Mood Variables Research Articles

Seasonal mood variation in youth and young adults with bipolar spectrum disorder: A longitudinal prospective analysis

ObjectiveTo determine whether there are latitude and seasonal differences in the prevalence of mood episodes (depression and mania) in youth and young adults with Bipolar Spectrum Disorder (BD). MethodsMood polarity was prospectively evaluated in 413 participants with BD. Participants were enrolled in the Course and Outcome of Bipolar Youth (COBY) study at three sites (University of California Los Angeles-UCLA, Brown University, and the University of Pittsburgh Medical Center-UPMC) and interviewed on average every 7 months for an average of 91.9 months (range: 6–228 months), with a total of 274,123 weekly mood ratings. Associations between light exposure and mood polarity were estimated using generalized linear mixed models with time-varying covariates, considering the latitude and seasonality of the study sites and other potential confounders. ResultsAverage age at intake and at last assessment was 12.6 ± 3.3 and 27.2 ± 4.8 years-old, respectively. There were significantly more depressive episodes during winter than during summer, spring, and autumn. Considering latitude, UCLA showed significantly lower prevalence of depressive episodes, and an absence of seasonal pattern of depression, compared to the Brown/UPMC sites. For the entire sample, there were more manic/hypomanic episodes during summer than during winter. However, there were no significant between site seasonal differences in the prevalence of manic/hypomanic episodes. ConclusionsDepressive episodes are more prevalent during the winter and although less significant, manic/hypomanic episodes during the summer. Awareness and interventions to prevent or ameliorate the effects of seasonal variations in mood changes in BD are warranted.

Seasonal variation in mood among individuals with and without bipolar disorder

IntroductionBipolar disorder is a disorder characterized by cyclic changes in mood, yet limited research has explored longitudinal patterns of seasonality on mood symptoms in this population. This study aimed to examine longitudinal mood symptoms in individuals with bipolar type I and II, and healthy controls to determine if seasonal patterns were present and to validate the Global Seasonality Score as a measure of seasonality. MethodsParticipants from the Prechter Longitudinal Study of Bipolar Disorder were included. Seasonal variations in mood were determined from the Patient Health Questionnaire, Altman Self-Rating Mania scale, and the Seasonal Pattern Assessment Questionnaire. Mixed effects models were utilized to examine the effects of season and diagnostic group on patterns of mood over time. ResultsAll groups exhibited significant seasonal effects on mood symptoms, with evidence of decreased depressive symptoms and increased mania symptoms in longer daylight months. The Global Seasonality Score showed significant differences between diagnostic groups, with bipolar I and II groups demonstrating higher seasonality than healthy controls. High seasonality was associated with greater variance in mood symptoms. ConclusionThe present study found evidence of seasonal patterns in mood symptoms in individuals with bipolar type I and II. These results highlight the need for consideration of seasonality in assessment and treatment in bipolar disorder and suggest that interventions such as light therapy during seasons of heightened risk could be beneficial. The validation of the Global Seasonality Score as a reliable measure further underscores the benefit of utilizing self-report measures to identify periods of vulnerability.

Insomnia, OSA, and Mood Disorders: The Gut Connection.

With the growing body of research examining the link between sleep disorders, including insomnia and obstructive sleep apnea (OSA), and the gut microbiome, this review seeks to offer a thorough overview of the most significant findings in this emerging field. Current evidence suggests a complex association between imbalances in the gut microbiome, insomnia, and OSA, with potential reciprocal interactions that may influence each other. Notably, specific gut microbiome species, whether over- or under-abundant, have been associated with variation in both sleep and mood in patients diagnosed with, e.g., major depressive disorder or bipolar disorder. Further studies are needed to explore the potential of targeting the gut microbiome as a therapeutic approach for insomnia and its possible effects on mood. The variability in current scientific literature highlights the importance of establishing standardized research methodologies.

