Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder

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Cabrera JAuthorTorrent C.AuthorVieta E.Author

September 7, 2021

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Publicated to: International Journal of Bipolar Disorders. 9 (1): 26- - 2021-09-01 9(1), DOI: 10.1186/s40345-021-00231-7

Authors:

Bauer, M; Glenn, T; Achtyes, ED; Alda, M; Agaoglu, E; Altinbas, K; Andreassen, OA; Angelopoulos, E; Ardau, R; Vares, EA; Aydin, M; Ayhan, Y; Baethge, C; Bauer, R; Baune, BT; Balaban, C; Becerra-Palars, C; Behere, AP; Behere, PB; Belete, H; Belete, T; Belizario, GO; Bellivier, F; Belmaker, RH; Benedetti, F; Berk, M; Bersudsky, Y; Bicakci, S; Birabwa-Oketcho, H; Bjella, TD; Brady, C; Cabrera, J; Cappucciati, M; Castro, AMP; Chen, WL; Cheung, EYW; Chiesa, S; Crowe, M; Cuomo, A; Dallaspezia, S; Del Zompo, M; Desai, P; Dodd, S; Donix, M; Etain, B; Fagiolini, A; Fellendorf, FT; Ferensztajn-Rochowiak, E; Fiedorowicz, JG; Fountoulakis, KN; Frye, MA; Geoffroy, PA; Gonzalez-Pinto, A; Gottlieb, JF; Grof, P; Haarman, BCM; Harima, H; Hasse-Sousa, M; Henry, C; Hoffding, L; Houenou, J; Imbesi, M; Isometsä, ET; Ivkovic, M; Janno, S; Johnsen, S; Kapczinski, F; Karakatsoulis, GN; Kardell, M; Kessing, LV; Kim, SJ; König, B; Kot, TL; Koval, M; Kunz, M; Lafer, B; Landén, M; Larsen, ER; Lenger, M; Lewitzka, U; Licht, RW; Lopez-Jaramillo, C; MacKenzie, A; Madsen, HO; Madsen, SAKA; Mahadevan, J; Mahardika, A; Manchia, M; Marsh, W; Martinez-Cengotitabengoa, M; Martiny, K; Mashima, Y; McLoughlin, DM; Meesters, Y; Melle, I; Meza-Urzúa, F; Ming, MY; Monteith, S; Moorthy, M; Morken, G; Mosca, E; Mozzhegorov, AA; Munoz, R; Mythri, S; Nacef, F; Nadella, RK; Nakanotani, T; Nielsen, RE; O'Donovan, C; Omrani, A; Osher, Y; Ouali, U; Pantovic-Stefanovic, M; Pariwatcharakul, P; Petite, J; Pfennig, A; Ruiz, YP; Pilhatsch, M; Pinna, M; Pompili, M; Porter, R; Quiroz, D; Rabelo-da-Ponte, FD; Ramesar, R; Rasgon, N; Ratta-Apha, W; Ratzenhofer, M; Redahan, M; Reddy, MS; Reif, A; Reininghaus, EZ; Richards, JG; Ritter, P; Rybakowski, JK; Sathyaputri, L; Scippa, AM; Simhandl, C; Severus, E; Smith, D; Smith, J; Stackhouse, PW ; Stein, DJ; Stilwell, K; Strejilevich, S; Su, KP; Subramaniam, M; Sulaiman, AH; Suominen, K; Tanra, AJ; Tatebayashi, Y; Teh, WL; Tondo, L; Torrent, C; Tuinstra, D; Uchida, T; Vaaler, AE; Veeh, J; Vieta, E; Viswanath, B; Yoldi-Negrete, M; Yalcinkaya, OK; Young, AH; Zgueb, Y; Whybrow, PC

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Affiliations

Aalborg Univ Hosp, Psychiat, Aalborg, Denmark - Author

Aalborg Univ Hosp, Unit Psychiat Res, Aalborg, Denmark - Author

Aalborg Univ, Dept Clin Med, Aalborg, Denmark - Author

Aristotle Univ Thessaloniki, Fac Hlth Sci, Sch Med, Dept Psychiat 3, Thessaloniki, Greece - Author

