Abstract
Introduction
The notion that the moon exerts an influence on human behavior has long been a topic of interest. A number of studies have been conducted, yielding results that are, at least in part, contradictory. In this context, the objective of this study is to examine the impact of the lunar cycle on psychiatric emergency consultations.
Methods
This retrospective study analyzed 69,764 psychiatric consultations at the Centre Psychiatrique d’Orientation et d’Accueil, one of the largest psychiatric emergency departments in France, between 2016 and 2023. The data set comprised age, gender, reasons for consultations, diagnosis, disposition at the end of the consultation and lunar phases. The data were analyzed using four operational definitions of lunar exposure to ensure comparability with previous studies.
Results
No statistically significant correlation was identified between the phases of the lunar cycle and the number of consultations or hospital admissions. No trend was observed in relation to reasons for consultations or specific psychiatric disorders, regardless of the definition used.
Conclusion
The results confirm no significant influence of the lunar cycle on psychiatric emergencies, in line with the majority of existing studies. Despite popular beliefs, the study suggests that the moon has no effect on the number of emergency room consultations or the nature of psychiatric disorders, reinforcing the idea that such beliefs are scientifically unfounded at least at population level.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12245-026-01179-0.
Keywords: Psychiatric emergency, Lunar cycle, Moon cycle, Psychiatric disorders
Introduction
The 29.5-day lunar cycle reflects the moon’s orbit around the Earth and results in cyclic variations in nocturnal luminosity. Beliefs regarding lunar influence on human behavior date back to ancient civilizations, where lunar phases structured agricultural practices and calendars [1, 2]. The idea that the moon affects the human body and behavior has persisted across centuries and remains prevalent, including among mental health professionals [3–5]. However, within modern medical practice, any observed effects appear modest [6]. Earlier studies are cited to contextualize longstanding beliefs, whereas more recent research reflects contemporary psychiatric methodology.
The influence of the moon on psychiatric disorders has been the subject of study by several authors. This is due to both ancient beliefs and the physiological effects of the moon. For example, the variation in luminosity according to the lunar cycle may contribute to the onset of sleep disorders and, consequently, the emergence of psychiatric symptoms. While the link is modest, several studies have identified it. For instance, total sleep time was found to be 20 min shorter on full-moon days [7, 8] Additionally, qualitative and quantitative changes in sleep have been observed according to the lunar cycle. These include a reduction in deep sleep and an increased rate of awakenings during the night, particularly in women [1]. However, studies indicate that with the advent of industrialization and technological advancement, the moon’s influence on sleep has diminished in comparison to previous centuries (due to the presence of artificial light in urban areas) [9]. An alternative hypothesis is that of the gravitational force, which varies according to the lunar cycle and influences the tides. This, in turn, suggests a potential link with the human body, which contains high proportion of water [10–12]. This could affect sleep and emotional and behavioral disturbances. Other studies suggest the existence of an internal hormonal clock synchronized with the lunar cycle [13]. Melatonin levels are also thought to be affected [8].
A meta-analysis of 37 studies conducted in 1985 examined the relationship between the lunar cycle and human behavior. The analysis demonstrated that the influence of the moon on various behaviors, including psychiatric, suicidal and criminal tendencies, is statistically insignificant, with less than 1% variation [14]. Although some studies found significant results, the authors criticize their validity, pointing to statistical errors and lack of replicability, and conclude that the influence of the full moon is vastly overestimated [14]. Subsequent studies have investigated the potential association between the lunar cycle and psychiatric disorders. However, the number of studies in this area is limited, and the findings remain inconclusive. With regard to suicidal behavior, some studies have identified a potential influence of the moon, particularly in women under the age of 45 [15]. However, subsequent studies have not replicated this finding [10, 15–20]. In the context of bipolar disorder, one study observed an increase in hospital admissions on days when the moon is brighter [21]. This could be linked to a reduction in sleep time during new and full moons [13]. With regard to psychotic disorders, one study found an increase in behavioral disorders during new and full moons [22], with an increase in admissions during the first quarter moon, followed by the full moon for paranoid psychotic disorders [23].
The results of the various studies in the literature were contradictory, and the methodologies employed varied considerably from one study to another. Furthermore, no study on this subject has been conducted in France. In light of this, the primary objective of our study was to ascertain whether there was an influence of the lunar cycle on the daily number of consultations at one of the largest psychiatric emergency departments in France between 2016 and 2023. The secondary objectives were to determine whether the lunar cycle had an influence on the type of consultations. In addition to being based on data from a large psychiatric emergency department in France, this study aims to provide a comprehensive assessment of the potential lunar effect by examining multiple clinically relevant outcomes.
