The frequency of suicides around major public holidays: some surprising findings

Characteristics and related factors of suicide attempts among patients admitted to an Iranian poisoning center: Implications for suicide prevention

Background

Suicide is a major public health concern worldwide. Iran is no exception, with suicide rates increasing in recent years. Understanding the characteristics and related factors of suicide attempts can help inform suicide prevention efforts in Iran.

Methods

A cross-sectional study was conducted on patients who attempted suicide and were admitted to the poisoning emergency of an intoxication center in Shiraz, Iran, between November 2019 and January 2020. Data were collected using data sheets containing study variables completed by oral interviewers and analyzed using descriptive and inferential statistics.

Results

The study included 302 individuals, with the majority being females (63.6%), and the mean age was 28.19 (SD 19.25) years. The majority of patients were living in urban areas (82.5%) and unmarried (60.9%). Medical drug abuse was the most common method of self-poisoning (76.5%), followed by narcotics (15.6%). Suicide attempts were predominantly carried out at night (59.9%) and on working days (78.5%). Most patients had no history of previous suicidal attempts (64.2%), psychiatric problems (64.6%), or physical illnesses (84.8%). Female gender (P = 0.017) and the presence of an underlying disease (P = 0.016) were the two risk factors significantly associated with suicide on non-working days.

Conclusion

Our study highlights the need for comprehensive suicide prevention strategies that consider the complex interplay of individual, sociocultural, and environmental factors that contribute to suicidal behaviors. The high proportion of female suicide attempters and the timing of suicide attempts suggest the need for gender-specific suicide prevention programs and focused suicide prevention efforts during high-risk periods. Additionally, the association between physical illnesses and suicide attempts underscores the importance of integrated mental and physical health care services.

Time for time off? Secondary public holiday shows minimal net hospitalisation benefit

BACKGROUND

We aimed to use New Zealand's Anzac Day to test the public health effect of secondary public holidays; and to use weekly hospitalisation counts to identify which dates were more health suitable for a potential new public holiday.

METHODS

We conducted a retrospective population cohort study of hospital admissions in New Zealand between 23 April and 27 May 1988-2018. We compared acute and arranged hospitalisation and mortality rates in holiday (Anzac Day Monday to Friday) and non-holiday (Anzac Day Saturday or Sunday) years, for mid-week holidays and long weekends; and measured total weekly average acute and arranged hospitalisation counts.

RESULTS

Hospitalisation rates were lower in holiday years than non-holiday years (rate ratio (RR) 0.96, 95% CI 0.95 to 0.96, p<0.001), with fewer arranged admissions (RR 0.93, 95% CI 0.93 to 0.94, p<0.001), but no significant difference for acute admissions (RR 1.00, 95% CI 0.99 to 1.00, p=0.087). Holiday year acute admission rates were lower than non-holiday years for children aged 0-4 years, but higher for adults aged 15-44 years. Holidays reduced arranged admissions most in children and areas of higher socioeconomic deprivation. There was no significant difference for mortality. Average weekly acute hospitalisations were higher than arranged admissions between 10 June and 7 October.

CONCLUSION

Secondary holidays do not reduce deaths; or acute hospital admissions except in the holiday week; and may delay elective treatment. However, if New Zealand is to add a new public holiday, it would have least detrimental health effect scheduled between 10 June and 7 October.