Asha Hosp, Asha Bipolar Clin, Hyderabad, Telangana, India - Author

Bahir Dar Univ, Coll Med & Hlth Sci, Dept Psychiat, Bahir Dar, Ethiopia - Author

Baskent Univ, Dept Psychiat, Fac Med, Ankara, Turkey - Author

Ben Gurion Univ Negev, Fac Hlth Sci, Beer Sheva Mental Hlth Ctr, Dept Psychiat, Beer Sheva, Israel - Author

Ben Gurion Univ Negev, Psychiat, Beer Sheva, Israel - Author

BIPOLAR Zentrum Wiener Neustadt, Wiener Neustadt, Austria - Author

Butabika Hosp, Kampala, Uganda - Author

Cheongju Hosp, Dept Psychiat, Cheongju, South Korea - Author

China Med Univ CMU, Coll Med, Taichung, Taiwan - Author

China Med Univ, An Nan Hosp, Tainan, Taiwan - Author

ChronoRecord Assoc, Fullerton, CA USA - Author

City Helsinki, Psychiat, Dept Social Serv & Hlth Care, Helsinki, Finland - Author

Copenhagen Univ Hosp, Psychiat Ctr Copenhagen, Copenhagen, Denmark - Author

Dalhousie Univ, Dept Pharmacol, Halifax, NS, Canada - Author

Dalhousie Univ, Dept Psychiat, Halifax, NS, Canada - Author

Datta Meghe Inst Med Sci Deemed Univ, Jawaharlal Nehru Med Coll, Dept Psychiat, Wardha, India - Author

Deakin Univ, Sch Med, IMPACT Inst Mental & Phys Hlth & Clin Translat, Barwon Hlth, Geelong, Vic, Australia - Author

Dept Mental Hlth & Subst Abuse, Piacenza, Italy - Author

Diego Portales Univ, Dept Psychiat, Santiago, Chile - Author

Dr Jose Horwitz Psychiat Inst, Mood Disorders Clin, Santiago, Chile - Author

Elblandklinikum Radebeul, Dept Psychiat & Psychotherapy, Radebeul, Germany - Author

Erable Med Cabinet 324, Tunisian Bipolar Forum, Lac 2, Tunis, Tunisia - Author

Favaloro Univ, Neurosci Inst, Bipolar Disorder Program, Buenos Aires, DF, Argentina - Author

GHU Paris Psychiat & Neurosci, Dept Psychiat, F-75014 Paris, France - Author

GHU Paris Psychiat & Neurosci, F-75014 Paris, France - Author

Hacettepe Univ, Dept Psychiat, Fac Med, Ankara, Turkey - Author

Harvard Med Sch, McLean Hosp, Boston, MA 02115 USA - Author

Hasanuddin Univ, Fac Med, Dept Psychiat, Makassar, Indonesia - Author

Helsinki Univ Hosp, Helsinki, Finland - Author

Hop Bichat Claude Bernard, AP HP, Dept Psychiat & Addictol, Paris, France - Author

Hosp Angeles del Pedregal, Mexico City, DF, Mexico - Author

Inst Mental Hlth, Dept Gen Psychiat, Mood Disorders Unit, Singapore, Singapore - Author

Inst Mental Hlth, Res Div, Singapore, Singapore - Author

Inst Nacl Psiquiatria Ramon de la Fuente Muniz, Subdirecc Invest Clin, Mexico City, DF, Mexico - Author

Ist Sci San Raffaele, Div Neurosci, Psychiat & Clin Psychobiol, Milan, Italy - Author

Johann Wolfgang Goethe Univ Frankfurt Main, Univ Hosp Frankfurt, Dept Psychiat Psychosomat Med & Psychotherapy, Frankfurt, Germany - Author

Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden - Author

Keio Univ, Dept Neuropsychiat, Sch Med, Tokyo, Japan - Author

Khanty Mansiysk Clin Psychoneurol Hosp, Khanty Mansiysk, Russia - Author

Kings Coll London, Inst Psychiat Psychol & Neurosci, Dept Psychol Med, London, England - Author

Lucio Bini Mood Disorder Ctr, Cagliari, Italy - Author

Mahidol Univ, Siriraj Hosp, Fac Med, Dept Psychiat, Bangkok, Thailand - Author

Mataram Univ, Fac Med, Dept Psychiat, Mataram, Indonesia - Author

Mayo Clin, Dept Psychiat & Psychol, Mayo Clin Depress Ctr, Rochester, MN USA - Author

Med Univ Graz, Dept Psychiat & Psychotherapeut Med, Graz, Austria - Author

Michigan State Univ CHM, Helen DeVos Childrens Hosp, Child & Adolescent Psychiat, Grand Rapids, MI USA - Author

Michigan State Univ, Coll Human Med, Div Psychiat & Behav Med, Grand Rapids, MI USA - Author

Michigan State Univ, Coll Human Med, Traverse City Campus, Traverse City, MI USA - Author

Michigan State Univ, Dept Neurosci, E Lansing, MI 48824 USA - Author

Mood Disorder Lucio Bini Ctr, Cagliari, Italy - Author

Mood Disorder Lucio Bini Ctr, Rome, Italy - Author

NASA, Sci Directorate, Climate Sci Branch, Langley Res Ctr, Hampton, VA USA - Author

Natl & Capodistrian Univ Athens, Eginit Hosp, Med Sch, Dept Psychiat, Athens, Greece - Author

Natl Inst Hlth & Welf, Helsinki, Finland - Author

Natl Inst Mental Hlth & Neuro Sci NIMHANS, Dept Psychiat, Bengaluru, India - Author

Natl Inst Psychiat Ramon de la Fuente Muniz, Mexico City, DF, Mexico - Author

Northwestern Univ, Dept Psychiat, Feinberg Sch Med, Chicago, IL 60611 USA - Author

Norwegian Univ Sci & Technol NTNU, Dept Mental Hlth, Trondheim, Norway - Author

Pine Rest Christian Mental Hlth Serv, Grand Rapids, MI USA - Author

Poznan Univ Med Sci, Dept Adult Psychiat, Poznan, Poland - Author

Rigshosp, Copenhagen Affect Disorder Res Ctr CADIC, Psychiat Ctr Copenhagen, Copenhagen, Denmark - Author

Sapienza Univ Rome, St Andrea Hosp, Dept Neurosci Mental Hlth & Sensory Organs, Rome, Italy - Author

Selcuk Univ, Dept Psychiat, Fac Med, Konya, Turkey - Author

Selcuk Univ, Mazhar Osman Mood Ctr, Dept Psychiat, Fac Med, Konya, Turkey - Author

Sigmund Freud Privat Univ, Bipolar Zentrum Wiener Neustadt, Vienna, Austria - Author

Soviet Psychoneurol Hosp, Urai, Russia - Author

St Olavs Univ Hosp, Dept Psychiat, Trondheim, Norway - Author

St Patricks Univ Hosp, Trinity Coll Inst Neurosci, Dept Psychiat, Trinity Coll Dublin, Dublin, Ireland - Author

Stanford Sch Med, Dept Psychiat & Behav Sci, Palo Alto, CA USA - Author

Taichung Vet Gen Hosp, Dept Psychiat, Chiayi Branch, Chiayi, Taiwan - Author

Tech Univ Dresden, Univ Hosp Carl Gustav Carus, Fac Med, Dept Psychiat & Psychotherapy, Dresden, Germany - Author

Tokyo Metropolitan Inst Med Sci, Affect Disorders Res Project, Setagaya Ku, Tokyo, Japan - Author