Seasonal Variation in Mood Among Undergraduate Medical Professionals

Seasonal Variation in Mood Among Undergraduate Medical Professionals

SOCIAL MOOD OF RUSSIAN SOCIETY AS A MARKER OF SOCIO-POLITICAL CHANGES IN CONDITIONS OF UNCERTAINTY

Based on the analysis of monitoring research data, the article proposes a view of social mood as a marker of socio-political changes, including a socio-psychological mechanism of adaptation to a traumatic period of uncertainty. Based on the data of the Institute of Socio-Political Problems of the Federal Research Center of the Russian Academy of Sciences and in comparison with the results of studies by leading analytical centers of the country, the psychological state of Russian society is characterized, in particular, the dynamics of social mood over the past three years through the prism of emotional and rational indicators: an assessment of the current situation in the country, the dynamics of social expectations, the direction of social optimism, the spectrum of the problem field of Russians, an assessment of the perception of power, political loyalty and political alienation, political participation. The mobility and variability of social mood is presented in the values of its intensity and the vector of changes. The interdependence of the tonal and subject socio-political orientation of social mood is revealed. A conclusion is made about the positive tonality and restrained right-center political orientation of the social mood of Russian society. At the same time, the accumulation in social memory of the result of reflexive orientation toward social changes forms in the mass consciousness a potential source of both obstacles and opportunities for the transformation of social memory. The question is raised about the direction of such transformation, about the possible mutual influence of social mood, socio-political practices, changes in the structure of social memory depending on the socio-political context and time.

The Protective Role of Cognitive Reserve: A Preliminary Study on Parkinsonian Patients Undergoing Deep Brain Stimulation.

Background/Objectives: High cognitive reserve (CR) has been shown to have beneficial effects on global cognition, cognitive decline, and risk of dementia in Parkinson's disease (PD). We evaluated the influence of CR on the long-term cognitive outcomes of patients with PD who underwent subthalamic nucleus deep brain stimulation (STN-DBS). Methods: Twenty-five patients with PD underwent neuropsychological screening using the Montreal Cognitive Assessment (MoCA) at baseline, 1 year, and 5 years after bilateral STN-DBS. CR was assessed using the Cognitive Reserve Index questionnaire. According to CR score, patients were assigned to two different groups (LowCR group ≤ 130, HighCR group > 130). Results: Our data showed that patients in the HighCR group obtained a better performance with the MoCA total score at long-term follow-up compared to those in the LowCR group ([mean ± SE] LowCR group: 21.4 ± 1.2 vs. HighCR group: 24.5 ± 1.3, p = 0.05). The cognitive profile of the HighCR group remained unchanged over time. Conversely, the LowCR group had worse global cognition 5 years after surgery (T0: 25.3 ± 0.6 vs. T2: 21.4 ± 1.2, p = 0.02). Cognitive decline was not associated with mood, demographics, or clinical variables. Conclusions: These preliminary findings suggest that higher CR may be protective in PD cognition after STN-DBS. Specifically, a high CR may help cope with long-term decline in the context of surgical treatment. Quantifying a patient's CR could lead to more personalized medical care, tailoring postoperative support and monitoring for those at higher risk of cognitive decline.

Within-person biological mechanisms of mood variability in childhood and adolescence.

Mood variability, the day-to-day fluctuation in mood, differs between individuals and develops during adolescence. Because adolescents show higher mood variability and average mood than children and adults, puberty might be a potential biological mechanism underlying this increase. The goal of this preregistered developmental study was to examine the neural and hormonal underpinnings of adolescent-specific within-person changes in mood variability, with a specific focus on testosterone, cortisol, pubertal status, and resting-state functional brain connectivity. Data from two longitudinal cohorts were used: the L-CID twin study (aged 7-13, N at the first timepoint = 258) and the accelerated Leiden Self-Concept study (SC; aged 11-21, N at the first timepoint = 138). In both studies resting-state functional magnetic resonance imaging (rs-fMRI) data was collected, as well as daily mood. Additionally, in the SC study self-reported puberty testosterone and cortisol were collected. Random intercept cross-lagged panel models (RI-CLPM) were used to study the within-person relations between these biological measures and mood variability and average mood. Mood variability and average mood peaked in adolescence and testosterone levels and self-reported puberty also showed an increase. Connectivity between prefrontal cortex (dlPFC and vmPFC) and subcortical regions (caudate, amygdala) decreased across development. Moreover, higher testosterone predicted average negative mood at the next time point, but not vice versa. Further, stronger vmPFC-amygdala functional connectivity predicted decreases in mood variability. Here, we show that brain connectivity during development is an important within-person biological mechanism of the development of mood in adolescents. PRACTITIONER POINTS: Mood variability peaks in adolescence. Within-person changes in testosterone predict within-person changes in mood. Within-person changes in vmPFC-amygdala connectivity predict within-person changes in mood variability.

