High prevalence of self-reported depressive mood during the winter season among Swedish senior high school students

Insight from focus group interviews: adolescent girls' well-being in relation to experiences of winter, nature and seasonal changes in Northern Finland

BACKGROUND

According to previous studies, gender-related differences have been found in relation to the experience of well-being. There are also research results indicating that environment and seasonal variation have an influence on the well-being.

AIM

The aim of the study was to describe how adolescent girls living in northern Finland experience nature, winter and seasonal changes and meaning of these to their well-being.

METHODS

In this descriptive, qualitative research, 17 girls aged 13-16 who live in northern Finland participated in five focus group interviews where they presented photographs of nature they took themselves. Participation for the girls was voluntary, and the data were analysed by using content analysis.

FINDINGS

Three main categories were found: winter which expresses participative and confrontational meanings, natural environment that provides meaningful stimulus and seasonal variations binding experiences. Winter had a dual effect on girls' well-being. Nature's healing elements were described by the girls as invigorating, varying and stimulating of a wide range of senses. Nature offered soothing and revitalising experiences for the girls. On the one hand, seasonal changes were seen as a refreshing change, but on the other hand, the changes were described oppressive and burdensome.

CONCLUSION

The girls described how they experienced the multiple elements of nature and environment through different senses. These sensations and feelings seem to transport the girls to a larger experience in which nature and seasonal changes were partially elements that fulfilled the girls' needs but also required adaptation.

RELEVANCE TO CLINICAL PRACTICE

This experiential description encourages us to develop new means of promotive actions and brings a novel perspective and understanding about how to incorporate and implement these findings to enhance girls' well-being. Findings from this study need to be understood in this particular context in northern Finland among adolescent girls.

Impact of seasons on stroke-related depression, mediated by vitamin D status

BACKGROUND

This study aimed to describe the seasonal variation of depression prevalence among stroke patients at 1 month and to explore whether vitamin D plays a role in the association between seasons and post-stroke depression (PSD).

METHODS

Data were collected from 402 acute stroke patients. Seasons were stratified by summertime (June to November) and wintertime (December to May) based on vitamin D status. The impact of seasons on PSD was assessed via binary logistic regression, with summertime considered the referent category. The mediating effect was used to evaluate whether vitamin D plays a role in the association between seasons and PSD.

RESULTS

The prevalence of PSD was significantly higher in the wintertime group than in the summertime group (P = 0.003). The serum vitamin D level was lower in wintertime than in summertime (P < 0.001). Lower vitamin D levels were associated with higher HAMD scores (P < 0.001). In the multivariate analysis, patients in the wintertime group had a higher prevalence of PSD compared with those in the summertime group across all binary logistic regression models after adjusting for potential confounders. When serum vitamin D was added to the above model, there was no association between seasons and PSD (P = 0.056). Vitamin D was independently associated with PSD (OR 0.95, 95% CI 0.935-0.966, P < 0.001).

CONCLUSION

There was a clear seasonal variation in depression prevalence among stroke patients. Vitamin D status plays a critical mediating role in the relationship between season and post-stroke depression.

The meaning of seasonal changes, nature, and animals for adolescent girls' wellbeing in northern Finland: A qualitative descriptive study

Wellbeing is complex, holistic, and subjectively perceived. Issues such as gender, age, and environment seem to affect it. Therefore, the aim of this qualitative study was to describe the meaning of seasonal changes, nature, and animals towards 13-16-year-old girls' wellbeing in Northern Finland. In the spring of 2014, through purposive sampling, a total of 19 girls participated in semi-structured interviews from various parts of Northern Finland. The data were analysed using content analysis. Afterwards, the analysis combining the category participatory involvement with environment was found, and this consisted of three main categories: adaptation to seasonal changes, restorative nature, and empowering interactivity with animals. Seasonal changes had an effect on girls' wellbeing; in the summertime, they felt happy and vivacious, active, and outgoing. Instead, during the winter months, girls' mood and activity seemed to be lower and they felt lazier and depressed. Nature brought mainly positive feelings to girls; being in nature was experienced as liberating and relaxing, and it offered opportunities to relax and have sensory perceptions. Interaction with animals was perceived as empowering. They were experienced as altruistic and comforting companions. Animals were important to girls, and they contributed to girls' lives through positive effects towards their mental and physical wellbeing. Based on the results of this study, we can recommend that being in nature and interacting with animals should be supported because they seem to have benefits towards adolescent girls' health and wellbeing. In order to facilitate the negative effects of winter, the school days should be arranged in such a way that it would be possible for girls to have outdoor activities during the daytime. The challenge for the future is perhaps the purposeful utilisation of nature's and the animals' positive effects towards their wellbeing.

