Hostname: page-component-5d84bcc8dc-6jkbs Total loading time: 0 Render date: 2026-09-10T01:37:50.044Z Has data issue: false hasContentIssue false
  • English
  • Français

What is this thing called “SAD”? A critique of the concept of seasonal affective disorder

Published online by Cambridge University Press:  18 May 2011

Vidje Hansen ,
Ingunn Skre  and
Eiliv Lund
Vidje Hansen*
Affiliation:
Institute of Clinical Medicine, University of Tromsø(Norway)
Ingunn Skre
Affiliation:
institute of Psychology, University of Tromsø(Norway)
Eiliv Lund
Affiliation:
Institute of Community Medicine, University of Tromsø(Norway)
*
Address for correspondence: Professor V. Hansen, Department of Clinical Psychiatry, Psychiatric Department UNN, p.o. 6124, N-9291 Tromsø, (Norway). E-mail: vidje.hansen@unn.no
Get access Rights & Permissions [Opens in a new window]

Summary

Background – Seasonal Affective Disorder (SAD) is supposed to be caused by lack of daylight in winter. Yet the population of Northern Norway, living without sun for two winter months, does not spontaneously complain about depression during the dark period. Aims – To summarize research bearing upon the validity of the concept of SAD. Method – Review of relevant literature concerning the epidemiology of SAD and the questionnaire developed to measure it in general populations, the Seasonal Pattern Assessment Questionnaire (SPAQ). Results – Large population studies from northern Norway do not point to a higher prevalence of depression in winter than expected in any other general population. The psychometric properties of SPAQ are rather poor, and the diagnosis of SAD based on SPAQ bears little relationship to a meaningful concept of depression. Conclusions – Seasonal Affective Disorder is not a valid medical construct. Instead, “Recurrent depression with seasonal pattern” as defined in the DSM-IV and the ICD-10 should be used as terms. However, more research is needed to establish whether it is at all fruitful to single out such a subtype of recurrent depression.

Declaration of Interest: None.

Keywords

seasonal affective disordervalidityseasonal pattern assessmentquestionnaireepidemiology

Information

Type
Special Articles
Information
Epidemiology and Psychiatric Sciences , Volume 17 , Issue 2 , June 2008 , pp. 120 - 127
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

