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Bakstein E, Mladá K, Fárková E, Kolenič M, Španiel F, Manková D, Korčáková J, Winkler P, Hajek T. Cross-sectional and within-subject seasonality and regularity of hospitalizations: A population study in mood disorders and schizophrenia. Bipolar Disord 2020; 22:508-516. [PMID: 31883178 DOI: 10.1111/bdi.12884] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Seasonal peaks in hospitalizations for mood disorders and schizophrenia are well recognized and often replicated. The within-subject tendency to experience illness episodes in the same season, that is, seasonal course, is much less established, as certain individuals may temporarily meet criteria for seasonal course purely by chance. AIMS In this population, prospective cohort study, we investigated whether between and within-subject seasonal patterns of hospitalizations occurred more frequently than would be expected by chance. METHODS Using a compulsory, standardized national register of hospitalizations, we analyzed all admissions for mood disorders and schizophrenia in the Czech Republic between 1994 and 2013. We used bootstrap tests to compare the observed numbers of (a) participants with seasonal/regular course and (b) hospitalizations in individual months against empirical distributions obtained by simulations. RESULTS Among 87 184 participants, we found uneven distribution of hospitalizations, with hospitalization peaks for depression in April and November (X2 (11) = 363.66, P < .001), for mania in August (X2 (11) = 50.36, P < .001) and for schizophrenia in June (X2 (11) = 70.34, P < .001). Significantly more participants than would be expected by chance, had two subsequent rehospitalizations in the same 90 days in different years (7.36%, bootstrap P < .01) or after a regular, but non-seasonal interval (6.07%, bootstrap P < .001). The proportion of participants with two consecutive hospitalizations in the same season was below chance level (7.06%). CONCLUSIONS Psychiatric hospitalizations were unevenly distributed throughout the year (cross-sectional seasonality), with evidence for regularity, but not seasonality of hospitalizations within subjects. Our data do not support the validity of seasonal pattern specifier. Season may be a general risk factor, which increases the risk of hospitalizations across psychiatric participants.
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Affiliation(s)
- Eduard Bakstein
- National Institute of Mental Health, Klecany, Czech Republic
| | - Karolína Mladá
- National Institute of Mental Health, Klecany, Czech Republic
| | - Eva Fárková
- National Institute of Mental Health, Klecany, Czech Republic.,3rd School of Medicine, Charles University, Prague, Czech Republic
| | - Marian Kolenič
- National Institute of Mental Health, Klecany, Czech Republic.,3rd School of Medicine, Charles University, Prague, Czech Republic
| | - Filip Španiel
- National Institute of Mental Health, Klecany, Czech Republic
| | - Denisa Manková
- National Institute of Mental Health, Klecany, Czech Republic
| | - Jana Korčáková
- National Institute of Mental Health, Klecany, Czech Republic.,3rd School of Medicine, Charles University, Prague, Czech Republic
| | - Petr Winkler
- National Institute of Mental Health, Klecany, Czech Republic
| | - Tomas Hajek
- National Institute of Mental Health, Klecany, Czech Republic.,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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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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Abstract
Much the most common type of seasonal affective disorder at temperate latitudes is recurrent winter depression, which probably affects around 3% of adults in the UK to a clinically significant degree. In this article, diagnosis and presentation are discussed and symptoms are contrasted with those of non-seasonal depression. Aetiology and epidemiology, with regard to age, gender and latitude of residence, are described. Sufferers are often treated with light therapy, and this is described in some detail, with mention of effectiveness, prediction of outcome, timescales of response, side-effects, use of lightboxes and alternatives to lightboxes. Other general aspects of the management of seasonal affective disorder, including the use of antidepressant medication, are also outlined.
