. There were 10 serious adverse events throughout the whole trial, which were not considered related to study treatment. Conclusions and Relevance The findings in this study did not indicate superiority of bright light therapy over placebo red light therapy in a large sample of adolescent inpatients with moderate or severe major depressive disorder. Both groups benefited equally from treatment as usual, showing relevant symptom reduction. Trial Registration German Clinical Trials Register: DRKS00013188.
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Affiliation(s)
- Tanja Legenbauer
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany
| | - Inken Kirschbaum-Lesch
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany
| | - Carina Jörke
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany
| | - Michael Kölch
- Department of Child and Adolescent Psychiatry and Psychotherapy, Brandenburg Medical School, Faculty of Health Sciences Brandenburg, Neuruppin, Germany
- Department of Child and Adolescent Psychiatry and Neurology, Rostock University Medical Center, Rostock, Germany
| | - Olaf Reis
- Department of Child and Adolescent Psychiatry and Neurology, Rostock University Medical Center, Rostock, Germany
| | - Christoph Berger
- Department of Child and Adolescent Psychiatry and Neurology, Rostock University Medical Center, Rostock, Germany
| | - Alexander Dück
- Department of Child and Adolescent Psychiatry and Neurology, Rostock University Medical Center, Rostock, Germany
| | | | - Inga Becker-Hebly
- Department of Child and Adolescent Psychiatry, Hamburg University, Hamburg, Germany
| | - Stefanie Bienioschek
- Department of Child and Adolescent Psychiatry and Psychotherapy, Brandenburg Medical School, Faculty of Health Sciences Brandenburg, Neuruppin, Germany
| | - Jennifer Schroth
- Department of Child and Adolescent Psychiatry and Psychotherapy, Brandenburg Medical School, Faculty of Health Sciences Brandenburg, Neuruppin, Germany
| | - Christian Ruckes
- Interdisciplinary Centre for Clinical Trials, University Medical Center, Mainz, Germany
| | - Oliver Deuster
- Interdisciplinary Centre for Clinical Trials, University Medical Center, Mainz, Germany
| | - Martin Holtmann
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany
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Luo H, Cheng J, Zhang Z, Zhang Y, Wang X, Hu R, Li J, Guo Y, Luo Q. Seasonal patterns in Chinese population: Validating the seasonal pattern assessment questionnaire and exploring associations with psychiatric diagnoses and biological rhythms. Chronobiol Int 2024; 41:609-620. [PMID: 38644696 DOI: 10.1080/07420528.2024.2337875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/27/2024] [Indexed: 04/23/2024]
Abstract
Seasonal patterns (SP) exert a notable influence on the course and prognosis of patients with affective disorders, serving as a specifier in diagnosis. However, there is limited exploration of seasonality among psychotic patients, and the distinctions in seasonality among psychiatric patients remain unclear. In this study, we enrolled 198 psychiatric patients with anxiety and depressive disorders (A&D), bipolar disorder (BD), and schizophrenia (SZ), as well as healthy college students. Online questionnaires, including the Seasonal Pattern Assessment Questionnaire (SPAQ) for seasonality, the Morningness and Eveningness Questionnaire-5 (MEQ-5) for chronotypes, and the Pittsburgh Sleep Quality Index (PSQI), were administered. The validity and reliability of the Chinese version of the SPAQ were thoroughly analyzed, revealing a Cronbach's alpha of 0.896 with a two-factor structure. Results indicated that higher seasonality was correlated with poorer sleep quality and a more delayed chronotype (p < 0.05). Significant monthly variations were particularly evident in BD, specifically in mood, appetite, weight, social activities, and sleep dimensions (p < 0.001). In summary, the Chinese version of SPAQ is validated, demonstrating moderate correlations between seasonality, chronotype, and sleep quality. BD patients exhibited the strongest seasonality, while mood disorder patients displayed more delayed chronotypes than SZ.
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Affiliation(s)
- Huirong Luo
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juan Cheng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Psychiatry, Nanchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Zheng Zhang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yinlin Zhang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Children and Adolescents, Chongqing Mental Health Center, Chongqing, China
| | - Xueqian Wang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- School of Psychology, Army Military Medical University, Chongqing, China
| | - Renqin Hu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junyao Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanwei Guo
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Luo
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Iorio C, Pacitti F, Rossi A, Iorio P, Pompili A. Declarative Memory Impairment and Emotional Bias in Recurrent Depression with a Seasonal Pattern: The Interplay between Emotion and Cognition in Seasonal Affective Disorder. Brain Sci 2022; 12:brainsci12101352. [PMID: 36291286 PMCID: PMC9599318 DOI: 10.3390/brainsci12101352] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 11/30/2022] Open
Abstract
Seasonal Affective Disorder (SAD) is a subtype of Major Depressive Disorder (MDD) with a seasonal pattern. Although it is a pathological condition limited to specific seasons of the year, during the symptomatic period, patients may experience a significant impairment of well-being and daily quality of life as a result of the depressed mood, associated with other symptoms defined as atypical of MDD. While extensive evidence of memory deficits has been found in MDD, explicit memory impairments in SAD are insufficiently studied. This study aims to investigate the cognitive processing of emotional stimuli in women with SAD, in particular the interplay between emotions and declarative memory. One hundred and twenty young women, screened from an initial number of 1125 university students, were divided into two groups, an experimental one that included 60 medically untreated women affected by “winter type SAD” and a control group of 60 non-SAD women. Different subjects were randomly submitted to two types of audio−visual stories, neutral or arousal, and then their memory performances were analyzed by means of a free-recall test and a recognition memory test. In both the free-recall test (p < 0.008) and in the recognition memory test (p < 0.002), the SAD group showed impaired memory performances. Taken together, our novel key findings suggest that SAD is characterized by impairment in declarative memory and attentional bias for emotional negative stimuli.