Allen, J., Lam, R. W., Remick, R. & Sadovnick, A. (1993). Depressive symptoms and family history in seasonal and nonseasonal mood disorders, American Journal of Psychiatry 150, 443–448.Google ScholarPubMed
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (3. ed. revised). American Psychiatric Association: Washington DC.Google Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (A. ed., text revision). American Psychiatric Association: Washington DC.Google Scholar
Avasthi, A., Sharma, A., Gupta, N., Kulhara, P., Varma, V. K., Malhotra, S. & Mattoo, S. K. (2001). Seasonality and affective disorders: a report from North India, Journal of Affective Disorders 64, 145–154.Google ScholarPubMed
Axelsson, J., Káradóttir, R. & Karlsson, M. (2002a). Differences in prevalence og seasonal affective disorder that are not explained by either genetic or lattitude differences. International Journal of Circumpolar Health 61, 17–20.CrossRefGoogle Scholar
Axelsson, J., Stefansson, C. G., Magnusson, A., Sigvaldason, H. & Karlsson, H. (2002b). Seasonal affective disorders: relevance of Icelandic and Icelandic-Canadian evidence to etiological hypothesis. Canadian Journal of Psychiatry Al, 153–158.CrossRefGoogle Scholar
Axelsson, J., Ragnarsdottir, S., Pind, J. & Sigbjørnsson, R. (2004). Dailight availability: A poor predictor of depression in Iceland. International Journal of Circumpolar Health 63, 267–277.CrossRefGoogle Scholar
Bagby, R.M., Schuller, D.R., Levitt, A.J., Joffe, R.T. & Harkness, K.L. (1996). Seasonal and non-seasonal depression and the five-factor model of personality. Journal of Affective Disorders 38, 89–95.CrossRefGoogle ScholarPubMed
Blazer, D., Kessler, R.C. & Swartz, M. (1998). Epidemiology of recurrent major and minor depression with a seasonal pattern. British Journal of Psychiatry 172, 164–167.CrossRefGoogle ScholarPubMed
Brennen, T. (2001). Seasonal cognitive rhythms within the arctic circle: An individual differences approach. Journal of Environmental Psychology 21, 191–199.CrossRefGoogle Scholar
Brennen, T. & Martinussen, M. (1999). Arctic cognition. A study of cognitive performance in summer and winter at 69 degrees North”. Applied Cognitive Psychology 13, 561–580.3.0.CO;2-J>CrossRefGoogle Scholar
Christensen, E. M., Larsen, J. K. & Gjerris, A. (2003). The stability of the Seasonal Pattern Assessment Questionnaire score index over time and the validity compared to classifiction according to DSM-III-R. Journal of Affective Disorders 1A, 167–172.CrossRefGoogle Scholar
de Graaf, R., van Dorsselaer, S., ten Have, M., Schoemaker, C. & Vollebergh, W.A. (2005). Seasonal variations in mental disorders in the general population of a country with a maritime climate: findings from the Netherlands mental health survey and incidence study. American Journal of Epidemiology 162, 654–661.CrossRefGoogle ScholarPubMed
Devold, O., Barlinghaug, E. & Backer, J.E. (1957). Sleep-disturbances in the dark period (in Norwegian). Journal of the Norwegian Medical Association 77, 836–837.Google Scholar
Dollinger, S. J. & Leong, F. (1993). Volunteer bias and the five-factor model. Journal of Psychology 127, 29–36.CrossRefGoogle Scholar
Eagles, J.M., Howie, F.L., Cameron, I.M., Wileman, S.M., Andrew, J., Robertsen, C. & Naji, S.A. (2002). Use of health care services in seasonal affective disorder”. British Journal of Psychiatry 180, 449–454.CrossRefGoogle ScholarPubMed
Eastwood, M.R. & Peter, A.M. (1988). Epidemiology and seasonal affective disorder. Psychlogical Medicine 18, 799–806.CrossRefGoogle ScholarPubMed
Grof, P. (2002). Mood disorders – New definitions, treatment, directions, and understanding. Canadian Journal of Psychiatry Al, 123–124.CrossRefGoogle Scholar
