Ethnic differences in seasonal affective disorder and associated factors among five immigrant groups in Norway.

BACKGROUND: Research studies on seasonal affective disorder (SAD) among immigrant populations are scarce. The objective of this article was to explore the associated risk and protective factors on prevalence of winter SAD (W-SAD), sub syndromal SAD (S-SAD) and Summer-SAD among five immigrant groups living in Oslo, Norway. METHODS: The Oslo Immigrants Health study (innvandrer HUBRO, 2002), is a large cross sectional epidemiological survey conducted among five of the largest immigrant groups living in Oslo. 1047 subjects were included in the analysis out of 3019 who participated in the survey. Mailed questionnaire which included selected items of the seasonal pattern assessment questionnaire (SPAQ), Hopkins symptom check list (HSCL) and other variables were used in the analysis. RESULTS: The lowest levels of W-SAD were found among Sri Lankan men and women and the highest among Iranians. W-SAD was significantly associated with country of birth, younger age, smoking, presence of mental distress, frequent visits to general practitioner or psychiatrist, self reported poor health and presence of chronic disorders. S-SAD was significantly associated with country of birth, smoking and higher levels of alcohol consumption. LIMITATIONS: SPAQ was not culturally validated. Poor response rate (39.7%) can also be considered as a limitation. CONCLUSIONS: Ethnic differences in W-SAD and S-SAD were observed. Sri Lankans had the lowest levels of W-SAD. However, there is a need for culturally validated instruments and further research must focus on exploring protective factors for SAD.

Estacionalidad en admisiones hospitalarias por Trastorno Bipolar en Santa María, Córdoba, Argentina / Seasonal pattern in hospital admissions due to bipolar disorder in Santa María, Córdoba, Argentina

Introducción: el objetivo del trabajo es establecer si existe un patrón de estacionalidad en las internaciones hospitalarias por trastorno bipolar en el Hospital Colonia Santa María, Córdoba, Argentina, entre los años 2000 y 2003. Materiales y métodos: se tomaron los episodios afectivos internados con diagnóstico de trastorno bipolar (CIE-IO) durante el período y se analizaron las historias clínicas según los criterios del DSM-IV. Se incluyeron las internaciones de toda la historia patobiográfica del individuo. Resultados: se incluyeron 84 episodios afectivos: 43 maníacos (51%), 20 depresivos (24%), 15 mixtos (18%) y 6 hipomaníacos (7%). Se encontró una asociación estadísticamente significativa (p<0,001) entre episodios afectivos del trastorno bipolar y estación del año, con un patrón estacional de manía-hipomanía en verano y depresión en invierno. Los episodios mixtos presentan pico en verano pero se distribuyen más uniformemente en el año. Conclusiones: existe estacionalidad en las internaciones por trastorno bipolar.

Introduction: The purpose of this research is to establish if there is a seasonal pattern in hospitalizations due to affective episodes of bipolar disorder in Hospital Colonia Santa Maria, Córdoba, Argentina, between 2000-2003. Materials and methods: The affective episodes considered were those which required patient hospitalization with bipolar disorder diagnosis (ICD-I0). Medical histories were analyzed subsequently, according to the DSM-IV criteria. The episodes considered were those with hospitalization during all the pathobiographical history of the patient. Outcome: 84 affective episodes were considered. 43 were maniac (51 %), 20 were depressive (24%), 15 were mixed (18%) and 6 were hypomaniac (7%). A statistically significant association was found (p<0,00l) between affective episodes of bipolar disorder and the season of the year, with a seasonal pattern of mania-hypomania in summer and depression in winter. Mixed episodes were distributed more consistently in the year with a peak in summer. Conclusion: In this research a relationship is established between bipolar disorder and seasonal nature in hospitalizations.

