Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

A positive relationship between ambient temperature and bipolar disorder identified using a national cohort of psychiatric inpatients

Abstract

Objective

This study characterizes the positive relationship between daily temperature and bipolar disorder in a cohort of Taiwanese psychiatric inpatients.

Methods

Meteorological data, provided by the Central Weather Bureau (CWB) of Taiwan, were interpolated to create representative estimates of mean diurnal temperatures for 352 townships. Psychiatric inpatient admissions enrolled in the national health-care insurance system were retrieved from the 1996–2007 Psychiatric Inpatient Medical Claim (PIMC) dataset. The generalized linear mixed models with Poisson distribution were used to evaluate the relative risks of mean diurnal temperature with respect to increased admissions for bipolar disorder, while adjusting for internal correlations and demographic covariates.

Results

Increased relative risks of bipolar disorder admissions were associated with the increasing trends of temperature over 24.0 °C (50th ‰), especially for adults and females. The highest daily diurnal temperatures above 30.7 °C (99th ‰) had the greatest risks of bipolar hospitalizations.

Conclusion

Understanding the increase of bipolar disorder admissions occurring in extreme heat is important in the preparation and prevention of massive recurrences of bipolar episodes.

This is a preview of subscription content, log in to check access.

Fig. 1

Abbreviations

CWB:

Central Weather Bureau

PIMC:

Psychiatric Inpatient Medical Claim

NHIRD:

National Health Insurance Research Database

NHI:

National Health Insurance

ICD-9:

International Classification of Diseases-Ninth Revision

GLMM:

Generalized linear mixed model

RR:

Relative risk

CI:

Confidence interval

BNHI:

Bureau of National Health Insurance

References

  1. 1.

    Albert PR, Lemonde S (2004) 5-HT1A receptors, gene repression, and depression: guilt by association. Neuroscientist 10:575–593

  2. 2.

    Barros RC, Branco LG, Carnio EC (2004) Evidence for thermoregulation by dopamine D1 and D2 receptors in the anteroventral preoptic region during normoxia and hypoxia. Brain Res 1030:165–171

  3. 3.

    Basu R, Samet JM (2002) Relation between elevated ambient temperature and mortality: a review of the epidemiologic evidence. Epidemiol Rev 24:190–202

  4. 4.

    Bauer M, Glenn T, Grof P, Rasgon NL, Marsh W, Sagduyu K, Alda M, Murray G, Quiroz D, Malliaris Y, Sasse J, Pilhatsch M, Whybrow PC (2009) Relationship among latitude, climate, season and self-reported mood in bipolar disorder. J Affect Disord 116:152–157

  5. 5.

    Bebbington P, Ramana R (1995) The epidemiology of bipolar affective disorder. Soc Psychiatry Psychiatr Epidemiol 30:279–292

  6. 6.

    Bernard SM (2007) Analysis of external drift kriging algorithm with application to precipitation estimation in complex orography. International Institute for Geo-Information Science and Earth Observation. Enschede, The Netherlands

  7. 7.

    Berry HL, Bowen K, Kjellstrom T (2010) Climate change and mental health: a causal pathways framework. Int J Public Health 55(2):123–132

  8. 8.

    Bih SH, Chien IC, Chou YJ, Lin CH, Lee CH, Chou P (2008) The treated prevalence and incidence of bipolar disorder among national health insurance enrollees in Taiwan, 1996–2003. Soc Psychiatry Psychiatr Epidemiol 43:860–865

  9. 9.

    Boulant JA (2000) Role of the preoptic-anterior hypothalamus in thermoregulation and fever. Clin Infect Dis 31(Suppl 5):S157–S161

  10. 10.

    Carrat F, Valleron AJ (1992) Epidemiologic mapping using the “kriging” method: application to an influenza-like illness epidemic in France. Am J Epidemiol 135:1293–1300

  11. 11.

    Cheng TM (2003) Taiwan’s new national health insurance program: genesis and experience so far. Health Aff (Millwood) 22:61–76

  12. 12.

    Chotai J, Smedh K, Johansson C, Nilsson LG, Adolfsson R (2004) An epidemiological study on gender differences in self-reported seasonal changes in mood and behaviour in a general population of northern Sweden. Nord J Psychiatry 58:429–437

  13. 13.