Haggarty, J., Cernovsky, Z. & Husni, M. (2001). The limited influence of latitude in rates of seasonal affective disorder. Journal of Nervous and Mental Disease 189, 482–484.CrossRefGoogle ScholarPubMed
Haggarty, J., Cernovsky, Z., Husni, M., Minor, K., Kermeen, P. & Mersky, H. (2005). Seasonal affective disorder in an Arctic community. Ada Psychiatrica Scandinavica 105, 378–384.CrossRefGoogle Scholar
Hansen, V., Jacobsen, B. K. & Husby, R. (1991). Mental distress during winter. An epidemiological study of 7759 adults north of Arctic Circle. Ada Psychiatrica Scandinavica 84, 137–141.CrossRefGoogle Scholar
Hansen, V., Lund, E. & Smith-Sivertsen, T. (1998). Self-reported mental distress under the shifting daylight in the high north. Psychological Medicine 28, 447–452.CrossRefGoogle ScholarPubMed
Hardin, T.A., Wehr, T.A., Brewerton, T., Kasper, S., Berretini, W., Rabkin, J. & Rosenthal, N.E. (1991). Evaluation of seasonality in six clinical populations and two normal populations. Journal of Psychiatric Research 25, 75–87.CrossRefGoogle ScholarPubMed
Hellekson, C.J., Kline, J.A. & Rosenthal, N.E. (1986). Phototherapy for seasonal affective disorder in Alaska. American Journal of Psychiatry 143, 1035–1037.Google ScholarPubMed
Husby, R. & Lingjaerde, O. (1990). Prevalence of reported sleeplessness in northern Norway, in relation to sex, age and season. Ada Psychiatrica Scandinavica 81, 542–547.CrossRefGoogle ScholarPubMed
Jain, U., Blais, M.A., Otto, M.W., Hirschfeld, D. & Sachs, G.S. (1999). Five-factor personality traits in patients with seasonal depression: Treatment effects and comparisons wity bipolar patients. Journal of Affective Disorders 55, 51–54.CrossRefGoogle Scholar
James, S.P., Wehr, T.A., Sack, D.A., Parry, B.L. & Rosenthal, N.E. (1985). Treatment of seasonal affective disorder with light in the evening. British Journal of Psychiatry 147, 424–428.CrossRefGoogle ScholarPubMed
Kasper, S., Wehr, T.A., Bartko, J.J., Gaist, P.A. & Rosenthal, N.E. (1989). Epidemiological findings of seasonal changes in mood and behaviour. Archives of General Psychiatry 46, 823–833.Google Scholar
Kringlen, E., Torgersen, S. & Cramer, V. (2001). A Norwegian Psychiatric Epidemiological study. American Journal of Psychiatry 158, 1091–1098.CrossRefGoogle ScholarPubMed
Levitt, A.J. & Boyle, M.H. (2002). The impact of latitude on the prevalence of seasonal depression. Canadian Journal of Psychiatry 47, 361–367CrossRefGoogle ScholarPubMed
Levitt, A.J., Boyle, M.H., Joffe, R.T. & Baumal, Z. (2000). Estimated prevalence of the Seasonal Subtype of Major Depression in a Canadian Community Sample. Canadian Journal of Psychiatry 45, 650–654.CrossRefGoogle Scholar
Lewy, A.J., Wehr, T.A. & Goodwin, F.K. (1980). Light suppresses melatonin secretion in humans. Science 210, 1267–1268.CrossRefGoogle ScholarPubMed
Lewy, A.J., Kern, H.A., Rosenthal N, E. & Wehr, T.A. (1982). Bright artificial light treatment of a manic-depressive patient with a seasonal mood cycle. American Journal of Psychiatry 139, 1496–1498.Google ScholarPubMed
Lingjaerde, O. & Reichborn-Kjennerud, T. (1993). Characteristics of winter depression in the Oslo area (60 degrees N). Ada Psychiatrica ScandinavicaSS, 111–120.CrossRefGoogle Scholar
Lingjaerde, O., Bratlid, T., Hansen, T. & Gøtestam, K.G. (1986). Seasonal affective disorder and midwinter insomnia in the far north. Studies on two related chronobiological disorders in Norway. Proceedings of the Collegium Internationale Neuro-Psychopharmacologicum 9, 187–189.Google Scholar
