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J Psychiatr Res. 2019 Mar 8;113:1-9. doi: 10.1016/j.jpsychires.2019.03.001. [Epub ahead of print]

Association between solar insolation and a history of suicide attempts in bipolar I disorder.

Author information

1
Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. Electronic address: michael.bauer@uniklinikum-dresden.de.
2
ChronoRecord Association, Fullerton, CA, USA.
3
Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
4
NORMENT - K.G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
5
Department of Psychiatry, National and Capodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece.
6
Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy.
7
Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey.
8
Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany.
9
Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
10
Department of Psychiatry, School of Medicine, University of Adelaide, Adelaide, Australia.
11
National Institute of Psychiatry '"Ramón de la Fuente Muñiz", Mexico City, Mexico.
12
Psychiatry and Addiction Medicine. Assistance Publique - Hôpitaux de Paris, INSERM UMR-S1144, Denis Diderot University, René Descartes University, FondaMental Foundation, Paris, France.
13
Department of Psychiatry, Faculty of Health Sciences, Beer Sheva Mental Health Center, Ben Gurion University of the Negev, Beer Sheva, Israel.
14
Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Victoria, Australia; Department of Psychiatry, Orygen, the National Centre for Excellence in Youth Mental Health, the Centre for Youth Mental Health and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia.
15
Van Research and Training Hospital, Van, Turkey.
16
Butabika Hospital, Kampala, Uganda.
17
Mood Disorders Clinic, Dr. Jose Horwitz Psychiatric Institute, Santiago de Chile, Chile.
18
Department of General Adult Psychiatry, Castle Peak Hospital, Hong Kong.
19
Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Victoria, Australia; Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia.
20
Department of Molecular Medicine and Department of Mental Health (DAI), University of Siena and University of Siena Medical Center (AOUS), Siena, Italy.
21
Division of Neurosciences, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
22
Department of Psychiatry & Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA.
23
Department of Psychiatry, University Hospital of Alava, University of the Basque Country, CIBERSAM, Vitoria, Spain.
24
Department of Psychiatry, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
25
Mood Disorders Center of Ottawa, University of Toronto, Toronto, ON, Canada.
26
Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Tokyo, Japan.
27
AP-HP, Hopitaux Universitaires Henri Mondor and INSERM U955 (IMRB) and Université Paris Est and Institut Pasteur, Unité Perception et Mémoire, Paris, France.
28
Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland.
29
Department of Psychiatry, University of Tartu, Tartu, Estonia.
30
Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
31
Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
32
Private practice, Tunis, Tunisia.
33
Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland.
34
BIPOLAR Zentrum Wiener Neustadt, Wiener Neustadt, Austria.
35
Khanty-Mansiysk Clinical Psychoneurological Hospital, Khanty-Mansiysk, Russia.
36
Department of Affective Disorders, Q, Mood Disorders Research Unit, Aarhus University Hospital, Aarhus, Denmark.
37
Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
38
Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg and Mölndal, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
39
Unit for Psychiatric Research, Aalborg University Hospital, Psychiatry, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
40
Mood Disorders Program, Hospital Universitario San Vicente Fundación, Research Group in Psychiatry, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia.
41
Department of Psychiatry, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
42
Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada; Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.
43
Department of Psychiatry, University of Massachusetts, Worcester, MA, USA.
44
Department of General Psychiatry, Mood Disorders Unit, Institute of Mental Health, Singapore City, Singapore.
45
Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA.
46
Department of Mental Health, Norwegian University of Science and Technology - NTNU, Trondheim, Norway; Department of Psychiatry, St Olavs' University Hospital, Trondheim, Norway.
47
Soviet Psychoneurological Hospital, Urai, Russia.
48
Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
49
Asha Bipolar Clinic, Asha Hospital, Hyderabad, Telangana, India.
50
Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia.
51
Department of Psychiatry, NIMHANS, Bangalore, India.
52
Tunisian Bipolar Forum, Érable Médical Cabinet 324, Lac 2, Tunis, Tunisia.
53
Unit for Psychiatric Research, Aalborg University Hospital, Psychiatry, Aalborg, Denmark.
54
Hospital "Ángeles del Pedregal", Mexico City, Mexico.
55
Lucio Bini Mood Disorder Center, Cagliari, Italy.
56
Deparment of Psychiatry, Diego Portales University, Santiago de Chile, Chile.
57
UCT/MRC Human Genetics Research Unit, Division of Human Genetics, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
58
Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA, USA.
59
Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.
60
Department of Psychiatry, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.
61
Department of Neuroscience and Mental Health, Federal University of Bahia, Salvador, Brazil.
62
Science Directorate/Climate Science Branch, NASA Langley Research Center, Hampton, VA, USA.
63
Department of Psychiatry, MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa.
64
Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Buenos Aires, Argentina.
65
Research Division, Institute of Mental Health, Singapore.
66
Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
67
Department of Social Services and Health Care, Psychiatry, City of Helsinki, Finland.
68
Schizophrenia & Affective Disorders Research Project, Tokyo Metropolitan Institute of Medical Science, Seatagaya, Tokyo, Japan.
69
McLean Hospital-Harvard Medical School, Boston, MA, USA; Mood Disorder Lucio Bini Centers, Cagliari e Roma, Italy.
70
Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
71
Consejo Nacional de Ciencia y Tecnología - Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico.
72
Department of Psychology, Chapman University, Orange, CA, USA.
73
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA.

Abstract

In many international studies, rates of completed suicide and suicide attempts have a seasonal pattern that peaks in spring or summer. This exploratory study investigated the association between solar insolation and a history of suicide attempt in patients with bipolar I disorder. Solar insolation is the amount of electromagnetic energy from the Sun striking a surface area on Earth. Data were collected previously from 5536 patients with bipolar I disorder at 50 collection sites in 32 countries at a wide range of latitudes in both hemispheres. Suicide related data were available for 3365 patients from 310 onset locations in 51 countries. 1047 (31.1%) had a history of suicide attempt. There was a significant inverse association between a history of suicide attempt and the ratio of mean winter solar insolation/mean summer solar insolation. This ratio is smallest near the poles where the winter insolation is very small compared to the summer insolation. This ratio is largest near the equator where there is relatively little variation in the insolation over the year. Other variables in the model that were positively associated with suicide attempt were being female, a history of alcohol or substance abuse, and being in a younger birth cohort. Living in a country with a state-sponsored religion decreased the association. (All estimated coefficients p < 0.01). In summary, living in locations with large changes in solar insolation between winter and summer may be associated with increased suicide attempts in patients with bipolar disorder. Further investigation of the impacts of solar insolation on the course of bipolar disorder is needed.

KEYWORDS:

Bipolar disorder; Seasonal variation; Solar insolation; Suicide; Sunlight

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