Tokyo Metropolitan Matsuzawa Hosp, Dept Psychiat, Setagaya Ku, Tokyo, Japan - Author

Trinity Coll Dublin, Dept Psychiat, St Patricks Univ Hosp, Dublin, Ireland - Author

Univ Antioquia, Hosp Univ San Vicente Fdn, Fac Med, Dept Psychiat,Mood Disorders Program,Res Grp Psyc, Medellin, Colombia - Author

Univ Barcelona, Hosp Clin, Clin Inst Neurosci, IDIBAPS,CIBERSAM, Barcelona, Catalonia, Spain - Author

Univ Basque Country, BioAraba Res Inst, Basque Hlth Serv, Osakidetza, Vitoria, Spain - Author

Univ Basque Country, Univ Hosp Alava, Dept Psychiat, CIBERSAM,BIOARABA, Vitoria, Spain - Author

Univ Cagliari, Dept Biomed Sci, Sect Neurosci & Clin Pharmacol, Sardinia, Italy - Author

Univ Cagliari, Dept Med Sci & Publ Hlth, Sect Psychiat, Cagliari, Italy - Author

Univ Calif Los Angeles, Dept Psychiat & Biobehav Sci, Semel Inst Neurosci & Human Behav, Los Angeles, CA 90024 USA - Author

Univ Calif San Diego, Dept Psychiat, San Diego, CA 92103 USA - Author

Univ Cape Town, Dept Psychiat, MRC Unit Risk & Resilience Mental Disorders, Cape Town, South Africa - Author

Univ Cape Town, Inst Infect Dis & Mol Med, Dept Pathol, Div Human Genet,SA MRC Genom & Precis Med Res Uni, Cape Town, South Africa - Author

Univ Clin Ctr Serbia, Clin Psychiat, Belgrade, Serbia - Author

Univ Cologne, Dept Psychiat & Psychotherapy, Med Sch, Cologne, Germany - Author

Univ Edinburgh, Ctr Clin Brain Sci, Edinburgh, Midlothian, Scotland - Author

Univ Fed Bahia, Dept Neurosci & Mental Hlth, Salvador, BA, Brazil - Author

Univ Fed Rio Grande do Sul, Dept Psychiat, Porto Alegre, RS, Brazil - Author

Univ Glasgow, NHS Greater Glasgow & Clyde, Forens Psychiat, Glasgow, Lanark, Scotland - Author

Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Dept Psychiat & Neurochem, Gothenburg, Sweden - Author

Univ Groningen, Univ Med Ctr Groningen, Dept Psychiat, Groningen, Netherlands - Author

Univ Helsinki, Dept Psychiat, Helsinki, Finland - Author

Univ Hosp Agcy Cagliari, Unit Clin Psychiat, Cagliari, Italy - Author

Univ Iowa, Dept Epidemiol, Iowa Neurosci Inst, Iowa City, IA USA - Author

Univ Iowa, Dept Internal Med, Iowa Neurosci Inst, Iowa City, IA 52242 USA - Author

Univ Iowa, Dept Psychiat, Iowa Neurosci Inst, Iowa City, IA 52242 USA - Author

Univ Malaya, Fac Med, Dept Psychol Med, Kuala Lumpur, Malaysia - Author

Univ Massachusetts, Sch Med, Dept Psychiat, Worcester, MA 01655 USA - Author

Univ Melbourne, Dept Psychiat, Parkville, Vic, Australia - Author

Univ Melbourne, Florey Inst Neurosci & Mental Hlth, Parkville, Vic, Australia - Author

Univ Melbourne, Melbourne Med Sch, Dept Psychiat, Melbourne, Vic, Australia - Author

Univ Melbourne, Natl Ctr Excellence Youth Mental Hlth, Ctr Youth Mental Hlth,Orygen, Florey Inst Neurosci & Mental Hlth,Dept Psychiat, Melbourne, Vic, Australia - Author