Estacionalidad en admisiones hospitalarias por Trastorno Bipolar en Santa María, Córdoba, Argentina / Seasonal pattern in hospital admissions due to bipolar disorder in Santa María, Córdoba, Argentina

Introducción: el objetivo del trabajo es establecer si existe un patrón de estacionalidad en las internaciones hospitalarias por trastorno bipolar en el Hospital Colonia Santa María, Córdoba, Argentina, entre los años 2000 y 2003. Materiales y métodos: se tomaron los episodios afectivos internados con diagnóstico de trastorno bipolar (CIE-IO) durante el período y se analizaron las historias clínicas según los criterios del DSM-IV. Se incluyeron las internaciones de toda la historia patobiográfica del individuo. Resultados: se incluyeron 84 episodios afectivos: 43 maníacos (51%), 20 depresivos (24%), 15 mixtos (18%) y 6 hipomaníacos (7%). Se encontró una asociación estadísticamente significativa (p<0,001) entre episodios afectivos del trastorno bipolar y estación del año, con un patrón estacional de manía-hipomanía en verano y depresión en invierno. Los episodios mixtos presentan pico en verano pero se distribuyen más uniformemente en el año. Conclusiones: existe estacionalidad en las internaciones por trastorno bipolar.(AU)

Introduction: The purpose of this research is to establish if there is a seasonal pattern in hospitalizations due to affective episodes of bipolar disorder in Hospital Colonia Santa Maria, Córdoba, Argentina, between 2000-2003. Materials and methods: The affective episodes considered were those which required patient hospitalization with bipolar disorder diagnosis (ICD-I0). Medical histories were analyzed subsequently, according to the DSM-IV criteria. The episodes considered were those with hospitalization during all the pathobiographical history of the patient. Outcome: 84 affective episodes were considered. 43 were maniac (51 %), 20 were depressive (24%), 15 were mixed (18%) and 6 were hypomaniac (7%). A statistically significant association was found (p<0,00l) between affective episodes of bipolar disorder and the season of the year, with a seasonal pattern of mania-hypomania in summer and depression in winter. Mixed episodes were distributed more consistently in the year with a peak in summer. Conclusion: In this research a relationship is established between bipolar disorder and seasonal nature in hospitalizations.(AU)

Seasonal changes in sleep duration in African American and African college students living in Washington, D.C.

Duration of nocturnal melatonin secretion, a marker of "biological night" that relates to sleep duration, is longer in winter than in summer in patients with seasonal affective disorder (SAD), but not in healthy controls. In this study of African and African American college students, we hypothesized that students who met criteria for winter SAD or subsyndromal SAD (S-SAD) would report sleeping longer in winter than in summer. In addition, based on our previous observation that Africans report more "problems" with change in seasons than African Americans, we expected that the seasonal changes in sleep duration would be greater in African students than in African American students. Based on Seasonal Pattern Assessment Questionnaire (SPAQ) responses, African American and African college students in Washington, D.C. (N = 575) were grouped into a winter SAD/S-SAD group or a no winter diagnosis group, and winter and summer sleep length were determined. We conducted a 2 (season) x 2 (sex) x 2 (ethnicity) x 2 (winter diagnosis group) ANCOVA on reported sleep duration, controlling for age. Contrary to our hypothesis, we found that African and African American students with winter SAD/S-SAD report sleeping longer in the summer than in the winter. No differences in seasonality of sleep were found between African and African American students. Students with winter SAD or S-SAD may need to sacrifice sleep duration in the winter, when their academic functioning/efficiency may be impaired by syndromal or subsyndromal depression, in order to meet seasonally increased academic demands.

Mood sensitivity to seasonal changes in African college students living in the greater Washington D.C. metropolitan area.

The purpose of this study was to estimate the degree of seasonality and prevalence of winter- and summer-type seasonal affective disorder (SAD) in African immigrant college students in comparison with African American peers. A convenience sample of 246 African immigrants and 599 African Americans studying in Washington, D.C. completed the Seasonal Pattern Assessment Questionnaire (SPAQ), which was used to calculate a global seasonality score (GSS) and to estimate the prevalence of winter- and summer-type SAD. Degree of seasonality was related to a complex interaction between having general awareness of SAD, ethnicity, and gender. A greater percentage of African students reported experiencing a problem with seasonal changes relative to African American students, and had summer SAD, but the groups did not differ on GSS and winter SAD. African students reported more difficulties with seasonal changes than their African American peers, which could represent a manifestation of incomplete acclimatization to a higher latitude and temperate climate. As Africans also had a greater rate of summer SAD, this argues against acclimatization to heat.

