A systematic review on the effect of Ramadan on mental health: minor effects and no harm in general, but increased risk of relapse in schizophrenia and bipolar disorder

Abstract

A systematic review on the effect of Ramadan on mental health: minor effects and no harm in general, but increased risk of relapse in schizophrenia and bipolar disorder 2010). The effect of Ramadan fasting on sleep and daytime fatigue may depend on the season of the year, the latitude of the place, and thus the length of day and night. It may also depend on social factors such as working hours, shop opening times, meal and prayer times (Bahammam 2006). Sleep has been shown to be affected in many psychiatric disorders: Patients with depression often suffer interrupted sleep and sleep-onset rapid eye movement periods. Poor sleep may be an early sign or a trigger of depression and manic episodes in bipolar disorder. Sleep deprivation has been used as a therapy for severe depressive disorders. During manic episodes, the need for sleep is known to be reduced. Temporary sleep changes have been observed during Ramadan (Leiper et al 2008). Most of the effects of Ramadan fasting on sleep can be reproduced by experimental fasting outside Ramadan (BaHammam et al. 2014). Change of appetite is a main feature of different eating disorders and depression. Excessive fasting is the characteristic of anorexia nervosa. Fasting has been assumed to improve the mood, in general, but has only rarely been used to improve the mood in depression. Such interventions have not become general practice for practical reasons, but the long-term effects of fasting on mood are also not yet clear (Fond et al. 2012). The present systematic review will focus on mental health and assess how much it is affected by Ramadan. It investigates if Ramadan and the induced fasting have positive or negative effects on mental health in the general population, in special subgroups of the populations and in different patient groups. Methods systematic review of the literature We performed a literature search on Pubmed and Medline in September 2017 using the following search terms: Ramadan and mental health or depression or anxiety or schizophrenia or bipolar disorder. The search identified a total of 294 papers. We then reviewed their titles and abstracts. One paper in French was excluded. Ninety-nine papers were falsely identified because one of the authors had the name Ramadan, but were then excluded as these papers did not relate to the holy month of Ramadan, or mental health and Ramadan. Of the remaining 194 papers of which the abstracts were screened, 162 papers did not focus on mental health issues according to the abstracts. Thirty-two full papers were reviewed and assessed, and one additional paper was identified via the reference list. Two review papers and one editorial did not contain any data. Eight other papers did not focus on mental health or provide any data on mental health in Ramadan. The data from 22 studies were extracted and summarised in a table. extraction of information The data extraction focused on study question, study design, subject characteristics, assessment instruments, outcome, study results, conclusions and possible bias. The foci of individual studies and their designs showed considerable variety. However, we did not apply any further selection of papers concerning study type, quality and outcome, as this would reduce the number of papers considerably and would, therefore, have restricted the current already limited overview on the effects of Ramadan on mental health. results Table 1 gives the results of paper selection and data extraction. The literature in relation to the effects of Ramadan on mental health is limited to a few areas: that is, effects in the general population and healthy volunteers (7 papers), in sports (3 papers), on eating and eating disorders (3 papers), on severe physical disorders (3 papers) and on mental disorders including bipolar disorder and schizophrenia (6 papers). effect in general population and healthy subjects The studies on the effects of Ramadan on mood and mental health in the general population and healthy volunteers provide contradicting evidence. Three studies reported positive effects: Depression and stress levels, were significantly reduced in Iranian nurses after in comparison with before the holy month of Ramadan; the effects on anxiety levels were lower and statistically non-significant (Koushali et al. 2013). Mood and the processing of emotional stimuli in volunteers