Methods
Data collection location
The data presented in this study were collected from consultations held at the Centre Psychiatrique d’Orientation et d’Accueil (CPOA), which is situated within the campus of the Sainte-Anne hospital in the 14th arrondissement of Paris. This is the one of the largest psychiatric emergency centre in France, open 24 h a day, 7 days a week, with over 9,000 consultations per year.
Inclusion period
This retrospective study included all patients who consulted the CPOA between 16 January 2016 (implementation of the computerized medical record system at the CPOA) and 31 December 2023. If a patient presented multiple times during the study period, each consultation was counted as a separate instance. The data were extracted anonymously from the patient files and transmitted to us on a daily basis by the Medical Information Department (DIM) of GHU Paris Psychiatry and Neurosciences.
Patients
The primary data collected included the date of the consultation, the age of the patient at the time of the consultation, the sex (male/female), the reason for the consultation, the diagnosis made at the conclusion of the consultation according to the PMSI (Programme de Médicalisation des Systèmes d’Information, the French national hospital discharge database) code derived from ICD-10 [24], the patient’s disposition at the end of the consultation (discharge vs. hospital admission), the mode of hospitalization in the event of inpatient admission (voluntary or involuntary admission), and the use or non-use of mechanical restraints in the emergency department.
Reasons for consultation were systematically collected from patient files and grouped into 20 categories: - anxiety - sleep disorders - eating disorders - somatic complaints - suicidal behavior, self-aggression - depressive ideation - suicidal ideation - hetero-aggressive behavior - agitation, excitement - delusions, hallucinations - social withdrawal or marked behavioral withdrawal- confusional syndrome - wandering, running away, pathological travel - mutism - alcohol-related request - drug-related request - requests for information - administrative-related request - social-related request (accommodation) - other.
Diagnoses were derived from PMSI coding, according to ICD-10 [24]. These were the following diagnoses, which we grouped into six categories: F1 (mental and behavioral disorders related to the use of psychoactive substances), F2 (schizophrenia, schizotypal disorder and delusional disorders), F3 (mood disorders) including F30 (manic episode), F4 (neurotic disorders, stress-related disorders and somatoform disorders), F5 (behavioral syndromes associated with physiological disturbances and physical factors), F6 (personality and behavioral disorders in adults).
Patients under the age of 15 were excluded from our analyses (0.2% of patients).
Lunar calendar
The lunar calendar has been provided by the astronomical calculations and information service of the Paris Observatory. It was established by calculating astronomical phenomena over a calculation period from 16 January 2016 to 31 December 2023. The geocentric phases of the moon are calculated using the apparent geocentric longitudes of the moon and sun. All times are given in French legal time.
Statistical analysis
The data were analyzed on a daily basis. Initially, a descriptive analysis was conducted. Several operational definitions of lunar exposure, previously used in the literature, were tested to ensure comparability across studies and to strengthen methodological robustness:
Definition 1: the day of the full moon was compared to the other days of the lunar cycle.
Definition 2: the day of the full moon, the day before and the day after (full moon -/+ 1 day) were compared with the other days of the lunar cycle.
Definition 3: the day of the full moon and the three days before and after (full moon -/+ 3 days) was compared with the other days of the lunar cycle.
Definition 4: the cycle has been divided into four phases of about 7 days each, surrounding the 4 main periods of the lunar cycle.
For these different definitions, a univariate analysis has been carried out; means were compared using a Student’s t-test; proportions are compared using a chi-square test or ANOVA for multi-factor variables.
To control for temporal confounding, an adjusted analysis was conducted using quasi-Poisson regression for count data. The daily number of consultations was modeled according to lunar phase while adjusting for month, year, and weekend effects. Quasi-Poisson models were used to account for mild overdispersion. Adjusted analyses were performed using the primary definition (full moon vs. other days).
Statistical significance was set at two-sided p < 0.05, and results were interpreted cautiously with regard to multiple comparisons.
Analyses were performed using R Studio software.
Ethical aspects
This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. All data were fully anonymized prior to analysis. In accordance with French regulations governing retrospective studies using anonymized health data, individual written consent was not required. Patients were informed of the possible use of their data for research purposes and were given the opportunity to object (non-opposition procedure); no objections were recorded. This research project was registered on the Health Data Hub platform, and GHU Paris signed a commitment to the reference methodology MR004 on 20 July 2018 (simplified declaration to the national Commission on Information Technology and Freedoms [CNIL]). Finally, this research was approved by the GHU Paris Research Ethics Committee on 12/10/2024 (accreditation number 2024-CER-A-027).