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Seto B, Kodama K, Griffin D, Seto J, Obana K, Taira D. Effect of Hometown Seasonality on Undergraduate Students' Risk of Developing Seasonal Affective Disorder. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:298-303. [PMID: 34877542 PMCID: PMC8646863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Seasonal affective disorder (SAD) is a prevalent and potentially serious medical condition. Young adults are at particularly high risk. However, it is unknown if college students whose hometowns are in geographic areas with less seasonal variability, such as in the state of Hawai'i, are particularly vulnerable if they attend schools in areas with seasonal variability. An adapted version of the Seasonal Patterns Assessment Questionnaire (SPAQ) was administered to students at 3 universities to test this hypothesis. Surveys were administered twice: a baseline (T0) assessment in the fall and a follow-up (T1) assessment in the winter and were administered in the second month of each semester. A linear regression model was constructed to identify potential risk factors for developing seasonal fluctuations in mood (SPAQ scores T1-T0). Study subjects (n=115) from non-seasonal hometowns had a 1.6-point greater increase in SPAQ score than students from seasonal hometowns (-0.26 ± 3.88 vs 1.35 ± 3.03; P =.01). This difference is independent of demographic and lifestyle predictors (linear regression coefficient: β = 1.73; standard error = 0.68; P =.012). Interestingly, SPAQ score changes of students from seasonal hometowns did not differ significantly from 0 (t = -0.97; P =.33), indicating that they did not generally experience seasonal shifts in depressive symptoms. Students from less seasonal hometowns and counselors at seasonal institutions should be aware that these students could be more at risk of developing depressive symptoms and address these concerns before interfering with students' daily and academic lives.
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Affiliation(s)
- Brendan Seto
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (BS, KO)
| | - Kelsie Kodama
- Washington University School of Medicine, St. Louis, MO (KK)
| | - Danielle Griffin
- Department of Psychology, University of Maryland, Catonsville, MD (DG)
| | - Jason Seto
- The Queens Medical Center, Honolulu, HI (JS)
| | - Kyle Obana
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (BS, KO)
| | - Deborah Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai‘i, Hilo, HI (DT)
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Wirz-Justice A, Ajdacic V, Rössler W, Steinhausen HC, Angst J. Prevalence of seasonal depression in a prospective cohort study. Eur Arch Psychiatry Clin Neurosci 2019; 269:833-839. [PMID: 30022319 DOI: 10.1007/s00406-018-0921-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 07/09/2018] [Indexed: 11/28/2022]
Abstract
The prevalence of autumn/winter seasonality in depression has been documented in the longitudinal Zurich cohort study by five comprehensive diagnostic interviews at intervals over more than 20 years (N = 499). Repeated winter major depressive episodes (MDE-unipolar + bipolar) showed a prevalence of 3.44% (5× more women than men), whereas MDE with a single winter episode was much higher (9.96%). A total of 7.52% suffered from autumn/winter seasonality in major and minor depressive mood states. The clinical interviews revealed novel findings: high comorbidity of Social Anxiety Disorder and Agoraphobia within the repeated seasonal MDE group, high incidence of classic diurnal variation of mood (with evening improvement), as well as a high rate of oversensitivity to light, noise, or smell. Nearly twice as many of these individuals as in the other MDE groups manifested the syndrome of atypical depression (DSM-V), which supports the prior description of seasonal affective disorder (SAD) as presenting primarily atypical symptoms (which include hypersomnia and increase in appetite and weight). This long-term database of regular structured interviews provides important confirmation of SAD as a valid diagnosis, predominantly found in women, and with atypical vegetative symptoms.
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Affiliation(s)
- Anna Wirz-Justice
- Centre for Chronobiology, Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Vladeta Ajdacic
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Hans-Christoph Steinhausen
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
- Clinical Psychology and Epidemiology, Institute of Psychology, University of Basel, Basel, Switzerland
- Child and Adolescent Mental Health Centre, Capital Region Psychiatry, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, University of Southern Denmark, Odense, Denmark
| | - Jules Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
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Akram F, Jennings TB, Stiller JW, Lowry CA, Postolache TT. Mood Worsening on Days with High Pollen Counts is associated with a Summer Pattern of Seasonality. Pteridines 2019; 30:133-141. [PMID: 31631951 PMCID: PMC6800045 DOI: 10.1515/pteridines-2019-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Summer/spring-type seasonal affective disorder (S-SAD) is the less common subtype of seasonal affective disorder and evidence regarding potential triggers of S-SAD is scarce. Recent reports support association of airborne-pollen with seasonal exacerbation of depression (mood seasonality) and timing of suicidal behavior. Therefore, we hypothesized that Old Order Amish (OOA) with summer/spring pattern of seasonality (abbreviated as summer pattern) and S-SAD will have significant mood worsening on high pollen days. Methods: A seasonal pattern of mood worsening and SAD parameters were estimated using Seasonal Pattern Assessment Questionnaire (SPAQ). Age- and gender-adjusted ANCOVAs and post hoc analyses were conducted to compare mood worsening on days with high pollen counts between summer-pattern vs no-summer-pattern of mood worsening, S-SAD vs no-S-SAD, winter-pattern vs no-winter-pattern of mood worsening, and W-SAD vs no-W-SAD groups. Results: The prevalence of S-SAD was 0.4%, while 4.5% of individuals had a summer pattern of mood seasonality. A statistically significant difference for mood worsening on high pollen days was observed between summer-pattern vs no-summer-pattern of mood worsening (p = 0.006). The significant association between S-SAD vs no-SAD groups (p = 0.032) for mood worsening on high pollen days did not withstand Bonferroni adjustment for multiple comparisons. No significant association was found for winter-pattern vs no-winter-pattern of mood worsening (p = 0.61) and for W-SAD vs no-W-SAD (p = 0.19) groups. Conclusion: Our results are consistent with previous studies implicating links between aeroallergen exposure and summer pattern of seasonality, but not the winter pattern of seasonality.
