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Day and night light exposure are associated with psychiatric disorders: an objective light study in >85,000 people

Abstract

Circadian rhythm disturbance is a common feature of many psychiatric disorders. Light is the primary input to the circadian clock, with daytime light strengthening rhythms and night-time light disrupting them. Therefore, habitual light exposure may represent an environmental risk factor for susceptibility to psychiatric disorders. We performed the largest to date cross-sectional analysis of light, sleep, physical activity, and mental health (n = 86,772 adults; aged 62.4 ± 7.4 years; 57% women). We examined the independent association of day and night-time light exposure with covariate-adjusted risk for psychiatric disorders and self-harm. Greater night-time light exposure was associated with increased risk for major depressive disorder, generalized anxiety disorder, PTSD, psychosis, bipolar disorder, and self-harm behavior. Independent of night-time light exposure, greater daytime light exposure was associated with reduced risk for major depressive disorder, PTSD, psychosis, and self-harm behavior. These findings were robust to adjustment for sociodemographics, photoperiod, physical activity, sleep quality, and cardiometabolic health. Avoiding light at night and seeking light during the day may be a simple and effective, non-pharmacological means of broadly improving mental health.

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Fig. 1: Flow diagram of the light-data study sample.
Fig. 2: Associations of day and night-time light exposure with psychiatric disorders and self-harm.
Fig. 3: Associations of day and night-time light exposure with symptom severity scales and wellbeing.

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Data availability

The data used in this study are available in the UK Biobank resource subject to project approval by the UK Biobank Access Management Team. The authors of the present study are approved for access under application 6818.

Code availability

Data organization and statistical analysis were performed in R (version 4.1.0). Data analysis code is available at https://github.com/dpwindred/Axivity_AX3_Light.

References

  1. Walker, W. H., Walton, J. C., DeVries, A. C. & Nelson, R. J. Circadian rhythm disruption and mental health. Transl. Psychiatry 10, 28 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Freeman, D., Sheaves, B., Waite, F., Harvey, A. G. & Harrison, P. J. Sleep disturbance and psychiatric disorders. Lancet Psychiatry 7, 628–637 (2020).

    Article  PubMed  Google Scholar 

  3. Wirz-Justice, A., Bromundt, V. & Cajochen, C. Circadian disruption and psychiatric disorders: the importance of entrainment. Sleep Med. Clin. 4, 273–284 (2009).

    Article  Google Scholar 

  4. Mure, L. S. et al. Diurnal transcriptome atlas of a primate across major neural and peripheral tissues. Science 359, 6381 (2018).

    Article  Google Scholar 

  5. Schmidt, C., Collette, F., Cajochen, C. & Peigneux, P. A time to think: circadian rhythms in human cognition. Cogn. Neuropsychol. 24, 755–789 (2007).

    Article  PubMed  Google Scholar 

  6. Reppert, S. M. & Weaver, D. R. Coordination of circadian timing in mammals. Nature 418, 935–941 (2002).

    Article  PubMed  Google Scholar 

  7. Winfree, A. T. The Geometry of Biological Time (Springer, 1980).

  8. Bano-Otalora, B. et al. Bright daytime light enhances circadian amplitude in a diurnal mammal. Proc. Natl Acad. Sci. USA 118, e2100094118 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Dijk, D.-J. et al. Amplitude reduction and phase shifts of melatonin, cortisol and other circadian rhythms after a gradual advance of sleep and light exposure in humans. PLoS ONE 7, e30037 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Klepeis, N. E. et al. The National Human Activity Pattern Survey (NHAPS): a resource for assessing exposure to environmental pollutants. J. Expo. Sci. Environ. Epidemiol. 11, 231–252 (2001).

    Article  Google Scholar 

  11. Wright Kenneth, P. et al. Entrainment of the human circadian clock to the natural light–dark cycle. Curr. Biol. 23, 1554–1558 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  12. Tancredi, S., Urbano, T., Vinceti, M. & Filippini, T. Artificial light at night and risk of mental disorders: a systematic review. Sci. Total Environ. 833, 155185 (2022).

