Seasonal Pattern Assessment Questionnaire Research Articles

Association between seasonal affective disorder and subjective quality of the sleep/wake cycle in adolescents

The relationship between seasonal affective disorder (SAD) and subjective quality of sleep/wake cycle in adolescents was explored. The Seasonal Pattern Assessment Questionnaire for Children and Adolescents (SPAQ-CA) and Mini Sleep Questionnaire (MSQ) were administered to 345 adolescents living in the city of Cesena (Emilia-Romagna region, Italy) (299 females; age range: 14–18 years), to determine SAD and perceived quality of the sleep/wake cycle. The response rate was 92% for females and 90.2% for males. The MSQ includes two factors, sleep and wake, with lower scores corresponding to a lower quality of sleep and wake. The MSQ includes cut-off criteria to detect a good or bad sleep and wake quality. Adolescents with SAD (16±5.7) scored significantly lower than those not affected on wake factor (19.5±4.3), while no effect has been observed on sleep factor. SAD was the only one significant predictor of good/bad wake quality, while it did not reach significant level with reference to good/bad sleep quality. Present results are indications of a possible influence of SAD on wake quality and further studies are necessary to confirm them.

Low serum BDNF levels in depressed patients cannot be attributed to individual depressive symptoms or symptom cluster

Objectives. Low serum BDNF levels have been found in depressed patients. No study has systematically investigated whether individual symptoms or symptom profiles within a depressed population contribute to low BDNF levels found in depressed subjects. Methods. All 1070 patients with a past 6-month diagnosis of major depressive disorder from the Netherlands Study of Depression and Anxiety (NESDA) were included. Composite International Diagnostic Interview (CIDI) and Inventory of Depressive Symptoms (IDS) items were tested individually in separate multiple regression analyses with serum BDNF level as the dependent and the CIDI or IDS item as independent variable. Subsequently, we compared BDNF levels between patients with seasonal affective disorder (based on the Seasonal Pattern Assessment Questionnaire) and melancholic depression, atypical depression and moderate depression (based on a latent class analysis). All analyses were adjusted for confounders. Results. Only one item was significantly associated with serum BDNF levels, namely the CIDI item “loss of interest” (β = 0.14; P < 0.01). Counterintuitively the presence of this symptom was associated with higher BDNF levels. Other items and the comparison between different types of depression did not reveal significant differences. Conclusions. Decreased serum BDNF levels in depression cannot be attributed to a specific symptom or symptom cluster.

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

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

SELF-ATTRIBUTED SEASONALITY OF MOOD AND BEHAVIOR: A REPORT FROM THE NETHERLANDS STUDY OF DEPRESSION AND ANXIETY

Seasonal changes in mood and behavior are considered to be common in the general population and in patients with psychiatric disorders. However, in several studies this seasonality could not be demonstrated. The present study examined self-attributed seasonality of depressive symptoms among patients with a lifetime diagnosis of a depressive disorder (D), an anxiety disorder (A), a comorbid depressive and anxiety disorder (DA), and healthy controls (HC). The CIDI was used to establish diagnoses according to DSM-IV criteria in 2,168 participants of the Netherlands Study of Depression and Anxiety (NESDA). The Seasonal Pattern Assessment Questionnaire (SPAQ) was administered to assess variation in mood and behavior. Of the 2,168 participants 53.5% reported seasonality of mood. Highest percentages of low mood were seen in the winter months. Although all groups showed this pattern of lowered mood during the winter months, D, A, and DA were significantly (P < .001) more likely to experience seasonality is this respect. This was also shown for seasonal changes in energy, social activities, sleeping, eating, weight and for the Global Seasonality Score. A limitation of this study was the cross-sectional design. Seasonal variation in mood and behavior was demonstrated for both participants with a lifetime diagnosis of depression and/or anxiety disorder and for healthy controls, but patients with anxiety and/or depression were more likely to experience this seasonal variation. Clinicians should take into account that the time of the year could influence the feelings of well- and ill-being of their patients.

