title: Frequency and characteristics of individuals with seasonal pattern among depressive patients attending primary care in France.
abstract: OBJECTIVE
  High rates of bipolar disorder (BD) have been found among major depressives with seasonal pattern (SP) consulting in psychiatric departments, as well as among patients seeking primary care. As SP was reported to be common in the latter, the current study was designed to assess (a) the frequency and characteristics of SP among major depressives attending primary care and (b) the prevalence and aspects of BD in this population.
  
  
  METHODS
  Among 400 patients who consulted French general practitioners (GPs) for major depression between February and December 2010, 390 could be included in the study: 167 (42.8%) met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for seasonal pattern [SP(+)], whereas 223 (57.2%) did not meet these criteria [SP(-)]. The two groups were compared on demographic, clinical, family history and temperamental characteristics.
  
  
  RESULTS
  Compared to SP(-), SP(+) patients were more frequently female, married and with a later age at first depressive episode, and showed more atypical vegetative symptoms, comorbid bulimia and stimulant abuse. They also exhibited more lifetime depressive episodes, were more often diagnosed as having BD II and met more often bipolarity specifier criteria, with higher rates of bipolar temperaments and a higher BD family loading. Among SP(+) patients, 68.9% met the bipolarity specifier criteria, whereas 31.1% did not. Seasonality was not influenced by climatic conditions. The following independent variables were associated with SP: BD according to bipolarity specifier, female gender, comorbid bulimia nervosa, hypersomnia, number of depressive episodes and family history of substance abuse.
  
  
  CONCLUSIONS
  Seasonal pattern is frequent among depressive patients attending primary care in France and may be indicative of hidden bipolarity. Given the risks associated with both SP and bipolarity, GPs are likely to have a major role in regard to prevention.
authors.affiliation: Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France. Electronic address: jazorin@ap-hm.fr.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Azorin
authors.affiliation: Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Adida
authors.affiliation: Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France.
authors.forename: Raoul
authors.initials: R
authors.lastname: Belzeaux
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology*; D003865:Major Depressive Disorder / Q000453:epidemiology*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D016574:Seasonal Affective Disorder / Q000453:epidemiology*; D012621:Seasons; D012737:Sex Factors
keywords: Bipolar disorder; Primary care; Seasonal affective disorder; Seasonal pattern