Personality of seasonal affective disorder analyzed by Tri-dimensional Personality Questionnaire

BACKGROUND: Although there have been numerous reports in personality of mood disorders, there have been few reports in regard with personality of winter seasonal affective disorder (SAD). Furthermore, no reports have been published concerning summer SAD personality characteristics. Thus, this study was conducted to assess the personality of winter and summer SAD using Tri-dimensional Personality Questionnaire (TPQ) that have been used in a variety of mental disorders. METHODS: A total of 6135 Japanese were evaluated with TPQ, the Seasonal Pattern Assessment Questionnaire (SPAQ) and the Self-rating Depression Scale (SDS). Winter, summer and non-SAD groups were classified by SPAQ. We compared the difference of personality trait among these three groups in consideration of gender, age and SDS score influence. RESULTS: Winter SAD demonstrated higher "Novelty Seeking" and "Harm Avoidance"; summer SAD showed higher "Harm Avoidance" than the non-SAD group. "Harm Avoidance" in both SAD groups was re-analyzed using SDS score as a covariate, and "Novelty Seeking" in winter SAD using age as a covariate. As a result, the significance of high "Novelty Seeking" and high "Harm Avoidance" in winter SAD was excluded. However, "Harm Avoidance" remained the significant difference between summer and non-SAD. LIMITATION: SAD was diagnosed only by SPAQ and not by interview. The state-dependency of "Harm Avoidance" was not confirmed in identical patients over lapse of time. CONCLUSION: Patients with winter SAD have high "Harm Avoidance" dependent on the depressive state that is in accordance with non-seasonal depression. Patients with summer SAD have high "Harm Avoidance" possibly independent from the depressive state.     

Seasonal affective disorder and social deprivation in Aberdeen

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.     

Prevalence of seasonal affective disorder in primary care; a comparison of the seasonal health questionnaire and the seasonal pattern assessment questionnaire

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).     

The Seasonal Health Questionnaire: a preliminary validation of a new instrument to screen for seasonal affective disorder

BACKGROUND: The main screening tool for Seasonal Affective Disorder (SAD) is the Seasonal Pattern Assessment Questionnaire, but its reliability and validity have been thrown into doubt by several studies. METHOD: In this study we developed a new questionnaire, the Seasonal Health Questionnaire (SHQ), which is scored by computer to derive the four main operational criteria for diagnosis of SAD. A group of clinically diagnosed SAD patients was contrasted with a group of patients with recurrent non-seasonal depressive disorder using the SPAQ and the SHQ. RESULTS: The SHQ could be completed without difficulty by patients with long histories of recurrent mood disorder. The SPAQ and the Rosenthal Criteria were the least specific of the criteria for identifying SAD - misclassifying many non-seasonal patients. CONCLUSIONS: After further development the SHQ may be a more appropriate screening instrument for SAD. The SPAQ should no longer be used for this purpose as it gives misleadingly high estimates of prevalence.     

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.     

Seasonal variations in mood and behaviour: epidemiological findings in the north tropics.

BACKGROUND: There has been no epidemiological study of seasonal affective disorder (SAD) in the north tropics. METHODS: The investigators randomly mailed the Seasonal Pattern Assessment Questionnaire (SPAQ) to 520 residents in Chiang Mai Municipality. RESULTS: The prevalence rates of summer SAD, subsyndromal summer SAD and winter SAD are 6.19%, 8.25% and 1.03%, respectively. CONCLUSIONS: The epidemiological study of SAD in the north tropics finds a high prevalence of summer SAD, low prevalence of winter SAD and the correlation between 'feel worst' response and temperature. LIMITATIONS: The reliability and validity of SPAQ in diagnosing summer SAD is probably low. The response rate from the studied sample is low. CLINICAL RELEVANCE: The prevalence of summer SAD in the tropics is much higher than that in the temperate zone and may relate to temperature.     