Month of birth and mood seasonality: A comparison between countries in the northern and southern hemispheres

A previous study has reported a significant month-of-birth effect on mood seasonality in the northern hemisphere. Higher mood seasonality was observed for university students born during spring or summer months (long photoperiod) compared to those born during autumn or winter months (short photoperiod). The aim of this study was to test the hypothesized photoperiod effect by comparing the correlation between month of birth and mood seasonality in two countries located at the opposite poles of the terrestrial globe: Italy (northern hemisphere) and New Zealand (southern hemisphere). On the basis of the photoperiod-at-birth hypothesis, we expected to find higher mood seasonality among individuals born in months with longer photoperiods in both countries. The Seasonal Pattern Assessment Questionnaire was administered to 1514 young adults (1088 women, 426 men; 1027 Italians, 487 New Zealanders), with ages ranging from 18 to 34 years. The Global Seasonality Score, which is a measure of mood seasonality, was calculated from the Seasonal Pattern Assessment Questionnaire. A significant overall month-of-birth effect was observed on the Global Seasonality Score, but only for men. Men born in April and August (corresponding in Italy to a long photoperiod, in New Zealand to a short photoperiod) had higher mood seasonality than those born in February, regardless of country. A significant month-of-birth effect was found on mood seasonality, but results do not support the hypothesis based on the photoperiod effect.

Test-retest reliability of the Seasonal Pattern Assessment Questionnaire in Old Order Amish

Research on test-retest reliability of the Season Pattern Assessment Questionnaire (SPAQ) is sparse, and to date, has not been done with subgroups such as the Old Order Amish. We examined the test-retest reliability of the SPAQ in a sample of Old Order Amish. A total of 68 Old Order Amish participants completed the SPAQ twice, with 4 months between administrations. Quantitative data analyses were carried out to determine respective strengths of test-restest reliability for two variables [i.e., Global Seasonality Score (GSS), and Problem Rating Score (PRS)]. Results revealed the test-retest reliability of the SPAQ in this population to be strong within the respective variables (GSS, α= 0.87; and PRS, α= 0.79) using Cronbach's alpha.

Bright Light for Weight Loss: Results of a Controlled Crossover Trial

Objective: To investigate whether bright light treatment can reduce body mass in overweight subjects irrespective of their seasonal (= light) dependence. Methods: A crossover, placebo-controlled, randomized clinical trial was performed between November and April in Novosibirsk, Russia (55° N). The trial comprised a 3-week in-home session of morning bright light treatment using a device of light-emitting diodes and a 3-week placebo session by means of a deactivated ion generator, separated by an off-protocol period of at least 23 days. The number of placebo and light sessions was matched with respect to season. Data were obtained from 34 overweight women, aged 20-54 years, 10 were seasonal-dependent according to the Seasonal Pattern Assessment Questionnaire. Weekly measures included body weight, percentage body fat by bioimpedancemetry, and subjective scores (appetite, mood, energy levels). Results: Motivation and expectation towards weight loss were similar for the two intervention sessions. With light, compared to the placebo session, weight did not reduce significantly, but percentage fat, fat mass, and appetite were significantly lower (average fat reduction 0.35 kg). The latter two results remained significant after excluding seasonal-dependent subjects from the analysis. Irrespective of the type of intervention, seasonal-dependent subjects had greater weight and fat mass changes during treatment (decline p < 0.036) or between sessions (regain p < 0.003). Photoperiod (p = 0.0041), air temperature to a lesser extent (p = 0.012), but not sunshine (p = 0.29) was associated with the weight change (greater weight reduction if the second session was in spring). Conclusion: Morning bright light treatment reduces body fat and appetite in overweight women and may be included in weight control programs.

Seasonality of mood and behavior in the Old Order Amish

Background/ObjectiveWe examined seasonality and winter seasonal affective disorder (SAD) in the Old Order Amish of Lancaster County, Pennsylvania, a unique population that prohibits use of network electric light in their homes. MethodsWe estimated SAD using the seasonal pattern assessment questionnaire (SPAQ) in 1306 Amish adults and compared the frequencies of SAD and total SAD (i.e., presence of either SAD or subsyndromal-SAD) between men and women, young and old, and awareness of (ever vs. never heard about) SAD. Heritability of global seasonality score (GSS) was estimated using the maximum likelihood method, including a household effect to capture shared environmental effects. ResultsThe mean (±SD) GSS was 4.36 (±3.38). Prevalence was 0.84% (95% CI: 0.36–1.58) for SAD and 2.59% (95% CI: 1.69–3.73) for total SAD. Heritability of GSS was 0.14±0.06 (SE) (p=0.002) after adjusting for age, gender, and household effects. LimitationsLimitations include likely overestimation of the rates of SAD by SPAQ, possible selection bias and recall bias, and limited generalizability of the study. ConclusionsIn the Amish, GSS and SAD prevalence were lower than observed in earlier SPAQ-based studies in other predominantly Caucasian populations. Low heritability of SAD suggests dominant environmental effects. The effects of awareness, age and gender on SAD risk were similar as in previous studies. Identifying factors of resilience to SAD in the face of seasonal changes in the Amish could suggest novel preventative and therapeutic approaches to reduce the impact of SAD in the general population.