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Affiliation(s)
- Faisal Akram
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Tyler B Jennings
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - John W Stiller
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Christopher A Lowry
- Department of Integrative Physiology, Center for Neuroscience, and Center for Microbial Exploration, University of Colorado Boulder, Boulder, CO 80309, USA; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO, 80045, USA; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO 80045, USA
| | - Teodor T Postolache
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, 21201, USA; Saint Elizabeths Hospital, Psychiatry Residency Training Program, Washington, DC, 20032, USA; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO, 80045, USA; Amish Research Clinic of the University of Maryland, Lancaster, PA, 17602, USA
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7
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LoBello SG, Mehta S. No evidence of seasonal variation in mild forms of depression. J Behav Ther Exp Psychiatry 2019; 62:72-79. [PMID: 30248516 DOI: 10.1016/j.jbtep.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 08/31/2018] [Accepted: 09/14/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND OBJECTIVES Seasonal Affective Disorder (SAD) is ubiquitous in popular culture and has influenced psychiatric diagnosis with the inclusion of the seasonal pattern modifier for the Major Depressive Episode in DSM. However, recent research has not supported the association of Major Depressive Episode with seasonal changes. The present study was conducted to determine if a seasonally-related pattern of occurrence of mild variants of depression could be demonstrated in a population-based study. METHODS This is a cross-sectional U.S. survey of adults who completed the PHQ-8 Depression Scale with mild depression defined using a PHQ-8 cut score and a second model based on the DSM-5 diagnosis, Depression with insufficient symptoms. Regression models were used to determine if either variant of mild depression was related to season, latitude, or measures of daylight hours. RESULTS Neither measure of mild depression was related to daylight hours or its proxy measures. LIMITATIONS Screening instruments for depression, even if consistent with DSM-5 diagnostic criteria, do not allow a formal diagnosis of depression or the exclusion of similar-appearing disorders. Current depression symptoms but not duration of depressive episode is measured. CONCLUSIONS Mild depression is not related to seasonal changes or proxy measures of light exposure. The findings cast doubt on light deficiency as a causal factor of depressive disorders, which underpins the inclusion of the seasonal pattern modifier in DSM-5 and light supplementation as a treatment modality.
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Affiliation(s)
- Steven G LoBello
- Department of Psychology, Auburn University at Montgomery, 7430 East Drive, Montgomery, AL, 36117, United States.
| | - Sheila Mehta
- Department of Psychology, Auburn University at Montgomery, 7430 East Drive, Montgomery, AL, 36117, United States.
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Holtmann M, Mokros L, Kirschbaum-Lesch I, Kölch M, Plener PL, Ruckes C, Schulte-Markwort M, Legenbauer T. Adolescent depression: Study protocol for a randomized, controlled, double-blind multicenter parallel group trial of Bright Light Therapy in a naturalistic inpatient setting (DeLight). Trials 2018; 19:568. [PMID: 30340625 PMCID: PMC6194631 DOI: 10.1186/s13063-018-2949-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 09/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depressive disorders are among the most prominent health problems in youth. Even with the best available pharmacological and non-pharmacological treatments, remission rates are low. Without early treatment, depression in youth is associated with a high risk of symptom progression, chronicity, co-morbidity, and suicidal behavior. Thus, adolescent depression is a prime candidate for innovation in treatment. In depressive adults, meta-analytic evidence has proven that bright light therapy (BLT) is a potent low-threshold intervention, promising due to easy application, low side effects, and optimized compliance. In adolescents, studies with small samples show promising effects. This randomized controlled trial will examine the effectiveness of BLT in youth inpatients. METHODS/DESIGN In this randomized, controlled, double-blind multicenter parallel group trial, morning BLT is applied for four weeks in addition to treatment as usual (TAU) for depressed youth inpatients (daily morning exposure to bright light via light-emitting glasses, 10,000 lx, for 30 min) and will be compared to a control condition (placebo light treatment, red light, identical light glasses). The primary objective is to assess whether BLT reduces symptoms of depression in youth with greater effect compared to placebo light therapy. Secondary objectives are to examine the impact of BLT on responder status, application of antidepressant medication, and further depression-related symptoms (sleep, activity, quality of life, satisfaction with health, general psychopathology, alertness, and circadian function). N = 224 patients will be recruited in a naturalistic inpatient setting. A follow-up will be carried out after three and six months. DISCUSSION The study aims to discuss and evaluate BLT as an additive method supporting standardized clinical procedures dealing with severe to moderate depressive symptoms in youth. TRIAL REGISTRATION German Clinical Trials Register, DRKS00013188 . Registered on November 30, 2017.
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Affiliation(s)
- Martin Holtmann
- Clinic for Child and Adolescent Psychiatry, LWL University Hospital Hamm of the Ruhr-University Bochum, Heithofer Allee 64, 59071 Hamm, Germany
| | - Laura Mokros
- Clinic for Child and Adolescent Psychiatry, LWL University Hospital Hamm of the Ruhr-University Bochum, Heithofer Allee 64, 59071 Hamm, Germany
| | - Inken Kirschbaum-Lesch
- Clinic for Child and Adolescent Psychiatry, LWL University Hospital Hamm of the Ruhr-University Bochum, Heithofer Allee 64, 59071 Hamm, Germany
| | - Michael Kölch
- Department Child and Adolescent Psychiatry and Psychotherapy, Brandenburg Medical School, Neuruppin, Germany
| | - Paul L. Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Christian Ruckes
- Interdisciplinary Centre for Clinical Trials, Mainz University, Mainz, Germany
| | | | - Tanja Legenbauer
- Clinic for Child and Adolescent Psychiatry, LWL University Hospital Hamm of the Ruhr-University Bochum, Heithofer Allee 64, 59071 Hamm, Germany
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Cassidy SA, Bradley L, Bowen E, Wigham S, Rodgers J. Measurement properties of tools used to assess depression in adults with and without autism spectrum conditions: A systematic review. Autism Res 2018; 11:738-754. [PMID: 29360200 PMCID: PMC6001465 DOI: 10.1002/aur.1922] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 12/05/2017] [Accepted: 12/27/2017] [Indexed: 12/03/2022]
Abstract
Depression is the most commonly experienced mental health condition in adults with autism spectrum conditions (ASC). However, it is unclear what tools are currently being used to assess depression in ASC, or whether tools need to be adapted for this group. This systematic review therefore aimed to identify tools used to assess depression in adults with and without ASC, and then evaluate these tools for their appropriateness and measurement properties. Medline, PsychINFO and Web of Knowledge were searched for studies of depression in: (a) adults with ASC, without co‐morbid intellectual disability; and (b) adults from the general population without co‐morbid conditions. Articles examining the measurement properties of these tools were then searched for using a methodological filter in PubMed, and the quality of the evidence was evaluated using the COSMIN checklist. Twelve articles were identified which utilized three tools to assess depression in adults with ASC, but only one article which assessed the measurement properties of one of these tools was identified and thus evaluated. Sixty‐four articles were identified which utilized five tools to assess depression in general population adults, and fourteen articles had assessed the measurement properties of these tools. Overall, two tools were found to be robust in their measurement properties in the general population—the Beck Depression Inventory (BDI‐II), and the patient health questionnaire (PHQ‐9). Crucially only one study was identified from the COSMIN search, which showed weak evidence in support of the measurement properties of the BDI‐II in an ASC sample. Implications for effective measurement of depression in ASC are discussed. Autism Res2018, 11: 738–754. © 2018 The Authors Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc. Lay Summary Depression is the most common mental health problem experienced by adults with autism. However, the current study found very limited evidence regarding how useful tools developed for the general population are for adults with autism. We therefore suggest how these tools could be adapted to more effectively assess depression in adults with autism, and improve these individuals access to mental health assessment and support.
