The short dark days of winter, related lack of energy, and low mood have always been part of life for those living in northern latitudes. For many, the gradual changes of the seasons are accompanied by the gradual degradation of their mental health. This disruptive effect is called Seasonal Affective Disorder (SAD). It is defined as major depressive episodes characterized by their seasonal recurrence for at least 2 consecutive years. Symptoms generally involve fatigue and a severe lack of energy leading to difficulty in performing daily activities as well as increased worry, anxiety, and irritability. Product Design in the field of SAD is positioned primarily in the treatment phase. Bright Light Therapy (BLT) products are used to attempt to alleviate the symptoms of the disorder. Efforts should focus on the prevention of mental illness to have a holistic impact on sustainable development. This project aims to identify an innovation opportunity where Product Design can be leveraged to prevent SAD. By leveraging semiotics, the study of signs and how meanings are created, in the field of lighting and design, a concept was developed that aims at complementing existing regulations in providing users with the conditions for improved well-being in the home. SAD is strongly linked to natural light and its cycles. Windows, the main provider of this kind of light in the home, have practical, comfort- and information-related roles. The developed concept aims at enhancing the meaning of windows to highlight our dependency on natural light cycles and prevent SAD. To effectively evaluate the concept and its effectiveness in creating meaning, it must be further developed and exposed to potential users.

Background: Traditional psychosocial treatments have been adapted for use with individuals with bipolar affective disorders due to the limited prophylactic nature of pharmacotherapy and the recognition of the role of psychosocial factors in the course of this disorder. Psychosocial interventions that include a prodromal monitoring and management component have been empirically shown to be an effective adjunct to medication for the treatment of bipolar disorder. Aims: There is a deficit of quantitative research that examines the impact of individualrelated (e.g. age, self-efficacy), disorder-related (e.g. time since diagnosis, experience of prodromal symptoms) and treatment-related (e.g. level of psychosocial input) factors on individuals’ ability to manage this disorder via the use of prodromal monitoring. The current research aimed to investigate factors that are associated with the identification and management of prodromal symptoms. Method: Participants completed five self-report measures in order to provide information on their experience of prodromal symptoms, current mood state, general self-efficacy, view of social support from significant others, and demographic and clinical-related variables. The data were collected from 101 participants, 58 of whom were female. The sample consisted of individuals with a diagnosis of bipolar disorder type I and II. Results: Univariate and bivariate analyses were used to explore the relationship between individual, disorder, and treatment-related variables associated with participants’ experience of bipolar disorder. Variables that were significantly associated with participants’ perception of their ability to identify and manage prodromes were further investigated using ordinal logistic regression analyses. The results indicated that general self-efficacy and prodromal-specific help from significant others were associated with an increase in participants’ perception of their ability to identify manic and depressive prodromal symptoms. General self-efficacy was also associated with participants’ view of their ability to manage cognitive and behavioural prodromes. Experience of prodromal symptoms (e.g. consistency of symptoms experienced, type of prodrome experienced) was associated the participants’ perception of their ability to identify and manage prodromes. In general, disorder-related variables (e.g. time since diagnosis, mood state, diagnosis type, and number of episodes experienced) were not significantly associated with the participants’ view of their ability to identify and manage prodromal symptoms. Individual-related variables such as gender and age, however, were associated with prodromal identification. Conclusion: The results indicated the need to consider constructs such as general selfefficacy and experience of prodromal symptoms (e.g. consistency of symptoms, types of prodromes experienced, and ability to recognise prodromes when they first present) when helping patients to learn how to identify and manage prodromal symptoms. In addition gender differences and the role of help from significant others were highlighted as variables that should be considered when using prodromal monitoring approaches with patients with bipolar disorder. Limitations of the research are reviewed in relation to the methodology used. Clinical implications and directions for future research are considered.

Psychiatric patients, particularly schizophrenics, tend to be less accurate decoders of facial expressions than normals. The involvement of three basic information processing stages in this deficit was investigated: attention; encoding; and processing. Psychiatric inpatients, classified by diagnosis and severity of pathology, and nonpatient controls were administered seven facial cue decoding tasks. Orientation of attention was assessed through rate of diversion of gaze from the stimuli. Encoding was assessed using simple tasks, requiring one contrast of two facial stimuli and selection from two response alternatives. Processing was assessed using a more complex task, requiring several contrasts between stimulus faces and selection from numerous response alternatives. Residualized error scores were used to statistically control for effects of attention on task performance. Processing task performance was evaluated using ANCOVA to control for effects of encoding. Schizophrenics were characterized by generalized information processing deficit while affective disorder subjects evidenced impairment only in attending. Attention impairments in both groups were related to severity of psychopathology. Problems in encoding and processing were related only to a schizophrenic diagnosis. Their decoding deficits appeared attributable to general visuospatial discrimination impairment rather than repression-sensitization defenses or the affective connotation of cues. Adequacy of interpersonal functioning was associated with measures of attending and processing but not encoding. The measures of encoding, however, may have lacked adequate discriminating power due to low difficulty.

