TY - JOUR

T1 - Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder

AU - Bauer, Michael

AU - Glenn, Tasha

AU - Achtyes, Eric D.

AU - Alda, Martin

AU - Agaoglu, Esen

AU - Altınbaş, Kürşat

AU - Andreassen, Ole A.

AU - Angelopoulos, Elias

AU - Ardau, Raffaella

AU - Vares, Edgar Arrua

AU - Aydin, Memduha

AU - Ayhan, Yavuz

AU - Baethge, Christopher

AU - Bauer, Rita

AU - Baune, Bernhard T.

AU - Balaban, Ceylan

AU - Becerra-Palars, Claudia

AU - Behere, Aniruddh P.

AU - Behere, Prakash B.

AU - Belete, Habte

AU - Belete, Tilahun

AU - Belizario, Gabriel Okawa

AU - Bellivier, Frank

AU - Belmaker, Robert H.

AU - Benedetti, Francesco

AU - Berk, Michael

AU - Bersudsky, Yuly

AU - Bicakci, Şule

AU - Birabwa-Oketcho, Harriet

AU - Bjella, Thomas D.

AU - Brady, Conan

AU - Cabrera, Jorge

AU - Cappucciati, Marco

AU - Castro, Angela Marianne Paredes

AU - Chen, Wei Ling

AU - Cheung, Eric Y.Wo

AU - Chiesa, Silvia

AU - Crowe, Marie

AU - Cuomo, Alessandro

AU - Dallaspezia, Sara

AU - Del Zompo, Maria

AU - Desai, Pratikkumar

AU - Dodd, Seetal

AU - Donix, Markus

AU - Etain, Bruno

AU - Fagiolini, Andrea

AU - Fellendorf, Frederike T.

AU - Ferensztajn-Rochowiak, Ewa

AU - Fiedorowicz, Jess G.

AU - Fountoulakis, Kostas N.

AU - Frye, Mark A.

AU - Geoffroy, Pierre A.

AU - Gonzalez-Pinto, Ana

AU - Gottlieb, John F.

AU - Grof, Paul

AU - Haarman, Bartholomeus C.M.

AU - Harima, Hirohiko

AU - Hasse-Sousa, Mathias

AU - Henry, Chantal

AU - Høffding, Lone

AU - Houenou, Josselin

AU - Imbesi, Massimiliano

AU - Isometsä, Erkki T.

AU - Ivkovic, Maja

AU - Janno, Sven

AU - Johnsen, Simon

AU - Kapczinski, Flávio

AU - Karakatsoulis, Gregory N.

AU - Kardell, Mathias

AU - Kessing, Lars Vedel

AU - Kim, Seong Jae

AU - König, Barbara

AU - Kot, Timur L.

AU - Koval, Michael

AU - Kunz, Mauricio

AU - Lafer, Beny

AU - Landén, Mikael

AU - Larsen, Erik R.

AU - Lenger, Melanie

AU - Lewitzka, Ute

AU - Licht, Rasmus W.

AU - Lopez-Jaramillo, Carlos

AU - MacKenzie, Alan

AU - Madsen, Helle Østergaard

AU - Madsen, Simone Alberte Kongstad A.

AU - Mahadevan, Jayant

AU - Mahardika, Agustine

AU - Manchia, Mirko

AU - Marsh, Wendy

AU - Martinez-Cengotitabengoa, Monica

AU - Martiny, Klaus

AU - Mashima, Yuki

AU - McLoughlin, Declan M.

AU - Meesters, Ybe

AU - Melle, Ingrid

AU - Meza-Urzúa, Fátima

AU - Ming, Mok Yee

AU - Monteith, Scott

AU - Moorthy, Muthukumaran

AU - Morken, Gunnar

AU - Mosca, Enrica

AU - Mozzhegorov, Anton A.

AU - Munoz, Rodrigo

AU - Mythri, Starlin V.

AU - Nacef, Fethi

AU - Nadella, Ravi K.

AU - Nakanotani, Takako

AU - Nielsen, René Ernst

AU - O‘Donovan, Claire

AU - Omrani, Adel

AU - Osher, Yamima

AU - Ouali, Uta

AU - Pantovic-Stefanovic, Maja

AU - Pariwatcharakul, Pornjira

AU - Petite, Joanne

AU - Pfennig, Andrea

AU - Ruiz, Yolanda Pica

AU - Pilhatsch, Maximilian

AU - Pinna, Marco

AU - Pompili, Maurizio

AU - Porter, Richard

AU - Quiroz, Danilo

AU - Rabelo-da-Ponte, Francisco Diego

AU - Ramesar, Raj

AU - Rasgon, Natalie

AU - Ratta-apha, Woraphat

AU - Ratzenhofer, Michaela

AU - Redahan, Maria

AU - Reddy, M. S.

AU - Reif, Andreas

AU - Reininghaus, Eva Z.

AU - Richards, Jenny Gringer

AU - Ritter, Philipp

AU - Rybakowski, Janusz K.

AU - Sathyaputri, Leela

AU - Scippa, Ângela M.

AU - Simhandl, Christian

AU - Severus, Emanuel

AU - Smith, Daniel

AU - Smith, José

AU - Stackhouse, Paul W.

AU - Stein, Dan J.

AU - Stilwell, Kellen

AU - Strejilevich, Sergio

AU - Su, Kuan Pin

AU - Subramaniam, Mythily

AU - Sulaiman, Ahmad Hatim

AU - Suominen, Kirsi

AU - Tanra, Andi J.

AU - Tatebayashi, Yoshitaka

AU - Teh, Wen Lin

AU - Tondo, Leonardo

AU - Torrent, Carla

AU - Tuinstra, Daniel

AU - Uchida, Takahito

AU - Vaaler, Arne E.

AU - Veeh, Julia

AU - Vieta, Eduard

AU - Viswanath, Biju

AU - Yoldi-Negrete, Maria

AU - Yalcinkaya, Oguz Kaan

AU - Young, Allan H.

AU - Zgueb, Yosra

AU - Whybrow, Peter C.

N1 - Publisher Copyright: © 2021, The Author(s).

PY - 2021

Y1 - 2021

N2 - Background: Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. Methods: Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). Results: This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01. Conclusion: A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed.

AB - Background: Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. Methods: Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). Results: This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01. Conclusion: A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed.

KW - Bipolar disorder

KW - Circadian

KW - Psychiatry

KW - Seasonal variation

KW - Solar insolation

KW - Suicide

KW - Sunlight

U2 - 10.1186/s40345-021-00231-7

DO - 10.1186/s40345-021-00231-7

M3 - Journal article

C2 - 34467430

AN - SCOPUS:85114003020

VL - 9

JO - International Journal of Bipolar Disorders

JF - International Journal of Bipolar Disorders

SN - 2194-7511

IS - 1

M1 - 26

ER -