Self-reported health in adolescent girls varies according to the season and its relation to medication and hormonal contraception--a descriptive study

OBJECTIVES

To study seasonal variations in self-rated health and depressive symptoms in adolescent girls and possible differences in reported health with regard to use of medications.

METHOD

The SF-36 questionnaire was completed by 1250 girls with a mean age of 17 years, who visited a health centre in the course of one year. From January to July inclusive, depressive symptoms in 453 of the participants were also assessed using MADRS-S. Age and regular medication data were recorded.

RESULTS

Significantly better mental health and less depressive symptoms were reported during the summer, than in winter months. Seasonality was more related to the SF-36 mental, than physical health subscales. Respondents treated with hormonal contraceptives (HCs) only and those not taking any medication scored better on several SF-36 subscales, than girls on antidepressives and other medications. Respondents taking HCs tended to report better physical health and less depressive symptoms on MADRS-S than those taking no medication.

CONCLUSIONS

Adolescent girls showed seasonal variations in self-reported health and depressive symptoms, with more symptoms during winter months. HC users tended to report better physical health and less depressive symptoms than those on no medication. The high prevalence of suspected depression during the winter months deserves attention.

Seasonal patterns of abdominal pain consultations among adults and children

BACKGROUND AND AIM

Consultations for chronic abdominal pain are frequent in adults and children. A seasonal pattern of abdominal pain consultations with winter predominance was shown in previous pediatric studies; however, no studies have investigated whether such a pattern exists in adult patients. Understanding the differences in seasonal patterns of abdominal pain consultations among adults and children may indicate that either different mechanisms exist for common chronic pain conditions or triggering factors may vary by age. The aim of the study was to investigate whether a seasonal variation in abdominal pain consultation patterns exists among adults and children.

METHODS

The number of outpatient consultations among children (5-17 years) and adults (18 years or older) with a diagnosis of abdominal pain of nonspecified origin (International Classification of Diseases-9 code 789.0) from May 2000 to December 2008 was identified in an administrative claims database. The primary outcome measure was the rate of abdominal pain consultations (total number of abdominal pain consultations/total number of distinct patients by month×1000) by season in children and adults. Seasons were defined as follows: winter (December-February), spring (March-May), summer (June-August), and fall (September-November). A trend test was conducted to determine the degree of linearity in the patterns between the 2 groups. Among children, subanalyses by age 5 to 11 years and 12 to 17 years and sex were conducted.

RESULTS

A total of 172.4 million distinct patients (13.4% children, 87.6% adults) were identified in the database between May 2000 and December 2008. During the same time period, 15.6 million patient consultations for abdominal pain were identified (10.1% children, 89.9% adults). Children demonstrated a seasonal pattern in abdominal pain consultations, which best fit a quadratic regression curve, with consultations less common during the summer months. Abdominal pain consultations in adults were linear with no seasonal predominance. The trend in seasonal variation of abdominal pain consultations among children stratified by age and sex remained consistent with the overall child population.

CONCLUSIONS

Abdominal pain consultations in children are less common during summer months, whereas no evidence of seasonal pattern of consultation was found in adults. Factors involved in the pathogenesis of abdominal pain in adults and children may differ.

Season of birth and mood seasonality in late childhood and adolescence

A significant season of birth effect on mood seasonality has been detected in young adults, with higher sensitivity to seasonal changes for people born during spring or summer months (long photoperiod) than those born during autumn or winter months (short photoperiod). The aim of this study was to verify whether the birth season effect on mood seasonality is already present in late childhood and adolescence. To this end, the Seasonal Pattern Assessment Questionnaire for Children and Adolescents (SPAQ-CA) was administered to 1523 Italian participants (870 females, 653 males), ranging from 10 to 17 years of age. The Global Seasonality Score (GSS) was computed as a measure of mood seasonality. Analysis of covariance showed a significant season of birth effect on GSS; although no comparisons were significant when Tukey's posthoc test for unequal samples was performed, it was observed that adolescents born in summer achieved the highest scores while those born in winter obtained the lowest. The present data point out that a significant season of birth effect on mood seasonality is already present in late childhood and adolescence.