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Affiliation(s)
- S A Cassidy
- School of Psychology, University of Nottingham, UK.,Institute of Neuroscience, Newcastle University, UK.,Centre for Innovative Research Across the Life Course, Coventry University, UK
| | - L Bradley
- Centre for Innovative Research Across the Life Course, Coventry University, UK
| | - E Bowen
- Centre for Violence Prevention, University of Worcester, UK
| | - S Wigham
- Institute of Neuroscience, Newcastle University, UK
| | - J Rodgers
- Institute of Neuroscience, Newcastle University, UK
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10
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Major depression with seasonal pattern: Reply to Winkler, et al. J Affect Disord 2017; 222:21-22. [PMID: 28667889 DOI: 10.1016/j.jad.2017.06.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/15/2017] [Accepted: 06/26/2017] [Indexed: 01/08/2023]
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Winthorst WH, Roest AM, Bos EH, Meesters Y, Penninx BWJH, Nolen WA, de Jonge P. Seasonal affective disorder and non-seasonal affective disorders: results from the NESDA study. BJPsych Open 2017; 3:196-203. [PMID: 28904813 PMCID: PMC5572284 DOI: 10.1192/bjpo.bp.116.004960] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/07/2017] [Accepted: 07/19/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Seasonal affective disorder (SAD) is considered to be a subtype of depression. AIMS To compare the clinical picture of SAD to non-seasonal affective disorders (non-SADs). METHOD Diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were established in 2185 participants of the Netherlands Study of Depression and Anxiety. The Seasonal Pattern Assessment Questionnaire was administered to diagnose SAD. Symptoms of depression and anxiety were measured with the Inventory of Depressive Symptoms, the Beck Anxiety Inventory and the Fear Questionnaire. RESULTS Participants with SAD, participants with a lifetime bipolar disorder and participants with a lifetime comorbid anxiety and depressive disorder scored highest in terms of psychopathology in the past year. The seasonal distribution of major depressive episodes was not different for participants with or without SAD. CONCLUSIONS SAD may be a measure of severity of depression with a subjectively perceived worsening of symptoms in the winter months. DECLARATION OF INTEREST Y.M. has received research funding and served as a consultant for Royal Philips Electronics NV and The Litebook Company Ltd. W.A.N. has received grants from the Netherlands Organization for Health Research and Development, the European Union, the Stanley Medical Research Institute, Astra Zeneca, Eli Lilly, GlaxoSmithKline and Wyeth; has received honoraria/speaker's fees from Astra Zeneca, Pfizer, Servier and Wyeth; and has served in advisory boards for Astra Zeneca, Pfizer and Servier. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Wim H Winthorst
- , MD, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annelieke M Roest
- , PhD, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth H Bos
- , PhD, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ybe Meesters
- , PhD, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Brenda W J H Penninx
- , PhD, Department of Psychiatry/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Willem A Nolen
- , MD, PhD, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter de Jonge
- , PhD, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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12
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Winkler D, Pjrek E, Spies M, Willeit M, Dorffner G, Lanzenberger R, Kasper S. Has the existence of seasonal affective disorder been disproven? J Affect Disord 2017; 208:54-55. [PMID: 27744127 DOI: 10.1016/j.jad.2016.08.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 07/19/2016] [Accepted: 08/24/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Dietmar Winkler
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
| | - Edda Pjrek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Marie Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Matthäus Willeit
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Georg Dorffner
- Section for Artificial Intelligence and Decision Support, Medical University of Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
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Meesters Y, Winthorst WH, Duijzer WB, Hommes V. The effects of low-intensity narrow-band blue-light treatment compared to bright white-light treatment in sub-syndromal seasonal affective disorder. BMC Psychiatry 2016; 16:27. [PMID: 26888208 PMCID: PMC4758137 DOI: 10.1186/s12888-016-0729-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 02/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The discovery of a novel photoreceptor in the retinal ganglion cells with a highest sensitivity of 470-490 nm blue light has led to research on the effects of short-wavelength light in humans. Several studies have explored the efficacy of monochromatic blue or blue-enriched light in the treatment of SAD. In this study, a comparison has been made between the effects of broad-wavelength light without ultraviolet (UV) wavelengths compared to narrow-band blue light in the treatment of sub-syndromal seasonal affective disorder (Sub-SAD). METHOD In a 15-day design, 48 participants suffering from Sub-SAD completed 20-minute sessions of light treatment on five consecutive days. 22 participants were given bright white-light treatment (BLT, broad-wavelength light without UV 10 000 lux, irradiance 31.7 Watt/m(2)) and 26 participants received narrow-band blue light (BLUE, 100 lux, irradiance 1.0 Watt/m(2)). All participants completed daily and weekly questionnaires concerning mood, activation, sleep quality, sleepiness and energy. Also, mood and energy levels were assessed by means of the SIGH-SAD, the primary outcome measure. RESULTS On day 15, SIGH-SAD ratings were significantly lower than on day 1 (BLT 54.8 %, effect size 1.7 and BLUE 50.7 %, effect size 1.9). No statistically significant differences were found on the main outcome measures. CONCLUSION Light treatment is an effective treatment for Sub-SAD. The use of narrow-band blue-light treatment is equally effective as bright white-light treatment. TRIAL REGISTRATION This study was registered in the Dutch Trial Register (Nederlands Trial Register TC = 4342 ) (20-12-2013).