Family and twin studies have shown a heritable component to seasonal affective disorder (SAD). While a few studies have examined individual genetic variants in SAD, many methodological issues exist in the current literature. First, most studies combined major depression (MDD) and bipolar (BD) cases in the genetic analysis of SAD. This makes it difficult to differentiate the effect from MDD and BD. Second, most studies adopted a candidate gene approach and used fairly small sample sizes. This does not allow for testing across a wide variety of genes, and it yields less robust P-values. Third, healthy controls have been used, but not case comparisons, which makes it difficult to differentiate the effects of seasonality from that of the primary illness (MDD and BD). To overcome these issues, seasonal MDD and BD cases were separated into two different studies in this thesis; sample sizes for both studies are the largest in the current SAD molecular genetics literature; GWAS was used to test for potential risk loci in a hypothesis-free fashion; case comparisons were incorporated to exclude potential genetic contributions related generally to the primary diseases themselves (MDD and BD). For MDD, we performed a GWAS with 562 seasonal MDD cases and 1,225 comparison cases with non-seasonal MDD. Subjects were drawn from two iterations of the Genetics of Recurrent Early Onset Depression (GenRED) study. Seasonal cases were those whose depressive episodes typically started in fall or winter. A mega-analysis of the two GWAS datasets was done using SNPTEST. We found that two single nucleotide polymorphisms (SNPs), rs149882931 and rs77073398, on chromosome 16p12.1 were associated with seasonal depression, at a genome-wide significant level (OR= 1.66, P= 3.59 x 10-8 and OR=1.62, 4.76 x 10-8, respectively). Since SAD is more prevalent in females, a female-specific analysis was carried out. The two variants were more significant in this analysis: P=2.18x10-9 (OR=1.89) and P=2.79x10-9 (OR=1.82), respectively, and a significant sex-by-SNP interaction was observed. These SNPs are located in a conserved intergenic region between the genes HS3ST4 and C16orf82. The protein product of HS3ST4 modifies the side chains of heparan sulfate proteoglycans. We therefore tested the hypothesis that the heparan sulfate biosynthesis pathway would be enriched in nominally significant SNPs using the SNP ratio test, and found evidence for such enrichment (P=0.008, SNP ratio test, P=0.027, SKAT). For BD, the GWAS analysis of 818 seasonal BD cases and 1,515 healthy controls showed that BD-S is most strongly associated with two SNPs within the ZBTB20 genes. BD subjects were drawn from NIMH Bipolar Genetics Study (BIGS), and seasonal cases were defined as those with depressive episodes starting in fall or winter. An association study was carried out with SNPTEST, and we found two single nucleotide polymorphisms (SNPs) in the intronic region of ZBTB20 gene to be associated with BD-S (rs7646282, OR=2.34, P= 7.23 x 10-8 and rs139459337, OR=2.37, 8.05 x 10-8). A similar case-only study was carried out with 818 BD-S cases and 1239 cases without seasonal depressive symptoms (non-BDS), though no SNP was found to be significantly associated in this analysis. rs7646282 is the strongest SNP in cis-association with ZBTB20 gene expression, and ZBTB20 has been shown to affect the neural development of the hippocampus, a brain region implicated in the pathophysiology of BD. Finally, we sought to determine whether there is a role for circadian rhythm genes in BD susceptibility. In this study, we used a discovery set of 189 exome-sequenced BD patients and 105 healthy controls to look for circadian genes associated with BD. We found the DRD2 gene to be the circadian gene most strongly associated with BD. Among the rare damaging variants in the DRD2 gene, the S311C variant was the predominant SNP. To test whether this variant segregates in family members with BD, we genotyped the family members of probands from the discovery sample. This data was used for a linkage and family-based association study. Even though the linkage analysis was only very weakly positive, the family-based association study showed significant segregation of the variant in family members with BD (P< 0.05). To follow up on this finding, we further genotyped 2,185 unrelated BD cases and 1,982 healthy controls. We found no support for the S311C variant in this replication dataset. Sub-phenotype study of psychotic features and mood-incongruence also did not show significant association. Meta-analysis with 2,994 BD cases and 3,661 controls, however, revealed no association between the S311C variant and BD.

