Abstract
The specific impact of weather factors on psychiatric disorders has been investigated only in few studies with inconsistent results. We hypothesized that meteorological conditions influence the number of cases presenting in a psychiatric emergency room as a measure of mental health conditions. We analyzed the number of patients consulting the emergency room (ER) of a psychiatric hospital in Berlin, Germany, between January 1, 2008, and December 31, 2014. A total of N = 22,672 cases were treated in the ER over the study period. Meteorological data were obtained from a publicly available data base. Due to collinearity among the meteorological variables, we performed a principal component (PC) analysis. Association of PCs with the daily number of patients was analyzed with autoregressive integrated moving average model. Delayed effects were investigated using Granger causal modeling. Daily number of patients in the ER was significantly higher in spring and summer compared to fall and winter (p < 0.001). Three PCs explained 76.8% percent of the variance with PC1 loading mostly on temperature, PC2 on cloudiness and low pressure, and PC3 on windiness. PC1 and PC2 showed strong association with number of patients in the emergency room (p < 0.010) indicating higher patient numbers on warmer and on cloudy days. Further, PC1, PC2, and PC3 predicted the number of patients presenting in the emergency room for up to 7 days (p < 0.050). A secondary analysis revealed that the effect of temperature on number of patients was mostly due to lower patient numbers on cold days. Although replication of our findings is required, our results suggest that weather influences the number of psychiatric patients consulting the emergency room. In particular, our data indicate lower patient numbers during very cold temperatures.
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References
Amr M, Volpe FM (2012) Seasonal influences on admissions for mood disorders and schizophrenia in a teaching psychiatric hospital in Egypt. J Affect Disord 137(1-3):56–60. https://doi.org/10.1016/j.jad.2011.12.039
Arfken C, Zeman LL, Yeager L, Mischel E, Amirsadri A (2002) Frequent visitors to psychiatric emergency services: staff attitudes and temporal patterns. J Behav Health Serv Res 29(4):490–496. https://doi.org/10.1007/BF02287355
Belleville G, Foldes-Busque G, Dixon M, Marquis-Pelletier É, Barbeau S, Poitras J, Chauny JM, Diodati JG, Fleet R, Marchand A (2013) Impact of seasonal and lunar cycles on psychological symptoms in the ED: an empirical investigation of widely spread beliefs. Gen Hosp Psychiatry 35(2):192–194. https://doi.org/10.1016/j.genhosppsych.2012.10.002
Bidargaddi N, Bastiampillai T, Schrader G, Adams R, Piantadosi C, Strobel J, Tucker G, Allison S (2015) Changes in monthly unemployment rates may predict changes in the number of psychiatric presentations to emergency services in South Australia. BMC Emerg Med 15(1):16. https://doi.org/10.1186/s12873-015-0042-5
Bulbena A, Pailhez G, Aceña R, Cunillera J, Rius A, Garcia-Ribera C, Gutiérrez J, Rojo C (2005) Panic anxiety, under the weather? Int J Biometeorol 49(4):238–243. https://doi.org/10.1007/s00484-004-0236-0
Bulbena A, Sperry L, Cunillera J (2006) Psychiatric effects of heat waves. Psychiatr Serv 57(10):1519. https://doi.org/10.1176/ps.2006.57.10.1519
Bulbena A, Sperry L, Garcia Rivera C, Merino A, Mateu G, Torrens M, San Gil J, Cunillera J (2009) Impact of the summer 2003 heat wave on the activity of two psychiatric emergency departments. Actas Esp Psiquiatr 37(3):158–165
Catalano R, McConnell W (1999) Psychiatric emergencies: the check effect revisited. J Health Soc Behav 40(1):79–86. https://doi.org/10.2307/2676380
Catalano R, McConnell W, Forster P, McFarland B, Thornton D (2003) Psychiatric emergency services and the system of care. Psychiatr Serv 54(3):351–355. https://doi.org/10.1176/appi.ps.54.3.351
Christodoulou C, Douzenis A, Papadopoulos FC, Papadopoulou A, Bouras G, Gournellis R, Lykouras L (2012) Suicide and seasonality. Acta Psychiatr Scand 125(2):127–146. https://doi.org/10.1111/j.1600-0447.2011.01750.x
Coimbra DG, Pereira e Silva AC, de Sousa-Rodrigues CF, Barbosa FT, de Siqueira Figueredo D, Araújo Santos JL, Barbosa MR, de Medeiros Alves V, Nardi AE, de Andrade TG (2016) Do suicide attempts occur more frequently in the spring too? A systematic review and rhythmic analysis. J Affect Disord 196:125–137. https://doi.org/10.1016/j.jad.2016.02.036