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Jia Y, Zhu H, Leung SW. Comparative efficacy of selective serotonin reuptake inhibitors (SSRI) in treating major depressive disorder: a protocol for network meta-analysis of randomised controlled trials. BMJ Open 2016; 6:e010142. [PMID: 27267106 PMCID: PMC4908880 DOI: 10.1136/bmjopen-2015-010142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There have been inconsistent findings from randomised controlled trials (RCTs) and systematic reviews on the efficacies of selective serotonin reuptake inhibitors (SSRIs) as the first-line treatment of major depressive disorder (MDD). Besides inconsistencies among randomised controlled trials (RCTs), their risks of bias and evidence grading have seldom been evaluated in meta-analysis. This study aims to compare the efficacy of SSRIs by conducting a Bayesian network meta-analysis, which will be the most comprehensive evaluation of evidence to resolve the inconsistency among previous studies. METHODS AND ANALYSES SSRIs including citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline and vilazodone have been selected. Systematic database searching and screening will be conducted for the RCTs on drug treatment of patients with MDD according to pre-specified search strategies and selection criteria. PubMed, the Cochrane Library, EMBASE, ScienceDirect, the US Food and Drug Administration Website, ClinicalTrial.gov and WHO Clinical Trials will be searched. Outcome data including Hamilton Depression Rating Scale (HDRS), Montgomery-Åsberg Depression Rating Scale (MADRS) and Clinical Global Impression (CGI) from eligible RCTs will be extracted. The outcomes will be analysed as ORs and mean differences under a random-effects model. A Bayesian network meta-analysis will be conducted with WinBUGS software, to compare the efficacies of SSRIs. Subgroup and sensitivity analysis will be performed to explain the study heterogeneity and evaluate the robustness of the results. Meta-regression analysis will be conducted to determine the possible factors affecting the efficacy outcomes. The Cochrane risk of bias assessment tool will be used to assess the RCT quality, and the Grading of Recommendation, Assessment, Development and Evaluation will be used to assess the strength of evidence from the meta-analysis. ETHICS AND DISSEMINATION No ethical approval is required because this study includes neither confidential personal patient data nor interventions with patients. PROTOCOL REGISTRATION NUMBER CRD42015024879.
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Affiliation(s)
- Yongliang Jia
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Hongmei Zhu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Siu-wai Leung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
- School of Informatics, University of Edinburgh, Edinburgh, UK
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Azorin JM, Adida M, Belzeaux R. Frequency and characteristics of individuals with seasonal pattern among depressive patients attending primary care in France. Gen Hosp Psychiatry 2015; 37:76-80. [PMID: 25467075 DOI: 10.1016/j.genhosppsych.2014.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/30/2014] [Accepted: 11/02/2014] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Jean-Michel Azorin
- Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France.
| | - Marc Adida
- Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France
| | - Raoul Belzeaux
- Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France
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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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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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Simonsen H, Shand AJ, Scott NW, Eagles JM. Seasonal symptoms in bipolar and primary care patients. J Affect Disord 2011; 132:200-8. [PMID: 21429586 DOI: 10.1016/j.jad.2011.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 02/17/2011] [Accepted: 02/17/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is evidence of seasonality in bipolar affective disorder (BAD) and the preponderance of atypical symptoms in bipolar depressive episodes is also seen in winter type Seasonal Affective Disorder. Differences in seasonal symptoms between BAD and appropriate comparison populations have been scrutinised only in small studies. METHODS Symptoms described on the Seasonal Pattern Assessment Questionnaire (SPAQ) were compared between 183 patients with BAD and 468 patients consulting their general practitioners. Statistical analyses were adjusted for differing age and gender distributions between the two groups. RESULTS Compared with the general practice patients, subjects with BAD reported greater seasonal fluctuations in mood (p=0.003). On one measure BAD subjects reported increased seasonal changes in social activity (p<0.001) and greater weight fluctuation over the year (p=0.001). The most striking differences were in sleep patterns; BAD subjects slept significantly more throughout the year, and slept for a mean of 1.8h more in winter than in summer (versus a 1.0h difference in the general practice group, p<0.001). Against 20% of the general practice group, 46% of BAD patients rated seasonal changes in well-being to be at least a moderate problem. LIMITATIONS The SPAQ was designed as a screening instrument for Seasonal Affective Disorder, not for studies of this nature. Some of the reported differences, notably in social activity and weight changes, may reflect secondary psychosocial effects of BAD. CONCLUSIONS Seasonal changes, most notably winter hypersomnia, should be identified in patients with BAD. These symptoms may respond to treatments such as light therapy that are used in recurrent winter depression.