Results
Over the course of the eight-year study period, a total of 69,764 consultations were conducted at the CPOA, representing 50,140 patients. The mean number of daily consultations was 23.95 (SD = 7.38; median = 24; IQR = 19–29). The distribution was approximately normal (skewness = 0.06), supporting the use of parametric tests. The socio-demographic data of the study population and the reasons for consultation are presented in Table 1 and Table 2.
Table 1.
Sociodemographic and clinical characteristics of patients consulting at the Centre Psychiatrique d’Orientation et d’Accueil during the study period. Values are presented as number of consultations (N = 69,764) and percentages, unless otherwise indicated
| Sociodemographic data |
N
(n = 69,764 visits) |
% |
|---|---|---|
| Sex | ||
|
Female Male |
37,138 32,626 |
53.2 46.8 |
| Age (years), mean | 35.9 (range 15.0–98.2, SD 15.2) | |
| Patient origin | ||
|
Home General hospital Street Institution Work School |
41,896 11,377 9,681 3,522 1,250 544 |
60.1 16.3 13.9 5.0 1.8 0.8 |
| Mode of arrival | ||
|
Personal means Ambulance Police or fire brigade Social services Other |
53,959 11,506 2,349 451 1,182 |
77.3 16.5 3.4 0.6 1.7 |
| Psychiatric history | ||
|
Previous psychiatric care First contact with psychiatry Previous suicide attempt < 1 week suicide attempt |
42,094 11,229 14,902 3,513 |
60,3% 16,1% 21,4% 5,0% |
Table 2.
Main reasons for consultation at the Centre Psychiatrique d’Orientation et d’Accueil during the study period
| Reasons for consultation |
n
(n = 69,764 visits) |
% |
|---|---|---|
| Anxiety | 21,223 | 30.4 |
| Sleep disorders | 6,186 | 8.9 |
| Eating disorders | 919 | 1.3 |
| Somatic complaints | 1,089 | 1.6 |
| Suicidal behavior | 4,372 | 6.3 |
| Depressive ideation | 22,274 | 31.9 |
| Suicidal ideation | 12,762 | 18.2 |
| Heteroaggressive behavior | 2,023 | 2.9 |
| Agitation - excitement | 4,980 | 7.1 |
| Delusions | 12,159 | 17.4 |
| Social withdrawal or bizarre behavior | 3,044 | 4.4 |
| Confusional syndrome | 272 | 0.4 |
| Wandering, pathological travel | 2,712 | 3.9 |
| Mutism | 204 | 0.3 |
| Complaints related to alcohol | 2,463 | 3.5 |
| Enquiries relating to drug addiction | 2,019 | 2.9 |
| Request for information | 809 | 1.2 |
| Administrative enquiries | 844 | 1.2 |
| Social enquiry | 1,345 | 1.9 |
Following their emergency department consultation, 28,665 patients (41.1%) required hospitalization, including 13,047 patients involuntary hospitalized (18.7% of consultations, 45.5% of hospitalizations). The remaining patients were discharged as outpatients (40,528 patients, 58.1%). Additionally, 1,704 patients (2.4%) required physical restraint during their stay in the emergency department.
Correlation between number of consultations and indications for hospitalization with the lunar cycle
Definition 1
The mean number of consultations on the day of the full moon was 24.3, compared with 23.9 on other days of the lunar cycle (p = 0.7). The mean number of hospitalizations on days with a full moon was 9.73, compared with 9.84 on other days (p = 0.53). The mean number of involuntary commitments on days with a full moon was 4.15, compared with 4.49 on other days of the cycle (p = 0.13).
Definition 2
The mean number of consultations during the three days surrounding the full moon was 24.04, in comparison to 23.89 on the remaining days of the cycle (p = 0.26). Similarly, the overall number of hospitalizations did not differ significantly (9.9 vs. 9.8, p = 0.20). There was no discernible difference in the number of involuntary commitments during this interval in comparison to the other days of the month (4.4 vs. 4.5, p = 0.26).
Definition 3
The total number of consultations during the three-day period preceding and following the full moon was 23.75, in comparison to 23.98 on other days (p = 0.54). The total number of hospital admissions over the six-day period surrounding the full moon was 9.81, in comparison to 9.84 on other days (p = 0.89).
Definition 4
The number of consultations did not differ significantly when the lunar cycle was divided into four equal periods (p = 0.163). Similarly, there was no notable difference or trend in the incidence of the number of hospitalizations in this model according to the lunar cycle.