    Article  PubMed  Google Scholar 

  13. Paksarian, D. et al. Association of outdoor artificial light at night with mental disorders and sleep patterns among US adolescents. JAMA Psychiatry 77, 1266–1275 (2020).

  14. Golden, R. N. et al. The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. Am. J. Psychiatry 162, 656–662 (2005).

    Article  PubMed  Google Scholar 

  15. Lam, R. W. et al. Efficacy of bright light treatment, fluoxetine, and the combination in patients with nonseasonal major depressive disorder: a randomized clinical trial. JAMA Psychiatry 73, 56–63 (2016).

    Article  PubMed  Google Scholar 

  16. Burns, A. C. et al. Time spent in outdoor light is associated with mood, sleep, and circadian rhythm-related outcomes: a cross-sectional and longitudinal study in over 400,000 UK Biobank participants. J Affect. Disord. 295, 347–352 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  17. Emens, J., Lewy, A. J., Kinzie, J. M., Arntz, D. & Rough, J. Circadian misalignment in major depressive disorder. Psychiatry Res. 168, 259–261 (2009).

    Article  PubMed  Google Scholar 

  18. Souêtre, E. et al. Circadian rhythms in depression and recovery: evidence for blunted amplitude as the main chronobiological abnormality. Psychiatry Res. 28, 263–278 (1989).

    Article  PubMed  Google Scholar 

  19. Avery, D. H., Wildschiødtz, G. & Rafaelsen, O. J. Nocturnal temperature in affective disorder. J Affect. Disord. 4, 61–71 (1982).

    Article  PubMed  Google Scholar 

  20. Hasler, B. P., Buysse, D. J., Kupfer, D. J. & Germain, A. Phase relationships between core body temperature, melatonin, and sleep are associated with depression severity: further evidence for circadian misalignment in non-seasonal depression. Psychiatry Res. 178, 205–207 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  21. Harvey, A. Sleep and circadian functioning: critical mechanisms in the mood disorders? Annu. Rev. Clin. Psychol. 7, 297–319 (2011).

    Article  PubMed  Google Scholar 

  22. Jewett, M. E., Kronauer, R. E. & Czeisler, C. A. Phase-amplitude resetting of the human circadian pacemaker via bright light: a further analysis. J. Biol. Rhythms 9, 295–314 (1994).

    Article  PubMed  Google Scholar 

  23. Khalsa, S. B. S., Jewett, M. E., Cajochen, C. & Czeisler, C. A. A phase response curve to single bright light pulses in human subjects. J. Physiol. 549, 945–952 (2003).

    Article  PubMed  PubMed Central  Google Scholar 

  24. McCarthy, M. J. et al. Neurobiological and behavioral mechanisms of circadian rhythm disruption in bipolar disorder: a critical multi-disciplinary literature review and agenda for future research from the ISBD task force on chronobiology. Bipolar Disord. 24, 232–263 (2022).

    Article  PubMed  Google Scholar 

  25. Esaki, Y. et al. Effect of nighttime bedroom light exposure on mood episode relapses in bipolar disorder. Acta Psychiatr. Scand. 146, 64–73 (2022).

    Article  PubMed  Google Scholar 

  26. Lewy, A. J., Wehr, T. A., Goodwin, F. K., Newsome, D. A. & Rosenthal, N. E. Manic–depressive patients may be supersensitive to light. Lancet 1, 383–384 (1981).

    Article  PubMed  Google Scholar 

  27. Hallam, K. T., Olver, J. S., Horgan, J. E., McGrath, C. & Norman, T. R. Low doses of lithium carbonate reduce melatonin light sensitivity in healthy volunteers. Int. J. Neuropsychopharmacol. 8, 255–259 (2005).