Mood changes in the course of preparation for the Brazilian university admission exam - a longitudinal study

OBJECTIVE

Academic examinations are an important source of stress for students. This study is intended to assess senior high school students' mood changes during the preparation for a very important academic examination, the Brazilian university admission examination.

METHOD

Positive and Negative Affect Schedule - Expanded Form was used to assess the students three times in the course of the months preceding the examination.

RESULTS

ANOVA for repeated measures showed that Negative Affect increased as the examination approached, and that this increment was already present months before the examination took place. A single conditionally independent random effect model showed that time spent studying was associated with fluctuations in mood.

CONCLUSION

Teenagers, in preparation for a very important examination, may present mood disturbances associated with both the proximity of the examination and their study load months before the examination actually takes place. Other stressing factors may play a role in these findings and should be further investigated.

Prevalence of self-reported seasonal affective disorders and the validity of the seasonal pattern assessment questionnaire in young adults Findings from a Swiss community study

BACKGROUND

The objective of this study was to expand the knowledge on the prevalence of self-reported Seasonal Affective Disorder (SAD) and to further study the validity of the Seasonal Pattern Assessment Questionnaire (SPAQ).

METHODS

A total of N=844 young adults were assessed in a Swiss community study by use of the SPAQ, a Seasonal Affective Disorders Questionnaire (SADQ), the Young Adult Self Report (YASR), the Centre for Epidemiologic Depression Scale (CES-D), and scales for measuring self-esteem, self-awareness and life events. At a second stage, a total of N=534 screen positives and controls were subjected to the Composite International Diagnostic Interview (M-CIDI) for the assessment of mental disorders. According to the SPAQ classification a group of SAD subjects and a group of subsyndromal SAD subjects (S-SAD) were defined. In addition, a third group of high-scoring depressives (HSD) subjects scoring above the 75th percentile of the CES-D was defined. Comparisons included these three groups and the rest of the sample serving as controls.

RESULTS

The weighted prevalence for SAD in this sample was 7.84% based on the SPAQ alone. With the addition of the SADQ, weighted prevalence rates dropped to 2.22%. Weighted subsyndromal SAD was 33.04%. Across the vast majority of scales, the SAD group was indistinguishable from the HSD group. These two groups scored highest, whereas the S-SAD group had an intermediate position and the controls had the lowest scores. SAD was best predicted by the CES-D total score.

CONCLUSIONS

The SPAQ as a single measure leads to an overestimation of SAD which, nevertheless, is a rather common phenomenon also in this central European population. The findings on the validity of the SPAQ are extended by showing that predominantly general aspects of depression are measured.

Lyme neuroborreliosis in children: a prospective study of clinical features, prognosis, and outcome

BACKGROUND

Evaluation of children with clinically suspected neuroborreliosis (NB) is difficult. With a prospective study design we wanted to characterize children with signs and symptoms indicative for NB, investigate clinical outcome and, if possible, identify factors of importance for recovery.

MATERIAL/METHODS

Children being evaluated for NB (n = 177) in southeast Sweden were categorized into 3 groups: "confirmed neuroborreliosis" (41%) with Borrelia antibodies in the cerebrospinal fluid, "possible neuroborreliosis" (26%) with pleocytosis but no Borrelia antibodies in the cerebrospinal fluid, and "not determined" (33%) with no pleocytosis and no Borrelia antibodies in the cerebrospinal fluid. Antibiotic treatment was given to 69% of children. Patients were followed during 6 months and compared with a matched control group (n = 174).

RESULTS

Clinical recovery at the 6-month follow-up (n = 177) was generally good and no patient was found to have recurrent or progressive neurologic symptoms. However, persistent facial nerve palsy caused dysfunctional and cosmetic problems in 11% of patients. Persistent nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls. Influence on daily life was reported to the same extent in patients and controls. Consequently, persistent headache and fatigue at follow-up should not be considered as attributable to NB. No prognostic factors could be identified.