Denissen JJ, Butalid L, Penke L, van Aken MA (2008) The effects of weather on daily mood: a multilevel approach. Emotion 8(5):662–667. https://doi.org/10.1037/a0013497
Dexter EG (1904) Weather influences: an empirical study of the mental and physiological effects of definite meteorological conditions. Macmillan & Co, New York
Diaz RJ et al (1996) Seasonality and psychiatric emergencies. Actas Luso Esp Neurol Psiquiatr Cienc Afines 24(5):253–259
Dominiak M, Swiecicki L, Rybakowski J (2015) Psychiatric hospitalizations for affective disorders in Warsaw, Poland: effect of season and intensity of sunlight. Psychiatry Res 229(1–2):287–294. https://doi.org/10.1016/j.psychres.2015.07.011
Garcia FM, Boada SS, Collsamata AX, Joaquim IG, Perez YA, Tricio OG, Ibiza CM (2009) Meteorological factors and psychiatric emergencies. Actas Esp Psiquiatr 37(1):34–41
Geoffroy PA, Bellivier F, Scott J, Etain B (2014) Seasonality and bipolar disorder: a systematic review, from admission rates to seasonality of symptoms. J Affect Disord 168:210–223. https://doi.org/10.1016/j.jad.2014.07.002
Granger CWJ (1969) Investigating causal relations by econometric models and cross-spectral methods. Econometrica 37(3):424–438. https://doi.org/10.2307/1912791
Hansen A, Bi P, Nitschke M, Ryan P, Pisaniello D, Tucker G (2008) The effect of heat waves on mental health in a temperate Australian city. Environ Health Perspect 116(10):1369–1375. https://doi.org/10.1289/ehp.11339
Huibers MJ, de Graaf LE, Peeters FP, Arntz A (2010) Does the weather make us sad? Meteorological determinants of mood and depression in the general population. Psychiatry Res 180(2–3):143–146. https://doi.org/10.1016/j.psychres.2009.09.016
Kalbitzer J, Kalbitzer U, Knudsen GM, Cumming P, Heinz A (2013) How the cerebral serotonin homeostasis predicts environmental changes: a model to explain seasonal changes of brain 5-HTT as intermediate phenotype of the 5-HTTLPR. Psychopharmacology 230(3):333–343. https://doi.org/10.1007/s00213-013-3308-1
Klimstra TA, Frijns T, Keijsers L, Denissen JJA, Raaijmakers QAW, van Aken MAG, Koot HM, van Lier PAC, Meeus WHJ (2011) Come rain or come shine: individual differences in how weather affects mood. Emotion 11(6):1495–1499. https://doi.org/10.1037/a0024649
Large WA, Johnson FN (1980) Psychiatric diagnosis on acute admission related to prevailing weather conditions. Psychiatr Clin (Basel) 13(2):90–95
Lee HC, Tsai SY, Lin HC (2007) Seasonal variations in bipolar disorder admissions and the association with climate: a population-based study. J Affect Disord 97(1–3):61–69. https://doi.org/10.1016/j.jad.2006.06.026
Licanin I, Fisekovic S, Babic S (2012) Admission rate of patients with most common psychiatric disorders in relation to seasons and climatic factors during 2010/2011. Mater Sociomed 24(2):94–99. https://doi.org/10.5455/msm.2012.24.94-99
Lurie SJ, Gawinski B, Pierce D, Rousseau SJ (2006) Seasonal affective disorder. Am Fam Physician 74(9):1521–1524
Makris GD, Reutfors J, Osby U, Isacsson G, Frangakis C, Ekbom A, Papadopoulos FC (2013) Suicide seasonality and antidepressants: a register-based study in Sweden. Acta Psychiatr Scand 127(2):117–125. https://doi.org/10.1111/j.1600-0447.2012.01891.x
Mawson D, Smith A (1981) Relative humidity and manic admissions in the London area. Br J Psychiatry 138(2):134–138. https://doi.org/10.1192/bjp.138.2.134
Mc Mahon B, Andersen SB, Madsen MK, Hjordt LV, Hageman I, Dam H, Svarer C, da Cunha-Bang S, Baaré W, Madsen J, Hasholt L, Holst K, Frokjaer VG, Knudsen GM (2016) Seasonal difference in brain serotonin transporter binding predicts symptom severity in patients with seasonal affective disorder. Brain 139(5):1605–1614. https://doi.org/10.1093/brain/aww043
McWilliams S, Kinsella A, O'Callaghan E (2013) The effects of daily weather variables on psychosis admissions to psychiatric hospitals. Int J Biometeorol 57(4):497–508. https://doi.org/10.1007/s00484-012-0575-1
McWilliams S, Kinsella A, O'Callaghan E (2014) Daily weather variables and affective disorder admissions to psychiatric hospitals. Int J Biometeorol 58(10):2045–2057. https://doi.org/10.1007/s00484-014-0805-9
Morali D, Jehel L, Paterniti S (2008) The August 2003 heat wave in France: effects on psychiatric disorders and suicidal behavior. Presse Med 37(2):224–228. https://doi.org/10.1016/j.lpm.2007.06.025
Parker GB, Graham RK (2016) Seasonal variations in rates of hospitalisation for mania and hypomania in psychiatric hospitals in NSW. J Affect Disord 191:289–291. https://doi.org/10.1016/j.jad.2015.11.053