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Affiliation(s)
- Ybe Meesters
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, PO Box 30001, Groningen, 9700 RB, The Netherlands.
| | - Wim H. Winthorst
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, PO Box 30001, Groningen, 9700 RB The Netherlands
| | - Wianne B. Duijzer
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, PO Box 30001, Groningen, 9700 RB The Netherlands
| | - Vanja Hommes
- Philips Consumer Lifestyle Drachten, Drachten, The Netherlands.
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14
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Chronotherapeutic treatments for depression in youth. Eur Child Adolesc Psychiatry 2016; 25:151-61. [PMID: 25982568 DOI: 10.1007/s00787-015-0720-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 04/29/2015] [Indexed: 11/27/2022]
Abstract
Chronotherapeutics such as wake therapy and bright light therapy are well-established methods in treating adults with depressive disorders and are additionally beneficent for sleep regulation. Few studies concerning chronotherapeutics in juvenile depression exist, though the established treatments are insufficient and sleep disorders often co-occur. In this study, we investigate the impact of two types of chronotherapeutics on depressive symptoms and sleep behavior in a juvenile setting. Juvenile inpatients (n = 62) with moderate to severe depressive symptoms took part in either a combined setting consisting of one night wake therapy followed by 2 weeks bright light therapy or in a setting of bright light therapy alone. Depressive symptoms, general psychopathology, clinical impression and sleep behavior were measured before (T1), directly after (T2) and 2 weeks after intervention (T3). Depressive symptoms decreased while sleep quality increased in both groups. The bright light therapy alone group showed further improvement at T3 in regards to depressive symptoms. Correlation analyses indicated significant negative correlations between sleep quality and awaking after restorative sleep with the depressive symptoms. However, only awaking after restorative sleep had a predictive impact on treatment outcome. The present study provides first evidence for a positive impact of chronotherapeutic interventions on treatment outcome in depressed juvenile inpatients. Bright light therapy seems to stabilize and further enhance reduction of depressive symptoms during follow-up, whereas one night wake therapy does not have an additional long-lasting impact on depressive symptoms and sleep parameters.
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15
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Pjrek E, Baldinger-Melich P, Spies M, Papageorgiou K, Kasper S, Winkler D. Epidemiology and socioeconomic impact of seasonal affective disorder in Austria. Eur Psychiatry 2016; 32:28-33. [PMID: 26802981 DOI: 10.1016/j.eurpsy.2015.11.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/16/2015] [Accepted: 11/21/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Seasonal affective disorder (SAD) is a subtype of recurrent depressive or bipolar disorder that is characterized by regular onset and remission of affective episodes at the same time of the year. The aim of the present study was to provide epidemiological data and data on the socioeconomic impact of SAD in the general population of Austria. METHODS We conducted a computer-assisted telephone interview in 910 randomly selected subjects (577 females and 333 males) using the Seasonal Health Questionnaire (SHQ), the Seasonal Pattern Assessment Questionnaire (SPAQ), and the Sheehan Disability Scale (SDS). Telephone numbers were randomly drawn from all Austrian telephone books and transformed using the random last digits method. The last birthday method was employed to choose the target person for the interviews. RESULTS Out of our subjects, 2.5% fulfilled criteria for the seasonal pattern specifier according to DSM-5 and 2.4% (95% CI=1.4-3.5%) were diagnosed with SAD. When applying the ICD-10 criteria 1.9% (95% CI=0.9-2.8%) fulfilled SAD diagnostic criteria. The prevalence of fall-winter depression according to the Kasper-Rosenthal criteria was determined to be 3.5%. The criteria was fulfilled by 15.1% for subsyndromal SAD (s-SAD). We did not find any statistically significant gender differences in prevalence rates. When using the DSM-5 as a gold standard for the diagnosis of SAD, diagnosis derived from the SPAQ yielded a sensitivity of 31.8% and a specificity of 97.2%. Subjects with SAD had significantly higher scores on the SDS and higher rates of sick leave and days with reduced productivity than healthy subjects. CONCLUSIONS Prevalence estimates for SAD with the SHQ are lower than with the SPAQ. Our data are indicative of the substantial burden of disease and the socioeconomic impact of SAD. This epidemiological data shows a lack of gender differences in SAD prevalence. The higher rates of females in clinical SAD samples might, at least in part, be explained by lower help seeking behaviour in males.
