Seasonal mood variation: an epidemiological study in northern Norway

In an epidemiological study carried out in the town of Tromsö in northern Norway an extensive questionnaire was sent twice, in summer and winter, to 1000 subjects to investigate the degree of symptoms of mood variation (depression or hypomania) during the polar winter night and midnight sun seasons. The results suggest that the general population north of the Arctic Circle shows a major seasonal mood variation. It is suggested that seasonal mood variation is a chronobiological mood disturbance related to and probably precipitated by extreme variations in light. The therapeutic implications and preventive measures are discussed.     

The prevalence of seasonal affective disorder in The Netherlands: a prospective and retrospective study of seasonal mood variation in the general population.

BACKGROUND: The aim of the present study was to assess the prevalence of seasonal affective disorder (SAD) in The Netherlands. METHODS: The subjects (n = 5356), randomly selected from community registers, were given the Seasonal Pattern Assessment Questionnaire and the Centre for Epidemiological Studies Depression Scale over a period of 13 months. The response rate was 52.6%. RESULTS: Three percent of the respondents met the criteria for winter SAD, 0.1% for summer SAD. The criteria for subsyndromal SAD, a milder form of SAD, were met by 8.5%, 0.3% of whom showed a summer pattern. Younger women received a diagnosis of SAD more often than men or older women. CONCLUSIONS: SAD subjects were significantly more often unemployed or on sick leave than other subjects. Respondents who met winter SAD criteria were significantly more depressed than healthy subjects, in both winter and summer. Finally, month of completion had no influence on the number of subjects meeting the SAD criteria.     

Depression and activity limitations: examining gender differences in the general population

BACKGROUND: This study examines the relationship between major depression, subclinical depressive symptomatology and activity limitation in a representative sample of Canadian men and women, with a particular emphasis on examining gender differences. METHODS: Over a 4-year period, the three waves of data were collected from a representative sample of Canadian adults aged 18-60 beginning in 1994. A brief diagnostic interview for major depression, current limitations in home, work, and other activities (e.g., leisure), presence of each of 13 chronic medical conditions, and other sociodemographic information were gathered. Regression analyses adjusted for potential confounding of time-dependent and time-invariant covariates. These analyses were performed separately for men and women. RESULTS: Major depression had a significant adverse impact on all types of activities for the entire community sample, and this impact was generally robust when controlling for potential confounders. Gender differences were observed for leisure activities with depressed men showing a higher likelihood of limitation in these activities than depressed women. CONCLUSIONS: The findings provide further evidence that major depression leads to impairments in a range of daily activities. Gender differences in the impact of depression on leisure activities may be important to consider in depression treatment.     

Validity of the mood disorder questionnaire: a general population study

OBJECTIVE: This study tested the validity in the adult general population of the Mood Disorder Questionnaire, a screening instrument for bipolar I and II disorders. The Mood Disorder Questionnaire has been validated in a psychiatric outpatient study group. METHOD: A total of 711 subjects (stratified by Mood Disorder Questionnaire score) were randomly selected from a group of 85,358 adult respondents in a nationwide epidemiological general population sample that was balanced for key demographic variables. Of these, 695 subjects received a telephone interview involving an abbreviated version of the Structured Clinical Interview for DSM-IV. RESULTS: A sensitivity of 0.281 and a specificity of 0.972 were obtained for the Mood Disorder Questionnaire. CONCLUSIONS: The Mood Disorder Questionnaire is a useful screening instrument for bipolar I and II disorders in the community. The operating characteristics of the Mood Disorder Questionnaire in the general population differ substantially from its characteristics in outpatient psychiatric settings.     

Lack of seasonal mood change in the Icelandic population: results of a cross-sectional study

OBJECTIVE: The prevalence of seasonal affective disorder-as measured by the Seasonal Pattern Assessment Questionnaire-has been found to be unexpectedly low among Icelanders. The aim of this cross-sectional study was to measure seasonal variations in the prevalence of anxiety and depression among Icelanders assessed with the Hospital Anxiety and Depression Questionnaire. METHOD: Four 1, 000-person cohorts, age 20-70 years, selected at random from the Icelandic National Register, were sent the Hospital Anxiety and Depression Scale by mail in either January, April, July, or October. Only responses from the 4-week period after each mailing were considered in the subsequent analysis. RESULTS: The mean anxiety and depression scores in winter were not higher than those in summer for either sex. There was no significant difference between winter and summer in rates of actual or borderline cases of anxiety or depression or for the two categories combined. CONCLUSIONS: This lack of seasonality in anxiety and depression is in sharp contrast to findings from similar cross-sectional studies and may reflect the low propensity for seasonal affective disorder that has been described in the Icelandic population.     