Radua J, Pertusa A, Cardoner N (2010) Climatic relationships with specific clinical subtypes of depression. Psychiatry Res 175(3):217–220. https://doi.org/10.1016/j.psychres.2008.10.025
Rajkumar RP, Sarkar S (2015) Seasonality of admissions for mania: results from a general hospital psychiatric unit in Pondicherry, India. Prim Care Companion CNS Disord 17. https://doi.org/10.4088/PCC.15m01780
Salib E, Sharp N (1999) Does the weather influence dementia admissions? Int J Geriatr Psychiatry 14(11):925–935. https://doi.org/10.1002/(SICI)1099-1166(199911)14:11<925::AID-GPS37>3.0.CO;2-B
Salib E, Sharp N (2002) Relative humidity and affective disorders. Int J Psychiatry Clin Pract 6(3):147–153. https://doi.org/10.1080/136515002760276072
Santiago PN, McLay RN, Hammer PS (2005) Meteorologic factors in emergency evaluation, admission, and discharge. Psychiatr Serv 56:1625. https://doi.org/10.1176/appi.ps.56.12.1625
Schory TJ, Piecznski N, Nair S, el-Mallakh RS (2003) Barometric pressure, emergency psychiatric visits, and violent acts Can J Psychiatr 48:624–627
Shapira A, Shiloh R, Potchter O, Hermesh H, Popper M, Weizman A (2004) Admission rates of bipolar depressed patients increase during spring/summer and correlate with maximal environmental temperature. Bipolar Disord 6(1):90–93. https://doi.org/10.1046/j.1399-5618.2003.00081.x
Shiloh R, Shapira A, Potchter O, Hermesh H, Popper M, Weizman A (2005) Effects of climate on admission rates of schizophrenia patients to psychiatric hospitals. Eur Psychiatry 20(1):61–64. https://doi.org/10.1016/j.eurpsy.2004.09.020
Shiue I, Perkins DR, Bearman N (2016) Physically equivalent temperature and mental and behavioural disorders in Germany in 2009-2011. J Ment Health 25(2):148–153. https://doi.org/10.3109/09638237.2015.1101431
Sobel SN, Anisman S, Hamdy HI (1998) Administrative update: utilization of services. III. Factors affecting emergency service utilization at a rural community mental health center. Community Ment Health J 34(2):157–163. https://doi.org/10.1023/A:1018741018669
Sung TI, Chen MJ, Lin CY, Lung SC, Su HJ (2011) Relationship between mean daily ambient temperature range and hospital admissions for schizophrenia: results from a national cohort of psychiatric inpatients. Sci Total Environ 410–411:41–46. https://doi.org/10.1016/j.scitotenv.2011.09.028
Talaei A, Hedjazi A, Rezaei Ardani A, Fayyazi Bordbar MR, Talaei A (2014) The relationship between meteorological conditions and homicide, suicide, rage, and psychiatric hospitalization. J Forensic Sci 59(5):1397–1402. https://doi.org/10.1111/1556-4029.12471
Vaneckova P, Bambrick H (2013) Cause-specific hospital admissions on hot days in Sydney, Australia. PLoS One 8(2):e55459. https://doi.org/10.1371/journal.pone.0055459
Vida S, Durocher M, Ouarda TB, Gosselin P (2012) Relationship between ambient temperature and humidity and visits to mental health emergency departments in Quebec. Psychiatr Serv 63(11):1150–1153. https://doi.org/10.1176/appi.ps.201100485
Volpe FM, da Silva EM, dos Santos TN, de Freitas DE (2010) Further evidence of seasonality of mania in the tropics. J Affect Disord 124(1–2):178–182. https://doi.org/10.1016/j.jad.2009.11.001
Volpe FM, Del Porto JA (2006) Seasonality of admissions for mania in a psychiatric hospital of Belo Horizonte, Brazil. J Affect Disord 94(1–3):243–248. https://doi.org/10.1016/j.jad.2006.03.025
Wang B, Chen D (2013) Evidence for seasonal mania: a review. J Psychiatr Pract 19(4):301–308. https://doi.org/10.1097/01.pra.0000432600.32384.c5
Wang X, Lavigne E, Ouellette-kuntz H, Chen BE (2014) Acute impacts of extreme temperature exposure on emergency room admissions related to mental and behavior disorders in Toronto, Canada. J Affect Disord 155:154–161. https://doi.org/10.1016/j.jad.2013.10.042
Yackerson NS, Zilberman A, Todder D, Kaplan Z (2011) The influence of several changes in atmospheric states over semi-arid areas on the incidence of mental health disorders. Int J Biometeorol 55(3):403–410. https://doi.org/10.1007/s00484-010-0350-0
Acknowledgements
EJB is participant in the BIH Charité Clinician Scientist Program funded by Charité Universitätsmedizin Berlin and the Berlin Institute of Health. TAL is recipient of a Canadian Institutes of Health Research Postdoctoral Fellowship.
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Brandl, E.J., Lett, T.A., Bakanidze, G. et al. Weather conditions influence the number of psychiatric emergency room patients. Int J Biometeorol 62, 843–850 (2018). https://doi.org/10.1007/s00484-017-1485-z
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DOI: https://doi.org/10.1007/s00484-017-1485-z