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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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Vigod SN, Levitt AJ. Seasonal severity of depressive symptoms as a predictor of health service use in a community-based sample. J Psychiatr Res 2011; 45:612-8. [PMID: 20980021 DOI: 10.1016/j.jpsychires.2010.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 09/24/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine whether severity of seasonal depressive symptoms is an independent predictor of depression-specific health service use. METHODS Cross-sectional telephone survey evaluating mood-related symptom changes across seasons using a structured interview based on the World Mental Health Composite International Diagnostic Interview, in a community sample representative of the province of Ontario, Canada (N = 1605). This study focuses on the 625 individuals (out of a total of 1605 interviewed) who screened positive for lifetime depressive symptoms. Severity of seasonal symptoms of depression (or "seasonality") was measured using the Seasonal Depression Severity (SDS) score (range 0-36). The primary outcome was lifetime depression-specific use of health services from a physician (family physician or psychiatrist). Lifetime psychotropic medication use, use of health services from a non-physician therapist, and psychiatric hospitalization were secondary outcomes. Other important variables that are known to predict depression-specific health service use were considered in multivariable analysis. RESULTS In our sample of individuals with depressive symptoms, those who had used physician health services had higher SDS scores than non-users (11.5 (SD 7.2) vs. 9.7 (SD 6.4), t(616) = 3.182, P = 0.001). In multivariable analysis, SDS score was independently associated with depression-specific health service use by a physician (OR = 1.04, 95% CI 1.01-1.07, p = 0.004). The relationship between seasonality and use of psychotropic medication use was similar (OR = 1.04, 95% CI 1.01-1.07, p = 0.007). CONCLUSIONS Seasonality was independently associated with depression-specific health service use for individuals with depressive symptoms. The results imply that greater seasonality may independently reflect increased severity and need for treatment of depression.
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Affiliation(s)
- Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Øyane NM, Ursin R, Pallesen S, Holsten F, Bjorvatn B. Increased health risk in subjects with high self-reported seasonality. PLoS One 2010; 5:e9498. [PMID: 20209129 PMCID: PMC2831056 DOI: 10.1371/journal.pone.0009498] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 02/03/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Seasonal variations in mood and behaviour, termed seasonality, are commonly reported in the general population. As a part of a large cross-sectional health survey in Hordaland, Norway, we investigated the relationship between seasonality, objective health measurements and health behaviours. METHODOLOGY/PRINCIPAL FINDINGS A total of 11,545 subjects between 40-44 years old participated, completing the Global Seasonality Score, measuring seasonality. Waist/hip circumference, BMI and blood pressure were measured, and blood samples were analyzed for total cholesterol, HDL cholesterol, triglycerides and glucose. Subjects also completed a questionnaire on miscellaneous health behaviours (exercise, smoking, alcohol consumption). Hierarchical linear regression analyses were used to investigate associations between seasonality and objective health measurements, while binary logistic regression was used for analysing associations between seasonality and health behaviours. Analyses were adjusted for sociodemographic factors, month of questionnaire completion and sleep duration. Seasonality was positively associated with high waist-hip-ratio, BMI, triglyceride levels, and in men high total cholesterol. Seasonality was negatively associated with HDL cholesterol. In women seasonality was negatively associated with prevalence of exercise and positively associated with daily cigarette smoking. CONCLUSIONS/SIGNIFICANCE High seasonality was associated with objective health risk factors and in women also with health behaviours associated with an increased risk for cardiovascular disease.
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Affiliation(s)
- Nicolas M Øyane
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
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Abstract
Seasonal affective disorder (SAD) is defined as a history of major depressive episodes that recur regularly at a particular time of year. Depending on the diagnostic instruments and criteria available, the reported prevalence (1%-10%) varies. Neurotransmitter abnormalities have been implicated in the pathophysiology, but they do not necessarily explain the seasonal pattern or the known chronobiological abnormalities in SAD compared with nonseasonal depression. Circadian rhythm abnormalies have been hypothesized to account for these aspects of SAD, and they provide a rationale for the therapeutic use of light therapy. Family history, twin, and molecular genetics studies suggest that hereditary factors are also involved. Light therapy and antidepressant medication are effective treatment options, with limited evidence for the efficacy of psychotherapy. Some studies demonstrate that narrow-band short wavelength "blue" light, naturalistic dawn simulation, and high-density negative air ionization are effective. Patients should be informed of the benefits of diet and exercise. Light therapy should be clinically monitored in the same manner, as it is done for other antidepressant treatments.