Lund, E. & Hansen, V. (2001). Responses to the Seasonal Pattern Assessment Questionnaire in different seasons. American Journal of Psychiatry 158, 316–318.CrossRefGoogle Scholar
Magnusson, A. (1996). Validation of the Seasonal Pattern Assessment Questionnaire (SPAQ). Journal of Affective Disorders 40, 121–129.CrossRefGoogle ScholarPubMed
Mersch, P., Middendorp, H., Bouhuys, A.L., Beersma, D. & van den Hoofdakker, R.H. (1999). Seasonal affective disorder and latitude: a review of the literature. Journal of Affective Disorders 53, 35–48.CrossRefGoogle ScholarPubMed
Mersch, P.P., Vastenburg, N.C., Meesters, Y., Bouhuys, A.L., Beersma, D., van den Hoofdakker, R.H. & den Boer, J.A. (2004). The reliability and validity of the Seasonal Pattern Assessment Questionnaire: a comparison between patient groups. Journal of Affective Disorders 80, 209–219.CrossRefGoogle ScholarPubMed
Morrissey, S.A., Raggatt, P.T., James, B. & Rogers, J. (1996). Seasonal affective disorder: some epidemiological findings from a tropical climate. Australia and New Zeeland Journal of Psychiatry 30, 579–586.CrossRefGoogle ScholarPubMed
Murray, G. (2003). The Seasonal Pattern Assessment Questionnaire as a measure of mood seasonality: a prospective validation study. Psychiatry Research 120, 53–59.Google ScholarPubMed
Näyhä, S., Väisänen, E. & Hassi, J. (1994). Season and mental illness in an Arctic area of northern Finland. Ada Psychiatrica Scandinavica, Suppl. 377, 46–49.CrossRefGoogle Scholar
Nilssen, O., Brenn, T., Høyer, G., Lipton, R.I., Boiko, J. & Tkatchev, A. (1999). Self-reported seasonal variation in depression at 78 degree north. The Svalbard Study. International Journal of Circumpolar Health 58, 14–23.Google ScholarPubMed
Potkin, S.G., Zetin, M., Stamnekovic, V., Kripke, D. & Bunney, W.E. (1986). Seasonal Affective Disorder: Prevalence varies with latitude and climate. Journal of Clinical Neuropharmacology 9, 181–183.Google ScholarPubMed
Raheja, S.K., King, E.A. & Thompson, C. (1996). The seasonal pattern assessment questionnaire for identifying seasonal affective disorders. Journal of Affective Disorders 41, 193–199.CrossRefGoogle ScholarPubMed
Robins, L.N., Wing, J.K., Wittchen, H.U., Helzer, J.E., Babor, T., Burke, J., Farmer, A., Jablensky, A., Pickens, R., Regier, D.A., Sartorius, N. & Towle, L. (1988). The Composite International Diagnostic Interview. Archives of General Psychiatry 45, 1069–1077.CrossRefGoogle ScholarPubMed
Rosen, L.N., Targum, S.D., Terman, M., Bryant, M.J., Hoffmann, H., Kasper, S., Hamovit, J.R., Docherty, J., Welch, B. & Rosenthal, N.E. (1990). Prevalence of seasonal affective disorder at four latitudes. Psychiatry Research 31, 131–144.CrossRefGoogle ScholarPubMed
Rosenthal, N.E. (1993). Winter Blues. Seasonal Affective Disorder. What It Is and How to Overcome It. Guilford Press: New York.Google Scholar
Rosenthal, N.E., Sack, D.A., Gillin, J.C., Lewy, A.J., Goodwin, F.K., Davenport, Y., Mueller, P.S., Newsome, D.A. & Wehr, T.A. (1984a). Seasonal Affective Disorder. A description of the syndrome and preliminary findings with light therapy. Archives of General Psychiatry 41, 72–80CrossRefGoogle ScholarPubMed
Rosenthal, N.E., Bradt, G.H. & Wehr, T.A. (1984b). Seasonal Pattern Assessment Questionnaire. National Institute of Mental Health: Bethesda MD.Google Scholar
Rosenthal, N.E., Sack, D.A., Carpenter, C.J., Parry, B.L., Mendelson, W.B. & Wehr, T.A. (1985). Antidepressant effects of light in seasonal affective disorder. American Journal of Psychiatry 142, 163–170.Google ScholarPubMed
Rosenthal, N.E., Carpenter, C.J., James, S.P., Parry, B.L., Rogers, S. L. & Wehr, T.A. (1986). Seasonal affective disorder in children and adolescents. American Journal of Psychiatry 143, 356–358.Google ScholarPubMed
