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Don’t Let Anyone Bully You Into Thinking Bullying Is Not Important!
Ellen L Lipman
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In Review
Identifying and Targeting Risk for Involvement in Bullying and Victimization
Wendy M Craig, Debra J Pepler
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Consequences of Bullying in Schools
Ken Rigby
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Interventions to Reduce School Bullying
Peter K Smith, Katerina Ananiadou, Helen Cowie
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Review Paper
Major Depressive Disorder in Adolescence: A Brief Review of the Recent Treatment Literature
Robert Milin, Selena Walker, Joy Chow
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Original Research
Behaviour in Children With Language Development Disorders
Ulrike Willinger, Esther Brunner, Gabriele Diendorfer-Radner, Judith Sams, Ulrike Sirsch, Brigitte Eisenwort
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An Electrophysiologic Study: Can Semantic Context Processes Be Mobilized in Patients With Thought-Disordered Schizophrenia?
Milena Kostova, Christine Passerieux, Jean-Paul Laurent, Marie-Christine Hardy-Baylé
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Brief Communication
Barometric Pressure, Emergency Psychiatric Visits, and Violent Acts
Thomas J Schory, Natasha Piecznski, Sunil Nair, Rif S El-Mallakh
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Pilot Study: Access to Fitness Facility and Exercise Levels in Olanzapine-Treated Patients
Suzanne Archie, Jane Hamilton Wilson, Shelley Osborne, Heather Hobbs, Jean McNiven
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Behavioural and Substance Use Problems in Rural and Urban Delinquent Youths
Frank J Elgar, John Knight, Graham J Worrall, Gregory Sherman
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Book Reviews
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A Guide to Asperger Syndrome.
Reviewed by
Jovan Simeon, MD

Effective Leadership.
Reviewed by
Mary Pearson, MA

Handbook of Depression.
Reviewed by
Mostafa Showraki, MD, FRCPC

Letters to the Editor
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Re: Evolutionary Perspectives on Schizophrenia

Re: 2002—Defining the 21st Century II

Re: Unfree Associations: Inside Psychoanalytic Institutes

Re: Strategies of Collaboration Between General Practitioners and Psychiatrists: a Survey of Practitioners’ Opinions and Characteristics

Reply to Dr Ungar

Fungal Dermatitis with Olanzapine in Schizophrenia

Re: Canadian Psychiatric Inpatient Religious Commitment

Brief Communication

Barometric Pressure, Emergency Psychiatric Visits, and Violent Acts

Thomas J Schory, MD¹, Natasha Piecznski, MA, MDiv, LMFT², Sunil Nair, MD³, Rif S El-Mallakh, MD⁴

At the dawn of modern medicine, Hippocrates observed that cold and warm winds affected the physical and psychological wellness of his patients (1). A small number of medical conditions have been linked to weather variables, particularly barometric pressure (2,3). In psychiatry, seasonal variations in disease presentations are clearly part of seasonal affective disorder (4) and bipolar illness (5–7). More tenuous associations have also been suggested. It has been argued that maximum temperature, rainfall, and cloud cover are significantly correlated with parasuicide in women (1). Geller and Shannon found an association between high humidity and psychiatric presentations (8). Conversely, Modai and others found no correlation between humidity or other weather variables and psychiatric presentations (9). The idea that cycles of the moon are associated with acts of violence such as homicide and suicide (1) has been refuted in careful studies (10).

Our experience in working in an emergency psychiatric service (EPS) suggested that barometric pressure is associated with an increase in the number of emergent visits. Consequently, we examined the association of variables related to barometric pressure with the number of EPS visits. Additionally, since abnormal behaviour may also encompass nonpsychiatric presentations, we also investigated the relation of weather variables to the incidence of violent crimes and suicides.

Method

We obtained data for emergent psychiatric visits, 23-hour psychiatric holding bed unit (HBU) admissions, and inpatient psychiatric admissions from the University of Louisville Hospital EPS records for 1999.

With the exception of February, we obtained weather data to reflect the entire year from the weather division of a local television station—a total of 337 days. (February data had been collected in a different location and were not available.) We collected data for violent crimes from the Jefferson County Police Department. Suicide data were obtained from the medical examiner’s office.

We applied a regression analysis for associational analyses. Chi-square was used for categorical analyses. Statistical significance was set at P < 0.05. The primary outcome variable was set a priori as the relation of behavioural variables and barometric pressure. Since there were 15 primary comparisons, Bonferroni correction was not needed.

Results

In 1999, there were 4717 visits to EPS, with 1165 patients placed in the HBU and 1585 patients admitted to the hospital. There were 3804 violent criminal acts and 71 suicides reported in the 337 days of the study period. 