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Affiliation(s)
- Robert H Howland
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
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14
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Eagles JM, Scott NW, Cameron IM, Wileman SM, Naji SA. Dates of birth and seasonal changes in well-being among 4904 subjects completing the seasonal pattern assessment questionnaire. J Affect Disord 2007; 104:161-5. [PMID: 17379317 DOI: 10.1016/j.jad.2007.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 02/12/2007] [Accepted: 02/14/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Abnormal distributions of birthdates, suggesting intrauterine aetiological factors, have been found in several psychiatric disorders, including one study of out-patients with Seasonal Affective Disorder (S.A.D.). We investigated birthdate distribution in relation to seasonal changes in well-being among a cohort who had completed the Seasonal Pattern Assessment Questionnaire (SPAQ). METHOD A sample of 4904 subjects, aged 16 to 64, completed the SPAQ. 476 were cases of S.A.D. on the SPAQ and 580 were cases of sub-syndromal S.A.D. (S-S.A.D.). 92 were interview confirmed cases of S.A.D. Months and dates of birth were compared between S.A.D. cases and all others, between S.A.D. and S-S.A.D. cases combined and all others, and between interview confirmed cases and all others. Seasonality, as measured through seasonal fluctuations in well-being on the Global Seasonality Scores (GSS) of the SPAQ, was compared for all subjects by month and season of birth. RESULTS There was no evidence of an atypical pattern of birthdates for subjects fulfilling criteria for S.A.D., for the combined S.A.D./S-S.A.D. group or for interview confirmed cases. There was also no relationship between seasonality on the GSS and month or season of birth. LIMITATIONS Diagnoses of S.A.D. made by SPAQ criteria are likely to be overinclusive. CONCLUSION Our findings differ from studies of patients with more severe mood disorders, including psychiatric out-patients with S.A.D. The lack of association between seasonality and birthdates in our study adds credence to the view that the aetiology of S.A.D. relates to separable factors predisposing to affective disorders and to seasonality.
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Affiliation(s)
- John M Eagles
- Royal Cornhill Hospital, Cornhill Road, Aberdeen, AB25 2ZH, UK.
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Rastad C, Ulfberg J, Sjödén PO. High prevalence of self-reported depressive mood during the winter season among Swedish senior high school students. J Am Acad Child Adolesc Psychiatry 2006; 45:231-238. [PMID: 16429094 DOI: 10.1097/01.chi.0000190466.93447.0e] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There are few studies regarding the prevalence of seasonal variation in mood among children and adolescents. The main objective of this study was to estimate the prevalence of self-reported depressive mood during the winter season among Swedish adolescents and to investigate gender differences. Another aim was to analyze the factor structure and internal consistency of the Kiddie SPAQ (K-SPAQ), a pediatric version of the Seasonal Pattern Questionnaire (SPAQ). METHOD All students 17 to 18 years old, registered in the second year of senior high school in Falun, a district in central Sweden, were screened with the K-SPAQ in January 2003 (response rate 87.3%, n = 756). RESULTS The prevalence of self-reported depressive mood during the winter season was estimated at 20.1% (n = 151/751) and was higher among girls (25.5%) than boys (13.8%). Approximately 8% reported more severe depressive symptoms. Depressive mood during the summer was rare (0.1%, n = 1/751). Factor analysis of the General Seasonal Score items in the K-SPAQ revealed a two-factor structure. A Cronbach's alpha of 0.87 demonstrated a good internal consistency. CONCLUSIONS Depressive symptoms during autumn and winter were common among Swedish senior high school students, especially among girls. This is probably an underdiagnosed condition among adolescents that ought to receive more attention from the health and school authorities.
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Affiliation(s)
- Cecilia Rastad
- From the Center for Clinical Research Dalarna (CKF) and the Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden (C.R.); the Sleep Disorders Center, Department of Internal Medicine, Avesta Hospital, Avesta, Sweden, and CKF (J.U.); and the Department of Public Health and Caring Sciences, Uppsala University, and CKF (P.O.S.).
| | - Jan Ulfberg
- From the Center for Clinical Research Dalarna (CKF) and the Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden (C.R.); the Sleep Disorders Center, Department of Internal Medicine, Avesta Hospital, Avesta, Sweden, and CKF (J.U.); and the Department of Public Health and Caring Sciences, Uppsala University, and CKF (P.O.S.)
| | - Per-Olow Sjödén
- From the Center for Clinical Research Dalarna (CKF) and the Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden (C.R.); the Sleep Disorders Center, Department of Internal Medicine, Avesta Hospital, Avesta, Sweden, and CKF (J.U.); and the Department of Public Health and Caring Sciences, Uppsala University, and CKF (P.O.S.)