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Affiliation(s)
- E Pjrek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria.
| | - P Baldinger-Melich
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - M Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - K Papageorgiou
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - S Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - D Winkler
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
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Bogen S, Legenbauer T, Gest S, Holtmann M. Lighting the mood of depressed youth: Feasibility and efficacy of a 2 week-placebo controlled bright light treatment for juvenile inpatients. J Affect Disord 2016; 190:450-456. [PMID: 26551404 DOI: 10.1016/j.jad.2015.09.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/06/2015] [Accepted: 09/15/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Sarah Bogen
- LWL University Hospital of the Ruhr University Bochum, Hospital for Child and Adolescent Psychiatry, Heithofer Allee 64, 59071 Hamm, Germany
| | - Tanja Legenbauer
- LWL University Hospital of the Ruhr University Bochum, Hospital for Child and Adolescent Psychiatry, Heithofer Allee 64, 59071 Hamm, Germany.
| | - Stephanie Gest
- LWL University Hospital of the Ruhr University Bochum, Hospital for Child and Adolescent Psychiatry, Heithofer Allee 64, 59071 Hamm, Germany
| | - Martin Holtmann
- LWL University Hospital of the Ruhr University Bochum, Hospital for Child and Adolescent Psychiatry, Heithofer Allee 64, 59071 Hamm, Germany
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Prevalence, behavioral manifestations and associated individual and climatic factors of seasonality in the Korean general population. Compr Psychiatry 2015; 57:148-54. [PMID: 25527359 DOI: 10.1016/j.comppsych.2014.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/14/2014] [Accepted: 10/20/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUNDS Seasonality, an individual trait of seasonal variations in mood and behavior, has received clinical attention for its association with mood disorders. This study aimed to explore the prevalence, specific manifestation, and associated individual and climatic factors of seasonality in the non-elderly adult population. METHODS Five hundred fifty-two participants [male n=220; female n=332; mean age 34.92years, standard deviation (SD) 10.18] with no psychiatric history were recruited from the Seoul metropolitan area (37°33'58.87″N 126°58'40.63″E). Seasonality was evaluated using the Seasonal Pattern Assessment Questionnaire. Climatic variables used in analyses were averaged over recent 5years (from 2008 to 2013) on a monthly basis. RESULTS The mean global seasonality score (GSS) was 5.53 (SD 3.91), and 16.2% (n=89) of participants had seasonal affective disorder (SAD) or sub-SAD. The "feeling worst" month in most of the participants with significant seasonality were winter (41.6%) or summer (38.2%). Socio-demographic factors including age and sex were not related to the seasonality. Decreased sunlight amount and diurnal temperature range in a given and previous month, and increased humidity in a previous month showed significant associations with the percentage of participants with the worst mood. The most frequently reported symptom related to seasonality was 'changes in energy level'. Specific manifestations were not significantly different between the winter type and the summer type. CONCLUSION The summer and winter type seasonality in the non-clinical adult population did not differ in terms of behavioral manifestations. Decreased sunlight amount, diurnal temperature range, and increased humidity appeared to be major climatic factors associated with seasonality.
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Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. DEPRESSION RESEARCH AND TREATMENT 2015; 2015:178564. [PMID: 26688752 PMCID: PMC4673349 DOI: 10.1155/2015/178564] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 11/01/2015] [Accepted: 11/10/2015] [Indexed: 12/12/2022]
Abstract
Seasonal affective disorder or SAD is a recurrent major depressive disorder with a seasonal pattern usually beginning in fall and continuing into winter months. A subsyndromal type of SAD, or S-SAD, is commonly known as "winter blues." Less often, SAD causes depression in the spring or early summer. Symptoms center on sad mood and low energy. Those most at risk are female, are younger, live far from the equator, and have family histories of depression, bipolar disorder, or SAD. Screening instruments include the Seasonal Pattern Assessment Questionnaire (SPAQ). Typical treatment includes antidepressant medications, light therapy, Vitamin D, and counselling. This paper provides an overview of SAD.
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Winthorst WH, Roest AM, Bos EH, Meesters Y, Penninx BWJH, Nolen WA, de Jonge P. Self-attributed seasonality of mood and behavior: a report from the Netherlands study of depression and anxiety. Depress Anxiety 2014; 31:517-23. [PMID: 23695951 DOI: 10.1002/da.22130] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 03/07/2013] [Accepted: 04/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Seasonal changes in mood and behavior are considered to be common in the general population and in patients with psychiatric disorders. However, in several studies this seasonality could not be demonstrated. The present study examined self-attributed seasonality of depressive symptoms among patients with a lifetime diagnosis of a depressive disorder (D), an anxiety disorder (A), a comorbid depressive and anxiety disorder (DA), and healthy controls (HC). METHODS The CIDI was used to establish diagnoses according to DSM-IV criteria in 2,168 participants of the Netherlands Study of Depression and Anxiety (NESDA). The Seasonal Pattern Assessment Questionnaire (SPAQ) was administered to assess variation in mood and behavior. RESULTS Of the 2,168 participants 53.5% reported seasonality of mood. Highest percentages of low mood were seen in the winter months. Although all groups showed this pattern of lowered mood during the winter months, D, A, and DA were significantly (P < .001) more likely to experience seasonality is this respect. This was also shown for seasonal changes in energy, social activities, sleeping, eating, weight and for the Global Seasonality Score. A limitation of this study was the cross-sectional design. CONCLUSIONS Seasonal variation in mood and behavior was demonstrated for both participants with a lifetime diagnosis of depression and/or anxiety disorder and for healthy controls, but patients with anxiety and/or depression were more likely to experience this seasonal variation. Clinicians should take into account that the time of the year could influence the feelings of well- and ill-being of their patients.
