Exposure-lag-response association between sunlight and schizophrenia in Ningbo, China

Previous studies found that mental disorders such as bipolar disorder, seasonal affective disorder and schizophrenia, often show seasonal variability, which usually be attributed to the variations in the number of natural sunlight. However, few studies have been conducted on the acute effects of exposure to sunlight on the onset of these disease. The aim of this study was to evaluate the exposure-response relationship between sunshine duration and the hospital admissions for schizophrenia. We obtained data on hospital admissions for schizophrenia from the largest psychiatric hospital in Ningbo, China, during 2012-2016. A Distributed lag non-linear model was used to estimate the exposure-lag-response relationship between sunlight and schizophrenia. We calculated the effects of short and long sunshine duration, defined using the cutoffs at the 1st and 99th sunshine duration percentiles. We detected significant and non-linear associations between sunlight and schizophrenia, and the overall estimated relative risk (RR) for a lag of 0-21 days was 1.45 (95% CI: 1.07, 1.97) and 1.41(95% CI: 0.72, 2.75) for short and long sunshine duration, respectively. The burden of schizophrenia was greater during periods with short sunshine duration than during periods with long sunshine duration, with the AFs of 19.94% (95% CI: 8.65%, 28.24%) and 2.12% (95% CI: -2.70%, 5.57%), respectively. The female and people more than 45 years old were most susceptible to these effects. We repeated our analysis by using global solar radiation as a continuous exposure variable of sunlight intensity in the model, and the result shows that the female and middle-aged and eldly patients were also susceptible to the effects of low levels of global solar radiation. Our findings suggest that there may be a relationship between lack of exposure to sunlight and increased risk of hospital admissions for schizophrenia. Policymakers and doctors should promote further understanding of the health benefits of sunlight and take effective measures to prevent schizophrenia.