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16
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Abstract
The prevalence of winter depression was unknown in Sweden, therefore prevalence figures of seasonal affective disorder (SAD) and subsyndromal SAD (S-SAD) were estimated. Age and gender differences, prevalence in the group of non-responders and some psychometric qualities of the Seasonal Pattern Assessment Questionnaire (SPAQ) were calculated. A modified version of the SPAQ was sent to a random sample of 2500 persons (response rate 66.3%, n=1657) between 18 and 64 years residing in Dalarna, a county in central Sweden. The sample was proportionally stratified according to age, gender and home municipality. The prevalence of winter SAD was estimated at 8% and S-SAD at 10.8%. It was approximately twice as common among women and younger persons. A total of 3.1% reported seasonal problems to be severe or disabling and 19.3% that everyday life was negatively affected. Experiencing seasonally changing depressive symptoms was common in the population. Factor analysis of the Global Seasonal Score resulted in one factor and the internal consistency was 0.88 (Cronbach's alpha). The results indicate that self-reported recurrent depression during winter is common in Sweden and should therefore receive more attention from health care authorities.
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Affiliation(s)
- Cecilia Rastad
- Center for Clinical Research Dalarna (CKF), Falun, Sweden. cecilia,
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17
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Abstract
The operational criteria for seasonal affective disorder (SAD) have undergone several changes since first proposed in 1984. SAD is currently included as a specifier of either bipolar or recurrent major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The International Classification of Diseases, Tenth Edition has provisional diagnostic criteria for SAD. The most characteristic quality of SAD is that the symptoms usually present during winter and remit in the spring. Furthermore, the symptoms tend to remit when the patients are exposed to daylight or bright light therapy. The cognitive and emotional symptoms are as in other types of depression but the vegetative symptoms are the reverse of classic depressive vegetative symptoms, namely increased sleep and increased appetite. SAD is a common condition, but the exact prevalence rates vary between different studies and countries and is consistently found to be more common in women and in youth. SAD probably possibly occurs in children although not as commonly as in young adults. Some studies have found that certain ethnic groups who live at high northern latitudes may have adapted to the long arctic winter.
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Affiliation(s)
- Andres Magnusson
- Department of Psychiatry, Aker University Hospital, Oslo, Norway.
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18
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Thompson C, Thompson S, Smith R. Prevalence of seasonal affective disorder in primary care; a comparison of the seasonal health questionnaire and the seasonal pattern assessment questionnaire. J Affect Disord 2004; 78:219-26. [PMID: 15013246 DOI: 10.1016/s0165-0327(02)00314-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2002] [Revised: 08/02/2002] [Accepted: 08/16/2002] [Indexed: 10/27/2022]
Abstract
BACKGROUND Prevalence rates of SAD suggested by previous studies have ranged from 1 to 12% depending on the diagnostic criteria used. The Seasonal Pattern Assessment Questionnaire (SPAQ), a widely used screening tool, has been shown to have low specificity for SAD. The Seasonal Health Questionnaire (SHQ) was designed to better reflect the clinical criteria for SAD and has been shown to have a higher specificity then the SPAQ in a psychiatric outpatient setting. OBJECTIVE The current study was designed to assess the validity of the SHQ in general practice against systematic research interviews, to compare the sensitivity, specificity and positive predictive values of the SHQ and the SPAQ and to use these data to estimate the prevalence of SAD in primary care. METHODS 809 subjects in a consecutive series of patients attending Southampton general practices in winter 2000/01 completed the SHQ followed by the SPAQ; 56 were interviewed using the Structured Clinical Interview for DSM (SCID). RESULTS The SHQ was more sensitive and specific than the SPAQ and had higher positive and negative predictive values in screening for SAD. The SPAQ indicated a prevalence of SAD of 10.7% (95% CI 8.6-13.1) while the SHQ provided a significantly lower estimate of 5.6% (95% CI 4.2-7.4).