Seasonal changes in mood and creative activity among eminent Italian writers.

A sample of 33 eminent Italian writers was studied. They were nominees of three of the most important literary Italian awards (Strega, Campiello, and Viareggio). The Seasonal Pattern Assessment Questionnaire was mailed to 105 writers during the period October 2003 and January 2004, of whom 39 replied. 33 (M age=54.5 yr., SD= 12.5; 8 women and 25 men) completed the questionnaire. Among respondents, spring and summer months showed highest ratings of "feel best." During the summer a decline in creativity was not significant; respondents also reported sleeping least. Scores on the Global Seasonality Score suggested writers appeared to show higher seasonal sensitivity than the general population. Seasonal changes were considered as a problem by a majority of them. Although writers showed high seasonal sensitivity, no significant relationship was found between the seasonal pattern of mood and self-reported creativity.

Seasonal variation in mood in African American college students in the Washington, D.C., metropolitan area.

OBJECTIVE: The authors attempted to estimate the occurrence, frequency, and pattern (winter versus summer) of seasonal affective disorder in African American college students. They hypothesized that winter seasonal affective disorder would be more prevalent than summer seasonal affective disorder. METHOD: Undergraduate and graduate college students who identified themselves as African Americans living in the Washington, D.C., metropolitan area were invited to participate in the study. The Seasonal Pattern Assessment Questionnaire was used to calculate a global seasonality score and to estimate the frequency of seasonal affective disorder and subsyndromal seasonal affective disorder. The frequency of the summer versus winter pattern of seasonality of seasonal affective disorder was compared by using multinomial probability distribution tests. The effects of gender and the awareness of seasonal affective disorder were evaluated with a two-way analysis of variance. RESULTS: Of 646 students who were invited to participate, 597 returned the questionnaires, and 537 (83.1%) fully completed them. Winter seasonal affective disorder was significantly more prevalent than summer seasonal affective disorder. The mean global seasonality score was 8.3 (SD=5.3). The majority of the subjects (80%) were not aware of the existence of seasonal affective disorder. CONCLUSIONS: The authors found that the frequency, magnitude, and pattern of seasonality of mood in African American students were similar to those previously reported in the general population at similar latitude, but that awareness of the existence of seasonal affective disorder, a condition with safe and effective treatment options, was lower.

Cross-regional survey of seasonal affective disorders in adults and high-school students in Japan.

BACKGROUND: In Asian countries, there is no epidemiological report on seasonal affective disorder (SAD) in different age groups and different geographic regions surveyed at the same time. The aim of this study was to estimate the prevalence rates of SAD and risk factors for SAD in adults and high-school students, with special reference to the difference of winter SAD between northern and southern regions in Japan. METHODS: A total of 3237 high-school students and 4858 workers living in Japan (31.3-43.5 degrees N) responded to this epidemiological survey using Japanese version of the Seasonal Pattern Assessment Questionnaire (SPAQ). RESULTS: The overall prevalence rates of winter SAD (subsyndromal winter SAD) and summer SAD (subsyndromal summer SAD) in high-school students were 0.91(2.21) and 0.81(2.57)%, respectively. In workers, these rates were 0.45(1.16) and 0.43(0.71)%, respectively. Although no regional difference was noted in high-school students with winter seasonal type, the estimated odds ratio of this type for northern workers was nearly 3-fold higher than the southern counterparts. The prevalence rates of each seasonal type were not significantly different between two sexes in both age groups. No clear dependence on latitude was seen with regard to summer SAD in both age groups. LIMITATIONS: The effect of climate on SAD could not be entirely excluded from geophysical factor as indexed by latitude. CONCLUSIONS: SAD was less common in adults than in high-school students. While latitude was a major determinant of winter type in adults, socio-cultural factors or other contributing factors might affect the development of this type in high-school students.