The changes of the seasons are a phenomenon we as people in many cases are affected by multiple times a year. However, how much this change affects us differs from where in the world you live. In the northern hemisphere, life can change drastically when the sun goes from shining the majority of the day to the day being mostly in darkness during wintertime. Most people are affected by this change somehow, especially the change from brighter days to darker. This is when feelings of community, hopefulness and happiness can be switched out with feelings of loneliness, malaise and even depression. This paper shows that although not all people experience the changes in these black-or-white ways, it is clear that the gray area between not being affected at all or shutting down completely is large and sometimes hard to define.  In this study, we have examined the general outlook towards winter darkness and the experiences of students at Umeå University, Sweden, who moved here from a more southern part of Sweden where the darkness is not as drastically changing during wintertime. We also interviewed the student health team at Umeå University to gain knowledge about however this is something they are working actively against or not. / Förändringarna i årstid är något vi människor utsätts för flera gånger varje år, men hur denna förändring ser ut skiljer sig väldigt mycket beroende på var i världen man bor. I den nordliga delen av världen förändras livet väldigt mycket då man går från sol större delen av dagen till mörker större delen av dagen under vintertid.  De flesta människor påverkas av denna förändring i årstid, framförallt den förändring där vi går ifrån ljusare tider mot mörkare. Här kan känslor av gemenskap, hoppfullhet och lycka bytas ut mot känslor av ensamhet, nedstämdhet och depression. Uppsatsen visar att alla människor självklart inte lider av säsongsförändringarna på detta svart-eller-vitt sätt. I spektrumet av att inte påverkas alls till att sluta fungera på grund av säsongsförändringar så är det tydligt att det finns flera olika svar på hur människor påverkas.  I vår studie har vi undersökt inställningen till vintermörkret och upplevelserna hos studenter på Umeå universitet som flyttat upp till Norrland samt att vi har intervjuat Studenthälsan på Umeå Universitet för att se huruvida detta är något de arbetar aktivt mot.

Tidigare studier visar på ett samband mellan årstidsbunden depression och underprissättning vid börsintroduktioner på den amerikanska marknaden. Studien undersöker detta samband på börsintroduktioner genomförda i Sverige, där prevalensen av årstidsbunden depression är hög. Prevalensen och effekten av årstidsbunden depression skattas genom dagslängd och förändringen av dagslängden. För att besvara forskningsfrågan utförs tre regressionsanalyser på studiens urval bestående av 147 börsintroduktioner genomförda år 2006 till 2019 på Nasdaq OMX Stockholm och Nasdaq First North. Resultatet visar en genomsnittlig underprissättning på 8,2%. Däremot uppvisas inget signifikant samband mellan årstidsbunden depression och underprissättning.

Many of us can relate to being tired and maybe even feel down during the winter months. Reports show that we spend more and more time indoors and with that, problems linked to low daylight exposure increases. The main recommendation from doctors is to try to spend more time outdoors to really get that dosage of the sun that one needs. Research also shows that people are not aware of the actual amount of time they spend either indoors or in their cars.  With this in mind, what could we do to create a healthier way of living?  In this project, I have chosen to explore how we can motivate and inspire people with a sensitivity to light to spend more time outdoors and help them stimulate their circadian rhythm. People that suffer from symptoms could in worst cases not even leave their bed making them unable to cope with their life. Using natural ways of changing habits could in most cases have a better effect than what heavy medication does.

To assess the long-term effects of antidepressant medication on balance, equilibrium, and postural reflexes, we studied 30 patients, ages 20-76 years, who had a diagnosis of depressive disorder (as defined by DSM-III-R criteria) and had been treated with tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) for ≤1 year. They were assessed by a Balance Master System. The assessment included three tasks: static balance, rhythmic weight shift, and limits of stability. When compared with 30 nonhospitalized healthy controls (of comparable age and the same sex), patients who took TCAs showed impaired balance function in all main indices. The results suggest that the impairment of balance function includes motor coordination, fine-motor control, postural reflexes,maintaining equilibrium, and reaction time. No obvious impairment of balance function was observed in patients who took SSRIs.

Circadian rhythms in physiology and behavior are synchronized by a central pacemaker, the suprachiasmatic nuclei (SCN) of the hypothalamus. Shift work, jet lag and sleep disorders can disrupt circadian rhythms, negatively impacting health and well-being. The SCN pacemaker resets rapidly in response to changes in the daily light cycle, however, adjustment of peripheral oscillators to changing time zones or work shifts is more gradual, leading to internal desynchrony. In addition, many diseases can impair the SCN’s ability to adjust to changes in the light cycle. My research investigated whether combined pharmacological inhibition of neuropeptide Y and serotonin could enhance resetting and attenuate transient cycles in locomotor activity following a sudden change in light exposure. I found that simultaneously blocking neuropeptide Y and serotonin receptors potentiated phase shifts during the late subjective night and significantly reduced transient cycles of locomotor activity in hamsters. Development of treatments that enhance the circadian system’s response to light may alleviate some of the negative health consequences experienced by travelers, shift workers and individuals with disease-related circadian desynchrony.

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