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Impact of seasonal and lunar cycles on psychological symptoms in the ED: An empirical investigation of widely spread beliefs

Authors:
Impact of seasonal and lunar cycles on psychological symptoms in the ED: an
empirical investigation of widely spread beliefs
Geneviève Belleville, Ph.D.
a,
, Guillaume Foldes-Busque, Psy.D., Ph.D.
b,c,d
, Mélanie Dixon, B.A.
a
,
Évelyne Marquis-Pelletier, B.A.
a
, Sarah Barbeau, B.A.
a
, Julien Poitras, M.D.
d
, Jean-Marc Chauny, M.D., M.Sc.
e
,
Jean G. Diodati, M.D.
e
, Richard Fleet, M.D., Ph.D.
b,d,f
, André Marchand, Ph.D.
b,g
a
School of Psychology, Université Laval, Québec, Canada G1V 0A6
b
Department of Psychology, Université du Québec à Montréal, Montréal, Canada
c
Department of Readaptation, Université Laval, Québec, Canada
d
Hôtel-Dieu de Lévis University-Afliated Hospital, Québec, Canada
e
Sacré-Coeur Hospital Research Centre, Québec, Canada
f
Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada
g
Intervention Axis, Centre de Recherche Fernand-Seguin, Montréal, Canada
a b s t r a c ta r t i c l e i n f o
Article history:
Received 3 July 2012
Revised 21 September 2012
Accepted 6 October 2012
Available online xxxx
Keywords:
Seasons
Lunar cycles
Anxiety disorders
Mood disorders
Suicide
Objectives: This study evaluates the impacts of seasonal and lunar cycles on anxiety and mood disorders, panic
and suicidal ideation in patients consulting the emergency department (ED) with a complaint of unexplained
chest pain (UCP).
Methods: Patients with UCP were recruited from two EDs. Psychiatric diagnoses were evaluated with the
Anxiety Disorders Interview Schedule for DSM-IV.
Results: Signicant seasonal effects were observed on panic and anxiety disorders, with panic more frequently
encountered during spring [odds ratio (OR)=1.378, 95% condence interval (CI)=1.0021.896] and anxiety
disorders during summer (OR=1.586, 95% CI=1.0372.425). Except for one signicant nding, no signicant
effects of lunar cycles were observed. These ndings encourage ED professionals and physicians to abandon
their beliefs about the inuence of lunar cycles on the mental health of their patients. Such unfounded beliefs
are likely to be maintained by self-fullling prophecies.
© 2012 Elsevier Inc. All rights reserved.
1. Introduction
In emergency departments (EDs), 80% of the nurses and 64% of the
physicians believe that lunar cycles affect the mental health of
patients [1]. This belief is more widely held in health professionals
than other professional groups [2]. It is also commonly thought that
human mental health can vary during seasonal cycles or certain times
of year [3].
Available empirical data indicate that seasonal cycles may
inuence depression and anxiety symptoms [46]. More mitigated
results are obtained when the impact of lunar cycles on mental health
is studied; it is generally concluded that available data do not support
its existence [3]. To date, however, the impacts of seasonal and lunar
cycles on psychological symptoms have not been investigated within
the context of nonpsychiatric ED, where beliefs about their inuence
are strongly held.
Patients consulting for unexplained chest pain (UCP) represent 3%
to 6% of patients seen in EDs [7] and suffer from many psychological
difculties [8], allowing for the study of the impacts of seasonal and
lunar cycles on psychological symptoms in EDs. This study presents
secondary analyses from data collected in two EDs [8]. The objective
was to evaluate the impacts of seasonal and lunar cycles on the
presence of psychological symptoms in patients consulting in EDs
with a complaint of UCP. We expected to nd seasonal, but no lunar,
patterns regarding the presence of panic, anxiety and mood disorders,
and suicidal ideation. For simplicity, we use panicto refer to panic
attack and panic disorder in this article.
2. Method
This cross-sectional study took place in the ED of two Canadian
university hospitals: Sacré-Cœur Hospital in Montreal and the
Université Laval afliated hospital centre Hôtel-Dieu de Lévis. The
ethics committees of both institutions approved the protocol. A
detailed description of the methodology can be found elsewhere [8].
Consenting patients were administered a clinical interview to assess
the presence of panic, and they completed self-report questionnaires.
Inclusion criteria were as follows: 18 years old, English or French
speaking, and normal serial electrocardiograms and cardiac enzyme.
General Hospital Psychiatry xxx (2012) xxxxxx
Corresponding author. Tel.: +1 418 656 2131x4226; fax: +1 418 656 3646.