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Affiliation(s)
- Chris Thompson
- Community Clinical Sciences Research Division, University of Southampton, Royal South Hants Hospital, Brinton's Terrace, Southampton SO19 4YP, UK.
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19
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Abstract
OBJECTIVE To estimate the prevalence of seasonal affective disorder (SAD) and its subsyndromal form (S-SAD) in Switzerland (47 degrees N). METHOD A representative sample from all three language areas of Switzerland (n = 980) were given a structured telephone interview using the extended Seasonal Pattern Assessment Questionnaire (SPAQ+). A smaller, but also representative sample in the city of Basel filled in the SPAQ+ form as well as undergoing a structured diagnostic interview. RESULTS In this Swiss sample, 2.2% of the population presented with symptom severity of SAD, 8.9% with S-SAD. In Basel, a much higher prevalence of SAD was found. Seasonal problems occurred more often in patients with the Diagnostic and Statistical Manual (DSM)-III diagnosis of major affective disorders than in those with pure anxiety disorders or no psychiatric diagnosis. CONCLUSION These estimates for SAD in Switzerland are similar to those found in the Zürich Study, using other methods, and for populations in the UK, with the limitations inherent in retrospective questionnaire studies.
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Affiliation(s)
- A Wirz-Justice
- Centre for Chronobiology, Psychiatric University Clinic and Outpatient Clinic, Basel, Switzerland
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20
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Eagles JM, Andrew JE, Wileman SM, Howie FL, Cameron IM, Naji SA. Seasonal affective disorder and social deprivation in Aberdeen. J Affect Disord 2002; 70:337-40. [PMID: 12128248 DOI: 10.1016/s0165-0327(01)00368-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Unlike non-seasonal depression, there is some evidence that seasonal affective disorder (SAD) is more common among more affluent socioeconomic groups. METHODS In primary care settings in Aberdeen, 4557 subjects had previously completed a Seasonal Pattern Assessment Questionnaire (SPAQ). From the subjects' postcodes they were allocated a Carstairs score which placed them in one of seven categories of socioeconomic deprivation. These categories were compared with regard to seasonal pathology from the SPAQ ratings. RESULTS Complete postcodes and Carstairs scores were established for 3772 (83%) of the 4557 subjects. No statistically significant relationship between socioeconomic deprivation and SPAQ ratings was detected. LIMITATIONS The study population was an affluent one relative to Scotland as a whole which may have reduced the likelihood of a positive finding. The study was conducted 7 years after the census on which postcode deprivation scores were calculated, and changes therein may have occurred. CONCLUSIONS SAD either has no relationship to social deprivation or is associated with affluence and this distinguishes it from non-seasonal depression.
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Affiliation(s)
- John M Eagles
- Royal Cornhill Hospital, Cornhill Road, Aberdeen AB25 2ZH, UK
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21
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McConville C, McQuaid M, McCartney A, Gilmore W. Mood and behaviour problems associated with seasonal changes in Britain and Ireland. Int J Soc Psychiatry 2002; 48:103-14. [PMID: 12182505 DOI: 10.1177/002076402128783154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Research from across the world has shown that rates of seasonal mood disturbances may vary according to such factors as geographical location, age and gender. Little is known of the nature of these problems within representative community samples in UK and Ireland. AIMS In two studies we examined the extent to which winter disrupts mood and behaviour among random samples of British and Irish adults. METHODS In the first study, 533 adults randomly chosen from electoral data from four towns spread across 50-58 degrees N completed the Seasonal Pattern Assessment Questionnaire (SPAQ). In the second study, 498 adults from two towns in Northern Ireland (54 degrees N) completed the SPAQ. RESULTS Although the combined response rate across the two studies was low (20.5%), the prevalence rates were similar to several other western European sites. The rate of SAD and S-SAD averaged across the six centres as determined from strict SPAQ criteria, was 6.7% and 10.5% respectively. There was some variability in rates from town to town, with one Northern Irish town presenting rates more associated with areas at much lower latitudes, although most differences between towns were not significant. As in most other studies, females of reproductive age tended to supply the higher number of incidences. CONCLUSION This report from community samples across six sites confirms earlier suggestions that rates of seasonal disturbance in mood and behaviour deserve serious consideration by mental health practitioners throughout the region.