Changes of clinical pattern in seasonal affective disorder (SAD) over time in a German-speaking sample.

OBJECTIVE: The goals of this study are to provide estimates of clinical and demographic variables of patients with seasonal affective disorder (SAD) in Germany and Austria, to compare our results with those of previously published SAD studies, and to find out whether the clinical pattern of SAD remained stable over several years. METHOD: We investigated 610 SAD patients from the outpatient clinics in Bonn (n = 190) and Vienna (n = 420). Patients in Bonn were recruited in the fall-winter season of the years 1989-1992, those in Vienna in the years 1993-2001. RESULTS: We observed a change in the clinical pattern in our patients: patients from Bonn, who were diagnosed and treated about 5 years earlier, were more likely to suffer from melancholic depression, whereas Viennese patients rather suffered from atypical depression (chi(2) = 54.952, df = 2, p < 0.001). The symptoms of hypersomnia, daytime fatigue, increased eating and carbohydrate-craving were more frequent in the Viennese sample, anxiety and deterioration of patients' capacity to perform at work predominated in Bonn. In addition, patients from Vienna obtained a higher GSS (global seasonality score, measured by the SPAQ - Seasonal Pattern Assessment Questionnaire) than those from Bonn (15.7 +/- 3.3 and 14.6 +/- 4.1 respectively; t = 3.104, p = 0.002). Taken together, our results were in good accordance to other published SAD materials, but we were able to demonstrate that our patients reported "feeling worst" (measured by item 13H of the SPAQ) in November and December, whereas SAD patients in the USA clearly had their worst months in January and February. CONCLUSIONS: We suggest that an increase in awareness of fall-winter depression in the last decade by both doctors, who referred patients, as well as patients or the entire population must have caused patients to sign up for light therapy at the Viennese SAD clinic because of having heard about the atypical symptom profile. This increased awareness of SAD can also be measured by a statistically significant reduction in the diagnostic latency (from the age of onset to the diagnosis of SAD) when comparing the two study locations.

Differences in prevalence of seasonal affective disorder that are not explained by either genetic or latitude differences.

The prevalence of winter SAD was measured in two groups of a(lult Manitobans of wholly Icelandic (lescent, 210 resident in Winnipeg (50 degrees N) and 252 resident in the nearby Interlake district (50.5 degrees N), using the Seasonal Pattern Assessment Questionnaire (SPAQ). These groups live practically at the same latitude and are according to all indications genetically identical. The age-and-sex-standardized prevalence rates of winter SAD proved to be markedly higher in the Winnipeg population than in the Interlake population: 4.8% and 1.2% (p<0.001), respectively. This four-fold dif ference is evidently unexplained by genetic factors or a difference in latitude; its causes have yet to be discovered.

Summer and winter patterns of seasonality in Chinese college students: a replication.

The goal of this study is to replicate an earlier epidemiological finding of seasonal changes in mood and behavior among Chinese medical students using an independent study population. Three hundred nineteen college students were surveyed with a Chinese version of the Seasonal Pattern Assessment Questionnaire (SPAQ) and the Beck Depression Inventory (BDI) in Jining, China, during March of 1996. The frequency of seasonal patterns and prevalence rates of seasonal affective disorder (SAD) were estimated and compared with data from the medical student survey conducted in the same city. The mean Global Seasonality Score (GSS) of this college student sample was 9.9 +/- 4.9; 84% of the subjects reported some problems with the changing seasons. Summer difficulties were more prevalent than winter difficulties by a ratio of 1.9 to 1 (38.9% v 20.1%). The estimated rates of summer SAD and subsyndromal-SAD (s-SAD) were 7.5% and 11.9%, respectively, as compared with the corresponding winter figures of 5.6% and 6.3%. In addition, the prevalence estimates of winter pattern or winter SADs were higher in males than in females, but the corresponding summer figures showed no gender difference. Compared with the data from the medical student survey, this college student sample had a higher GSS (P < .01) but comparable summer to winter and female to male ratios for the prevalence of SADs (P > .05). These results replicate our previous findings that seasonal problems are common in China, but the predominant problems are summer difficulties rather than winter difficulties, and there is no female preponderance in the prevalence estimates of such problems. Both findings stand in contrast to most Western studies but are consistent with the only other published study performed in the Orient.