Seasonal and weather-related behavioral effects among urban Aboriginal, urban non-Aboriginal, and remote Aboriginal participants in Canada

The influence of seasonal change and weather on mood, social activity, weight, food consumption, and sleep length was compared across urban Aboriginals (n = 43), urban non-Aboriginals (n = 49), and remote Aboriginals (n = 39) in Ontario, Canada. Such research is important since climate change may differentially shape the well-being of social groups. Behavioral items—including mood, social activity, weight, sleep, and food consumption—were measured using the Seasonal Pattern Assessment Questionnaire, and associations between these items and meteorological data were examined with bivariate and multivariate approaches. Weather variables had consistent, significant associations with behavior except within the remote Aboriginal group despite living in a more extreme climate. Lifestyle and adaptation may contribute to an increased weather tolerance among remote Aboriginal people, intriguing findings as cultures grapple with the implications of future climate change.

Circadian type and mood seasonality in adolescents

The aim of the present study was to investigate, for the first time, the relationship between circadian preference and mood seasonality in adolescents. To this end, 1539 participants (881 female; 658 male) completed the Morningness-Eveningness Questionnaire for Children and Adolescents and the Seasonal Pattern Assessment Questionnaire for Children and Adolescents to determine circadian preference and mood seasonality, respectively. Evening types achieved significantly higher mood seasonality scores than intermediate and morning types, as intermediates did than morning types. Agreeing with previous studies on young adults and adults, the present data indicate a significant relationship between eveningness and higher mood seasonality in adolescents.

Cross-national survey of winter and summer patterns of mood seasonality: a comparison between Italy and India

The aim of this study was to compare winter and summer patterns of mood seasonality in university students living at different latitudes: Bologna, 44° N (Italy), and Kalyani, 22° N (India). To assess the mood seasonality, the Seasonal Pattern Assessment Questionnaire was administered to 1370 university students (808 females, 562 males; 862 Italians, 508 Indians), ranging in age between 18 and 28 years. A significantly higher Global Seasonality Score was observed in females than males as well as in Italians than Indians. The estimated rates of summer seasonal affective disorder (SAD) and summer subsyndromal SAD were higher in Indians, whereas Italians reported higher percentage of winter SAD and winter subsyndromal SAD. The present findings are discussed in relation to the different environmental features between the 2 countries: high summer temperature in India and short winter photoperiod along with its great excursion over the year in Italy.

P-1043 - Seasonality and psychopathology: any association?

Objective To evaluate if individuals with seasonal changes in mood and behavior are more susceptible to present psychopathology than the general population. Methods We applied the Seasonal Pattern Assessment Questionnaire (SPAQ) and the Mental Health Screening Scale (ER-80) to 160 individuals. The variables studied were gender, age, marital status, education, SPAQ score index (SSI) and presence of psychopathology. Results The prevalence of individuals with seasonal changes in mood and behavior was very high, about 43.1% of the total. Out of those, 23.1% viewed seasonal changes as a moderate to severe problem. Individuals with seasonal profile (SSI ≥ 11) had more psychiatric morbidity than those without seasonal profile. This difference is statistically significant (t = 4.279, p Conclusions The authors recognize that the study of seasonality may contribute to the prevention, identification and better characterization of psychopathology.