    Article  PubMed  Google Scholar 

  28. Henriksen, T. E. et al. Blue-blocking glasses as additive treatment for mania: a randomized placebo-controlled trial. Bipolar Disord. 18, 221–232 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  29. Barbini, B. et al. Dark therapy for mania: a pilot study. Bipolar Disord. 7, 98–101 (2005).

    Article  PubMed  Google Scholar 

  30. Takeshima, M. et al. Efficacy and safety of bright light therapy for manic and depressive symptoms in patients with bipolar disorder: a systematic review and meta-analysis. Psychiatry Clin. Neurosci. 74, 247–256 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  31. Sit, D., Wisner, K. L., Hanusa, B. H., Stull, S. & Terman, M. Light therapy for bipolar disorder: a case series in women. Bipolar Disord. 9, 918–927 (2007).

    Article  PubMed  Google Scholar 

  32. Meesters, Y. & Van Houwelingen, ComelisA. J. Rapid mood swings after unmonitored light exposure. Am. J. Psychiatry 155, 306 (1998).

    Article  PubMed  Google Scholar 

  33. Sandahl, H., Baandrup, L., Vindbjerg, E., Jennum, P. & Carlsson, J. Social zeitgebers and circadian dysrhythmia are associated with severity of symptoms of PTSD and depression in trauma-affected refugees. Euro. Arch. Psychiatry Clin. Neurosci. 271, 1319–1329 (2021).

    Article  Google Scholar 

  34. McFarlane, A. C., Barton, C. A., Briggs, N. & Kennaway, D. J. The relationship between urinary melatonin metabolite excretion and posttraumatic symptoms following traumatic injury. J. Affect. Disord. 127, 365–369 (2010).

    Article  PubMed  Google Scholar 

  35. Paul, M. A. et al. Blunted nocturnal salivary melatonin secretion profiles in military-related posttraumatic stress disorder. Front. Psychiatry 10, 882 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  36. Youngstedt, S. D. et al. Bright light treatment of combat-related PTSD: a randomized controlled trial. Mil. Med. 187, e435–e444 (2022).

    Article  PubMed  Google Scholar 

  37. Raymackers, J.-M., Andrade, M., Baey, E., Vanneste, M. & Evrard, F. Bright light therapy with a head-mounted device for anxiety, depression, sleepiness and fatigue in patients with Parkinson’s disease. Acta Neurol. Belg. 119, 607–613 (2019).

    Article  PubMed  Google Scholar 

  38. Baxendale, S., O’Sullivan, J. & Heaney, D. Bright light therapy for symptoms of anxiety and depression in focal epilepsy: randomised controlled trial. Br. J. Psychiatry 202, 352–356 (2013).

    Article  PubMed  Google Scholar 

  39. Kalmbach, D. A., Pillai, V., Cheng, P., Arnedt, J. T. & Drake, C. L. Shift work disorder, depression, and anxiety in the transition to rotating shifts: the role of sleep reactivity. Sleep Med. 16, 1532–1538 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  40. Flo, E. et al. Shift work disorder in nurses—assessment, prevalence and related health problems. PLoS ONE 7, e33981 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  41. Skeldon, A. C., Dijk, D., Meyer, N. & Wulff, K. Extracting circadian and sleep parameters from longitudinal data in schizophrenia for the design of pragmatic light interventions. Schizophr. Bull. 48, 447–456 (2021).

    Article  PubMed Central  Google Scholar 

  42. Aichhorn, W., Stelzig-Schoeler, R., Geretsegger, C., Stuppaeck, C. & Kemmler, G. Bright light therapy for negative symptoms in schizophrenia: a pilot study. J. Clin. Psychiatry 68, 2142 (2007).

    Article  Google Scholar 

  43. Roopram, S. M., Burger, A. M., van Dijk, D. A., Enterman, J. & Haffmans, J. A pilot study of bright light therapy in schizophrenia. Psychiatry Res. 245, 317–320 (2016).