Self-reported seasonal variation in depression at 78 degree north. The Svalbard Study.

STUDY OBJECTIVES: To explore and compare the one year prevalence of self-reported depression in two ethnically different populations. DESIGN: A cross-sectional study of each population (1988-89 and 1993). SETTING: Norwegians living in Longyearbyen, Svalbard, and Russians living in Barentsburg and Pyramiden, Svalbard, both representing the world's two northern most regularly inhabited settlements. PARTICIPANTS: 506 Norwegians (327 men and 179 women) and 446 Russians (314 men and 132 women), all 18 years or older, living on Svalbard. MAIN RESULTS: Among Russians, the one year prevalence of self-reported depression lasting for at least 2 weeks was 26.8% for men and 44.7% for women. Corresponding figures for the Norwegians were 10.7 and 15.6%. For the period with polar night the figures were 5.5 and 6.7% for Norwegians, and 21.7 and 37.1% for Russian men and women, respectively. Depression was most common in the youngest age-group among Russians and in the oldest age-group among the Norwegians. CONCLUSION: The one year prevalence of depression was 2-3 times higher among Russians compared to Norwegians living on Svalbard. For the period with polar night, the figures were 4-5 times higher for Russians. As both populations are exposed to the same amount of daylight, seasonal depression may therefor not solely be a matter of lack of daylight. Because the Russian population came from lower latitudes than the Norwegians, we hypothesize that insufficient acclimatization after migration to the north is essential for the understanding of seasonal variation in depression.

Understanding seasonal affective disorder and experiences in northern Norway.

PURPOSE: To better understand a diagnosis corresponding to mental distress and sleep disturbance associated with seasonal change known as seasonal affective disorder (SAD). DESIGN: This ethnographically guided investigation, conducted from 1993 through 1995 in Tromsøo, Norway at a latitude of 69 degrees north describes how the residents experience extreme seasonal change. METHOD: Qualitative interview data from 28 participants plus observation, folk wisdom, and literature were used to describe local understanding of seasonality and illustrate how cultural values, meanings, and practices can contribute to alternative experiences that differ from scientists' expectations. FINDINGS: While there is evidence that human physiologic alterations occur in response to the changing seasonal patterns of light and dark and to a greater extent, at latitudes further from the equator, the findings related to psychological changes and their causes remain inconsistent and controversial. CONCLUSION: Investigators concerned with the effects of seasonal change should be aware of and develop an appreciation of cultural perception and adaptation.

Seasonal variations in hospital admissions for affective disorders by gender and ethnicity.

Hospital admission statistics for depression and mania have shown significant seasonal patterns. The present investigation was conducted to establish the pervasiveness of the impact of seasons on mood disorder presentation at Birmingham (52 degrees North) by gender and ethnicity. Non-mood disorder admissions were examined as a control to determine the specificity of any seasonal variation to affective illness. Case notes for 992 admissions, during January-December 1995 inclusive, to an inpatient unit were reviewed retrospectively. Admission data were broken down by gender and into three ethnic groups: Asian, white and black. Seasonality in admissions for depression, bipolar disorder and non-mood disorders was tested by gender and ethnicity. Admission frequencies for depression showed significant seasonal pattern, with the incidence of depression being highest in winter. Total admissions, bipolar and non-mood disorders did not show any significant seasonal variability. A gender effect was evident on seasonality of admissions for affective illness, with significant winter peak for depression and summer peak for bipolar disorder in women only. The Asian group was the only ethnic group that showed significant seasonal variation in depression, with a greater number of depressive episodes in winter. Environmental variables were related significantly to the incidence of mood disorders. Specific seasonal effect for affective illness was evidenced by the non-existence of seasonality in other psychiatric disorders. The reverse seasonal pattern for depression and mania suggests a maladaptive response of vulnerable individuals to specific functions of seasons.