Female gender but not season of birth is associated with mood seasonality in a near-equatorial Brazilian city

OBJECTIVE: Studies conducted mainly in countries located in the Northern Hemisphere have shown that season of birth influences mood seasonality. Greater mood seasonality has been observed for individuals born during spring/summer months than those born during autumn/winter months. Expanding past research to the Southern Hemisphere, in this study we examine the influence of season of birth on mood seasonality in a sample of 1,247 healthy young Brazilians. METHOD: The Seasonal Pattern Assessment Questionnaire was used to compute a global seasonality score as a measure of mood seasonality in a cross-sectional study. RESULTS: Analysis of covariance was conducted to examine the effects of month of birth and gender on mood seasonality, with age entered as a covariate. A main effect of gender was observed, F (1, 1197) = 17.86, p &lt; .01; partial Eta-squared = .02, with mood seasonality being higher for females (M = 8) than for males (M = 7). Contradicting previous findings, no significant main effect for month of birth was observed, F (1, 1197) = 0.65, p &gt; .05. CONCLUSION: The unexpected finding is tentatively explained by differences in geographic location and weather fluctuations between the sampling location in Brazil and other countries where season of birth has been found to influence mood seasonality. Additional studies with larger samples from the Southern Hemisphere are necessary to shed additional light on the possible significant influence of season of birth on mood.

The seasonality of bipolar affective disorder: Comparison with a primary care sample using the Seasonal Pattern Assessment Questionnaire

The seasonality of bipolar affective disorder: Comparison with a primary care sample using the Seasonal Pattern Assessment Questionnaire

Cognitive Vulnerability in Moderate, Mild, and Low Seasonality

This study examined the association between cognitive vulnerability factors and seasonality. Students (N = 88), classified based on the Seasonal Pattern Assessment Questionnaire as experiencing moderate (n = 26) or mild (n = 32) seasonality, and nondepressed, low-seasonality controls (n = 30) completed explicit (i.e., dysfunctional attitudes, automatic negative thoughts, seasonal attitudes, and rumination) and implicit (i.e., implicit associations test) measures of cognitive vulnerability at one winter and one nonwinter assessment. Relative to low- and mild-seasonality participants, moderate-seasonality participants endorsed more automatic thoughts and rumination in winter and more dysfunctional attitudes across both seasons. Moderate- and mild-seasonality participants endorsed more maladaptive seasonal attitudes than did low-seasonality participants. All groups demonstrated increased dysfunctional attitudes, automatic thoughts, and rumination and stronger implicit associations about light and dark during the winter. The findings support a possible cognitive mechanism of winter depression onset and/or maintenance unique to individuals with moderate, as opposed to mild, seasonality.

Influence of seasonal variation in mood and behavior on cognitive test performance among young adults

Background: Seasonal variations in mood and behavior are common among the general population and may have a deteriorating effect on cognitive functions. Aims: In this study the effect of seasonal affective disorder (SAD-like symptoms) on cognitive test performance were evaluated in more detail. Methods: The data were derived from the study Mental Health in Early Adulthood in Finland. Participants (n = 481) filled in a modified Seasonal Pattern Assessment Questionnaire (SPAQ) and performed cognitive tests in verbal and visual skills, attention and general intelligence. Results: SAD-like symptoms, especially regarding the seasonal variations in weight and appetite, had a significant effect on working memory (Digit Span Backward, P = 0.008) and auditory attention and short-term memory (Digit Span Forward, P = 0.004). The seasonal variations in sleep duration and mood had an effect on auditory attention and short-term memory (Digit Span Forward, P = 0.02 and P = 0.0002, respectively). The seasonal variations in social activity and energy level had no effect. Conclusions: Seasonal changes in mood, appetite and weight have an impairing effect on auditory attention and processing speed. If performance tests are not to repeated in different seasons, attention needs to be given to the most appropriate season in which to test.

Season of birth and mood seasonality in late childhood and adolescence

A significant season of birth effect on mood seasonality has been detected in young adults, with higher sensitivity to seasonal changes for people born during spring or summer months (long photoperiod) than those born during autumn or winter months (short photoperiod). The aim of this study was to verify whether the birth season effect on mood seasonality is already present in late childhood and adolescence. To this end, the Seasonal Pattern Assessment Questionnaire for Children and Adolescents (SPAQ-CA) was administered to 1523 Italian participants (870 females, 653 males), ranging from 10 to 17years of age. The Global Seasonality Score (GSS) was computed as a measure of mood seasonality. Analysis of covariance showed a significant season of birth effect on GSS; although no comparisons were significant when Tukey's posthoc test for unequal samples was performed, it was observed that adolescents born in summer achieved the highest scores while those born in winter obtained the lowest. The present data point out that a significant season of birth effect on mood seasonality is already present in late childhood and adolescence.