E-mail address: genevieve.belleville@psy.ulaval.ca (G. Belleville).
0163-8343/$ see front matter © 2012 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.genhosppsych.2012.10.002
Contents lists available at SciVerse ScienceDirect
General Hospital Psychiatry
j o u r n a l h o m e p a g e : h t t p : / / w w w . g h p j o u r n a l . c o m
Please cite this article as: Belleville G, et al, Impact of seasonal and lunar cycles on psychological symptoms in the ED: an empirical
investigation of widely spread beliefs, Gen Hosp Psychiatry (2012), http://dx.doi.org/10.1016/j.genhosppsych.2012.10.002
Exclusion criteria were as follows: objective medical cause explaining
the chest pain, any medical condition that could invalidate the
interview, any unstable condition or any physical trauma.
Psychiatric diagnoses were evaluated with the Anxiety Disorders
Interview Schedule for DSM-IV [9], a gold standard in the evaluation
of anxiety disorders. Item #9 from the Beck Depression Inventory-
Second Edition [10] was used to assess suicidal ideation.
Seasons and lunar phases were determined by the date of each
patient's ED visit. Specic dates for the beginning and end of each
season and lunar phase were found on the Web sites of National
Research Council Canada (www.nrc-cnrc.gc.ca) and the United States
Naval Observatory (www.usno.navy.mil), respectively. Lunar phases
were operationalized as 7-day periods, including the exact day of the
phase change ±3 days. We thus obtained possible ranges of four
seasons (winter, spring, summer and autumn) and four lunar phases
(new moon: 0% of the moon illuminated; rst quarter: 50%, increasing
illumination; full moon: 100%; last quarter: 50%, decreasing
illumination).
2.1. Data analysis
Bivariate forward stepwise logistic regression analyses were
conducted to assess the signicance of each season and lunar cycle
in predicting the following: panic attacks, anxiety disorders other
than panic disorder, unipolar mood disorders and suicidal ideation. A
total of 32 analyses (4 seasons+4 lunar cycles, multiplied by 4
predicted variables) were performed. Each season was compared with
the three other seasons as the reference category; each lunar cycle
was compared with the three other lunar cycles. Given the
exploratory nature of the study, no correction was made for multiple
tests. The HosmerLemeshow goodness-of-t test was used to assess
the t of the regression models. Intercorrelations were assessed to
identify potential multicollinearity problems.
3. Results
Between March 11th, 2005, and April 30th, 2008, 4750 ED patients
with chest pain were screened; 1694 were potentially eligible for
participation. Consent was obtained from 1059 patient; 288 patients
were excluded. The nal sample included 771 participants with UCP
(47.08% women; mean age=53.9, S.D.=15.19).
Signicant impacts of seasons (Fig. 1) were found for panic attacks
and anxiety disorders other than panic disorder. The probability of
reporting a panic attack was 37% higher during spring [odds ratio (OR)=
1.378, 95% condence interval (CI)=1.0021.896]) and 37% lower
during autumn (OR=0.634, 95% CI=0.4590.875). Anxiety disorders
other than panic disorder were 58% more likely to be encountered
during summer (OR=1.586, 95% CI=1.0372.425). Mood disorders and
suicidal ideation showed no seasonal patterns.
No signicant impacts of lunar cycles were observed on panic,
anxiety and mood disorders, or suicidal ideation (Fig. 1). There was
one exception: anxiety disorders other than panic disorder were 32%
0
10
20
30
40
50
60
Spring Summer Autumn Winter
%
Seasons
Panic
Anxiety Disorders
Mood Disorders
Suicidal Ideation
0
10
20
30
40
50
60
New Moon First Quarter Full Moon Last Quarter
%
Lunar Cycles
Panic
Anxiety Disorders
Mood Disorders
Suicidal Ideation
* Significantly different from all other seasons, P<.05
* Si
g
nificantly different from all other lunar cycles, P<.05
n=209 n=179 n=219 n=162
n=192 n=146 n=190 n=189
Fig. 1. Proportion of patients reporting psychological symptoms according to seasons and lunar cycles.
2G. Belleville et al. / General Hospital Psychiatry xxx (2012) xxxxxx
Please cite this article as: Belleville G, et al, Impact of seasonal and lunar cycles on psychological symptoms in the ED: an empirical
investigation of widely spread beliefs, Gen Hosp Psychiatry (2012), http://dx.doi.org/10.1016/j.genhosppsych.2012.10.002
less frequent during the last quarter (OR=0.684, 95% CI=0.489
0.959).