    Article  PubMed  Google Scholar 

  44. Cajochen, C., Zeitzer, J. M., Czeisler, C. A. & Dijk, D.-J. Dose–response relationship for light intensity and ocular and electroencephalographic correlates of human alertness. Behav. Brain Res. 115, 75–83 (2000).

    Article  PubMed  Google Scholar 

  45. Vandewalle, G. et al. Spectral quality of light modulates emotional brain responses in humans. Proc. Natl Acad. Sci. USA 107, 19549–19554 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  46. Hattar, S., Liao, H.-W., Takao, M., Berson, D. M. & Yau, K.-W. Melanopsin-containing retinal ganglion cells: architecture, projections, and intrinsic photosensitivity. Science 295, 1065–1070 (2002).

    Article  PubMed  PubMed Central  Google Scholar 

  47. Fernandez, D. C. et al. Light affects mood and learning through distinct retina–brain pathways. Cell 175, 71–84.e18 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  48. LeGates, T. A., Fernandez, D. C. & Hattar, S. Light as a central modulator of circadian rhythms, sleep and affect. Nat. Rev. Neurosci. 15, 443–454 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  49. Scheuermaier, K., Laffan, A. M. & Duffy, J. F. Light exposure patterns in healthy older and young adults. J. Biol. Rhythms 25, 113–122 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  50. Obayashi, K., Saeki, K. & Kurumatani, N. Association between light exposure at night and insomnia in the general elderly population: the HEIJO-KYO cohort. Chronobiol. Int. 31, 976–982 (2014).

    Article  PubMed  Google Scholar 

  51. Benedito-Silva, A. A. et al. Association between light exposure and metabolic syndrome in a rural Brazilian town. PLoS ONE 15, e0238772 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  52. Collins, R. What makes UK Biobank special? Lancet 9822, 1173–1174 (2012).

    Article  Google Scholar 

  53. Sudlow, C. et al. UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLoS Med. 12, e1001779 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  54. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).

  55. Davis, K. A. S. et al. Mental health in UK Biobank—development, implementation and results from an online questionnaire completed by 157 366 participants: a reanalysis. BJPsych Open 6, e18 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  56. Doherty, A. et al. Large scale population assessment of physical activity using wrist worn accelerometers: the UK Biobank Study. PLoS ONE 12, e0169649 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

This work was funded in part by the Australian Government Research Training Program (ACB) and National Health and Medical Research Council (NHMRC; project number = GNT1183472; S.W.C.). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

Authors

Contributions

A.C.B., S.W.C., and A.J.K.P. conceptualized the research idea and acquired funding. All authors contributed to the methodology and development of the analysis plan. A.C.B., D.P.W., S.W.C., A.J.K.P., M.K.R., R.S., and J.M.L. acquired the data. A.C.B. completed the formal analysis, visualizations of the data, and wrote the original draft of the manuscript. All authors reviewed the manuscript and provided critical comments. All authors approved the final manuscript.

Corresponding author

Correspondence to Angus C. Burns.

Ethics declarations

Competing interests

A.J.K.P. and S.W.C. have received research funding from Delos and Versalux, and they are co-founders and co-directors of Circadian Health Innovations PTY LTD. S.W.C. has also received research funding from Beacon Lighting and has consulted for Dyson. P.O. was a co-founder of Axivity Ltd and a director until 2015. C.V. is a board member of the Working Time Society and a research committee member for DiME. All other authors have no competing interests.

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Nature Mental Health thanks Sarah Chellappa, Yuichi Esaki, Jamie M. Zeitzer, and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Supplementary Information

Supplementary Figs. 1 and 2, Tables 1–17, and Methods.

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Supplementary Data 1

AX3 device validation data.

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Burns, A.C., Windred, D.P., Rutter, M.K. et al. Day and night light exposure are associated with psychiatric disorders: an objective light study in >85,000 people. Nat. Mental Health 1, 853–862 (2023). https://doi.org/10.1038/s44220-023-00135-8

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