Univ Munster, Dept Psychiat, Munster, Germany - Author

Univ Oslo, Inst Clin Med, Oslo, Norway - Author

Univ Oslo, Oslo Univ Hosp, NORMENT Ctr, Div Mental Hlth & Addict, Oslo, Norway - Author

Univ Otago, Dept Psychol Med, Christchurch, New Zealand - Author

Univ Ottawa, Sch Epidemiol & Publ Hlth, Dept Psychiat, Ottawa, ON, Canada - Author

Univ Paris Est Creteil, Fdn FondaMental, Translat Neuropsychiat, IMRB,INSERM, F-94010 Creteil, France - Author

Univ Paris Saclay, Neurospin, CEA, F-91191 Gif Sur Yvette, France - Author

Univ Paris, AP HP, FondaMental Fdn, Dept Psychiat & Med Addictol,INSERM UMR S1144, Paris, France - Author

Univ Paris, F-75006 Paris, France - Author

Univ Paris, INSERM, NeuroDiderot, Paris, France - Author

Univ Sao Paulo, Dept Psychiat, Bipolar Disorder Res Program, Med Sch, Sao Paulo, Brazil - Author

Univ Siena, Dept Mol Med, Sch Med, Siena, Italy - Author

Univ Southern Denmark, Dept Clin Res, Odense, Denmark - Author

Univ Southern Denmark, Dept Reg Hlth Res, Esbjerg, Denmark - Author

Univ Southern Denmark, Univ Clin, Mental Hlth Dept Odense, Esbjerg, Denmark - Author

Univ Tartu, Dept Psychiat, Tartu, Estonia - Author

Univ Toronto, Dept Psychiat, Ottawa, ON, Canada - Author

Univ Toronto, Mood Disorders Ctr Ottawa, Ottawa, ON, Canada - Author

Univ Tunis El Manar, Razi Hosp, Fac Med, Tunis, Tunisia - Author

Univ Vita Salute San Raffaele, Milan, Italy - Author

Abstract

Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries.Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun's electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries).This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p? [+]

Keywords

age-of-onsetbirth-cohortcircadiancircadian-rhythmsglobal analysislightmoodmortalitypopulationpsychiatryratesseasonal variationsolar insolationsuicidesunlightAdultArticleBipolar disorderBipolar i disorderCircadianCircadian rhythmExploratory researchFemaleHumanIlluminationInformation processingMajor clinical studyMaleManic-depressive illnessPsychiatryRadiació solarSeasonal variationSolar insolationSolar radiationStatistical significanceSubstance abuseSubstance use disordersSuicideSuicide attemptSunlightTrastorn bipolar

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal International Journal of Bipolar Disorders due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2021, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Psychiatry and Mental Health.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 1.02. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 13, 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2026-04-05, the following number of citations:

WoS: 14
Scopus: 9
Europe PMC: 3

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Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Argentina; Australia; Austria; Brazil; Canada; Chile; China; Colombia; Denmark; Estonia; Ethiopia; Finland; France; Germany; Greece; Hong Kong; India; Indonesia; Israel; Italy; Japan; Malaysia; Mexico; Netherlands; New Zealand; Norway; Poland; Republic of Korea; Russia; Serbia; Singapore; South African Republic; Sweden; Taiwan; Thailand; Tunisia; Turkey; Uganda; United Kingdom; United States of America.

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Awards linked to the item

Open Access funding enabled and organized by Projekt DEAL. Michael Berk is supported by a NHMRC Senior Principal Research Fellowship (1156072). Pierre A. Geoffroy, Chantal Henry and Josselin Houenou received grants from the French Agence Nationale pour la Recherche (ANR-11-IDEX-0004 Labex BioPsy Olfaction and Bipolar Disorder collaborative project, ANR-10-COHO-10-01 psyCOH and ANR-DFG ANR-14-CE35-0035 FUNDO). Mok Yee Ming, Mythily Subramaniam, and Wen Lin Teh received funding from the National Medical Research Centre (NMRC) Centre Grant (Ref No: NMRC/CG/M002/2017_IMH).