    Christensen EM, Gjerris A, Larsen JK, Bendtsen BB, Larsen BH, Rolff H, Ring G, Schaumburg E (2003) Life events and onset of a new phase in bipolar affective disorder. Bipolar Disord 5:356–361

  14. 14.

    Compton WM 3rd, Helzer JE, Hwu HG, Yeh EK, McEvoy L, Tipp JE, Spitznagel EL (1991) New methods in cross-cultural psychiatry: psychiatric illness in Taiwan and the United States. Am J Psychiatry 148:1697–1704

  15. 15.

    Craddock N, O’Donovan MC, Owen MJ (2005) The genetics of schizophrenia and bipolar disorder: dissecting psychosis. J Med Genet 42:193–204

  16. 16.

    CWB (1971-2000) Mean pressure at station. Central Weather Bureau, Ministry of Transportation and Communications, Taipei

  17. 17.

    Fanchiang C (2004) New IC health insurance card expected to offer many benefits. Taiwan Journal January 2

  18. 18.

    Federman EJ, Drebing CE, Boisvert C, Penk W, Binus G, Rosenheck R (2000) Relationship between climate and psychiatric inpatient length of stay in Veterans Health Administration hospitals. Am J Psychiatry 157:1669–1673

  19. 19.

    Fritze JG, Blashki GA, Burke S, Wiseman J (2008) Hope, despair and transformation: climate change and the promotion of mental health and wellbeing. Int J Ment Health Syst 2:13

  20. 20.

    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 116:1369–1375

  21. 21.

    Hasegawa H, Ishiwata T, Saito T, Yazawa T, Aihara Y, Meeusen R (2005) Inhibition of the preoptic area and anterior hypothalamus by tetrodotoxin alters thermoregulatory functions in exercising rats. J Appl Physiol 98:1458–1462

  22. 22.

    Hirschfeld RM, Lewis L, Vornik LA (2003) Perceptions and impact of bipolar disorder: how far have we really come? Results of the national depressive and manic–depressive association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry 64:161–174

  23. 23.

    Hwu HG, Yeh EK, Chang LY (1989) Prevalence of psychiatric disorders in Taiwan defined by the Chinese Diagnostic Interview Schedule. Acta Psychiatr Scand 79:136–147

  24. 24.

    Ishiwata T, Hasegawa H, Yazawa T, Otokawa M, Aihara Y (2002) Functional role of the preoptic area and anterior hypothalamus in thermoregulation in freely moving rats. Neurosci Lett 325:167–170

  25. 25.

    Ivleva EI, Morris DW, Moates AF, Suppes T, Thaker GK, Tamminga CA (2010) Genetics and intermediate phenotypes of the schizophrenia–bipolar disorder boundary. Neurosci Biobehav Rev 34:897–921

  26. 26.

    Jha SK, Mallick BN (2009) Presence of alpha-1 norepinephrinergic and GABA-A receptors on medial preoptic hypothalamus thermosensitive neurons and their role in integrating brainstem ascending reticular activating system inputs in thermoregulation in rats. Neuroscience 158:833–844

  27. 27.

    Judd LL, Akiskal HS (2003) The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. J Affect Disord 73:123–131

  28. 28.

    Kaiser R, Rubin CH, Henderson AK, Wolfe MI, Kieszak S, Parrott CL, Adcock M (2001) Heat-related death and mental illness during the 1999 Cincinnati heat wave. Am J Forensic Med Pathol 22:303–307

  29. 29.

    Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS (1994) Lifetime and 12 month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 51:8–19

  30. 30.

    Koike K, Matsuda S, Gu B (2001) Evaluation of interpolation accuracy of neural kriging with application to temperature-distribution analysis. Math Geol 33:421–448

  31. 31.

    Komarova TG (2009) Cholinergic mechanisms of the medial preoptic areas of the hypothalamus in the control of thermoregulation and the states of sleep and waking in pigeons. Neurosci Behav Physiol 39:553–558

  32. 32.

    Kovats RS, Hajat S, Wilkinson P (2004) Contrasting patterns of mortality and hospital admissions during hot weather and heat waves in Greater London, UK. Occup Environ Med 61:893–898

  33. 33.