4. Discussion
Signicant seasonal effects were observed on panic and anxiety
disorders, thus partially conrming our hypothesis. No seasonal
effects were found on mood disorders and suicidal ideation. Except for
one signicant nding indicating a lesser probability to encounter
panic during the last quarter of the moon, no signicant effects of
lunar cycles were observed.
The observation of seasonal patterns for panic and anxiety is
consistent with previously published ndings [4]. In accordance with
most published data [3], we found no signicant impact of lunar
cycles on any of the studied psychological symptoms, with the
exception of less frequent anxiety disorders other than panic disorder
during the last quarter. To the best of our knowledge, this nding is
not supported by any theory or empirical data published to date.
Unfortunately, the design of the present study does not allow for any
explanation of this nding. For this nding as well as for the others
observed with seasonality, the effect may be due to confounding
variables that were not measured. It may also be a type I error (false
positive).
Although several methodological characteristics (secondary na-
ture of the analyses and restriction of the sample to UCP patients)
limit the generalizability of the conclusions, the current ndings
enlighten about the higher probability of encountering anxiety
disorders during summer and panic during spring in UCP patients.
This information may help ED professionals to identify anxiety and
panic, conditions that are rarely detected in ED [8]. Findings
encourage ED professionals and physicians to abandon their beliefs
about the inuence of lunar cycles on the mental health of their
patients. Such unfounded beliefs could cloud their clinical judgment
in critical situations and should not be upheld in a professional
environment such as the ED. Beliefs about the effect of lunar cycles on
patients are likely to be maintained by self-fullling prophecies, i.e.,
expectations about events that affect a person's behavior in a manner
that causes those expectations to be fullled.
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3G. Belleville et al. / General Hospital Psychiatry xxx (2012) xxxxxx
Please cite this article as: Belleville G, et al, Impact of seasonal and lunar cycles on psychological symptoms in the ED: an empirical
investigation of widely spread beliefs, Gen Hosp Psychiatry (2012), http://dx.doi.org/10.1016/j.genhosppsych.2012.10.002
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... However, no seasonal ef- fects could be observed on mood disorders and suicidal ide- ation. With respect to the effects of lunar cycles, a lesser prob- ability was detected to encounter panic during the last quarter of the moon [7]. Seasonal patterns are reported for panic and anxiety disorders [8]. ...
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... Throughout history, sleepwalking, insanity, and epilepsy have all been connected with lunar effects [4][5][6]. In relevant literature, significant seasonal impacts on panic and anxiety disorders were reported [7]. However, no seasonal effects could be observed on mood disorders and suicidal ideation. ...
... However, no seasonal effects could be observed on mood disorders and suicidal ideation. With respect to the effects of lunar cycles, a lesser probability was detected to encounter panic during the last quarter of the moon [7]. Seasonal patterns are reported for panic and anxiety disorders [8]. ...
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Seasonal variations in the prevalence of mental disorders in general population surveys have rarely been noted. Using a representative sample of the Dutch population, the authors studied the seasonality of 1-month mental disorders and gender-by-season and age-by-season interactions. Data were obtained from the Netherlands Mental Health Survey and Incidence Study, a psychiatric epidemiologic study in which 7,076 adults aged 18-64 years were interviewed (1996) using the Composite International Diagnostic Interview. Seasonal statistical differences were not found for the category "any diagnosis", although prevalence was higher in winter (18.1%) and lower in summer (16.0%). Seasonal variations were also not found for the main categories "mood disorders", "anxiety disorders", "substance-use disorders", "eating disorders", and "schizophrenia". Some differences were found for individual disorders, mostly anxiety. Panic disorder was more frequently reported in winter than in summer, generalized anxiety disorder more frequently in winter than in other seasons, and obsessive-compulsive disorder more frequently in autumn than in summer. Only a few gender and age differences in seasonal variation were found. The authors conclude that there are only limited seasonal variations in mental disorders in general population studies, at least in countries with a mild maritime climate. For reliable estimation of the prevalence of some disorders, these findings have implications for the design of large-scale population studies.
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Patients presenting to the emergency department with chest pain are a common and perplexing problem. Because of the limitations of the initial evaluation, most patients are admitted, although many are found to have noncardiac causes of their symptoms, Recognition of these limitations has driven the investigation-of newer evaluation techniques and protocols in an attempt to improve diagnostic sensitivity without increasing overall costs. These have included modifications of the standard electrocardiogram and use of newer myocsrrdial markers of necrosis, such as mass assays far CK-MB as well as troponin T and troponin I. Use of acute rest myocardial perfusion imaging also has been shown to be a highly valuable technique for risk stratification of the intermediate- to low-risk chest pain patient. (C)2000 by Excerpta Medica, Inc.
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