Seasonal affective disorder in eight groups in Turkey: a cross-national perspective

OBJECTIVE: Previous estimates of the prevalence of seasonal affective disorder (SAD) in community-based samples generally originated from western countries. We report prevalence rates in eight groups from four latitudes in Turkey. METHOD: Seasonal Pattern Assessment Questionnaire (SPAQ) was distributed to the community-based samples from eight different locations at four latitudes in Turkey. The prevalence rates of winter SAD and subsyndromal SAD (S-SAD) were estimated for the four groups at the same latitudes by using SPAQ responses. RESULTS: We distributed 3229 SPAQs, had an overall response rate of 54.16% and 1749 SPAQs were included in the analyses. Seasonality was reported as a problem by 549 subjects (31.57%) of our 1749 respondents. Prevalence of winter SAD and S-SAD are estimated as 4.86 and 8.35%, respectively, for the whole group. Prevalence rates were determined for each center and for four latitudes (two centers at the same latitude were grouped as one). In Adana-Gaziantep (lt. 37), Izmir-Elazi? (lt. 38), Eski?ehir-Ankara (lt. 39) and Trabzon-Edirne (lt. 41), the prevalence rates for winter SAD were 6.66, 2.25, 8.00 and 3.76%, respectively. CONCLUSIONS: Our prevalence estimates of winter SAD are similar to those found in previous community-based studies at the same latitudes; no correlation was found between latitude and prevalence of winter SAD, which could be related to the sampling methodology or to the fact that there were only 5 degrees of difference between the latitudes.     

A dual vulnerability hypothesis for seasonal depression is supported by the seasonal pattern assessment questionnaire in relation to the temperament and character inventory of personality in a general population

BACKGROUND: Personality structure obtained from the psychobiological Temperament and Character Inventory (TCI) was studied in relation to self-reported seasonal variations in mood and behavior measured by the Seasonal Pattern Assessment Questionnaire (SPAQ). METHODS: The subjects comprised 1761 adults (57.6% women) in the age range 35-85 years, enrolled in the Betula prospective random cohort study of Umea, Sweden. RESULTS: Personality profiles of subjects who reported the occurrence of a high degree of seasonal variation as such were associated with a combination of high self-transcendence (ST) and high persistence (PS), irrespective of the level of harm avoidance (HA). Subjects who reported feeling worst in winter were associated with high HA, irrespective of the levels of ST and PS. Also, subjects feeling worst in summer or experiencing overall problems with seasonal variation were associated with high HA in their personality profiles. Using the SPAQ criteria to define seasonal affective disorder (SAD) or subsyndromal SAD (S-SAD), subjects with these disorders often had combinations of high self-transcendence (ST) and high persistence (PS), but with different associations with HA. LIMITATIONS: No evaluations were made for SAD or subsyndromal SAD according to the DSM-IV or ICD 10 criteria. CONCLUSIONS: Our results relating SPAQ with TCI give support for a dual vulnerability hypothesis for seasonal depression proposed in the literature, where it is attributed to a combination of a seasonal factor and a depression factor. Examining the literature regarding the relationships between the different TCI scales and monoamine neurotransmitter functions, those relationships suggest that these two vulnerability factors for seasonal depression may be modulated by different neurotransmitter systems.     

How common is seasonal affective disorder in temperate Australia? A comparison of BDI and SPAQ estimates

BACKGROUND: The frequency of winter Seasonal Affective Disorder (SAD) in temperate Australia is unknown. METHOD: A random community sample in Melbourne completed four waves of data collection (winter and summer across two years). The presence of winter SAD was estimated in three ways: (i) self-reports on the Seasonal Pattern Assessment Questionnaire (SPAQ), (ii) evidence of significant depression as assessed on the Beck Depression Inventory (BDI) in winters and not summers, and (iii) a combined definition based on both SPAQ and BDI estimates. RESULTS: Of 1080 questionnaires originally mailed, complete four-wave BDI data was obtained from 380 respondents, and complete SPAQ data from 297. The frequency of winter SAD as estimated from SPAQ data was 0.7% and from BDI data was 0.5%. One participant (1 of 297, 0.3%) met BDI criteria and approached caseness on SPAQ criteria. LIMITATIONS: A larger sample is necessary to definitively estimate prevalence. CONCLUSIONS: Winter SAD appears to be rare in temperate Australia. The best estimate from the current study (0.3%) is an advance on simple self-report estimates and provides a necessary reference point for clinicians and researchers.     