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Affiliation(s)
- Wim H Winthorst
- Department of Psychiatry and Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, The Netherlands
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20
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Oginska H, Oginska-Bruchal K. Chronotype and personality factors of predisposition to seasonal affective disorder. Chronobiol Int 2014; 31:523-31. [DOI: 10.3109/07420528.2013.874355] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Bogen S, Legenbauer T, Bogen T, Gest S, Jensch T, Schneider S, Holtmann M. Morning light therapy for juvenile depression and severe mood dysregulation: study protocol for a randomized controlled trial. Trials 2013; 14:178. [PMID: 23773310 PMCID: PMC3689601 DOI: 10.1186/1745-6215-14-178] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 04/29/2013] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The prevalence of depression in young people is increasing. The predominant co-morbidities of juvenile depression include sleep disturbances and persistent problems with the sleep-wake rhythm, which have shown to influence treatment outcomes negatively. Severe mood dysregulation is another condition that includes depressive symptoms and problems with the sleep-wake rhythm. Patients with severe mood dysregulation show symptoms of depression, reduced need for sleep, and disturbances in circadian functioning which negatively affect both disorder-specific symptoms and daytime functioning. One approach to treating both depression and problems with the sleep-wake rhythm is the use of light therapy. Light therapy is now a standard therapy for ameliorating symptoms of seasonal affective disorder and depression in adults, but has not yet been investigated in children and adolescents. In this trial, the effects of 2 weeks of morning bright-light therapy on juvenile depression and severe mood dysregulation will be evaluated. METHODS/DESIGN A total of 60 patients with depression, aged between 12 and 18 years, in some cases presenting additional symptoms of affective dysregulation, will be included in this trial. Morning bright-light therapy will be implemented for 2 weeks (10 sessions of 45 minutes each), either with 'active' light (10,000 lux) or 'inactive' light (100 lux). A comprehensive test battery will be conducted before and after treatment and at follow-up 3 weeks later, to assess depression severity, sleep, and attention parameters. Melatonin levels will be measured by assessing the Dim Light Melatonin Onset. DISCUSSION In this pilot study, the use of morning bright-light therapy for juvenile depression and severe mood dysregulation shall be evaluated and discussed. TRIALS REGISTRATION Current Controlled Trials ISRCTN89305231.
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Affiliation(s)
- Sarah Bogen
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Tanja Legenbauer
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Thorsten Bogen
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Stephanie Gest
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Thomas Jensch
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Silvia Schneider
- Department of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Martin Holtmann
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
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The association between adult attachment style and delusional-like experiences in a community sample of women. J Nerv Ment Dis 2013; 201:525-9. [PMID: 23686161 DOI: 10.1097/nmd.0b013e318294a257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Community-based surveys have found that many otherwise well individuals endorse delusional-like experiences (DLEs). There is extensive literature that describes the demographic and psychosocial correlates of DLE; however, we know little about the association between DLE and attachment style. The association between DLEs (assessed by the Peters Delusional Inventory [PDI]) and interpersonal relationship style (as assessed by the Adult Attachment Questionnaire and the Dyadic Adjustment Scale) was examined in 3360 women. When adjusted for the presence of depressive and anxiety symptoms, high scores on the PDI (lowest versus highest quartiles) were associated with a) difficulties in adult attachment style particularly in the discomfort with closeness and preoccupation with relationships subscales and b) conflictual dyadic adjustment (adjusted odds ratios and 95% confidence intervals, 2.43 and 1.94-3.04, 2.50 and 1.99-3.14, and 2.90 and 1.38-6.06, respectively). The association between adult attachment style and DLE provides new clues into the causal pathway underpinning these common experiences.
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Raheja UK, Stephens SH, Mitchell BD, Rohan KJ, Vaswani D, Balis TG, Nijjar GV, Sleemi A, Pollin TI, Ryan K, Reeves GM, Weitzel N, Morrissey M, Yousufi H, Langenberg P, Shuldiner AR, Postolache TT. Seasonality of mood and behavior in the Old Order Amish. J Affect Disord 2013; 147:112-7. [PMID: 23164460 PMCID: PMC3606685 DOI: 10.1016/j.jad.2012.10.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 10/23/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND/OBJECTIVE We examined seasonality and winter seasonal affective disorder (SAD) in the Old Order Amish of Lancaster County, Pennsylvania, a unique population that prohibits use of network electric light in their homes. METHODS We estimated SAD using the seasonal pattern assessment questionnaire (SPAQ) in 1306 Amish adults and compared the frequencies of SAD and total SAD (i.e., presence of either SAD or subsyndromal-SAD) between men and women, young and old, and awareness of (ever vs. never heard about) SAD. Heritability of global seasonality score (GSS) was estimated using the maximum likelihood method, including a household effect to capture shared environmental effects. RESULTS The mean (±SD) GSS was 4.36 (±3.38). Prevalence was 0.84% (95% CI: 0.36-1.58) for SAD and 2.59% (95% CI: 1.69-3.73) for total SAD. Heritability of GSS was 0.14±0.06 (SE) (p=0.002) after adjusting for age, gender, and household effects. LIMITATIONS Limitations include likely overestimation of the rates of SAD by SPAQ, possible selection bias and recall bias, and limited generalizability of the study. CONCLUSIONS In the Amish, GSS and SAD prevalence were lower than observed in earlier SPAQ-based studies in other predominantly Caucasian populations. Low heritability of SAD suggests dominant environmental effects. The effects of awareness, age and gender on SAD risk were similar as in previous studies. Identifying factors of resilience to SAD in the face of seasonal changes in the Amish could suggest novel preventative and therapeutic approaches to reduce the impact of SAD in the general population.
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Affiliation(s)
- Uttam K Raheja
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
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Bijlenga D, van der Heijden KB, Breuk M, van Someren EJW, Lie MEH, Boonstra AM, Swaab HJT, Kooij JJS. Associations between sleep characteristics, seasonal depressive symptoms, lifestyle, and ADHD symptoms in adults. J Atten Disord 2013; 17:261-75. [PMID: 22210799 DOI: 10.1177/1087054711428965] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The authors explored associations between ADHD symptoms, seasonal depressive symptoms, lifestyle, and health. METHOD Adult ADHD patients (n = 202) and controls (n = 189) completed the ASESA questionnaire involving lifestyle, eating pattern, and physical and psychological health, and validated measures on ADHD and sleep. ASESA is the Dutch acronym for inattention, sleep, eating pattern, mood, and general health questionnaire. RESULTS Indication for delayed sleep phase syndrome (DSPS) was 26% in patients and 2% in controls (p < .001). Patients reported shorter sleep, longer sleep-onset latency, and later midsleep. Shorter (R (2) = .21) and later (R (2) = .27) sleep were associated with hyperactivity, male gender, younger age, and seasonal depressive symptoms. Seasonal depressive symptoms were related to hyperactivity, female gender, unemployment, and late sleep (pseudo R (2) = .28). Higher body mass index (BMI) was associated with shorter sleep in patients (ρ = -.16; p = .04) and controls (ρ = -.17; p = .02). Longer sleep showed lower odds for indication of metabolic syndrome (OR = -0.17; p = .053). CONCLUSION DSPS is more prevalent in ADHD and needs further investigation to establish treatment to prevent chronic health issues.