Treatment-emergent symptoms during short-term ketamine administration in treatment-resistant bipolar depression: A retrospective cross-sectional descriptive study

Symptoms that emerge during pharmacological treatment of bipolar depression are frequently observed, underscoring the necessity for comprehensive treatment monitoring. This observational study sought to observe the correlation of eight intravenous ketamine infusions with treatment-emergent depressive symptoms in treatment-resistant bipolar depression patients who maintained their baseline psychotropic and chronic somatic treatments. Depressive symptoms were evaluated using the Inventory of Depressive Symptomatology Self-Report 30 (IDS-SR30). Treatment-emergent symptoms TES were defined as symptoms absent at baseline but present at the conclusion of the study. The most common TES included decreased appetite, increased weight, hypersomnia, and diurnal mood variation. Conversely, feelings of sadness, altered perceptions of the future, decreased interest in sex, and physical discomfort were absent in all patients. Notably, 13.6 % of patients reported thoughts of death or suicide. Larger-scale studies, integrating clinician-rated and patient-reported outcome measures, are essential to deepen our understanding of treatment-emergent symptoms. Establishing regulatory or professional definitions for treatment-emergent symptoms is warranted to improve the robustness of future research endeavors.

Examining time-varying dynamics of co-occurring depressed mood and anxiety

BackgroundDimensional frameworks of psychopathology call for multivariate approaches to map co-occurring disorders to index what symptoms emerge when and for whom. Ecological momentary assessment (EMA) offers a method for assessing and differentiating the dynamics of co-occurring symptoms with greater temporal granularity and naturalistic context. The present study used multivariate mixed effects location-scale modeling to characterize the time-varying dynamics of depressed mood and anxiety for women diagnosed with social anxiety disorder (SAD) and major depression (MDD). MethodsWomen completed five daily EMA surveys over 30 days (150 EMA surveys/woman, T ≈ 5250 total observations) and two clinical diagnostic and retrospective self-report measures administered approximately two months apart. ResultsThere was evidence of same-symptom lagged effects (bs = 0.08–0.09), but not cross-symptom lagged effects (bs < 0.01) during EMA. Symptoms co-varied such that momentary spikes from one's typical level of anxiety were associated with increases in momentary depressed mood (b = 0.19) and greater variability of depressed mood (b = 0.06). Similarly, spikes from one's typical levels of depressed mood were associated with increases in momentary anxiety (b = 0.19). Furthermore, the presence and magnitude of effects demonstrated person-specific heterogeneity. LimitationsOur findings are constrained to the dynamics of depressed and anxious mood among cisgender women with primary SAD and current or past MDD. ConclusionsFindings from this work help to characterize how daily experiences of co-occurring mood and anxiety fluctuate and offer insight to aid the development of momentary, person-specific interventions designed to regulate symptom fluctuations.

Dynamics of Mood Swings during Menstrual Cycles between Physically active and Inactive Adolescents: A Tripura-based Study

The menstrual cycle is an important biological process in women that is associated with a range of physical symptoms that can shape how women think, feel, and participate in daily life activities. This study employed a qualitative survey design to investigate the effect of physical activity and menstrual cycle on mood variability in adolescents. Purposively, 40 participants from Tripura University (n=20, physically active and n=20 Inactive) completed the Brunel mood scale questionnaire that explored menstrual cycle events: anger, tension, depression, fatigue, confusion, happiness and calmness. The participants’ response was further analysed descriptively through percentage analysis and differences between physically active and inactive students were assessed using the Mann Whitney-U test. The descriptive results depicted a mean rank of 16.20 and 24.80 of mood swing among Physically Active Students and Physically Inactive students respectively which shows a higher mood swing in inactive women. The significant difference was observed between physically active students and physically inactive students (two groups as U-value was 114.000 which was smaller than the critical value i.e., 127). Persons involved in physical activity have less chance of mood swing compared to sedentary people. In addition, the study concluded that regular moderate exercise helps reduce factors that enhance mood swing during the menstrual cycle.

