Prevalence of seasonal depression in a prospective cohort study

  • Anna Wirz-Justice
  • Vladeta Ajdacic
  • Wulf Rössler
  • Hans-Christoph Steinhausen
  • Jules AngstEmail author
Original Paper


The prevalence of autumn/winter seasonality in depression has been documented in the longitudinal Zurich cohort study by five comprehensive diagnostic interviews at intervals over more than 20 years (N = 499). Repeated winter major depressive episodes (MDE—unipolar + bipolar) showed a prevalence of 3.44% (5× more women than men), whereas MDE with a single winter episode was much higher (9.96%). A total of 7.52% suffered from autumn/winter seasonality in major and minor depressive mood states. The clinical interviews revealed novel findings: high comorbidity of Social Anxiety Disorder and Agoraphobia within the repeated seasonal MDE group, high incidence of classic diurnal variation of mood (with evening improvement), as well as a high rate of oversensitivity to light, noise, or smell. Nearly twice as many of these individuals as in the other MDE groups manifested the syndrome of atypical depression (DSM-V), which supports the prior description of seasonal affective disorder (SAD) as presenting primarily atypical symptoms (which include hypersomnia and increase in appetite and weight). This long-term database of regular structured interviews provides important confirmation of SAD as a valid diagnosis, predominantly found in women, and with atypical vegetative symptoms.


Seasonality Affective disorders Comorbid disorders Zürich longitudinal cohort study 



This work was supported by Grant numbers 3200-050881.97/1 and 32-50881.97 of the Swiss National Science Foundation.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest with the present study.

Ethical approval

The study was approved (1978) by the Ethical Committee of the Zurich University Psychiatric Hospital and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

All persons gave their informed consent prior to their inclusion in the study.