    Kovats RS, Kristie LE (2006) Heatwaves and public health in Europe. Eur J Public Health 16:592–599

  34. 34.

    Kushikata T, Hirota K, Kotani N, Yoshida H, Kudo M, Matsuki A (2005) Isoflurane increases norepinephrine release in the rat preoptic area and the posterior hypothalamus in vivo and in vitro: relevance to thermoregulation during anesthesia. Neuroscience 131:79–86

  35. 35.

    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 97:61–69

  36. 36.

    Lee HJ, Kim L, Joe SH, Suh KY (2002) Effects of season and climate on the first manic episode of bipolar affective disorder in Korea. Psychiatry Res 113:151–159

  37. 37.

    Li Q, Wichems C, Heils A, Van De Kar LD, Lesch KP, Murphy DL (1999) Reduction of 5-hydroxytryptamine (5-HT)(1A)-mediated temperature and neuroendocrine responses and 5-HT(1A) binding sites in 5-HT transporter knockout mice. J Pharmacol Exp Ther 291:999–1007

  38. 38.

    Lin MT, Tsay HJ, Su WH, Chueh FY (1998) Changes in extracellular serotonin in rat hypothalamus affect thermoregulatory function. Am J Physiol 274:R1260–R1267

  39. 39.

    Lish JD, Dime-Meenan S, Whybrow PC, Price RA, Hirschfeld RM (1994) The National Depressive and Manic–Depressive Association (DMDA) survey of bipolar members. J Affect Disord 31:281–294

  40. 40.

    Lu JF, Hsiao WC (2003) Does universal health insurance make health care unaffordable? Lessons from Taiwan. Health Aff (Millwood) 22:77–88

  41. 41.

    Maes M, Scharpe S, Verkerk R, D’Hondt P, Peeters D, Cosyns P, Thompson P, De Meyer F, Wauters A, Neels H (1995) Seasonal variation in plasma l-tryptophan availability in healthy volunteers. Relationships to violent suicide occurrence. Arch Gen Psychiatry 52:937–946

  42. 42.

    Mallick BN, Joseph MM (1998) Adrenergic and cholinergic inputs in preoptic area of rats interact for sleep–wake thermoregulation. Pharmacol Biochem Behav 61:193–199

  43. 43.

    McMichael AJ, Wilcox BA (2010) Climate change, human health, and integrative research: a transformative imperative. Ecohealth 6(2):163–164

  44. 44.

    McMichael AJ, Woodruff RE, Hales S (2006) Climate change and human health: present and future risks. Lancet 367:859–869

  45. 45.

    Modai I, Kikinzon L, Valevski A (1994) Environmental factors and admission rates in patients with major psychiatric disorders. Chronobiol Int 11:196–199

  46. 46.

    Morrissey SA, Raggatt PT, James B, Rogers J (1996) Seasonal affective disorder: some epidemiological findings from a tropical climate. Aust N Z J Psychiatry 30:579–586

  47. 47.

    Myers DH, Davies P (1978) The seasonal incidence of mania and its relationship to climatic variables. Psychol Med 8:433–440

  48. 48.

    Nicholas AC, Seiden LS (2003) Ambient temperature influences core body temperature response in rat lines bred for differences in sensitivity to 8-hydroxy-dipropylaminotetralin. J Pharmacol Exp Ther 305:368–374

  49. 49.

    Potash JB, Bienvenu OJ (2009) Neuropsychiatric disorders: shared genetics of bipolar disorder and schizophrenia. Nat Rev Neurol 5:299–300

  50. 50.

    Proudfoot J, Doran J, Manicavasagar V, Parker G (2010) The precipitants of manic/hypomanic episodes in the context of bipolar disorder: a review. J Affect Disord 133(3):381–387

  51. 51.

    Radua J, Pertusa A, Cardoner N (2010) Climatic relationships with specific clinical subtypes of depression. Psychiatry Res 175:217–220

  52. 52.

    Rothman KJ, Greeland S, Lash TL (2008) Validity in Epidemiologic Studies. In: Rothman KJ, Greeland S, Lash TL (eds) Modern epidemiology. Lippincott Williams & Wilkins, Philadephia, pp 137–146

  53. 53.