Rosenthal, R. & Rubin, D. (1978). Interpersonal expectancy effects:The first 345 studies. Behavioural and Brain Sciences 1, 377–415.CrossRefGoogle Scholar
Saarijärvi, S., Lauerma, H., Helenius, H. & Saarilehto, S. (1999). Seasonal affective disorders among rural Finns and Lapps. Ada Psychiatrica Scandinavica 99, 95–101.CrossRefGoogle ScholarPubMed
Sandanger, I., Nygård, J.F., Ingebrigtsen, G., Sørensen, T. & Dalgard, O.S. (1999). Prevalence, incidence and age at onset of psychiatric disorders in Norway. Social Psychiatry and Psychiatric Epidemiology 34, 570–579.CrossRefGoogle ScholarPubMed
Sherer, M.A., Weingartner, H., James, S.P. & Rosenthal, N.E. (1985). Effects of melatonin on performance testing in patients with seasonal affective disorder. Neuroscience Letters 58, 277–282.CrossRefGoogle ScholarPubMed
Skou Nilsen, L., Hansen, V. & Olstad, R. (2004). Improvement in mental health over time in Northern Norway. A prospective study of a general population followed for 9 years, with special emphasis on the influence of darkness in winter. Social Psychiatry and Psychiatric Epidemiology 39, 273–279.CrossRefGoogle ScholarPubMed
Srisurapanont, M. & Intaprasert, S. (1999). Seasonal variations in mood and behaviour: epidemiological findings in the north tropics. Journal of Affective Disorders 54, 97–99.CrossRefGoogle ScholarPubMed
Swedish Council on Technology in Health Care (2007). Light Therapy for Depression (in Swedish). Statens beredning for medicinsk utvardering: Stockholm. Retrieved December 11, 2007 from http://www.sbu.se/sv/Publicerat/Gul/Ljusterapi-vid-depression-samt-ovrig-behandling-av-arstidsbunden-depression/Google Scholar
Tam, E., Lam, R. W., Robertsen, H., Stewart, J., Yatham, L. & Zis, A. (1997). Atypical depressive symptoms in seasonal and non-seasonal mood disorders. Journal of Affective Disorders 44, 39–44.CrossRefGoogle ScholarPubMed
Tansella, M. (2006). Recent advances in depression. Where are we going? Epidemiologia e Psichiatria Sociale 15, 1–3.CrossRefGoogle ScholarPubMed
Thompson, C. & Cowan, A. (2001). The seasonal health questionnaire: a preliminary validation of a new instrument to screen for Seasonal Affective Disorder. Journal of Affective Disorders 64, 89–98.Google ScholarPubMed
Thompson, C. & Isaacs, G. (1988). Seasonal affective disorder- a British sample. Symptomatology in relation to mode of referral and diagnostic subtype. Journal of Affective Disorders 14, 1–11.CrossRefGoogle ScholarPubMed
Thompson, C, Stinson, D., Fernandez, M., Fine, J. & Isaacs, G. (1988). A comparison of normal, bipolar and seasonal affective disorder subjects using the Seasonal Pattern Assessment Questionnaire. Journal of Affective Disorders 14, 257–264.CrossRefGoogle ScholarPubMed
Thompson, C, Thompson, S. & Smith, R. (2005). Prevalence of seasonal affective disorder in primary care; a comparison of the seasonal health questionnaire and seasonal pattern assessment questionnaire. Journal of Affective Disorders 78, 219–226.CrossRefGoogle Scholar
van Praag, H. (1993). Seasonal Affective Disorder (winter depression). In “Make-believes” in Psychiatry or the Perils of Progress, pp. 176–188. Brunner/Mazel: New York.Google Scholar
Williams, R. J. & Schmidt, G.G. (1993). Frequency of seasonal affective disorder among individuals seeking treatment at a northern Canadian mental health center. Psychiatry Research 46, 41–45.CrossRefGoogle Scholar
World Health Organisation (1992). The ICD-10 Classification of Mental and Behavioral Disorders: Clinical Description and Diagnostic Guidelines. World Health Organisation: Geneva.Google Scholar