CONCLUSIONS

Clinical recovery was satisfactory in children being evaluated for NB although persistent symptoms from facial nerve palsy occurred. Persistent nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls.

Seasonal variation in the presentation of abdominal pain

BACKGROUND

Anxiety and depression, conditions frequently associated with childhood chronic abdominal pain (AP), are characterized by seasonal exacerbations. A seasonal pattern characterized by a higher frequency of consultations for AP during winter has been suspected but has never, to our knowledge, been demonstrated. We hypothesize the presence of a seasonal variation in AP consultations with a winter predominance.

AIMS

To determine the seasonal distribution of AP consultations among centers across time and geographic latitude.

PATIENTS AND METHODS

This was a retrospective cohort study. The number of outpatient consultations from primary care clinics and every pediatric specialty clinic that resulted in a diagnosis of AP and the total number of outpatient consultations (2001-2004) from 6 tertiary care institutions (Chicago, Pittsburgh, Wilmington, Pensacola, Orlando, Jacksonville) was determined. Rates of consultations were compared across time and between cities. Four time periods of interest, with 2- and 3-month definitions, were arbitrarily selected. Seasonal rates across time were compared separately for each of the 2-month (January-February vs June-July) and 3-month periods (January-March vs June-August). Logistic regression models for each city were used to determine variations in the rate of outpatient AP cases by season or by year.

RESULTS

A total of 3,929,522 outpatient consultations and 73,591 AP consultations were analyzed. The rates of AP consultations were consistently higher in the winter months at all of the sites. The results differed between sites at northern and southern latitudes.

CONCLUSIONS

There seems to be a seasonal variation in consultation patterns for AP at the tertiary care level. A possible role of daylight hours, climate, latitude, and stress is proposed.

Autumn peak in shooting suicides of children and adolescents from northern Finland

Suicide is one of the leading causes of death among adolescents worldwide. Studies on the seasonal pattern of youth suicides are rare and the results are very contradictory and heterogeneous. Generally, suicide methods affect the pattern of suicide seasonality. Shooting is the most common suicide method among Finnish adolescents. We investigated whether shooting suicides of victims aged less than 18 years are correlated with a specific period of the year. Also, the seasonal pattern of shooting suicides in adolescents was compared with that of adult victims. Our data comprised 42 adolescent suicide victims and, for comparison, 1,926 adult suicide victims over the years 1988 to 2004 from Northern Finland. Of these, 59.5% (n = 25) of the adolescents and 28.8% (n = 554) of the adults had committed suicide by shooting. We observed that shooting suicides among the under-aged showed a significant peak in autumn (ratio 2.70, 95% CI: 1.97-3.42), while those of adult victims peaked in spring (ratio 1.19, 95% CI: 1.05-1.35). The monthly pattern of suicides correlated significantly with the mean duration of daily sunshine hours (trailing by 3 months) in the under-aged (r = 0.67, p = 0.016), but not in the adults (r = 0.06, p = 0.854). The role of firearm availability, psychosocial factors such as start of the school year, and some biological factors are discussed.

Mood seasonality: a cross-sectional study of subjects aged between 10 and 25 years

BACKGROUND

Most of the earlier studies on mood seasonality were conducted in adults and there are few available data on children and adolescents. In two cross sectional surveys, we examined the role of age and gender on seasonal sensitivity in subjects aged 10 to 25 years.

METHODS

In survey one, the Seasonal Pattern Assessment Questionnaire for Children and Adolescents (SPAQ-CA) was administered to 1709 subjects (845 females and 864 males) from 10 to 17 years. In survey two, the Seasonal Pattern Assessment Questionnaire (SPAQ) was administered to 1867 subjects (1061 females and 806 males) from 18 to 25 years.

RESULTS

Only in survey one was a significant positive correlation found between age and Global Seasonality Score (GSS) (r=.29; p<.00001). Significant gender differences were found at age 14 years and above in survey one, and at all ages in survey two.

CONCLUSIONS

The results support the hypothesis that seasonal sensitivity is higher in female subjects.