Gender differences in the heritability of seasonal mood change

The study estimated gender differences in the magnitude of genetic and environmental influence in seasonal mood change. The self-report Seasonal Pattern Assessment Questionnaire (SPAQ) was completed by 339 volunteer reared-together twin pairs (187 monozygotic pairs, 152 dizygotic pairs) and analysed using biometric genetic models. The SPAQ yields a global seasonality score (GSS) which is an index of change in sleep patterns, social activities, mood, weight, appetite, and energy level. The GSS was significantly heritable among males and females, estimated to account for 69% and 45% of the total variance, respectively. For the individual symptoms, changes in sleep patterns, social activities, mood, appetite, and energy levels were accounted for primarily by additive genetic effects in both males (median, 45.5%) and females (median, 30.5%). For both sexes, weight changes were not heritable. Sex-by-genotype analyses suggested that the genetic factors influencing female seasonality may not be the same as those influencing male seasonality. ©1997 Elsevier Science Ireland Ltd.     

An epidemiological study of eating disorders in a northern area of Japan

Nadaoka T, Oiji A, Takahashi S, Morioka Y, Kashiwakura M, Totsuka S. An epidemiological study of eating disorders in a northern area of Japan. Scand 1996: 93: 305–310. © Munksgaard 1996. A total of 97 patients with eating disorders who visited the Department of Neuro-Psychiatry, Yamagata University Hospital, between 1978 and 1992 were studied. According to the diagnostic criteria of DSM-III-R, there were 48 cases of anorexia nervosa (AN), 38 cases of bulimia nervosa (BN) and 11 cases with both AN and BN. Both the number of patients and the ratio to all out-patients in each year increased four times during the period 1988–1992 compared to the previous period. With regard to their places of residence, the number of patients with AN and with BN from every district appeared to increase at almost the same rate, although the majority of the patients were from medium-sized cities. These findings may indicate that eating disorders are influenced by urbanization.     

Dialectal and gender differences in nasalance for a Mandarin population

The purpose of this study was to determine whether there are dialectal and gender related differences in nasalance of main Mandarin vowels and three sentences in 400 Chinese normal adults. The mean nasalance score difference for dialect and gender was significant (p < .001) in all speech materials. For different dialects, the average nasalance scores show that Chongqing > Beijing > Shanghai > Guangzhou for the nasal sentence, oro-nasal sentence, /a/, /i/ and /u/. In addition, the average nasalance scores of females were higher than those of males for all speech materials in all dialects. The clinical significance of this study can be helpful in making nasalance clinical decisions for Chinese people with cleft palate, hearing disorders and dysarthria with resonance disorders. It also shows the theoretical and socio-cultural features for linguists considering dialects and gender.     

Autism in northern Sweden. A population based follow-up study: Psychopathology

A follow-up study based on a population survey of children with infantile autism from a northern Swedish county is reported. The original survey was performed during 1977–1979. In the country of Västerbottens 39 cases of childhood psychosis were identified in the age group 0–20 years (prevalence 5.6/10,000). According to DSM-III-R, 38 children met the criteria of autistic disorder. The follow-up study was performed in 1987–1988, after eight to nine years. Thirty-four individuals participated (20 males and 14 females). Each child was evaluated according to the Medical Research Council's Schedule of Handicaps, Behaviours and Skills, DSM-III-R symptom check-list, Lotter's modified Questionnaire and information about the academic and social situation. Most symptoms showed stability over time. The individuals had a poor outcome. A few, mostly males, improved in function. Only one boy had grown out of autism without showing any autistic-like symptoms at all. Four cases, the majority being females, showed a mildly deteriorating course. In one case symptoms of schizophrenia developed. In most children language and communication had improved. The few well-functioning individuals with autism in this study were males. The proportion of severe mental retardation was greater in the female group.