The reliability and validity of the Seasonal Pattern Assessment Questionnaire: a comparison between patient groups

Background: The Seasonal Pattern Assessment Questionnaire (SPAQ) is a frequently used screening instrument in the research on Seasonal Affective Disorder (SAD). Nevertheless, studies on its reliability and validity are relatively scarce. In the present study the reliability and the contrast validity of the SPAQ are investigated. Methods: SAD patients, selected by means of a clinical interview, non-seasonal depressed out-patients, non-depressed out-patients, and a control group, are contrasted to estimate the discriminating power of the SPAQ. Also, the reliability and factor structure of the seasonality and the climate subscales are investigated. To study food intake the Seasonal Food Preference Questionnaire (SFPQ) was developed. Results: The SAD criterion of the SPAQ shows good specificity (94%), but a low sensitivity (44%). Discriminant analysis shows sufficient ability to classify subjects (81% correctly classified). The Global Seasonality Scale has a good internal consistency. It consists of two factors, a psychological factor and a food factor. The SFPQ is sensitive for carbohydrate intake by SAD patients. Limitations: Most SAD patients had received treatment and completed the SPAQ while they were not depressed, which may have influenced the sensitivity. Conclusions: The SPAQ is not sensitive enough to be considered a diagnostic instrument for SAD. Nevertheless, it is accurate enough to be used as a screenings instrument. The only false positives were found in the depressive group. The accuracy of prevalence Figs. can be improved by completion of the SPAQ in the summer months, combined with the completion of a depression scale.     

The stability of the Seasonal Pattern Assessment Questionnaire score index over time and the validity compared to classification according to DSM-III-R

BACKGROUND: In 1984, Rosenthal et al. described a group of patients characterised by repeated winter depression with atypical symptoms eventually followed by summer mania or hypomania (seasonal affective disorder, SAD). The relationship between SAD and the classical manic-depressive disorder is uncertain. The aim of this study was to validate the Seasonal Pattern Assessment Questionnaire (SPAQ) classification in relation to the DSM-III-R criteria of seasonal patterns in a group of patients with bipolar affective disorder and to evaluate the stability of the SPAQ score index over time. METHODS: A group of bipolar patients were followed for 3 years with examinations every third month and at hospitalisation. At inclusion and at each following examination the patients were rated with the Hamilton Depression Rating Scale, the Newcastle Depression Rating Scale, and the Bech-Rafaelsen Mania Rating Scale. At inclusion and once a year the patients completed the SPAQ. RESULTS: Fifty-six patients agreed to participate and 46 patients completed 1 year or more. Eight patients, all women, had at least one SPAQ score index (SSI) of 11 or more. Women scored significantly higher than men on SPAQ. The test/re-test reliability of SSI between two consecutive years was good, but decreased as the time difference between tests increased. Moreover, we found no relation between seasonal variations of affective episodes according to SSI and DSM-III-R. LIMITATIONS: The group of patients with seasonality according to DSM-III-R or SSI was small. CONCLUSION: The validity of SSI between two consecutive years is good, but decreases as the time difference between tests increases. There is no relationship between seasonality defined by DSM-III-R and SSI. Female bipolar patients show, as the general population, seasonal variations in mood, energy, sociality, appetite, and sleep independently of their affective episodes. SSI cannot be used for the prediction of seasonal variation in a group of bipolar patients.     

Seasonal and nonseasonal depression: how do they differ? Symptom profile,clinical and family history in a general population sample

BACKGROUND: A small number of studies have previously compared the symptom profiles and clinical and family history patterns of patients with seasonal and nonseasonal depression. However, previous research has tended to be conducted in secondary and tertiary care populations. Little comparative data is available for seasonal and nonseasonal depression in general population samples. METHODS: Patients aged 18-64 registered on a primary care database in North Wales were screened via post for the presence of SAD via the Seasonal Patterns Assessment Questionnaire (SPAQ) and depression via the Beck Depression Inventory (BDI). Interview-confirmed cases of SAD (n=25) and major depression (n=43) were compared in terms of symptom profile, clinical history and family history of psychiatric disorder. RESULTS: Seasonal depression was found to be associated with lower occupational and cognitive impairment and psychiatric intervention than nonseasonal depression. The symptoms of hopelessness and weight loss were particularly predictive for nonseasonal depression. LIMITATIONS: The study was conducted at only one geography. CLINICAL RELEVANCE: Seasonal depression's discrete symptom profile may be used to distinguish cases of seasonal and nonseasonal depression in primary care patients. CONCLUSIONS: SAD appears to be a relatively mild variant of depression, but this finding should not detract from the need for improved identification and treatment of SAD in primary care populations.     

