The objective of this study was to determine the pattern of new psychiatric patients with different psychiatric disorders seeking treatment in various months and seasons of the year. This study was conducted in the department of psychiatry, Govt. Medical College and Hospital, Chandigarh. Chandigarh is located on the globe at 30 degrees, 44 inches latitude (north) and 76 degrees, 48 inches longitude (east) in the foot of the Shivalik range of the Himalayas. The department of psychiatry is located on the main highway of Chandigarh, hence, a large number of patients from different states have visited this department for mental health services in the last six years.
The main interpretation of our observation is that new patients predominately visited and received diagnosis of mood disorders in the summer season while neurotic stress-related and somatoform disorders were predominantly recorded in the autumn. These findings suggest that the number of patients belonging to a specific diagnostic group seeking treatment may be uniquely influenced by the season. The possible relationship between the seasons (summer, autumn) and the months (May-July; July-Sept.) between two major diagnostic groups (mood disorders and neurotic stress-related and somatoform disorders) is elucidated in the present study. Although the study has described the utilization of treatment facilities by mentally ill patients in terms of attendance at the OPD as well as hospital admission and length of stay, it can be hypothesized that a large number of these patients might have had illness of recent onset or may have relapsed recently due to seasonal variations.
Many international studies of an average duration of 5-6 years also reported the effects of season on hospital utilization statistics.[3
] Similarly, our study has shown persistent findings for six consecutive years. ALOS and BOR were high in our study in the summer months. Seasonal variations have been observed in emergency psychiatric visits of the patients and a greater number of visits have been documented in the summer.[11
] Kecskes et al.
] reported that ALOS of inpatients had a significant relationship with the season. In the present study, the peak incidence of visits by patients with mood disorders was observed from May to July. In Chandigarh, the weather conditions show many variations during these months. The heat wave, which in fact starts in the first part of May, continues to sweep Chandigarh and other parts of north India with the mercury hovering well above the 40°C mark. The information received from the meteriological department revealed that the intensity of heat is maximum in the month of June when the sun is in its annual northward motion and reaches the Tropic of Cancer (23.5 degrees north latitude) and in mid-June, the sun turns about to move southward.
Our study showed that the number of patients with mood disorders has been consistently found to be maximum in the month of June during which the mean daily temperature is also high. Correlation analysis revealed a highly statistically significant relationship between the number of mood disorders and the maximum daily temperature. The build-up of the heat-wave peaks for a month or more from the first week of June onwards all over North India. In the summer, particularly from May to June, there is no rainfall in northern India and hot winds known as “loo, blow in a westerly direction. When humid air comes in contact with the “loo, it causes storms known as Norwesters. All these factors together contribute to the building up of above-normal temperatures. The prevailing unusual heat wave in North India is a localized phenomenon, but it could also be part of a much larger climate-changing regime. BOR of the admitted patients was also high in these months.
No statistically significant difference was found in the present study in the seasonal distribution of patients with schizophrenia, schizotypal and delusional disorders and mental and behavioral disorders due to psychoactive substance use during the last six years. In this study, four broad diagnostic groups were included. Our study is unique in the way that it has attempted to investigate the seasonal influence on service utilization by patients with these different types of psychiatric disorders. No national or international study has studied the seasonality pattern in patients' visits with neurotic stress-related and somatoform disorders. Even though this study has a few limitations (being hospital data-based, without gender and clinical subtypes or variables), its findings cannot be ignored. The unmet needs of this field of healthcare call for greater interest in this area. Importance should be given to a psychiatric patient's report of being affected by the seasonal, monthly and weather variables. We would suggest the replication of our study using more clinical details of patients with different psychiatric disorders.
The observations of the present study have a number of implications. Firstly, the findings may justify the need for more manpower in psychiatric wards during those months when the numbers of patients are at their peak. Staff can plan to go on leave so as to ensure proper availability of adequate staff during these months. Also, the administrator of the hospital can be sensitized to make more beds available for the care of mentally ill persons during the peak months. Secondly, for calculating the annual requirement of medication for the patients, the average requirement should be considered for the whole year and not for a particular month. Thirdly, this study's findings may help in planning research and to calculate the intake period for patients with mood disorders, neurotic stress-related and somatoform disorders.