Improvement in Fatigue, Sleepiness, and Health-Related Quality of Life with Bright Light Treatment in Persons with Seasonal Affective Disorder and Subsyndromal SAD

Cecilia Rastad, Jan Ulfberg, Per Lindberg, Cecilia Rastad, Jan Ulfberg, Per Lindberg

Abstract

Objective. To investigate the effects of bright light treatment for secondary outcome measures and to explore and validate empirically derived subgroups and treatment effects in subgroups. Methods. A descriptive design. A sample of forty-nine persons (mean age of 45.8) with clinically assessed seasonal affective disorder (SAD) or subsyndromal SAD (S-SAD) participated in a two-group clinical trial evaluating the effects of treatment with bright light therapy. A person-oriented cluster analysis was applied to study treatment effects in subgroups. Results. For the merged group, sleepiness (Epworth Sleepiness Scale), fatigue (fatigue questionnaire), and health-related quality of life (SF-36) were improved at posttreatment, and results were maintained at the one-month followup. Three distinct subgroups had a high level of fatigue in common, while the level of excessive daytime sleepiness and depressed mood differed between the subgroups. Over time, all subgroups improved following ten days treatment in a light room. Conclusion. Fatigue, excessive daytime sleepiness, and health-related quality of life improve in a similar way as depressed mood following treatment with bright light. The treatment was effective irrespective of the severity of the disorder, that is, for persons with SAD and subsyndromal SAD.

Figures

Figure 1
Figure 1
A hierarchical cluster analysis (Ward's method) of subjects with winter SAD and S-SAD (N = 49) based on baseline data taken from four measures: the fatigue questionnaire (FQ), the Epworth Sleepiness Scale (ESS), and the two subscales, the HAMD-21 and Atyp-8 (from the depression scale SIGH-SAD/SR).
Figure 2
Figure 2
The box plots illustrate results from ANOVA repeated measures analysis of the clusters/subgroups at baseline, posttreatment, and one-month followup. A reference (horizontal) line is given for each measure; the fatigue questionnaire (FQ), a population mean set at 12.2 [25] and the Epworth Sleepiness Scale (ESS), a cutoff for excessive daytime sleepiness set at ≥10 [26]. Two reference lines are given for the 29-item SIGH-SAD/SR depression scale, one representing scores for individuals without depressive symptoms set at ≤8 [31] and the other indicating possible depression set at ≥20 [32]. The reference lines for the SF-36 PCS (physical component summary scale) and MCS (mental component summary scale) represent mean values for the general population set at 50 [27].

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