Seasonal Pattern Assessment Questionnaire

The Seasonal Pattern Assessment Questionnaire (SPAQ) is a widely used, validated screening instrument for identifying seasonal variations in mood, behavior, and physiological symptoms. Originally developed by Norman E. Rosenthal and colleagues at the National Institute of Mental Health, it provides a standardized way to quantify the degree to which an individual's functioning fluctuates across the year. It captures core vegetative and psychological shifts that are central to Seasonal Affective Disorder (SAD), and can also help clinicians spot prodromal shifts before a full bipolar episode takes hold when symptoms cycle annually.

For clinicians, the SPAQ serves as a critical first step in evaluating patients who report predictable, seasonally linked mood episodes or recurring periods of lethargy. It offers an excellent gateway to open the depression conversation in session and structure clinical inquiry. While it is primarily a screening tool rather than a standalone diagnostic instrument, its Global Seasonality Score (GSS) offers a reliable metric for distinguishing between typical seasonal variations, subsyndromal SAD (S-SAD), and full-syndrome SAD. Repeated use can assist in treatment planning, such as evaluating the efficacy of bright light therapy or implementing a structured behavioral activation rationale.

The SPAQ measures the severity of seasonal fluctuations across physiological and psychological domains, alongside the subjective distress these changes cause. The items evaluate six core dimensions:

• Sleep length: Seasonal shifts in total sleep duration, including nighttime sleep and daytime naps.
• Social activity: Variations in the desire or effort to engage socially, prompting interventions to help patients break isolation, dose social contact, and maintain a baseline of connection.
• Mood: Seasonal changes in the overall feeling of well-being or depressive affect.
• Weight: Fluctuations in body mass tied to specific times of the year.
• Appetite: Changes in overall food intake and specific cravings, frequently manifesting as carbohydrate-seeking behaviors in winter.
• Energy level: The degree to which physical vitality and daily motivation wax or wane seasonally.

The questionnaire is intended for adults presenting with cyclical mood complaints, sleep disturbances, or seasonal lethargy.

Clinicians typically utilize the SPAQ during the intake process or when a patient describes mood changes that follow a seasonal pattern. It helps clarify whether the symptoms align with a biological rhythm or stem from other psychosocial stressors.

• Intake baseline: To establish a standardized measure of seasonality when patients report recurring winter depression or summer lethargy.
• Screening/cut-off: To differentiate between normal seasonal variations, subsyndromal SAD, and clinical SAD using established scoring thresholds.
• Differential support: To distinguish purely seasonal mood shifts from non-seasonal major depression, or to better understand bipolar disorder, its two poles, and any seasonal exacerbations.
• Monitoring change: To track subjective symptom severity across seasons and objectively measure whether a coping skill actually works as the year progresses.

Using a validated score adds precision to the clinical impression, providing a concrete severity index rather than relying solely on the patient's unstructured retrospective recall.