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Affiliation(s)
- Denise Bijlenga
- PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands.
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da Rocha NS, Chachamovich E, de Almeida Fleck MP, Tennant A. An introduction to Rasch analysis for Psychiatric practice and research. J Psychiatr Res 2013; 47:141-8. [PMID: 23069651 DOI: 10.1016/j.jpsychires.2012.09.014] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 08/17/2012] [Accepted: 09/20/2012] [Indexed: 10/27/2022]
Abstract
This article aims to present the main characteristics of Rasch analysis in the context of patient reported outcomes in Psychiatry. We present an overview of the main features of the Rasch analysis, using as an example the latent variable of depressive symptoms, with illustrations using the Beck Depression Inventory. We will show that with fitting data to the Rasch model, we can confirm the structural validity of the scale, including key attributes such as invariance, local dependency and unidimensionality. We also illustrate how the approach can inform on the meaning of the numbers attributed to scales, the amount of the latent traits that such numbers represent, and the consequent adequacy of statistical operations used to analyse them. We would argue that fitting data to the Rasch model has become the measurement standard for patient reported outcomes in general and, as a consequence will facilitate a quality improvement of outcome instruments in psychiatry. Recent advances in measurement technologies built upon the calibration of items derived from Rasch analysis in the form of computerized adaptive tests (CAT) open up further opportunities for reducing the burden of testing, and/or expanding the range of information that can be collected during a single session.
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Affiliation(s)
- Neusa Sica da Rocha
- Hospital de Clinicas de Porto Alegre, Programa de Pós Graduação em Ciências Médicas: Psiquiatria, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil.
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Winthorst WH, Post WJ, Meesters Y, Penninx BWHJ, Nolen WA. Seasonality in depressive and anxiety symptoms among primary care patients and in patients with depressive and anxiety disorders; results from the Netherlands Study of Depression and Anxiety. BMC Psychiatry 2011; 11:198. [PMID: 22182255 PMCID: PMC3280179 DOI: 10.1186/1471-244x-11-198] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 12/19/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Little is known about seasonality of specific depressive symptoms and anxiety symptoms in different patient populations. This study aims to assess seasonal variation of depressive and anxiety symptoms in a primary care population and across participants who were classified in diagnostic groups 1) healthy controls 2) patients with a major depressive disorder, 3) patients with any anxiety disorder and 4) patients with a major depression and any anxiety disorder. METHODS Data were used from the Netherlands Study of Depression and Anxiety (NESDA). First, in 5549 patients from the NESDA primary care recruitment population the Kessler-10 screening questionnaire was used and data were analyzed across season in a multilevel linear model. Second, in 1090 subjects classified into four groups according to psychiatric status according to the Composite International Diagnostic Interview, overall depressive symptoms and atypical versus melancholic features were assessed with the Inventory of Depressive Symptoms. Anxiety and fear were assessed with the Beck Anxiety Inventory and the Fear questionnaire. Symptom levels across season were analyzed in a linear regression model. RESULTS In the primary care population the severity of depressive and anxiety symptoms did not show a seasonal pattern. In the diagnostic groups healthy controls and patients with any anxiety disorder, but not patients with a major depressive disorder, showed a small rise in depressive symptoms in winter. Atypical and melancholic symptoms were both elevated in winter. No seasonal pattern for anxiety symptoms was found. There was a small gender related seasonal effect for fear symptoms. CONCLUSIONS Seasonal differences in severity or type of depressive and anxiety symptoms, as measured with a general screening instrument and symptom questionnaires, were absent or small in effect size in a primary care population and in patient populations with a major depressive disorder and anxiety disorders.
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Affiliation(s)
- Wim H Winthorst
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, The Netherlands.
| | - Wendy J Post
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, the Netherlands,Department of Pedagogy & Educational Sciences, University of Groningen, the Netherlands
| | - Ybe Meesters
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - Brenda WHJ Penninx
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, the Netherlands,Department of Psychiatry/EMGO Institute/Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands,Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - Willem A Nolen
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, the Netherlands
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FRIBORG ODDGEIR, BJORVATN BJØRN, AMPONSAH BENJAMIN, PALLESEN STÅLE. Associations between seasonal variations in day length (photoperiod), sleep timing, sleep quality and mood: a comparison between Ghana (5°) and Norway (69°). J Sleep Res 2011; 21:176-84. [DOI: 10.1111/j.1365-2869.2011.00982.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shand AJ, Scott NW, Anderson SM, Eagles JM. The seasonality of bipolar affective disorder: comparison with a primary care sample using the Seasonal Pattern Assessment Questionnaire. J Affect Disord 2011; 132:289-92. [PMID: 21377212 DOI: 10.1016/j.jad.2011.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 02/08/2011] [Accepted: 02/16/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND In contrast with recurrent unipolar depression, relatively little is known about the seasonality of depressive episodes in bipolar affective disorder (BAD). METHOD We compared responses on the Seasonal Pattern Assessment Questionnaire (SPAQ) between a cohort of 183 patients with BAD and a large sample of patients in primary care (N=4746). Comparisons were adjusted for age and gender. RESULTS 27% of the BAD patients fulfilled SPAQ criteria for Seasonal Affective Disorder (SAD. This gave an adjusted odds ratio of 3.73 (95% confidence intervals 2.64 to 5.27) in comparison with the rate among the primary care samples. Global seasonality scores were significantly higher among BAD patients (adjusted mean difference 1.73, 95% CI 0.97 to 2.49, p<0.001). LIMITATIONS The SPAQ was originally designed as a screening instrument rather than as a case-finding instrument. CONCLUSIONS Vigilance for seasonal symptom recurrence in BAD may be important with regard to management and relapse prevention.
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