Vitamin D and Mood Disorders Among Women: An Integrative Review

Integrative Review of the Literature

An integrative review includes studies using both experimental and non-experimental methodologies and thus was the chosen method to compile the findings of six quantitative research studies completed in the past 37 years (1971–2008).^[42] This timeframe was chosen because the research article premiering the assay to evaluate serum 25(OH)D was first published in 1971 by Haddad and Chyu.^[43] These six research articles were selected because each study conducted compared serum 25(OH)D and mood disorders that affect women, including SAD, PMS, major depressive disorder, and other mood disorders.

Peer-reviewed research studies were located using the CINAHL, PsycINFO, MEDLINE, and PubMed databases, as well as ancestry searching of reference lists from selected articles, using the following keywords: vitamin D; 25-hydroxyvitamin D (25[OH]D); depression; seasonal affective disorder; premenstrual syndrome; postpartum depression; perinatal depression; depressive disorder; mood disorder; and women. Studies were included if the sample consisted of at least 50% women; if the focus was on subjects with major depressive disorder, SAD, PMS, postpartum depression, perinatal depression, or other mood disorders; and if serum 25(OH)D was measured.

Of 11 studies initially identified, five were eliminated because they did not meet the inclusion criteria.^{[44,45,46,47,48]} The final six studies consist of one focused on SAD^[3]; one on seasonal mood changes (not defined as SAD)^[49]; one on PMS^[50]; one on major depressive disorder^[51]; one on major depression^[52]; and one on mood disorders.^[53] No studies focusing on postpartum or perinatal depression were identified.

The six studies were critiqued using the U.S. Preventative Services Task Force (USPSTF) rating system to evaluate the strength of the research. The USPSTF uses specific guidelines to evaluate the quality of the evidence pertaining to a specific topic in order to develop evidence-based clinical practice guidelines.^[54] These ratings are then used to determine the strength of the evidence.

Each study is given a rating of good, fair, or poor based on the evaluation of specific criteria of each type of study design.^[54] The criteria evaluated for randomized clinical trials (RCT) include: randomization of groups; distribution of confounders equally among groups; minimization of participant's loss to follow-up; equal, valid, and reliable measurements; clearly defined interventions; and consideration of all important outcomes.^[54] For descriptive studies, the criteria include: the evaluation of valid evidence for the setting and population under study, the evaluation of generalizable findings and application to other populations, and the determination of logical findings. The key findings of the studies evaluated are presented in Table 1 . Findings are limited to results that address mood disorders and serum 25(OH)D.

Cite this: Vitamin D and Mood Disorders Among Women: An Integrative Review - Medscape - Sep 01, 2008.

Research Studies Evaluating the Association of Vitamin D and Mood Disorders
Type of Mood Disorder	Author, Year	Type of Study	Sample	Measurement Instrument	Key Findings	USPSTF Rating
Major depressive disorder	Eskandari et al., 2007	Comparative descriptive	n=131; 21–45 years old; 121 white F, 10 nonspecified race	DSM-IV	25(OH)D significantly lower in women with MDD compared to controls (27±10.1 ng/mL vs. 34±14.4 ng/mL; P<.002)	Fair
Mood disorder	Wilkins et al., 2006	Comparative descriptive	n=80; =60 years old; 50 F, 30 M; 70 white, 10 AA; 40 with mild Alzheimer's, 40 non-demented	Depressive Features Battery; Depressive Symptoms Inventory	Vitamin D deficiency significantly associated with mood disorder (Wald X₂=7.66; df=2; P=.022)	Fair
Major depression	Schneider et al., 2000	Comparative descriptive	n=56; 18–85 years old, healthy; 12 F, 19 M; major depression: 14 F, 11 M*	DSM-III-R	25(OH)D serum levels not correlated to participants with major depression	Fair
SAD	Gloth, Alam, and Hollis, 1999	Randomized clinical trial	n=15; 15–61 years old; 14 F, 1 M; all white; all diagnosed with SAD	Hamilton Depression Score; SIGH-SAD; SAD-8	Increase in 25(OH)D significantly associated with improvement in depression scale scores (r²=0.26; P=.05)	Fair
PMS	Thys-Jacobs et al., 1995	Comparative descriptive	n=46; 28–42 years old; all white F	Self-recorded diary of PMS-related symptoms	PMS group had significantly lower 25(OH)D levels than controls (19.5±7.5 vs. 25.3±8.3 ng/mL; P<.02)	Fair
Seasonal mood changes	Harris and Dawson-Hughes, 1993	Randomized clinical trial	n=250, 43–72 years old, all white F	POMS questionnaire	POMS scores were not correlated with 25(OH)D serum levels	Fair

25(OH)D = 25-hydroxyvitamin D; AA = African American; DSM = Diagnostic and Statistical Manual of Mental Disorders; F = female; M = male; PMS = premenstrual syndrome; POMS = profile of mood states; SAD = seasonal affective disorder; USPSTF = U.S. Preventative Services Task Force.
*Study included because half of participants with major depression were female and therefore the study met the inclusion criteria.

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