Delayed sleep phase syndrome is related to seasonal affective disorder

Both delayed sleep phase syndrome (DSPS) and seasonal affective disorder (SAD) may manifest similar delayed circadian phase problems. However, the relationships and co-morbidity between the two conditions have not been fully studied. The authors examined the comorbidity between DSPS and SAD. We recruited a case series of 327 DSPS and 331 controls with normal sleep, roughly matched for age, gender, and ancestry. Both DSPS and controls completed extensive questionnaires about sleep, the morningness-eveningness trait, depression, mania, seasonality of symptoms, etc. The prevalences of SAD and subsyndromal SAD (S-SAD) were higher in DSPS compared to controls (χ(2)=12.65, p=0.002). DSPS were 3.3 times more likely to report SAD (odds ratio, 3.34; 95% CI, 1.41-7.93) compared to controls as defined by the Seasonal Pattern Assessment Questionnaire (SPAQ). Correspondingly, DSPS showed significantly higher seasonality scores compared to controls in mood, appetite, and energy level subscores and the global seasonality score (t=3.12, t=0.002; t=2.04, p=0.041; t=2.64, p=0.008; and t=2.15, p=0.032, respectively). Weight fluctuation during seasons and winter-summer sleep length differences were also significantly higher in DSPS than controls (t=5.16, p<0.001 and t=2.64, p=0.009, respectively). SAD and S-SAD reported significantly higher eveningness, higher depression self-ratings, and more previous mania symptoms compared to non-seasonal subjects regardless of whether they were DSPS or controls. These cases suggested that DSPS is partially comorbid with SAD. These data support the hypothesis that DSPS and SAD may share a pathophysiological mechanism causing delayed circadian phase.

Seasonal symptoms in bipolar and primary care patients

There is evidence of seasonality in bipolar affective disorder (BAD) and the preponderance of atypical symptoms in bipolar depressive episodes is also seen in winter type Seasonal Affective Disorder. Differences in seasonal symptoms between BAD and appropriate comparison populations have been scrutinised only in small studies. Symptoms described on the Seasonal Pattern Assessment Questionnaire (SPAQ) were compared between 183 patients with BAD and 468 patients consulting their general practitioners. Statistical analyses were adjusted for differing age and gender distributions between the two groups. Compared with the general practice patients, subjects with BAD reported greater seasonal fluctuations in mood (p=0.003). On one measure BAD subjects reported increased seasonal changes in social activity (p<0.001) and greater weight fluctuation over the year (p=0.001). The most striking differences were in sleep patterns; BAD subjects slept significantly more throughout the year, and slept for a mean of 1.8h more in winter than in summer (versus a 1.0h difference in the general practice group, p<0.001). Against 20% of the general practice group, 46% of BAD patients rated seasonal changes in well-being to be at least a moderate problem. The SPAQ was designed as a screening instrument for Seasonal Affective Disorder, not for studies of this nature. Some of the reported differences, notably in social activity and weight changes, may reflect secondary psychosocial effects of BAD. Seasonal changes, most notably winter hypersomnia, should be identified in patients with BAD. These symptoms may respond to treatments such as light therapy that are used in recurrent winter depression.

The seasonality of bipolar affective disorder: Comparison with a primary care sample using the Seasonal Pattern Assessment Questionnaire

In contrast with recurrent unipolar depression, relatively little is known about the seasonality of depressive episodes in bipolar affective disorder (BAD). We compared responses on the Seasonal Pattern Assessment Questionnaire (SPAQ) between a cohort of 183 patients with BAD and a large sample of patients in primary care (N=4746). Comparisons were adjusted for age and gender. 27% of the BAD patients fulfilled SPAQ criteria for Seasonal Affective Disorder (SAD. This gave an adjusted odds ratio of 3.73 (95% confidence intervals 2.64 to 5.27) in comparison with the rate among the primary care samples. Global seasonality scores were significantly higher among BAD patients (adjusted mean difference 1.73, 95% CI 0.97 to 2.49, p<0.001). The SPAQ was originally designed as a screening instrument rather than as a case-finding instrument. Vigilance for seasonal symptom recurrence in BAD may be important with regard to management and relapse prevention.