    Schory TJ, Piecznski N, Nair S, el-Mallakh RS (2003) Barometric pressure, emergency psychiatric visits, and violent acts. Can J Psychiatry 48:624–627

  54. 54.

    Schwartz PJ, Wehr TA, Rosenthal NE, Bartko JJ, Oren DA, Luetke C, Murphy DL (1995) Serotonin and thermoregulation. Physiologic and pharmacologic aspects of control revealed by intravenous m-CPP in normal human subjects. Neuropsychopharmacology 13:105–115

  55. 55.

    Serretti A, Artioli P, Lorenzi C, Pirovano A, Tubazio V, Zanardi R (2004) The C (-1019) G polymorphism of the 5-HT1A gene promoter and antidepressant response in mood disorders: preliminary findings. Int J Neuropsychopharmacol 7:453–460

  56. 56.

    Shand AJ, Scott NW, Anderson SM, Eagles JM (2011) The seasonality of bipolar affective disorder: comparison with a primary care sample using the Seasonal Pattern Assessment Questionnaire. J Affect Disord 132(1–2):200–208

  57. 57.

    Shanda AJ, Scottb NW, Andersona SM, Eagles JM (2011) The seasonality of bipolar affective disorder: comparison with a primary care sample using the Seasonal Pattern Assessment Questionnaire. J Affect Disord 132(1–2):200–208

  58. 58.

    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 6:90–93

  59. 59.

    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 20:61–64

  60. 60.

    Simonsen H, Shand AJ, Scott NW, Eagles JM (2011) Seasonal symptoms in bipolar and primary care patients. J Affect Disord 132(1–2):200–208

  61. 61.

    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

  62. 62.

    Symonds RL, Williams P (1976) Seasonal variation in the incidence of mania. Br J Psychiatry 129:45–48

  63. 63.

    Tiffin PA, Pearce MS, Parker L (2005) Social mobility over the lifecourse and self reported mental health at age 50: prospective cohort study. J Epidemiol Community Health 59:870–872

  64. 64.

    Tonetti L, Barbato G, Fabbri M, Adan A, Natale V (2007) Mood seasonality: a cross-sectional study of subjects aged between 10 and 25 years. J Affect Disord 97:155–160

  65. 65.

    Volpe FM, da Silva EM, dos Santos TN, de Freitas DE (2010) Further evidence of seasonality of mania in the tropics. J Affect Disord 124:178–182

  66. 66.

    Volpe FM, Tavares A, Del Porto JA (2008) Seasonality of three dimensions of mania: psychosis, aggression and suicidality. J Affect Disord 108:95–100

  67. 67.

    Weich S, Lewis G (1998) Poverty, unemployment, and common mental disorders: population based cohort study. BMJ 317:115–119

  68. 68.

    Weissman MM, Bruce LM, Leaf PJ (1991) Affective disorders, in psychiatric disorders in America. In: Robins LN, Regier DA (eds) The epidemiologic catchment area study. Free Press, New York, pp 53–80

  69. 69.

    Wrase J, Reimold M, Puls I, Kienast T, Heinz A (2006) Serotonergic dysfunction: brain imaging and behavioral correlates. Cogn Affect Behav Neurosci 6:53–61

  70. 70.

    Xie DW, Deng ZL, Ishigaki T, Nakamura Y, Suzuki Y, Miyasato K, Ohara K (1995) The gene encoding the 5-HT1A receptor is intact in mood disorders. Neuropsychopharmacology 12:263–268

Download references

Acknowledgments

We thank the National Health Research Institute for providing the Psychiatric Inpatient Medical Claim dataset, Dr. Kao-Chang Lin of the Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan, and Dr. Wen-Ching Chen of Yuli Hospital, Department of Health, Executive Yuan, Taiwan for offering valuable suggestions.

Author information

Correspondence to Huey-Jen Su.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Sung, T., Chen, M. & Su, H. A positive relationship between ambient temperature and bipolar disorder identified using a national cohort of psychiatric inpatients. Soc Psychiatry Psychiatr Epidemiol 48, 295–302 (2013). https://doi.org/10.1007/s00127-012-0542-5

Download citation

Keywords

  • Ambient temperature
  • Bipolar disorder
  • Cohort study
  • Relative risk