CHARACTERISTICS OF THE EMOTIONAL INTELLIGENCE OF YOUNG PEOPLE WITH DIFFERENT ACCENTUATIONS OF CHARACTER

The purpose of the work is to show the results of a theoretical and empirical study of the features of the emotional intelligence of young people with different accents and styles of humor. Methodology. 88 young men of late adolescence took part in the study - students of Kyiv secondary schools. Methods: 1) theoretical analysis and generalization of scientific literature on research issues; 2) diagnostic standardized methods: diagnostic test of character accentuation types (A.E. Lychko); emotional self-awareness test (O.I. Vlasova); questionnaire of emotional intelligence (D.V. Lusin); empathy questionnaire (Mehrabiana); questionnaire "Styles of humor" (Martin; 3) Descriptive statistics and the Pearson correlation coefficient were used to analyze the relationships between the results of the empirical study. The results. The researchers found that the most developed interpersonal emotional intelligence is characteristic of young people with a labile accentuation type, who are characterized by low self-awareness and high mood variability. High intrapersonal emotional intelligence is significantly associated with the astheno-neurotic type of accentuation, which is characterized by increased mental and physical fatigue and irritability in everyday life. This type of accentuation of the character turned out to be predominant among the researched (22%). Regarding the use of humor by the researched people, it was found that young men with demonstrative and hyperthymic types of character accentuations prefer an aggressive style of humor, which is destructive in content and directed at others. This significantly distinguishes them from young men of the age-standard development, for whom the most characteristic is a self-supporting style of humorous attitude to life events, which has a constructive meaning and productively affects the personality of the young man and his environment.

Personalized Machine Learning-Based Prediction of Wellbeing and Empathy in Healthcare Professionals.

Healthcare professionals are known to suffer from workplace stress and burnout, which can negatively affect their empathy for patients and quality of care. While existing research has identified factors associated with wellbeing and empathy in healthcare professionals, these efforts are typically focused on the group level, ignoring potentially important individual differences and implications for individualized intervention approaches. In the current study, we implemented N-of-1 personalized machine learning (PML) to predict wellbeing and empathy in healthcare professionals at the individual level, leveraging ecological momentary assessments (EMAs) and smartwatch wearable data. A total of 47 mood and lifestyle feature variables (relating to sleep, diet, exercise, and social connections) were collected daily for up to three months followed by applying eight supervised machine learning (ML) models in a PML pipeline to predict wellbeing and empathy separately. Predictive insight into the model architecture was obtained using Shapley statistics for each of the best-fit personalized models, ranking the importance of each feature for each participant. The best-fit model and top features varied across participants, with anxious mood (13/19) and depressed mood (10/19) being the top predictors in most models. Social connection was a top predictor for wellbeing in 9/12 participants but not for empathy models (1/7). Additionally, empathy and wellbeing were the top predictors of each other in 64% of cases. These findings highlight shared and individual features of wellbeing and empathy in healthcare professionals and suggest that a one-size-fits-all approach to addressing modifiable factors to improve wellbeing and empathy will likely be suboptimal. In the future, such personalized models may serve as actionable insights for healthcare professionals that lead to increased wellness and quality of patient care.

Mood variability during adolescent development and its relation to sleep and brain development

Mood swings, or mood variability, are associated with negative mental health outcomes. Since adolescence is a time when mood disorder onset peaks, mood variability during this time is of significant interest. Understanding biological factors that might be associated with mood variability, such as sleep and structural brain development, could elucidate the mechanisms underlying mood and anxiety disorders. Data from the longitudinal Leiden self-concept study (N = 191) over 5 yearly timepoints was used to study the association between sleep, brain structure, and mood variability in healthy adolescents aged 11–21 at baseline in this pre-registered study. Sleep was measured both objectively, using actigraphy, as well as subjectively, using a daily diary self-report. Negative mood variability was defined as day-to-day negative mood swings over a period of 5 days after an MRI scan. It was found that negative mood variability peaked in mid-adolescence in females while it linearly increased in males, and average negative mood showed a similar pattern. Sleep duration (subjective and objective) generally decreased throughout adolescence, with a larger decrease in males. Mood variability was not associated with sleep, but average negative mood was associated with lower self-reported energy. In addition, higher thickness in the dorsolateral prefrontal cortex (dlPFC) compared to same-age peers, suggesting a delayed thinning process, was associated with higher negative mood variability in early and mid-adolescence. Together, this study provides an insight into the development of mood variability and its association with brain structure.

