Depressed Patients Hospitalized in Southeast-Facing Rooms Are Discharged Earlier than Patients in Northwest-Facing Rooms

Gbyl, Krzysztof; Madsen, Helle Østergaard; Svendsen, Signe Dunker; Petersen, Paul Michael; Hageman, Ida; Volf, Carlo; Martiny, Klaus

doi:10.1159/000477249

Cited by 32 publications

(16 citation statements)

References 22 publications

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“…This has enormous implications also for architecture itself, demanding more daylight and more naturalistic artificial lighting in a still‐to‐be‐defined “healthy” combination. Already we know that higher daylight availability for hospitalised patients, as observed in east‐facing rooms, or with bigger windows, or with hospital beds nearer to windows, has been shown to act indirectly as “light therapy” and to consistently speed up recovery from depression (Beauchemin & Hays, ; Benedetti, Colombo, Barbini, Campori, & Smeraldi, ; Canellas et al., ; Gbyl et al., ). More generally, sunny rooms improve outcomes after a first attack of myocardial infarction (Beauchemin & Hays, ); improve sleep in medical wards (Bano et al., ); and reduce the need of painkillers after spinal surgery (Walch et al., ).…”

Section: Where Are We Today?mentioning

confidence: 99%

Perspectives in affective disorders: Clocks and sleep

Wirz‐Justice

Benedetti

2019

Eur J of Neuroscience

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Mood disorders are often characterised by alterations in circadian rhythms, sleep disturbances and seasonal exacerbation. Conversely, chronobiological treatments utilise zeitgebers for circadian rhythms such as light to improve mood and stabilise sleep, and manipulations of sleep timing and duration as rapid antidepressant modalities. Although sleep deprivation (“wake therapy”) can act within hours, and its mood‐elevating effects be maintained by regular morning light administration/medication/earlier sleep, it has not entered the regular guidelines for treating affective disorders as a first‐line treatment. The hindrances to using chronotherapeutics may lie in their lack of patentability, few sponsors to carry out large multi‐centre trials, non‐reimbursement by medical insurance and their perceived difficulty or exotic “alternative” nature. Future use can be promoted by new technology (single‐sample phase measurements, phone apps, movement and sleep trackers) that provides ambulatory documentation over long periods and feedback to therapist and patient. Light combinations with cognitive behavioural therapy and sleep hygiene practice may speed up and also maintain response. The urgent need for new antidepressants should hopefully lead to reconsideration and implementation of these non‐pharmacological methods, as well as further clinical trials. We review the putative neurochemical mechanisms underlying the antidepressant effect of sleep deprivation and light therapy, and current knowledge linking clocks and sleep with affective disorders: neurotransmitter switching, stress and cortico‐limbic reactivity, clock genes, cortical neuroplasticity, connectomics and neuroinflammation. Despite the complexity of multi‐system mechanisms, more insight will lead to fine tuning and better application of circadian and sleep‐related treatments of depression.

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Section: Where Are We Today?mentioning

confidence: 99%

Perspectives in affective disorders: Clocks and sleep

Wirz‐Justice

Benedetti

2019

Eur J of Neuroscience

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“…Sample size calculation was done using the SAS V.9.4 software using proc power for a two-sample independent sample t-test. In a previous study,2 on patients from the same ward, we found a mean HAM-D 17 score at admission of 23. This corresponds to a HAM-D 6 score of 13.…”

Section: Methods and Analysismentioning

confidence: 69%

“…Measured on a clear day, these differences were 57 000 lx at the summer solstice, 38 000 lx at the autumn equinox and 19 000 lx at the winter solstice. We found a significantly shorter inpatient stay for patients staying in SE-facing room compared with NW-facing rooms 2. Latest, West et al examined the effect of dynamic light versus static light in a cluster randomisation design in two cerebral stroke rehabilitation units in Copenhagen, Denmark (55.7°N).…”

Section: Introductionmentioning

confidence: 91%

“…These patients often have suicidal ideation and despair and need inpatient care including treatment with mood stabilisers, antipsychotics, antidepressants, psychoeducation, psychotherapy and occupational therapy. Typically, these patients will still suffer from varying degrees of depression when discharged2 3 and relapse, readmission and even suicide, on discharge, are major treatment challenges 4. Despite intense efforts during the last decades, there has been no breakthrough for either drug development or for any other treatment modality and 10%–25% of patients are treatment resistant 5.…”

