Where's the sun?

Now that I've lived in Pittsburgh for a few months, one of the most striking things to me is the absence of sun.

I had heard that Pittsburgh was similar to Seattle in terms of cloud cover. During the summer, it wasn't an issue, and indeed summer in Pittsburgh was beautiful. But once the time change happened, it was striking how little sunlight I saw every day. It is not uncommon for me to see no sunlight the whole day.

I think this has several health implications for the people living in western Pennsylvania. First, people like sun, and the absence of sun makes it less likely for people to be active outside. I am curious which is a bigger deterrent for outdoor activity- weather, or sunlight. Anecdotally from speaking to work colleagues, I think it's sunlight. And this can lead to less exercise.

The second issue is Seasonal Affective Disorder (SAD). I am starting to believe this is much more common than has been commonly realized. In particular, I see many patients with musculoskeletal pain, and I believe there is a high comorbidity with SAD in my patients.

I suspect that one of the changes we will see in the coming decades in the management of musculoskeletal conditions is the realization of the extent to which external environmental factors, including sunlight, contributes to our sense of well being.