Correlation between consultations by pathology and psychiatric symptomatology and the lunar cycle
Definition 1
There was no difference in the various reasons for consultation, or in the diagnosis made at the end of the consultation, between the days of the full moon and the other days of the cycle. The results are summarized in Tables 3 and 4. On full-moon days, the average number of physical restraints was 0.47, compared with 0.59 on non-full-moon days (p = 0.16).
Table 3.
Mean daily number of psychiatric consultations at the CPOA on full moon days compared with other days (Definition 1), by reason for consultation. Values are presented as mean (standard deviation). p-values were calculated using Student’s t-test
| Reason for consultation | Full moon | Other days | p |
|---|---|---|---|
| Anxiety | 7.35 (3.30) | 7.28 (3.29) | 0.84 |
| Sleep disorders | 2.09 (1.39) | 2.12 (1.72) | 0.81 |
| Eating disorders | 0.32 (0.51) | 0.32 (0.57) | 0.88 |
| Suicidal behavior | 1.48 (1.43) | 1.50 (1.34) | 0.91 |
| Depressive ideation | 7.68 (3.96) | 7.64 (3.74) | 0.94 |
| Suicidal ideation | 4.45 (2.72) | 4.38 (2.85) | 0.79 |
| Heteroaggressive behavior | 0.67 (0.87) | 0.70 (0.88) | 0.74 |
| Agitation–excitement | 1.77 (1.39) | 1.71 (1.38) | 0.68 |
| Delusions | 3.92 (2.12) | 4.18 (2.18) | 0.23 |
| Alcohol-related complaints | 0.73 (0.93) | 0.85 (0.97) | 0.20 |
Table 4.
Mean daily number of psychiatric consultations at the CPOA on full moon days compared with other days (Definition 1), by ICD-10 diagnostic categories. Values are presented as mean (SD). p-values were calculated using Student’s t-test
| ICD-10 diagnosis | Full moon | Other days | p-value |
|---|---|---|---|
| F1 — Substance use disorders | 1.81 (1.48) | 2.04 (1.53) | 0.13 |
| F2 — Psychotic disorders | 5.13 (2.05) | 5.21 (2.47) | 0.69 |
| F3 — Mood disorders | 8.37 (3.89) | 8.25 (3.70) | 0.76 |
| F30 — Manic episodes | 0.63 (0.79) | 0.76 (0.88) | 0.09 |
| F4 — Stress-related disorders | 4.82 (2.58) | 4.73 (2.67) | 0.74 |
| F5 — Behavioral syndromes | 0.47 (0.69) | 0.43 (0.69) | 0.53 |
| F6 — Personality disorders | 1.72 (1.34) | 1.93 (1.53) | 0.13 |
Definitions 2, 3, 4
There were no differences in reasons for consultation, diagnoses or number of involuntary admission in definitions 2, 3 and 4. The results are summarized in Table 1 in supplementary material.
Correlation between age, sex and the lunar cycle
The mean age of consultation did not vary according to the different lunar phases in definitions 1, 2, 3 and 4. Similarly, there was no gender difference according to the lunar cycle in any of the four definitions.
Multivariate analyses
In adjusted analyses using quasi-Poisson regression controlling for month, year, and weekend effects, no association was found between full moon days and the number of psychiatric emergency consultations (β = 0.02, p = 0.35).
Discussion
Our study suggests no significant link between psychiatric emergency room consultations and the lunar cycle, regardless of the definition used. This corroborates the findings of other studies [25–29]. Variability across studies may be explained by methodological heterogeneity, including differences in sample size, clinical settings, definitions of lunar phases, and statistical approaches. One study [30] reported a potential increase in emergency department attendance during the full moon, although this did not reach statistical significance. The number of hospital admissions remained unchanged throughout the course of our study, and these findings align with those of previous research studies [31–33]. A single study [30] however identified a significant decrease in admission rates around the full moon and an increase at the time of the new moon, in contrast to the findings of the study by Calver et al. [9], which reported twice as high rates of agitation on full moon days compared to other days of the cycle (p = 0.002). Another study posited an increase in violent behavior towards caregivers during the first and third quarters of the moon [34]. A number of other studies have indicated that there is no change in these behaviors. With regard to the necessity for restraint, the existing literature indicates a significant correlation between new and full moon days with regard to the administration of chemical restraint [33]. Furthermore, another study indicates an increase in this type of restraint in women around the new moon [30]. The findings of the present study align with those of previous research, indicating that there is no variation in the need for mechanical restraint according to the lunar cycle.