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Zusammenfassung Es wurde eine Nachuntersuchung durchgeführt, die auf einer epidemiologischen Untersuchung von Kindern mit infantilem Autismus aus einem nordschwedischen Bezirk basierte. Die Erstuntersuchung erfolgte zwischen 1977 und 1979. In dem Bezirk Västerbottens wurden 39 Fälle von Psychosen im Kindesalter in der Altersgruppe von 0–20 Jahren erfaßt (Prävalenz: 5,6/10.000). 38 Kinder erfüllten die DSM-III-R-Kriterien für eine autistische Störung. Die Nachuntersuchung erfolgte 8–9 Jahre später im Zeitraum von 1987–1988. 34 Individuen (20 männlich, 14 weiblich) nahmen an der Untersuchung teil. Jedes Kind wurde nach den Medical Research Council's Schedule of Handicaps, Behaviours and Skill, den DSM-III-R-Kriterien, Lotter's Modified Questionnaire und anamnestischen Angaben zur akademischen und sozialen Situation untersucht. Die meisten Symptome waren im Verlauf stabil geblieben. Die Prognose erwies sich als insgesamt schlecht. Wenige Kinder, zumeist männlichen Geschlechts, zeigten Funktionsverbesserungen. Lediglich ein Kind war aus dem Autismus herausgewachsen und zeigte keinerlei autistische Züge. Vier Fälle (drei weiblich) zeigten einen langsam progredienten Verlauf. In einem Fall stellten sich Symptome einer Schizophrenie ein. In dieser Studie waren die wenigen gut angepaßten Individuen mit Autismus männlichen Geschlechts. Der Anteil an schwerer geistiger Behinderung war beim weiblichen Geschlecht größer.

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Résumé Une étude de devenir d'une population d'enfants avec autisme infantile provenant d'un comté de Suède du Nord est rapportée. L'étude originale fut effectuée de 1977 à 1979. Dans le comté de Västerbottens 39 cas de psychose infantile furent identifiés dans un groupe d'âge de 0 à 20 ans (prévalence 5.6/10.000). Selon le DSM-III-R 38 enfants répondaient aux critères de troubles autistiques. L'étude de sulvi fut effectuée en 1987 et 1988, après 8 à 9 ans. 34 individus ont participé (20 hommes et 14 femmes). Chaque enfant a été évalué selon l'échelle de handicaps du Medical Research Council, comportements et compétences, DSM-III-R Symptom Check-lists, et le questionnaire modifié de Lotter avec enfin une information sur la situation scolaire et sociale. La pluplart des sympômes montraient une stabilité durant le temps des suivis. Les individus avaient un devenir pauvre. Quelques uns, la plupart des garçons, s'amélioraient dans leur fonctionnement. Seulement un garçon était sorti de l'autisme sans montrer aucun symptôme de type autistique. 4 cas, la majorité des filles, montraient un devenir modérément détérioré. Dans un cas, les symptômes de schizophrénie se sont développés. Pour la plupart des enfants, le langage et la communication s'étaient améliorés. Les quelques individus fonctionnant bien avec l'autisme dans cette étude étaient des garçons. La proportion de retard mental sévère était plus grande dans le groups des filles.

     

Cortisol and catecholamines changes as functions of time-of-day and self-reported mood

Six male graduate students, unrestricted in their lifestyle, collected their own urine over a seven-day period: it was analysed for cortisol, noradrenaline, adrenaline and dopamine. At each urination subjects self-assessed their mood. On two separate days, blood samples were collected at 4-hourly intervals for plasma cortisol assay. Mean plasma cortisol levels showed the expected circadian variation, but two subjects had divergent patterns. Mean urine cortisol accumulation also showed circadian variation with a 2–4 hour lag behind plasma values. Mean urine catecholamine levels showed both time of day and considerable individual variation. A statistical procedure, involving comparison of two models, was developed to determine differences between subjects' excretion patterns. An underlying common pattern of cortisol and catecholamines excretion was found. Regression of hormone levels against self-assessed mood changes revealed correlations of (1) adrenaline accumulation with physical fatigue, (2) cortisol with alertness and (3) ratios of adrenaline, noradrenaline and dopamine with tenseness and irritability.     

Mortality among persons with schizophrenia in Sweden: An epidemiological study

The objective of the study was to analyse 10-year mortality among persons with schizophrenia from an epidemiological perspective. This cohort study included all persons with schizophrenia (n=255) living in the northern catchment area in Uppsala in 1991, and 1275 subjects from the national population register matched for sex, age and living area. The prevalence of schizophrenia was 0.37% and the mortality rate for individuals with schizophrenia was higher than for referents: 23.0% vs. 11.2%. The higher mortality among those with schizophrenia was mainly the result of unnatural causes and cardiovascular disease, especially in men. Excess mortality from cardiovascular disease was more pronounced in middle age, irrespective of gender. Multivariate analysis revealed higher mortality among individuals with schizophrenia living in the city than among those living in less urbanized areas. People with schizophrenia die more often than those without schizophrenia from unnatural causes or circulatory diseases. Individuals with schizophrenia die sooner from circulatory diseases than those without schizophrenia. Having schizophrenia and living in the city also results in higher mortality than having schizophrenia and living in other areas. The risk of early death from circulatory disease needs to be studied in more detail to reveal the potential respective contributions of intrinsic patient vulnerability, lifestyle factors and side-effects from psychotropic drugs.     