Barometric pressure was significantly correlated with the number of EPS visits (r² = 0.017, P = 0.0178) and total acts of violence (r² = 0.015, P = 0.0257). There were no significant relations between barometric pressure and HBU admissions (r² = 0.005, P = 0.19), inpatient admissions (r² = 0.002, P = 0.36), or suicides (r² = 0.003, P = 0.3). 

Wind speed, which is related to periods of changing pressure, was associated with total violence (r² = 0.019, P = 0.012), but no other associations were found (EPS visits r² = 0.002, P = 0.39; HBU r² = 0.001, P = 0.62; inpatient r² = 0.01, P = 0.07; suicide r² = 0.005, P = 0.018). Relative humidity was not associated with any of the measured variables (EPS visits r² = 0.0003, P = 0.72; HBU r² = 0.001, P = 0.66; inpatient r² = 0.00007, P = 0.88; total violence r² = 0.007, P = 0.14; suicide r² = 0.003, P = 0.34). 

In 1999, barometric pressure in Louisville was significantly higher in winter (92.59 [SD 0.191] inH₂O) than in spring (29.51 [SD 0.165] inH₂O) (F = 3.85, P < 0.05) and summer (29.48 [SD 0.113] inH₂O) (F = 6.12, P < 0.05), but not autumn (29.957 [SD 0.156] inH₂O) (F = 0.26). EPS visits were greater in summer (mean visits daily15.0, SD 4.3) than in winter (mean visits daily 12.8, SD 3.7) (F = 4.223, P < 0.05), but not significantly different in spring (mean visits daily 14.0, SD 4.0) or in autumn (mean visits daily 13.8, SD 4.4). The use of the HBU was least in spring (mean patients daily 3.0, SD 1.5), compared with summer (mean patients daily 3.7, SD 1.5) (F = 2.94, P < 0.05) and autumn (mean patients daily 3.8, SD 1.8) (F = 3.99, P < 0.05), but not when compared with winter (mean patients daily 3.2, SD 1.5) (F = 0.213). There were no seasonal differences in the rates of inpatient admissions daily (winter mean 4.3, SD 2.2; spring mean 5.0, SD 2.4; summer mean 5.0, SD 2.4; autumn mean 4.5, SD 2.3; analysis of variance [ANOVA] P = 0.12). 

Discussion

This study found weak, but significant, correlations between low barometric pressure and the total number of emergent psychiatric visits and total reported acts of violent crime. There were no significant relations between barometric pressure and HBU admissions, inpatient admissions, or suicides. There were no associations between any of the behavioural variables and wind speed or humidity, other than an association between violence and wind speed.

The larger sample size of the current study (n = 4717) may account for our finding a relation while Modai and others (n = 393) did not (9). Further, Modai and others only considered individuals with a diagnosis of schizophrenia, unipolar depression, or bipolar disorder; our study included all emergent visits, independent of diagnosis.

One interpretation of our observations is a possible relation between barometric pressure and impulsivity. Subjects with impulsive behaviour that does not represent a symptom of a more serious, ongoing psychiatric illness are usually discharged. Alternatively, when patients are admitted, it is usually for an illness that has been worsening over days or weeks. Similarly, violent crimes are frequently either impulsive or crimes of opportunity; violence is rarely planned.

If this speculation is accurate, the mechanisms are not readily apparent. High altitude is associated with changes in mental status that have been attributed to the lower partial pressure of oxygen (11). However, more subtle changes have been noted at lower altitudes (for example, at 7500 ft, the pressure of commercial aircraft cabins) (11). Changes in cerebral blood flow and physiologic homeostasis have also been associated with barometric pressure. For example, intracranial aneurysms are more likely to rupture during fronts of low barometric pressure (2). Additionally, premature labour (3) and premature rupture of membranes during pregnancy (12), but not full-term delivery (13), may occur at a greater rate during low-pressure fronts. Cerebrospinal fluid (CSF) concentrations of the serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA) increase significantly with decreasing barometric pressure in men and women with depression but not in healthy women (14,15). Similarly, CSF concentration of the norepinephrine metabolite 4-hydroxy-3-methoxy- phenylglycol (HMPG) increases with increasing atmospheric pressure in healthy women (15). Clearly, additional investigation of the effect of barometric pressure on brain physiology is warranted.

