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Seasonal Pattern Assessment Questionnaire

Original Editor - Kapil Narale

Top Contributors - Kapil Narale and Vidya Acharya  

Introduction

The Seasonal Pattern Affective Questionnaire (SPAQ) was developed by Rosenthal et al (1984). [1] It is the most widely used questionnaire to asses the significant effects that a seasonal pattern can have on mood and behaviour. [1][2] It can be used in the general population, and in individuals with mood disorders, since there is no assumption made regarding the direction of the seasonal change and the capability of the tool to measure seasonal change regardless of illness. [1]

A primary feature of the SPAQ is the Seasonality Score index, which has a good test re-test reliability. [3][4] It was found that different groups of individuals who classified as having Seasonal Affective Disorder (SAD), Sub-Syndromal Affective Disorder (S-SAD), major depression without a seasonal pattern, and normal individuals had vastly varying scores on the Seasonality Score Index. [4] [5] The seasonality Score Index is seen to correlate well with the Hamilton Depression Rating Scale scores. [5] A major depressive episode being diagnosed was an indication of SAD, while it is a contraindication for S-SAD. [6] [5][7]

Purpose of the Seasonal Pattern Affective Questionnaire

The questionnaire is used to analyze changes in mood and behaviour based on changes in season. [8]

Seasonal Affective Disorder

See the Seasonal Affective Disorder page for information about this interesting disorder.

Grading of the Seasonal Pattern Affective Questionnaire

There are several scales used in the assessment and measurement, one of which is the Seasonality Score Index.

Criteria were developed to classify individuals who may have SAD or S-SAD. [9][10][11][12] The SPAQ is graded according to a cut off score assigned for each of six dimensions. [13] These dimensions include, sleep length, social activities, mood, energy level, weight, and appetite. [8] [13] The sum of these scores is the Seasonality Score (SS), which ranges from 0-32. [8] Expected scoring of the six dimensions are generally seen to follow the seasonal variations. [13] These dimensions are known to have 2 factors, a psychological factor, consisting of mood, sleep length, energy, and social activity, and a food factor, consisting of weight and appetite. The psychological factor is related to a reduced quality of life, and increased manic symptoms. The scores of both these factors should be considered separately. [14] Other scales assess the intensity at which seasonal changes are experienced as an issue, and in which months it is the best or the worst. These help determine the presence of SAD or S-SAD.

After an analysis involving a 'Winter problem' group and comparing SAD an S-SAD, it was found that with the cut off score of 11, the SPAQ may provide a conservative estimate of S-SAD. [8]

Kasper's criteria help determine the severity of SAD, and can be seen to increase with a score of 11 or greater within the six dimensions. [2][8] This can be confirmed with a subjective 'worse' feeling during one of the winter months. [8] Higher seasonality scores likely represent a consistent seasonality trait. Lower scores are seen to be unreliable. [2]

In summary, according to Kasper et al, 1989[10], the SPAQ criteria followed:

  1. Feeling worst in the Winter months
  2. An SS score of 11 or more
  3. Experiencing seasonal change as a mild issue, or having an issue at all

Individuals with an SS of 9 or 10 and at least mildly experienced seasonal change as an issue also were classified as experiencing S-SAD.

Individuals with consistent seasonal illness had a higher score on items of change in mood and social activities. [2]

None of the determinants from the SPAQ indicated prolonged seasonality changes on initial assessment. Higher global scores led to a sign of further episodes of depression in the near future. Higher scores of seasonality are seen to correlate with poorer symptoms of depression, mania, and anxiety, and a delayed circadian rhythm. [13]

Reliability and Validity

There are assigned cutoff scores on the SPAQ for the classification of SAD. There is a reported sensitivity of 40%[15] - 94%. [8]

With the assessment of the SPAQ, it was found that there was a positive predictive value of 48%, and an efficiency of 57% with confirming the presence of SAD after a 5-7 year follow up.

Despite the SPAQ being a quick assessment of seasonal variations, there is low test-retest reliability. Therefore the reliability is unconfirmed. Solely, it is unable to predict the severity and progression of illnesses or disorders based on information gathered with seasonal changes. [2]

It is said that the SPAQ may overestimate seasonal changes in mood and behaviour in a normal group of individuals. [16]

When SAD and S-SAD are classified into a 'winter issue', as done in a study by Magnussen (1996), the sensitivity, specificity, and positive predictive value of the SPAQ were 94%, 73%, and 45%, respectively. It is seen that the SPAQ poorly differentiates between the SAD and S-SAD, and hence has a poor ability in identifying the SAD. [8]

SPAQ Form

Here is a link to a SPAQ Form that is used for assessment.