  1. 1.
    Wehr TA (2001) Photoperiodism in humans and other primates: evidence and implications. J Biol Rhythms 16:348–364CrossRefGoogle Scholar
  2. 2.
    Wirz-Justice A (2018) Seasonality in affective disorders. Gen Comp Endocrinol 258:244–249CrossRefGoogle Scholar
  3. 3.
    Rosenthal NE, Sack DA, Gillin JC, Lewy AJ, Goodwin FK, Davenport Y, Mueller PS, Newsome DA, Wehr TA (1984) Seasonal affective disorder. A description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry 41:72–80CrossRefGoogle Scholar
  4. 4.
    Diagnostic and Statistical Manual of Mental Disorders Revised (DSM-III-R) (1987) American Psychiatric Association, Washington, DCGoogle Scholar
  5. 5.
    Traffanstedt MK, Mehta S, LoBello SG (2016) Major depression with seasonal variation. Is it a valid construct? Clin Psychol Sci 5:825–834CrossRefGoogle Scholar
  6. 6.
    Young MA (2016) Does seasonal affective disorder exist? A commentary on Traffanstedt, Mehta, and LoBello. Clin Psychol Sci 5:750–754CrossRefGoogle Scholar
  7. 7.
    Winkler D, Pjrek E, Spies M, Willeit M, Dorffner G, Lanzenberger R, Kasper S (2017) Has the existence of seasonal affective disorder been disproven? J Affect Disord 208:54–55CrossRefGoogle Scholar
  8. 8.
    Kegel M, Dam H, Ali F, Bjerregaard P (2009) The prevalence of seasonal affective disorder (SAD) in Greenland is related to latitude. Nord J Psychiatry 63:331–335CrossRefGoogle Scholar
  9. 9.
    Murray G (2004) How common is seasonal affective disorder in temperate Australia? A comparison of BDI and SPAQ estimates. J Affect Disorder 81:23–28CrossRefGoogle Scholar
  10. 10.
    Magnusson A (2000) An overview of epidemiological studies on seasonal affective disorder. Acta Psychiatr Scand 101:176–184CrossRefGoogle Scholar
  11. 11.
    Saarijärvi S, Lauerma H, Helenius H, Saarilehto S (1999) Seasonal affective disorders among rural Finns and Lapps. Act Psychiatr Scand 99:95–101CrossRefGoogle Scholar
  12. 12.
    Magnússon A, Axelsson J (1993) The prevalence of seasonal affective disorder is low among descendants of Icelandic emigrants in Canada. Arch Gen Psychiatry 50:947–951CrossRefGoogle Scholar
  13. 13.
    Booker JM, Hellekson CJ, Putilov AA, Danilenko KV (1990) Seasonal depression and sleep disturbances in Alaska and Siberia: a pilot study. Arct Med Res 50(Suppl. 5):281–284Google Scholar
  14. 14.
    Raheja UK, Stephens SH, Mitchell BD, Rohan KJ, Vaswani D, Balis TG, Nijjar GV, Sleemi A, Pollin TI, Ryan K, Reeves GM, Weitzel N, Morrissey M, Yousufi H, Langenberg P, Shuldiner AR, Postolache TT (2013) Seasonality of mood and behavior in the Old Order Amish. J Affect Disord 147:112–117CrossRefGoogle Scholar
  15. 15.
    Kasper S, Wehr TA, Bartko JJ, Gaist PA, Rosenthal NE (1989) Epidemiological findings of seasonal changes in mood and behavior. A telephone survey of Montgomery County, Maryland. Arch Gen Psychiatry 46:823–833CrossRefGoogle Scholar
  16. 16.
    Wirz-Justice A, Graw P, Kräuchi K, Wacker HR (2003) Seasonality in affective disorders in Switzerland. Acta Psychiatr Scand Suppl 418:92–95CrossRefGoogle Scholar
  17. 17.
    Steinhausen HC, Gundelfinger R, Winkler Metzke C (2009) Prevalence of self reported seasonal affective disorders and the validity of the seasonal pattern assessment questionnaire in young adults. Findings from a Swiss community study. J Affect Disord 115:347–354CrossRefGoogle Scholar
  18. 18.
    Wicki W, Angst J, Merikangas KR (1992) The Zurich Study. XIV. Epidemiology of seasonal depression. Eur Arch Psychiatry Clin Neurosci 241:301–306CrossRefGoogle Scholar
  19. 19.
    Derogatis LR (1977) SCL-90. Administration, Scoring and Procedures Manual-I for the R (revised) version and other instruments of the Psychopathology Rating Scale Series. Johns Hopkins University School of Medicine, ChicagoGoogle Scholar
  20. 20.
    Pjrek E, Baldinger-Melich P, Spies M, Papageorgiou K, Kasper S, Winkler D (2016) Epidemiology and socioeconomic impact of seasonal affective disorder in Austria. Eur Psychiatry 32:28–33CrossRefGoogle Scholar
  21. 21.
    Wirz-Justice A (2008) Diurnal variation of depressive symptoms. Dialogues Clin Neurosci 10:337–343Google Scholar
  22. 22.
    Postolache TT, Wehr TA, Doty RL, Sher L, Turner EH, Bartko JJ, Rosenthal NE (2002) Patients with seasonal affective disorder have lower odor detection thresholds than control subjects. Arch Gen Psychiatry 59:1119–1122CrossRefGoogle Scholar
  23. 23.
    Parker GB (2007) Atypical depression: a valid subtype? J Clin Psychiatry 68(Suppl 3):18–22Google Scholar
  24. 24.
    Haggarty JM, Cernovsky Z, Husni M, Minor K, Kermeen P, Merskey H (2002) Seasonal affective disorder in an Arctic community. Acta Psychiatr Scand 105:378–384CrossRefGoogle Scholar
  25. 25.