Low barometric pressures are usually associated with adverse weather conditions (16), and inclement weather may change human activities. Homeless men with psychiatric diagnoses are more inclined to visit shelters during inclement weather (17). Thus, the increase in EPS visits may be related to people seeking refuge from the elements. Similarly, increased violent crimes may be related to an increase in domestic violence attributable to people staying at home in bad weather. Inclement weather is difficult to define. For example, temperature measures are meaningful only as a deviation from norms and can only be analyzed seasonally (for example, a higher-than-typical temperature is good weather in winter but bad weather in summer). Additionally, precipitation may occur at normal temperatures or even “favourable” temperatures (for example, it may be cooler during a summer rainstorm). Consequently, analyzing temperature can be misleading, and we chose not to do so in this study. We attempted to investigate the issue of inclement weather by looking at seasonal variation. We found that the greatest number of EPS visits occurred in the summer, when the weather in the Louisville area varies from pleasant to hot and is associated with very little precipitation. The question can only be addressed in a prospective study that creates season-specific definitions of inclement weather.

In conclusion, our study showed a significant relation between low daily barometric pressure and both the number of EPS visits and the incidence of violent crimes. We propose that this relation is based on a relation between barometric pressure and impulsivity, but we acknowledge that other interpretations, including a spurious finding, may explain the data. We hypothesize that barometric pressure may alter the propensity toward impulsive behaviour through changes in brain monoamines (14,15) or cerebral blood flow (2). Additional study is required to further delineate this relation.

References

1. Barker A, Hawton K, Fagg J, Jennison C. Seasonal and weather factors in parasuicide. Br J Psychiatry 1994;165:376–80.

2. Chayatte D, Chen T, Braonstein K, Brass L. Seasonal fluctuation in the incidence of intracranial aneurysm rupture and its relationship to changing climatic conditions. J Neurosurg 1994;81:525–30.

3. Polansky GH, Varner MW, O’Gorman T. Premature rupture of membranes and barometric pressure changes. J Reprod Med 1985;30:189–91.

4. Gupta S, Murray RM. The relationship of environmental temperature to the incidence and outcome of schizophrenia. Br J Psychiatry 1992;160:788–92.

5. Symonds RL, Williams P. Seasonal variation in the incidence of mania. Br J Psychiatry 1976;129:45–8.

6. Goodwin FK, Jamison KR. Manic-depressive illness. New York: Oxford University Press; 1990. p 541–74.

7. Grider G, El-Mallakh RS, Huff MO, Buss TJR, Miller J, Valdes R Jr. Endogenous digoxin-like immunoreactive factor (DLIF) serum concentrations are decreased in manic bipolar patients compared to normal controls. J Affect Disord 1999;54:261–7.

8. Geller S, Shannon H. The moon, weather and mental hospital contacts: confirmation and explanation of the Transylvania effect. J Psychiatric Nursing 1976;14:13–7.

9. Modai I, Kikinzon L, Valevski A. Environmental factors and admission rates in patients with major psychiatric disorders. Chronobiol Int 1994;11:196–9.

10. Pokorny A. Moon phases, suicide, and homicide. Am J Psychiatry 1964;121:66–7.

11. Ward MP, Milledge JS, West JB. High altitude medicine and psychiology. 2nd ed. London (UK): Chapman and Hall Medical; 1995.

12. Steinman G, Leiner G. Spontaneous premature rupture of membranes. N Y State J Med 1978;78:900–1.

13. Noller KL, Resseguie LJ, Voss V. The effect of changes in atmospheric pressure on the occurrence of the spontaneous onset of labor in term pregnancies. Am J Obstet Gynecol 1996;174:1192–7.

14. Nordin C, Swedin A, Zachau A. CSF 5-HIAA and atmospheric pressure. Biol Psychiatry 1992:31:644–5.

15. Eklundh T, Fernstrom V, Nordin C. Influence of tapping-time and atmospheric pressure on concentrations of monoamine metabolites in cerebrospinal fluid: a prospective study in female volunteers. J Psychiatr Res 1994;28:511–7.

16. Neiburger M, Edinger JG, Bonner WD. Understanding our atmospheric environment. San Francisco (CA): WH Freeman and Co; 1982.

17. North CS, Pollio DE, Thompson SJ, Spitznagel EL, Smith EM. Diagnosis with weather conditions in a large urban homeless sample: the association of psychiatric epidemiology. Soc Psychiatry 1998;33:206–10.

Author(s)

Manuscript received November 2002, revised, and accepted February 2003.

1. Medical Student, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky.

2. Associate Minister, Caritas Peace Center, Louisville, Kentucky.

3. Resident Physician, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky.

4. Associate Professor and Director, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky.

Address for correspondence: Dr RS El-Mallakh, Director, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky 40292

e-mail: rselma01@athena.louisville.edu

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