References

  1. ↑ 1.0 1.1 1.2 Geoffroy P.A, Bellivier F, Scott J, Etain B. Seasonality and Bipolar Disorder: A Systematic Review, from Admission Rates to Seasonality of Symptoms. Journal of Affective Disorders. 2014:168:210–223.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Raheja S.K, King E.A, Thompson C. The seasonal pattern assessment questionnaire for identifying seasonal affective disorders. Journal of Affective Disorders. 1996:41:193-199.
  3. ↑ Hardin T.A, Wehr T.A, Brewerton T, Kasper S, Berrettini W, Rabkin J, Rosenthal N.E. Evaluation of seasonality in six clinical populations and two normal populations. Journal of Psychiatry Resources 1991:25:75-87.
  4. ↑ 4.0 4.1 Thompson C, Stinson D, Fernandez M, Fine J. Isaacs G. A comparison of normal, bipolar and seasonal affective disorder subjects using the Seasonal Pattern Assessment Questionnaire. Journal of Affective Disorders. 1988:14:257-264.
  5. ↑ 5.0 5.1 5.2 Kasper S, Rogers S.L, Yancey A, Schulz P.M, Skwerer R.G, Rosenthal N.E. Phototherapy in individuals with and without subsyndromal seasonal affective disorder. Archives in General Psychiatry. 1989:46:837-844.
  6. ↑ American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th Edn. American Psychiatric Association, Washington, DC.
  7. ↑ Kasper S, Rogers S.L, Yancey A, Schulz P.M, Skwerer R.G, Rosenthal N.E. Phototherapy in individuals with and without subsyndromal seasonal affective disorder. Archives in General Psychiatry. 1989:46:837-844.
  8. ↑ 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 Magnusson A. Validation of the Seasonal Pattern Assessment Questionnaire (SPAQ). Journal of Affective Disorders. 1996:40:121–129.
  9. ↑ Booker J.M, Hellekson C.J. Prevalence of seasonal affective disorder in Alaska. American Journal in Psychiatry. 1992:149:1176-1182.
  10. ↑ 10.0 10.1 Kasper S, Wehr T.A, Bartko J.J, Gaist P.A, Rosenthal N.E. Epidemiological findings of seasonal changes in mood and behavior. A telephone survey of Montgomery County, Maryland. Archives in General Psychiatry. 1989: 46:823-833.
  11. ↑ Magnusson A, Axelsson J. The prevalence of seasonal affective disorder is low among descendants of Icelandic emigrants in Canada. Archives in General Psychiatry. 1993:50(12):947-951.
  12. ↑ Rosen L.N, Targum S.D, Terman M, Bryant M.J, Hoffman H, Kasper SF, Hamovit J.R, Docherty J.P, Welch B, Rosenthal N.E. Prevalence of seasonal affective disorder at four latitudes. Psychiatry Resources. 1990:31:131- 144.
  13. ↑ 13.0 13.1 13.2 13.3 Reynaud E, Berna F, Haffen E, Weiner L, Maruani J, Lejoyeux M, Schroder C.M, Bourgin P, Geoffroy P.A. Validity and Usage of the Seasonal Pattern Assessment Questionnaire (SPAQ) in a French Population of Patients with Depression, Bipolar Disorders and Controls. Journal of Clinical Medicine. 2021:10 (1897):1-16.
  14. ↑ Mersch P.P.A, Vastenburg N.C, Meesters Y, Bouhuys A.L, Beersma D.G.M, van den Hoofdakker R.H, den Boer J.A. The Reliability and Validity of the Seasonal Pattern Assessment Questionnaire: A Comparison between Patient Groups. Journal of Affective Disorders. 2004:80:209–219.
  15. ↑ Mersch P.P.A, Vastenburg N.C, Meesters Y, Bouhuys A.L, Beersma D.G.M, van den Hoofdakker R.H, den Boer J.A. The Reliability and Validity of the Seasonal Pattern Assessment Questionnaire: A Comparison between Patient Groups. Journal of Affective Disorders. 2004:80:209–219.
  16. ↑ Nayyar K, Cochrane R. Seasonal changes in affective state measured prospectively and retrospectively. British Journal in Psychiatry. 1996:168:627-632.
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