Validation of the Seasonal Pattern Assessment Questionnaire (SPAQ)

The validity of the Seasonal Pattern Assessment Questionnaire (SPAQ) was examined by interviewing 81 individuals who had participated in an earlier community survey of seasonal affective disorder (SAD) in Iceland. When SAD and subsyndromal SAD (S-SAD) were combined into a ‘winter problem’ group, the questionnaire's sensitivity, specificity and positive predictive value for that group were 94%, 73% and 45%, respectively. The SPAQ discriminated poorly between SAD and S-SAD, and hence it had a poor case-finding ability for SAD. Clinical evaluation verified a diagnosis of SAD in individuals who had no previous information about this syndrome. The questionnaire furthermore identified a group of individuals who had generalized anxiety and marked seasonal variations. Clinical evaluation arrived at a similar prevalence rate of SAD as the questionnaire.     

Mood-worsening with high-pollen-counts and seasonality: a preliminary report

BACKGROUND: Because aeroallergens produce inflammation in the respiratory airways, and inflammation triggers depression in vulnerable individuals, we hypothesized that mood sensitivity to pollen, the most seasonal aeroallergen, will be associated with a greater seasonality of mood. Since pollen is absent during winter, we specifically predicted that mood sensitivity to tree pollen will predict non-winter SAD but not winter SAD. METHODS: A convenience sample of African and African American college students who lived in the Washington DC metropolitan area for at least the past 3 years completed the Seasonal Pattern Assessment Questionnaire (SPAQ), from which the Global Seasonality Score (GSS) was calculated, a diagnosis of cumulative SAD (syndromal or subsyndromal SAD) was derived, a seasonal pattern (winter vs non-winter) identified, and self-reported mood changes during high pollen counts obtained. A Mann-Whitney test was used to compare GSS between participants with vs without mood worsening during high pollen counts. The capability of mood worsening with high pollen counts, gender, ethnicity, and age to predict non-winter SAD was analyzed with logistic regressions. RESULTS: GSS was greater (z=5.232, p<0.001) in those who reported mood worsening with high pollen counts. Mood sensitivity to pollen predicted non-winter SAD (p=0.017), but not winter SAD. LIMITATIONS: The SPAQ is not a definitive tool to assess seasonality, and self-reported mood worsening with high pollen counts relies on recollection. No direct measures of depression scores or pollen counts were collected. The non-winter SAD concept has not been previously established. CONCLUSIONS: Our study, which should be considered preliminary in light of its limitations, suggests that self-reported mood-worsening with high pollen count is associated with a greater seasonality of mood, and predicts SAD of non-winter type.     

Seasonality and affective disorders: a report from North India

Case records of the patients with major affective disorders (ICD-10 criteria), seen over a 5 year period in a busy clinic in North India were examined for Seasonal Affective Disorder (SAD) as per DSM-III-R criteria. In addition, seasonality of episodes of all affective disorders was also studied. Around 5.67% of the cases (n=44) retrospectively met the DSM-III-R criteria of SAD and predominant pattern was that of summer depression (n=18). There was also a consistent pattern of seasonal mania either in conjunction with seasonal depression (n=18) or in form of seasonal recurrent mania (n=11). None of the cases of depression showed any atypical vegetative features. In cases not meeting criteria for SAD (n=731), there was a trend for peaks for depressive episodes in winter followed by a smaller peak in summer months while manic episodes had peaks towards rainy and winter months. As compared to seasonal patterns of affective disorders in temperate zones, there was a general trend for opposite patterns of seasonality in SAD as well as in non-SAD. The findings are discussed in context of the climatic conditions of North India.     