Cortisol and catecholamines changes as functions of time-of-day and self-reported mood

Six male graduate students, unrestricted in their lifestyle, collected their own urine over a seven-day period: it was analysed for cortisol, noradrenaline, adrenaline and dopamine. At each urination subjects self-assessed their mood. On two separate days, blood samples were collected at 4-hourly intervals for plasma cortisol assay. Mean plasma cortisol levels showed the expected circadian variation, but two subjects had divergent patterns. Mean urine cortisol accumulation also showed circadian variation with a 2–4 hour lag behind plasma values. Mean urine catecholamine levels showed both time of day and considerable individual variation. A statistical procedure, involving comparison of two models, was developed to determine differences between subjects' excretion patterns. An underlying common pattern of cortisol and catecholamines excretion was found. Regression of hormone levels against self-assessed mood changes revealed correlations of (1) adrenaline accumulation with physical fatigue, (2) cortisol with alertness and (3) ratios of adrenaline, noradrenaline and dopamine with tenseness and irritability.     

Genetic and environmental effects on self-reported depressive symptoms in a general population twin sample

To determine the etiology of self-reported depressive symptoms and their co-occurrence in the general population, multivariate genetic models were fitted to the responses of 771 female twin pairs (463 MZ, 308 DZ) to a 20-item epidemiological depression inventory (CES-D scale). A model which contained one common genetic factor, one shared environmental factor, and four unique environmental factors provided a useful account of symptom covariation. Under this model, the four non-shared environmental factors explained the largest proportion of variance in response to the CES-D scale, whereas a single common genetic factor explained substantially less of the variation in symptomatology. Consistent with previous findings (Kendler, Heath, Martin, & Eaves, Archives of General Psychiatry 43, 213-221, 1986) shared environmental influences were found to play a relatively minor role in the report of depressive symptoms. These results suggest that while genetic factors do contribute to the covariation among symptoms of depression, it is the largely non-shared environmental factors that account for the co-occurrence of symptoms in the general population.     

Seasonal variation of mood and behaviour in a healthy middle-aged population in Japan

A population survey of seasonality in six representative cities in Japan was conducted using the Japanese version of the Seasonal Pattern Assessment Questionnaire (SPAQ). The questionnaires were given to 951 parents (male: female ratio 1 : 1 age range 34-59 years) of high-school students. Significant regional differences in seasonal variations of mood, length of sleep, and weight were observed; the proportion of individuals reporting high seasonality in the two northern cities was significantly higher than that in the other areas. These results provide evidence for a northern predominance in the prevalence of seasonal affective disorder in Japan.     

An epidemiological study of migraine with aura in the San Severo general population: a pilot research project of cooperation between neurologists and general practitioners

OBJECTIVES: (A) To define the lifetime prevalence of migraine with aura (MA) in patients recruited in general practices for an epidemiologic study by the University of Parma Headache Centre from the general population of San Severo, Italy, and (B) to assess the recognition of MA in general practice. METHODS: The study was conducted over a period of 5 consecutive months (January to May 2001) on patients aged 18-65, taken from the following general practice populations: (a) from the patient population of 4 general practitioners (GPs; 3,616 patients) and (b) from the patient population of 12 GPs (12,996 patients). The clinical diagnosis of MA was subsequently confirmed by a headache specialist. RESULTS: For objective A, 648 patients (420 women and 228 men) were interviewed; MA diagnosis was confirmed in 10 patients (7 women and 3 men), lifetime MA prevalence being 1.5%. For objective B, 150 'suspected' MA cases (96 women and 54 men) were reported by the 12 GPs; however, the diagnosis of MA was confirmed in only 3 cases (2 women and 1 man). CONCLUSION: The prevalence of MA observed in our small sample of the general practice patient population was comparable with that observed in the general population of San Severo, Italy. The results also suggest that GPs may be overestimating the number of cases of MA in their patient population.     

