Effects of sunshine duration on daily outpatient visits for depression in Suzhou, Anhui Province, China.

Previous epidemiological studies have reported seasonal variation patterns of depression symptoms, which may be influenced by bad weather conditions, such as a lack of sunlight. However, evidence on the acute effects of sunshine duration on outpatient visits for depression is limited, especially in developing countries, and the results are inconsistent. We collected daily outpatient visits for depression from the local mental health centre in Suzhou, Anhui Province, China, during 2017-2019. We defined the 5th and 95th sunshine percentiles as short and long sunshine durations, respectively. A quasi-Poisson generalized linear regression model combined with a distributed lag nonlinear model was used to quantitatively assess the effects of short and long sunshine durations on outpatient visits for depression. Stratified analyses were further performed by gender, age and number of visits to identify vulnerable populations. A total of 26,343 depression cases were collected during the study period. An approximate U-shaped exposure-response association was observed between sunshine duration and depression outpatient visits. The cumulative estimated relative risks (RRs) for short and long sunshine durations at lag 0-21 days were 1.53 [95% confidence intervals (CI): 1.14, 2.06] and 1.13 (95% CI: 0.88, 1.44), respectively. Moreover, a short sunshine duration was associated with a greater disease burden than a long sunshine duration, with attributable fractions (AFs) of 16.64% (95% CI: 7.8%, 23.89%) and 2.24% (95% CI: -2.65%, 5.74%), respectively. Subgroup analysis showed that males, people aged less than 45 years and first-visit cases may be more susceptible to a lack of sunlight. For a long sunshine duration, no statistically significant associations were found in any population groups. Our study found that a short sunshine duration was associated with an increased risk of depression. The government, medical institutions, family members and patients themselves should fully recognize the important role of sunlight and take active measures to prevent depression.