Seasonal mood patterns in a northeastern college sample

Given that seasonality can be conceptualized along a developmental continuum, it is surprising that the college population has been largely excluded from previous epidemiological research on Seasonal Affective Disorder (SAD). In this study, college students completed the Seasonal Pattern Assessment Questionnaire (SPAQ) and Beck Depression Inventory twice during either the Fall or Spring academic semester. SAD prevalence rates were similar to those of nearby adult samples. The SPAQ demonstrated high test-retest reliability when administered during different seasons; however, gender differences only emerged during winter SPAQ administrations.     

Prevalence of premenstrual dysphoric disorder in female patients with seasonal affective disorder

BACKGROUND: Both seasonal affective disorder/winter type (SAD) and premenstrual dysphoric disorder (PMDD) are cyclical disorders characterized by so-called atypical depressive symptoms. In the present study we compared the point prevalence rates of PMDD between a sample of premenopausal female patients suffering from SAD and healthy female controls. METHODS: Forty-six female patients with SAD and 46 healthy controls were included in our study. All subjects underwent a semistructured clinical interview according to DSM IV criteria and completed the Seasonal Pattern Assessment Questionnaire. PMDD was diagnosed in a self-rating interview for PMDD according to DSM IV criteria. To verify the diagnosis of PMDD, all patients were followed up in stable summer remission using daily self-rating scales for two full menstrual cycles. RESULTS: Patients with SAD fulfilled significantly more often the diagnostic criteria for PMDD than female healthy controls (46% vs. 2%, respectively; chi-square: P<0.001). CONCLUSIONS: These results provide preliminary evidence for a high point prevalence rate of PMDD in premenopausal females with SAD. CLINICAL IMPLICATIONS: It would be worthwhile to investigate whether an additional diagnosis of PMDD has an impact on the clinical outcome and the response to bright light therapy in female patients with SAD.     

Personality and seasonal affective disorder: results from the CAN-SAD study

BACKGROUND: Personality factors have been implicated in seasonal affective disorder (SAD). The present study investigated the relationship between the five-factor model of personality (neuroticism, extraversion, openness, agreeableness, conscientiousness) and SAD. METHODS: Ninety-five patients with SAD completed personality measures before and after treatment in a clinical trial and during the summer months. The personality scores of the SAD patients were compared with a matched group of non-seasonal depressed patients and published normative data. Stability and change in personality scores with changes in mood state were assessed. Personality dimensions were evaluated as possible predictors of treatment outcome. RESULTS: SAD patients showed elevated openness scores relative to both non-seasonal depressed patients and norms. Their neuroticism scores were lower than non-seasonal depressed patients, but higher than norms. All personality dimensions showed large and highly significant test-retest correlations but several personality dimensions, particularly neuroticism and extraversion, also showed considerable change with changing mood state. None of the personality dimensions were significantly associated with treatment outcome. LIMITATIONS: Personality assessment relied on self-report. CONCLUSIONS: The personality profile of SAD patients differs from both non-seasonal depressed patients and norms. Elevated openness scores appear to be a unique feature of patients with SAD. Since mood state has a significant impact on personality scores, assessment of personality in SAD patients should ideally be conducted when they are in remission. Further investigation of the relationship between personality and SAD, especially the potential significance of elevated openness scores, is warranted.     

Gender differences in seasonal affective disorder (SAD)

Summary 146 women and 44 men (out- and inpatients; treatment sample) with Seasonal Affective Disorder (SAD; winter type) were tested for gender differences in demographic, clinical and seasonal characteristics. Sex ratio in prevalence was (women : men) 3.6 : 1 in unipolar depressives and 2.4 : 1 in bipolars (I and II). Sex ratios varied also between different birth cohorts and men seemed to underreport symptoms. There was no significant difference in symptom-profiles in both genders, however a preponderance of increased eating and different food selection on a trend level occured in women. The female group suffered significantly more often from thyroid disorders and from greater mood variations because of dark and cloudy weather. Women referred themselves to our clinic significantly more frequently as compared to men. In summary gender differences in SAD were similar to those of non-seasonal depression: the extent of gender differences in the prevalence of affective disorders appears to depend on case criteria such as diagnosis (unipolar vs. bipolar), birth cohort and number of symptoms as minimum threshold for diagnosis. We support the idea of applying sex-specific diagnostic criteria for diagnosing depression on the basis of our data and of the literature.