The seasonality of suicide attempts: a single poison control center perspective

Introduction: Suicide attempts by poisoning are increasing and suicide occurrence may be associated with seasonality. We performed a retrospective analysis of poisoning exposure data from a single Poison Control Center (PCC) to determine if suicide attempts were associated with season, day of the week, and/or US holidays.Methods: We analyzed exposure cases identified as "intentional overdose - suspected suicide attempt" over 2009-2012. We used singular spectrum analysis (SSA) to detect cyclic patterns in the data and then performed Poisson regression and t-tests to determine if the number of cases were associated with season, day of the week, and US holidays.Results: There were 42,578 cases of "intentional overdose - suspected suicide" during the study period. Singular Spectrum Analysis (SSA) showed that the number of cases associated with poisoning suicide attempts peaked in the Spring and dipped in the Fall. Regression analysis showed higher numbers of suspected suicide attempts from intentional overdose in spring compared with winter by 1.07 times (p = 0.003), and on Sunday (p < 0.001), Monday (p < 0.001), and Thursday (p = 0.02) compared with Saturday by at least 1.09 times. No significant difference was seen for most holidays except for lower numbers of cases around Christmas (3 days before and after; 22.0 vs. 32.3 on control dates, p < 0.001).Conclusions: Suicide attempts by poisoning are associated with season of the year and some days of the week. Further research is required determine reasons for these associations and implementation of public health interventions.

Suicides around Major Public Holidays in South Korea

A dip and peak pattern of suicide around major public holidays has been found in developed countries and explained by the broken promise effect. Focusing on two major holidays in South Korea (New Year's Day and Thanksgiving Day, both on the lunar calendar), replication of the dip and peak pattern was done by analyzing individual information on all suicides from 1997 to 2014. The replicated pattern revealed the most vulnerable group to be married men aged 50+ in nonmetropolitan areas in 2006-2014. Families, friends, and policy makers can use these findings to save the vulnerable.

The timing of general population and patient suicide in England, 1997-2012

BACKGROUND

There have been conflicting findings on temporal variation in suicide risk and few have examined the phenomenon in clinical populations. The study investigated seasonal and other temporal patterns using national data.

METHODS

Data on 73,591 general population and 19,318 patient suicide deaths in England between 1997 and 2012 were collected through the National Confidential Inquiry into Suicide examining suicide rates in relation to month of the year, day of the week, and individual days of national or religious significance.

RESULTS

Suicide incidence fell over successive months of the year and there was evidence of an overall spring peak. Monday was associated with the highest suicide rates and in the patient population this effect appeared to be more pronounced in those aged over 50 or those who lived alone. Suicide risk was significantly lower during Christmas, particularly for women. There was a peak in suicide on New Year's Day in the general population. Other 'special days' were not associated with a change in suicide incidence.

LIMITATIONS

We were limited to identifying associations between the variables investigated and were unable to explore causal mechanisms. We did not carry out comprehensive multi-variable adjustment in our regression models.

CONCLUSIONS

There is substantial seasonal and temporal variation in suicide deaths, and there appears to be some evidence in the clinical as well as the general population in England. Clinical services should be aware of the risk of suicide just after the weekend, especially in people who live alone, and the potential need for closer supervision during this period.

Time patterns of inpatient suicides

Abstract Objective. Time patterns of suicides have been investigated in many population-based studies, but there are no studies exploring time patterns of suicides during psychiatric inpatient stay up to now. Methods. All inpatient suicides (1998-2007) of a psychiatric university hospital were identified by the German psychiatric basic documentation system (DGPPNBADO). Descriptive and univariate analyses were performed to analyse time patterns of inpatient suicides. Results. No significant differences could be found for the occurrence of the 37 inpatient suicides due to season (χ(2)=1.595, P=0.696), month (χ(2)=4.838, P=0.958) or weekday (χ(2)=5.189, P=0.550) of suicide. Furthermore, we could not find an unequal distribution of suicides due to month of birth (χ(2)=12.622, P=0.337). 78.4% of inpatient suicides occurred within 50 days after admission. Fourteen inpatients committed suicide around public holidays, two around their birthday. Conclusions. Apart from a notably enhanced risk of suicide in the period after admission, we could not find any time patterns to be of high relevance to inpatient suicides. There may be more relevant risk factors than cyclic or temporal variations.

Can sports events affect suicidal behavior? A review of the literature and implications for prevention

BACKGROUND

Engagement in sports and physical activity, either actively as an athlete or in a passive way as a spectator, impacts interpersonal behavior and physical and mental health.