Section: Introductionmentioning

confidence: 99%

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Dynamic LED-light versus static LED-light for depressed inpatients: study protocol for a randomised clinical study

et al. 2020

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IntroductionRetrospective studies conducted in psychiatric inpatient wards have shown a relation between the intensity of daylight in patient rooms and the length of stay, pointing to an antidepressant effect of ambient lighting conditions. Light therapy has shown a promising antidepressant effect when administered from a light box. The emergence of light-emitting diode (LED) technology has made it possible to build luminaires into rooms and to dynamically mimic the spectral and temporal distribution of daylight. The objective of this study is to investigate the antidepressant efficacy of a newly developed dynamic LED-lighting system installed in an inpatient ward.Methods and analysisIn all, 150 inpatients with a major depressive episode, as part of either a major depressive disorder or as part of a bipolar disorder, will be included. The design is a two-arm 1:1 randomised study with a dynamic LED-lighting arm and a static LED-lighting arm, both as add-on to usual treatment in an inpatient psychiatric ward. The primary outcome is the baseline adjusted score on the 6-item Hamilton Depression Rating Scale at week 3. The secondary outcomes are the mean score on the Suicidal Ideation Attributes Scale at week 3, the mean score on the 17-item Hamilton Depression Rating Scale at week 3 and the mean score on the World Health Organisation Quality of Life-BREF (WHOQOL-BREF) at week 3. The spectral distribution of daylight and LED-light, with a specific focus on light mediated through the intrinsically photosensitive retinal ganglion cells, will be measured. Use of light luminaires will be logged. Assessors of Hamilton Depression Rating Scale scores and data analysts will be blinded for treatment allocation. The study was initiated in May 2019 and will end in December 2021.Ethics and disseminationNo ethical issues are expected. Results will be published in peer-reviewed journals, disseminated electronically and in print and presented at symposia.Trial registration numberNCT03821506; Pre-results.

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“…A few retrospective cohort studies based on daylight or LED light at inpatient wards have been carried out showing a shortened length of inpatient stay with brighter conditions [13][14][15][16]. Our group has recently investigated the impact of daylight in psychiatric inpatients and found a shorter stay in rooms located on the brighter south-east side of the building compared to rooms on the dimmer north-west side [17]. A recent randomised trial in poststroke patients showed a strengthening of melatonin rhythmicity and improved mood with brighter light conditions [18,19].…”

Section: Introductionmentioning

confidence: 99%

Dynamic LED light versus static LED light for depressed inpatients: results from a randomized feasibility trial

Volf

Aggestrup

Svendsen

et al. 2020

Pilot Feasibility Stud

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Background: Retrospective studies conducted in psychiatric wards have indicated a shorter duration of stay for depressed inpatients in bright compared to dim daylight-exposed rooms, pointing to a possible antidepressant effect of daylight conditions. Dynamic LED lighting, aiming to mimic daylight conditions, are currently been installed in several hospitals, but their feasibility is poorly investigated. Methods: To investigate the feasibility of these systems, we developed and installed a LED-lighting system in four rooms in a psychiatric inpatient ward. The system could function statically or dynamically regarding light intensity and colour temperature. The system consisted of (A) a large LED luminaire built into the window jamb mimicking sunlight reflections, (B) two LED light luminaires in the ceiling and (C) a LED reading luminaire. In the static mode, the systems provided constant light from A and B. In the dynamic mode, the system changed light intensity and colour temperature using A, B and C. Patients with unipolar or bipolar depression were randomised to dynamic or static LED lighting for 4 weeks, in addition to standard treatment. Primary outcome was the rate of patients discontinuing the trial due to discomfort from the lighting condition. Secondary outcomes were recruitment and dropout rates, visual comfort, depressive symptoms and suicidal ideation. Results: No participants discontinued due to discomfort from the LED lighting. Recruitment rate was 39.8%, dropout from treatment rates were 56.3% in the dynamic group and 33.3% in the static group. 78.1% in the dynamic group were satisfied with the lighting compared with 71.8% in the static group. Discomfort from the light (glare) was reported by 11.5% in the dynamic group compared to 5.1% in the static group. Endpoint suicidal scores were 16.8 (10.4) in the dynamic and 16.3 (14.9) in the static group. The lighting system was 100% functional. The light sensor system proved unstable. Conclusion: Dropout from treatment was high primarily due to early discharge and with a lack of endpoint assessments. The feasibility study has influenced an upcoming large-scale dynamic lighting efficacy trial where we will use a shorter study period of 3 weeks and with more emphasis on endpoint assessments. The lighting was well tolerated in both groups, but some found intensity too low in the evening. Thus, we will use higher intensity blue-enriched light in the morning and higher intensity amber (blue-depleted) light in the evening in the upcoming study. The light sensor system needs to be improved

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Depressed Patients Hospitalized in Southeast-Facing Rooms Are Discharged Earlier than Patients in Northwest-Facing Rooms

Cited by 32 publications

References 22 publications

Perspectives in affective disorders: Clocks and sleep

Perspectives in affective disorders: Clocks and sleep

Dynamic LED-light versus static LED-light for depressed inpatients: study protocol for a randomised clinical study

Dynamic LED light versus static LED light for depressed inpatients: results from a randomized feasibility trial

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