Abstract
BackgroundRetrospective studies conducted in psychiatric wards have indicated a shorter duration of stay for depressed inpatients in bright compared to dim daylight-exposed rooms, pointing to a possible antidepressant effect of daylight conditions. Dynamic LED lighting, aiming to mimic daylight conditions, are currently been installed in several hospitals, but their feasibility is poorly investigated.MethodsTo investigate the feasibility of these systems, we developed and installed a LED-lighting system in four rooms in a psychiatric inpatient ward. The system could function statically or dynamically regarding light intensity and colour temperature. The system consisted of (A) a large LED luminaire built into the window jamb mimicking sunlight reflections, (B) two LED light luminaires in the ceiling and (C) a LED reading luminaire. In the static mode, the systems provided constant light from A and B. In the dynamic mode, the system changed light intensity and colour temperature using A, B and C. Patients with unipolar or bipolar depression were randomised to dynamic or static LED lighting for 4 weeks, in addition to standard treatment. Primary outcome was the rate of patients discontinuing the trial due to discomfort from the lighting condition. Secondary outcomes were recruitment and dropout rates, visual comfort, depressive symptoms and suicidal ideation.ResultsNo participants discontinued due to discomfort from the LED lighting. Recruitment rate was 39.8%, dropout from treatment rates were 56.3% in the dynamic group and 33.3% in the static group. 78.1% in the dynamic group were satisfied with the lighting compared with 71.8% in the static group. Discomfort from the light (glare) was reported by 11.5% in the dynamic group compared to 5.1% in the static group. Endpoint suicidal scores were 16.8 (10.4) in the dynamic and 16.3 (14.9) in the static group. The lighting system was 100% functional. The light sensor system proved unstable.ConclusionDropout from treatment was high primarily due to early discharge and with a lack of endpoint assessments. The feasibility study has influenced an upcoming large-scale dynamic lighting efficacy trial where we will use a shorter study period of 3 weeks and with more emphasis on endpoint assessments. The lighting was well tolerated in both groups, but some found intensity too low in the evening. Thus, we will use higher intensity blue-enriched light in the morning and higher intensity amber (blue-depleted) light in the evening in the upcoming study. The light sensor system needs to be improvedTrial registrationClinicalTrials.gov: NCT03363529
Highlights
Retrospective studies conducted in psychiatric wards have indicated a shorter duration of stay for depressed inpatients in bright compared to dim daylight-exposed rooms, pointing to a possible antidepressant effect of daylight conditions
We developed a new general lighting system using dynamic light-emitting diode (LED) lighting installed in four single-bed patient rooms in a psychiatric inpatient ward
The Suicidal Ideation Attribution Scale (SIDAS) scale showed low to moderate degrees of suicidal ideation in both groups with baseline SIDAS scores in the dynamic/static group of 15.5 (SD = 6.8)/16.6 (SD = 11.7) and endpoint scores of 16.8 (SD = 10.4)/16.3 at (SD = 14.9) (n = 4/4)
Summary
Retrospective studies conducted in psychiatric wards have indicated a shorter duration of stay for depressed inpatients in bright compared to dim daylight-exposed rooms, pointing to a possible antidepressant effect of daylight conditions. The recent discovery of the intrinsically photosensitive retinal ganglion cells (ipRGC) [12], with peak sensitivity around 480 nm, and the development of the light-emitting diode (LED) technology have made it clinically relevant and possible to tailor specific light intensities and spectral distributions throughout the 24-h day. This technical development has spurred an interest, in psychiatric settings, to move from lightbox-administered light therapy towards using integrated LED-lighting systems exposing patients to dynamic light therapy throughout the day. A recent randomised trial in poststroke patients showed a strengthening of melatonin rhythmicity and improved mood with brighter light conditions [18, 19]
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