An overview of epidemiological studies on seasonal affective disorder

OBJECTIVE: To review and systematize all epidemiological studies of seasonal affective disorder (SAD). METHOD: The relevant papers were identified by searches in Medline, Excerpta Medica, PsychLIT and other databases. The primary reports were reviewed for additional citations. The studies were classified into retrospective and prospective population surveys, surveys of patient populations and studies of seasonal variations in psychiatric illnesses other than mood disorders. RESULTS: The prevalence estimates of SAD across 20 retrospective studies varied from 0% to 9.7%. All prospective population studies, except one, find seasonal variations in mood, depressive symptoms usually peaking in winter. SAD was more prevalent at higher northern latitudes, but the prevalence varied across ethnic groups. SAD has also been identified in children and adolescents. Seasonal exacerbations and remissions are not limited to mood disorders, it has also been found in bulimia nervosa, anxiety disorders and other psychiatric illnesses. CONCLUSION: The actuality of seasonal variation in mood has been documented thoroughly by both retrospective and prospective studies. In the general population, depressive symptoms peak in winter, and the most extreme form of this disposition, SAD, appears to be a relatively common disorder.     

The relationships between gender,psychopathic traits and self-reported delinquency: a comparison between a general population sample and a high-risk sample for juvenile delinquency

Background

Studies have shown that youths with high psychopathic traits have an earlier onset of delinquent behavior, have higher levels of delinquent behavior, and show higher rates of recidivism than youths with low psychopathic traits. Furthermore, psychopathic traits have received much attention as a robust indicator for delinquent and aggressive behavior in both boys and girls. However, there is a notable lack of research on gender differences in the relationship between psychopathic traits and delinquent behavior. In addition, most of the studies on psychopathic traits and delinquent behavior were conducted in high-risk samples. Therefore, the first objective of the current study was to investigate the relationship between psychopathic traits and specific forms of self-reported delinquency in a high-risk sample for juvenile delinquency as well as in a general population sample. The second objective was to examine the influence of gender on this relationship. Finally, we investigated whether the moderating effect of gender was comparable in the high-risk sample for juvenile delinquency and the general population sample.

Methods

Participants were 1220 adolescents of the German-speaking part of Switzerland (N = 351 high-risk sample, N = 869 general population sample) who were between 13 and 21 years of age. The Youth Psychopathic traits Inventory (YPI) was used to assess psychopathic traits. To assess the lifetime prevalence of the adolescents’ delinquent behavior, 15 items derived from a self-report delinquency instrument were used. Logistic regression analyses were used to examine the relationship between gender, psychopathic traits and self-reported delinquency across both samples.

Results

Our results demonstrated that psychopathic traits are related to non-violent and violent offenses. We found no moderating effect of gender and therefore we could not detect differences in the moderating effect of gender between the samples. However, there was a moderating effect of sample for the relationship between the callous and unemotional YPI scale and non-violent offenses. In addition, the regression weights of gender and sample were, for non-violent offenses, reduced to non-significance when adding the interaction terms.

Conclusions

Psychopathic traits were found to be present in a wide range of youths (i.e., high-risk as well as general population sample, young children as well as adolescents, boys as well as girls) and were related to delinquent behavior. The influence of age and YPI scales on self-reported delinquency was more robust than the influence of gender and sample. Therefore, screening for psychopathic traits among young children with psychosocial adjustment problems seems relevant for developing effective intervention strategies.

     

Historical changes of seasonal differences in the frequency of multiple sclerosis clinical attacks: a multicenter study

Previous papers show discordant patterns of monthly and seasonal differences in the frequency of multiple sclerosis relapses. Attacks are more often reported in spring and summer, but there are many variations, mainly as to summer peaks. This paper, an MSBase collaboration substudy, reports multiple series of relapses from 1980 to 2010, comparing ultradecennal trends of seasonal frequency of attacks in different countries. The MSBase international database was searched for relapses in series recording patient histories from 1980 up to 2010. The number of relapses by month was stratified by decade (1981–1990, 1991–2000, 2001–2010). Positive spring versus summer peaks were compared by odds ratios; different series were compared by weighted odds ratio (Peto OR). Decade comparison of the 1990s versus 2000s shows inversion of spring–summer peak (2000s = March; 1990s = July), significant in the whole group (Peto odds ratio = 1.31, CI = 1.10–1.56, p = 0.003) and in Salerno series (OR = 1.97, CI = 1.14–1.40). The global significance persisted also excluding Salerno series (Peto odds ratio = 1.25, CI = 1.04–1.50, p = 0.002). Multicentric data confirm a summer peak of relapses in the 1991–2000 decade, significantly different from the spring peak of 2001–2010. Seasonal frequency of relapses shows long-term variations, so that other factors such as viral epidemics might have more relevance than ultraviolet exposure.