With regard to the specific category of pathology or behavioral disorder, the results of our study also revealed no statistically significant findings. In contrast, a study found an increase in admissions to psychiatric wards for individuals with non-affective psychoses during the full and new moons [28]. Furthermore, there was a 32% reduction in emergency room admissions for “anxiety disorders other than panic disorder” during the last quarter moon [35]. In our study, conducted in the context of psychiatric emergencies, we found no evidence of an increased prevalence of sleep disorders during the full moon, no variation in suicidal behavior according to the lunar cycle, and no fluctuation in the decompensations of bipolar disorder or psychotic disorders according to the lunar cycle. These findings align with those reported in the existing literature outside the emergency context.
One of the key strengths of our study is the size of our sample. The CPOA is the largest psychiatric emergency department in France, with over 9,000 consultations each year. Furthermore, the study was conducted retrospectively over eight years, encompassing 69,764 consultations. Furthermore, our original study is the first in France to investigate the link between psychiatric emergencies and the lunar cycle. Given the variety of methodologies for studying the lunar cycle, comparisons between studies are inherently complex. Some studies may yield more precise results than others, which could lead to discrepancies in findings. To address this, we tested several operational definitions of lunar exposure commonly used in the literature rather than relying on a single definition, thereby improving comparability across studies and enhancing methodological robustness.
The consistency of null findings across studies suggests that lunar effects on psychiatric emergencies are unlikely to represent a measurable population-level phenomenon. Persistent beliefs may instead reflect cognitive biases, selective recall of unusual events, and the longstanding cultural symbolism attributed to the full moon. Despite the large sample size and extended study period, very small effects cannot be completely ruled out. However, any such effects would likely be of limited clinical relevance. Future research may therefore benefit from focusing on individual-level vulnerability factors, including circadian rhythm dysregulation and sensitivity to nocturnal light exposure.
It is important to acknowledge the limitations of our study, which may influence the interpretation of the findings. First, a potential classification bias is inherent to diagnostic coding in emergency settings. Diagnoses established at presentation are often provisional and may lack precision, which is a common limitation of emergency psychiatric care. In addition, grouping ICD-10 categories into broader classes may reduce diagnostic specificity. Similarly, reasons for consultation rely on routine clinical coding and may vary between clinicians. This measurement variability may attenuate small effects and reduce statistical power. Second, our study design did not allow exploration of individual-level susceptibilities, which should be investigated in future research using targeted or longitudinal approaches. Third, this was a monocentric study. Although the CPOA has a regional scope and extensive catchment area, its urban location in Paris may limit generalizability. Results might differ in rural settings, where moon visibility and nocturnal illumination vary more substantially. Furthermore, the CPOA exclusively manages psychiatric emergencies. Certain patient profiles are more likely to be treated in general emergency departments (e.g., suicide attempts requiring somatic care, substance intoxication, or severe hetero-aggressive behavior), making this setting less suitable for studying these presentations. Finally, meteorological conditions may influence moonlight exposure and thus modulate potential light-related lunar effects. Future studies integrating meteorological data and nocturnal light exposure could help clarify whether these factors influence lunar-related phenomena.
Conclusion
The hypothesis that the moon exerts an influence on human beings has persisted for centuries and continues to be a topic of discussion in the present era. The present study, the first of its kind in France, was conducted at one of the largest psychiatric emergency departments and revealed no impact of the lunar cycle on psychiatric emergency consultations in terms of number or subtype of pathologies, regardless of the definition used to define the lunar cycle. This finding is consistent with the majority of existing studies in the literature. Our findings add to the growing body of evidence suggesting that lunar phases are unlikely to have a clinically meaningful impact on psychiatric emergencies at the population level – although individual-level hypotheses remain to be explored. Future research could investigate whether individual-level vulnerability, such as circadian rhythm dysregulation, sleep disorders, or specific psychiatric phenotypes (e.g., bipolar spectrum), might interact with lunar phases in a subset of patients, rather than at a population level.
Supplementary Information
Below is the link to the electronic supplementary material.
Author contributions
CL and MAA collected the data, performed the statistical analyses, and drafted the manuscript. LT, RG, and APS validated the analyses, supervised the work, and revised the manuscript.
Funding
This research received no external funding.
Data availability
No datasets were generated or analysed during the current study.
Declarations
Ethics approval
Ethical approval is described in the Methods section.
Consent to participate
Consent to participate is described in the Methods section.
Competing interests
The authors declare no competing interests.
Footnotes
The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Publisher’s note
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
No datasets were generated or analysed during the current study.