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Affiliation(s)
- Chris McConville
- School of Psychology, University of Ulster, Coleraine, Co. Londonderry
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22
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Eagles JM, Howie FL, Cameron IM, Wileman SM, Andrew JE, Robertson C, Naji SA. Use of health care services in seasonal affective disorder. Br J Psychiatry 2002; 180:449-54. [PMID: 11983643 DOI: 10.1192/bjp.180.5.449] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Little is known about the presentation and management of seasonal affective disorder (SAD) in primary care. AIMS To determine the use of health care services by people suffering from SAD. METHOD Following a screening of patients consulting in primary care, 123 were identified as suffering from SAD. Each was age- and gender-matched with two primary care consulters with minimal seasonal morbidity, yielding 246 non-seasonal controls. From primary care records, health care usage over a 5-year period was established. RESULTS Patients with SAD consulted in primary care significantly more often than controls and presented with a wider variety of symptoms. They received more prescriptions, underwent more investigations and had more referrals to secondary care. CONCLUSIONS Patients with SAD are heavy users of health care services. This may reflect the condition itself, its comorbidity or factors related to the personality or help-seeking behaviour of sufferers.
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Affiliation(s)
- John M Eagles
- Royal Cornhill Hospital, Cornhill Road, Aberdeen AB25 2ZH, Scotland, UK.
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23
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Affiliation(s)
- J M Eagles
- Department of Psychiatry, Royal Cornhill Hospital, AB25 2ZH, Scotland, Aberdeen, UK.
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24
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Michalak EE, Wilkinson C, Dowrick C, Wilkinson G. Seasonal affective disorder: prevalence, detection and current treatment in North Wales. Br J Psychiatry 2001; 179:31-4. [PMID: 11435265 DOI: 10.1192/bjp.179.1.31] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a paucity of information concerning the prevalence and detection of seasonal affective disorder (SAD) in UK populations. AIMS To determine the prevalence, detection and current treatment of SAD within a general population sample. METHOD The study was conducted in conjunction with the Outcomes of Depression International Network (ODIN) project, a large European study of depression. At the North Wales arm of the project, 1999 adults were randomly selected from a health authority database and screened by post for SAD with the Seasonal Patterns Assessment Questionnaire (SPAQ). Those scoring above cut-off were offered diagnostic interview, after which diagnosis of SAD according to DSM-IV criteria could be made. RESULTS The prevalence rate of SAD was calculated to be 2.4% (95% CII.4-1.3). The majority of identified cases had not previously received a diagnosis of SAD from their general practitioner, although over half had been diagnosed with other forms of depression and had been prescribed antidepressant medication. CONCLUSIONS Although SAD was found to be common in this general population sample it appeared to be largely underdiagnosed and/or misdiagnosed.
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Affiliation(s)
- E E Michalak
- North Wales Section of the Department of General Practice, University of Wales College of Medicine, UK
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25
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Wileman SM, Eagles JM, Andrew JE, Howie FL, Cameron IM, McCormack K, Naji SA. Light therapy for seasonal affective disorder in primary care: randomised controlled trial. Br J Psychiatry 2001; 178:311-6. [PMID: 11282809 DOI: 10.1192/bjp.178.4.311] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Studies of light therapy have not been conducted previously in primary care. AIMS To evaluate light therapy in primary care. METHOD Fifty-seven participants with seasonal affective disorder were randomly allocated to 4 weeks of bright white or dim red light. Baseline expectations for treatment were assessed. Outcome was assessed with the Structured Interview Guide for the Hamilton Depression Scale, Seasonal Affective Disorder Version. RESULTS Both groups showed decreases in symptom scores of more than 40%. There were no differences in proportions of responders in either group, regardless of the remission criteria applied, with around 60% (74% white light, 57% red light) meeting broad criteria for response and 31% (30% white light, 33% red light) meeting strict criteria. There were no differences in treatment expectations. CONCLUSIONS Primary care patients with seasonal affective disorder improve after light therapy, but bright white light is not associated with greater improvements.
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Affiliation(s)
- S M Wileman
- Health Services Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
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