Implementing prevention of seasonal affective disorder from patients’ and physicians’ perspectives – a qualitative study

Abstract

BackgroundSeasonal affective disorder (SAD) is a seasonally recurrent type of major depression that has detrimental effects on patients’ lives during winter. Little is known about how it affects patients during summer and about patients’ and physicians’ perspectives on preventive SAD treatment. The aim of our study was to explore how SAD patients experience summers, what type of preventive treatment patients implement, which preventive treatment methods, if any, physicians recommend, and what factors facilitate or hinder implementation/recommendation of SAD prevention.MethodsWe conducted 15 semi-structured interviews, ten with adult patients with a history of SAD and five with physicians. Transcripts were analyzed by two researchers using an inductive thematic analysis approach.ResultsOne group of patients was able to enjoy summer and ignore thoughts of the upcoming winter. The other group feared the impending depressive episode in winter, and this fear negatively impacted these patients’ well-being during the summer. Preventive treatment was a relevant issue for all patients, and all but one person implemented SAD prevention during summer. We identified six factors that influenced patient use of preventive treatment of SAD. Four factors occur on an individual level (knowledge about disease and preventive treatment options, experience with treatment in acute phase, acceptability of intervention, willingness to take responsibility for oneself), one on an interpersonal level (social and work environment), and one on a structural level (healthcare system). All psychiatrists recommended some kind of preventive intervention, most commonly, lifestyle changes. Four factors influenced psychiatrists in recommending prevention of SAD (patient expectations, disease history and stability, risk/benefit ratio, lack of evidence).ConclusionsSuccess in the implementation of SAD prevention does not solely depend on the willingness of the patients, but is also influenced by external factors. Raising awareness of SAD among general practitioners and low-level access to mental-health support could help patients find appropriate help sooner. To better guide the optimal treatment choice, comparative effectiveness research on treatments to prevent a new onset in patients with a history of SAD and clinical practice guidelines on SAD are needed.

Ethics analysis of light and vitamin D therapies for seasonal affective disorder

“…Regarding light therapy, the clinical benefits shown by the meta-analysis (13) need to be put in contrast with the potential side effects such as irritability, headaches, eye strain, sleep disturbances, and insomnia (11). Light therapy was also judged to be time-consuming by patients as it requires a commitment both in the morning and in the evening that is hard to be incorporated into daily routines and thus has the potential to disturb one's personal life (15). The issue related to social inequality is driven by the lack of insurance coverage and hence the need of out-of-pocket expenses.…”

“…The insufficient clinical benefit profile of fluoxetine compared to the list of side effects seems to suggest a negative befit-harm ratio. With respect to the comparator of cognitive behavioral therapy (CBT), although there seem to be positive effects of CBT on SAD patients—especially when CBT is modified with respect to patients’ beliefs and values drawn from their spiritual narratives—the time-consuming nature of person-centered therapy serves as an obstacle that may prevent patients from seeking this treatment alternative (15;32).…”

“…Concerning SAD and the experience of winter fatigue, SAD patients report a lack of awareness of SAD among physicians and especially, among general practitioners (15). Such a lack of awareness may be a contributing factor to patients' self-stigma as patients themselves report doubts whether listlessness, social withdrawal, and depressed mood are a normal part of winter (15). The physicians' lack of knowledge combined with the SAD patients' potential self-stigma may mean that opportunities to recognize and treat SAD are missed (16).…”

“…In German-speaking countries approximately 2.5% of the population suffers from SAD. About 80% of those diagnosed with this illness will face a recurrent depressive episode the following winter, which has detrimental effects on their quality of life" (15).…”

“…"One major barrier patients encountered when searching for help, was that general practitioners did not recognize SAD symptoms. Consequently, SAD patients often remain mis-or underdiagnosed and continued to suffer from symptoms and functional disability" (15).…”