Alterations to sour taste intensity in depression

Sour foods, such as citrus fruits, some berries and fermented foods provide a range of nutrients and benefits important to mental health [1]. When sourness is perceived as unpleasant, intake of these foods may be reduced affecting mental health. Early research has shown changes to sour taste perception in depression and stress however, changes in anxiety have not been studied [4-8]. To address this gap and build on the knowledge base, a survey was conducted in which participants (n = 424) rated recalled intensity and liking of sour index foods and completed the Depression, Anxiety, and Stress Scale (DASS-21) to measure these states. Variations in sour taste and mood have been demonstrated between females and males, hence the data were explored for sex-differences. Standard least squares regression (post hoc Tukey’s HSD) compared means between groups, and nominal logistic regression assessed differences in distributions between categories. Recalled sour intensity was 16-19.2% higher in those with scores indicative of mild depression than in those with normal scores in the total sample (p range 0.03-0.04), and 17.9-21.3% higher in females (p values were 0.03). There were no differences in sour taste intensity between the intergroup means for anxiety or stress and no associations between sour liking and any of the mood states. The results suggest that the sourness of index foods increases in depression. Further research to elucidate the biological processes and possible taste-related genetic influences that may be occurring would be beneficial. With this knowledge it may be possible to screen for mood conditions by measuring changes to sour taste that appear alongside other signs and symptoms, create more tailored dietary interventions and develop additional therapeutics.

Awareness of Night Eating Syndrome Among College Students (18-29 Years) Native to Manipur

Abstract: Night Eating Syndrome (NES) is a stress-related disorder characterized by morning aphagia, evening hyperphagia and insomnia with the presence of nocturnal ingestions and mood variations which worsen in the evening and night. Presence of eating disorders, psychological disorders, sleep issues like trouble getting to sleep or staying asleep also contribute to this disorder . Night eating syndrome may lead to obesity, metabolic syndrome, diabetes and other life style disorders. The aim of this study is to create awareness of NES and its consequences among college students aged 18-29 years who are native to Manipur. The study collected demographic details and anthropometry measurements of the students and also studied their awareness of NES. Their knowledge about the association of regularly eating post dinner and adverse health outcomes was also studied. The following parameters were considered like age, gender, educational status, BMI category, physical level to study and to create awareness of NES among them. The study used descriptive and exploratory survey design with a quantitative approach to collect data from college students (18-29 years) who are native to Manipur. The sample size was 78 (as per inclusion criteria) consisting of both males and females together. This study revealed that the college students with a percentage of 61.5% from among the total respondents of 52, were not aware of NES and it’s consequences. The limitations of the study suggest further research in the area of Night Eating Syndrome to increase the awareness amongst the population and prevent the occurrence of lifestyle diseases.

Mood congruency in COVID-19 podcast discourse: an interpersonal meaning analysis

With the advent of podcasts, individuals are increasingly engaging with a diverse range of topics, from entertainment and education to news and personal narratives. In the wake of the global COVID-19 pandemic, podcasts have emerged as an influential platform for disseminating information. This current study attempts to depict the realization of Mood congruency in COVID-19 podcast discourse. Departing from qualitative approach, content analysis was employed as research design. The source of the data was obtained from Dedy Corbuzier’s YouTube Channel with Uus (comedian) as the guest in 2021 when COVID-19 case was known and recognized in Indonesia for the first time. The data were in the form of clauses obtained from the utterances from them. The utterances were electronically transcribed using sonix.ai before being rechecked manually to improve the data's reliability. From the analysis, it was found that the variation of Mood is appeared in the form of congruent and incongruent (grammatical metaphorical representation). The congruent representation shows how utterance should be in the form as it is. On the other hand, the grammatical metaphorical representation of Mood brings out the variation such as statement realized in interrogative, and command in declarative Mood. The incongruency can perform an indication of speakers’ creativity and politeness in interaction.

Examining Parent Mood, Feeding Context, and Feeding Goals as Predictors of Feeding Practices Used by Parents of Preschool Children With Avid Eating Behavior: Protocol for an Ecological Momentary Assessment Study.