    Booker JM, Hellekson CJ (1992) Prevalence of seasonal affective disorder in Alaska. Am J Psychiatry 149:1176–1182CrossRefGoogle Scholar
  26. 26.
    Magnússon A, Stefánsson JG. Prevalence of seasonal affective disorder in Iceland (1993) Arch Gen Psychiatry 50:941–946Google Scholar
  27. 27.
    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 58:429–437CrossRefGoogle Scholar
  28. 28.
    Okawa M, Shirakawa S, Uchiyama M, Oguri M, Kohsaka M, Mishima K, Sakamoto K, Inoue H, Kamei K, Takahashi K (1996) Seasonal variation of mood and behaviour in a healthy middle-aged population in Japan. Acta Psychiatr Scand 94:211–216CrossRefGoogle Scholar
  29. 29.
    Rosen LN, Targum SD, Terman M, Bryant MJ, Hoffman H, Kasper SF, Hamovit JR, Docherty JP, Welch B, Rosenthal NE (1990) Prevalence of seasonal affective disorder at four latitudes. Psychiatry Res 31:131–144CrossRefGoogle Scholar
  30. 30.
    Mersch PP, Middendorp HM, Bouhuys AL, Beersma DG, van den Hoofdakker RH (1999) The prevalence of seasonal affective disorder in The Netherlands: a prospective and retrospective study of seasonal mood variation in the general population. Biol Psychiatry 45:1013–1022CrossRefGoogle Scholar
  31. 31.
    Mersch PP, Middendorp HM, Bouhuys AL, Beersma DG, van den Hoofdakker RH (1999) Seasonal affective disorder and latitude: a review of the literature. J Affect Disord 53:35–48CrossRefGoogle Scholar
  32. 32.
    Thompson C, Thompson S, Smith R (2004) Prevalence of seasonal affective disorder in primary care; a comparison of the seasonal health questionnaire and the seasonal pattern assessment questionnaire. J Affect Disord 78:219–226CrossRefGoogle Scholar
  33. 33.
    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 132:289–292CrossRefGoogle Scholar
  34. 34.
    Sakamoto K, Kamo T, Nakadaira S, Tamura A, Takahashi K (1993) A nationwide survey of seasonal affective disorder at 53 outpatient university clinics in Japan. Acta Psychiatr Scand 87:258–265CrossRefGoogle Scholar
  35. 35.
    Blazer DG, Kessler RC, Swartz MS (1998) Epidemiology of recurrent major and minor depression with a seasonal pattern. The National Comorbidity Survey. Br J Psychiatry 172:164–167CrossRefGoogle Scholar
  36. 36.
    Eagles JM, Wileman SM, Cameron IM, Howie FL, Lawton K, Gray DA, Andrew JE, Naji SA (1999) Seasonal affective disorder among primary care attenders and a community sample in Aberdeen. Br J Psychiatry 175:472–475CrossRefGoogle Scholar
  37. 37.
    Michalak EE, Wilkinson C, Dowrick C, Wilkinson G (2001) Seasonal affective disorder: prevalence, detection and current treatment in North Wales. Br J Psychiatry 179:31–34CrossRefGoogle Scholar
  38. 38.
    Levitt AJ, Boyle MH, Joffe RT, Baumal Z (2000) Estimated prevalence of the seasonal subtype of major depression in a Canadian community sample. Can J Psychiatry 45:650–654CrossRefGoogle Scholar
  39. 39.
    Elbi H, Noyan A, Korukoğlu S, Unal S, Bekaroğlu M, Oğuzhanoğlu N, Türköz N, Abay E, Kumbasar H, Yurdakul S (2002) Seasonal affective disorder in eight groups in Turkey: a cross-national perspective. J Affect Disord 70:77–84CrossRefGoogle Scholar
  40. 40.
    Baek JH, Kim JS, Huh I, Lee K, Park JH, Park T, Ha K, Hong KS (2015) Prevalence, behavioral manifestations and associated individual and climatic factors of seasonality in the Korean general population. Compr Psychiatry 57:148–154CrossRefGoogle Scholar
  41. 41.
    Leonhardt G, Wirz-Justice A, Kräuchi K, Graw P, Wunder D, Haug HJ (1994) Long-term follow-up of depression in seasonal affective disorder. Compr Psychiatry 35:457–464CrossRefGoogle Scholar
  42. 42.
    Graw P, Gisin B, Wirz-Justice A (1997) Follow-up study of seasonal affective disorder in Switzerland. Psychopathol 30:208–214CrossRefGoogle Scholar
  43. 43.
    Sakamoto K, Nakadaira S, Kamo K, Kamo T, Takahashi K (1995) A longitudinal follow-up study of seasonal affective disorder. Am J Psychiatry 152:862–868CrossRefGoogle Scholar
  44. 44.
    Cléry-Melin ML, Gorwood P, Friedman S, Even C (2018) Stability of the diagnosis of seasonal affective disorder in a long-term perspective. J Affect Disord 227:353–357CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre for Chronobiology, Psychiatric ClinicsUniversity of BaselBaselSwitzerland
  2. 2.Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric HospitalUniversity of ZurichZurichSwitzerland
  3. 3.Department of Psychiatry and PsychotherapyCharité University Medicine BerlinBerlinGermany
  4. 4.Department of Child and Adolescent PsychiatryUniversity of ZurichZurichSwitzerland
  5. 5.Clinical Psychology and Epidemiology, Institute of PsychologyUniversity of BaselBaselSwitzerland
  6. 6.Child and Adolescent Mental Health CentreCapital Region PsychiatryCopenhagenDenmark
  7. 7.Department of Child and Adolescent PsychiatryUniversity of Southern DenmarkOdenseDenmark

Personalised recommendations