An avid eating behavior profile is characterized by a greater interest in food and a tendency to overeat in response to negative emotions. Parents use specific strategies to manage feeding interactions with children with avid eating behavior. While momentary and contextual factors, such as parental mood, have been found to influence parental feeding practices, there is a lack of research examining parents' daily experiences of feeding children with avid eating behavior. Examining this is important because parental feeding practices are key levers in tailored interventions to support children's healthy eating behavior. We aim to describe the ecological momentary assessment methods and procedures used in the APPETItE (Appetite in Preschoolers: Producing Evidence for Tailoring Interventions Effectively) project, which aims to examine how variation in parental mood, feeding goals, and the context of eating occasions affect the parental feeding practices used to manage feeding interactions with children with an avid eating behavior profile. Participants are primary caregivers from the APPETItE cohort who have a preschool-age child (aged 3-5 years) with an avid eating behavior profile. Caregivers complete a 10-day ecological momentary assessment period using signal- and event-contingent surveys to examine (1) mood and stress, (2) parental feeding goals, and (3) contextual factors as predictors of parental feeding practices. Recruitment and data collection began in October 2023 and is expected to be completed by spring 2024. The data have a 3-level structure: repeated measurements (level 1) nested within days (level 2) nested within an individual (level 3). Thus, lag-dependent models will be conducted to test the main hypotheses. The findings from this study will provide an understanding of caregivers' daily experiences of feeding preschool children with avid eating behavior, who are at greater risk for the development of obesity. Understanding the predictors of feeding practices at the moment they occur, and across various contexts, will inform the development of tailored resources to support caregivers in managing children's avid eating behavior. DERR1-10.2196/55193.

Effects of chronotype on sleep, mood and cardiovascular circadian rhythms in rotating night shift medical workers.

Whether chronotype affects the health outcomes of night shift work populations is unknown. This study aimed to assess the influence of different chronotypes in the rotating night shift population on sleep status, mood, blood pressure (BP), and heart rate variability (HRV), as well as the circadian rhythm of BP and HRV. A total of 208 rotating night shift workers were included. All participants completed structured questionnaires to assess chronotype, mood and sleep status. During their daily lives outside of the night shift, they underwent 24-hour Holter electrocardiogram monitoring and 24-hour ambulatory blood pressure monitoring. Day-time and night-time BP and BP dipping were obtained. Day-time and night-time HRV values (SDNN, RMSSD, LF, HF, LF nu, SD1, SD2 and SD2/SD1) were calculated and fitted to the cosine period curve. Three circandian parameters (mesor, amplitude and acrophase) were extracted to quantify the circadian rhythm of the HRV indices. Among all three groups, E-type showed more fatigue and sleepiness. In addition, E-type showed blunted diastolic BP dipping. Notably, E-type showed association with higher RMSSD, LF, HF and SD1 in the night time, and higher mesors of RMSSD and LF and amplitude of SD2/SD1 in circadian analysis. Chronotype is a factor affecting fatigue, sleepiness and cardiovascular circadian rhythms of rotating night shift workers. Chronotype should be taken into consideration for managing night-shift rotation to promote occupational health.

MOOD SWINGS AND THE FIRM SIZE PREMIUM

Evidence accumulated in the literature indicates that the size effect is related to corporate and macroeconomic variables and is paid to compensate for bearing risk. We show that the size premium is also driven by daily variations in investors’ moods. We focus on two conditions often cited as possible mechanisms that drive variations in mood: Monday and seasonal affective disorder. The findings are consistent with the evidence that mood deteriorates on Mondays and in the fall and are consistent with the claim that the size effect manifests during economic expansion but weakens in the contraction phase of the economic cycle.

Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders

BackgroundGeographical variations in mood and psychotic disorders have been found in upper-income countries. We looked for geographic variation in these disorders in Colombia, a middle-income country. We analyzed electronic health records from the Clínica San Juan de Dios Manizales (CSJDM), which provides comprehensive mental healthcare for the one million inhabitants of Caldas.MethodsWe constructed a friction surface map of Caldas and used it to calculate the travel-time to the CSJDM for 16,295 patients who had received an initial diagnosis of mood or psychotic disorder. Using a zero-inflated negative binomial regression model, we determined the relationship between travel-time and incidence, stratified by disease severity. We employed spatial scan statistics to look for patient clusters.ResultsWe show that travel-times (for driving) to the CSJDM are less than 1 h for ~50% of the population and more than 4 h for ~10%. We find a distance-decay relationship for outpatients, but not for inpatients: for every hour increase in travel-time, the number of expected outpatient cases decreases by 20% (RR = 0.80, 95% confidence interval [0.71, 0.89], p = 5.67E-05). We find nine clusters/hotspots of inpatients.ConclusionsOur results reveal inequities in access to healthcare: many individuals requiring only outpatient treatment may live too far from the CSJDM to access healthcare. Targeting of resources to comprehensively identify severely ill individuals living in the observed hotspots could further address treatment inequities and enable investigations to determine factors generating these hotspots.