AIMS

The study reviews literature on the relationship between sports spectatorship and suicidal behavior to ascertain whether sports spectatorship has an impact on suicidal behavior, either increasing the risk or being a protective factor.

METHODS

The literature was searched via PubMed/MEDLINE and PsycINFO. Nine studies published between 1986 and 2006 were identified.

RESULTS

The reviewed studies focused on the impact of sports events on the societal level, and analyzed data regarding national or local suicide rates. Their results indicate that sports events can have an impact on suicide mortality and morbidity, but this relationship seems to be mediated by age, gender, marital status, and alcohol consumption, as well as the process and outcome of the game (e.g., victory vs. defeat of the favored team).

CONCLUSIONS

There is some evidence that sports events can reduce the rates of suicide on the societal level; however, there is a lack of studies exploring how sports spectatorship might influence levels of suicide risk in individuals and how mediating variables might operate on the individual level.

The impact of holidays on suicide in Hungary

The suicide rate on religious and public holidays was examined for 133,699 suicides for Hungary for the period 1970-2002. For both men and women, more suicides were committed on Monday, while fewer were committed on the weekends. More suicides occurred on New Year's Day than expected. On Christmas Day and on Easter Sunday and Monday, suicides were less frequent only for men, a result consistent with Durkheim's theory. There was less evidence for Gabennesch's broken promise effect on the days after the holidays. National holidays had no impact on the frequency of suicide.

Variation in deliberate self-harm around Christmas and New Year

Seasonal and temporal variations in suicide by patient and demographic groups, though important, have been investigated infrequently. This study examined patterns of non-fatal deliberate self-harm (DSH) during Christmas and New Year (from December 16th to January 6th) by specific patient and demographic group. The sample comprised 19,346 people who presented with 31,369 episodes of DSH to a general hospital Emergency Department in Oxford, UK. Autoregression analysis of all episodes from 1976 to 2003 (controlling for day of the week, month and year) revealed significant reductions (-30% to -40%) in the occurrence of DSH compared with expected numbers on each day from December 19th to 26th (except the 23rd), though no significant increase was found on any of the subsequent 11 days. When analysed separately, young people aged under 25 years showed decreases (-60%) in the occurrence of DSH on several days throughout Christmas (p<0.001) and New Year (p<0.01). Patients with partner relationship problems showed a decrease 3 days before Christmas Day (-80%, p<0.001) and an increase on New Year's Day (+100%, p<0.01). Patients with family relationship problems showed decreases before Christmas and after New Year (-60%, p<0.01). Patients with social isolation problems, or a previous history of DSH showed decreases (-60%, p<0.01) before Christmas only. Patients who used alcohol at the time of DSH or in the 6h beforehand, but did not chronically misuse alcohol, showed an increase (+250%, p<0.01) on New Year's Day. There was no significant variation in the occurrence of DSH for patient groups with either low/medium or high suicide intent. The findings elucidate how social and individual factors may interact in contributing to DSH. They are of theoretical interest, and have important clinical implications regarding identification of patient groups especially susceptible to DSH at New Year.

Seasonal fluctuation of suicide in Hungary between 1970-2000

The authors studied the seasonal fluctuation of suicide events in Hungary in a 31-year period. A summer maximum and a winter minimum were found in both genders. A second autumn peak did not occur among women. The suicide rate of Hungary fell markedly in 1998, parallel with the fundamental political-economical-social changes in the country. After 1988 the ANOVA statistic did show a moderate decrease in the seasonal fluctuation but only among those under 29 years of age. This young generation was the real "winner" of the deep social changes which suggests an indirect connection between the decrease of the seasonal fluctuation of suicide and the socio-political changes.

Inequalities in daily variations of deaths from suicide in Lithuania: identification of possible risk factors

The aim of this study was to analyze daily variations in mortality from suicides of Lithuanian urban and rural populations in two different periods of economic and political development of the country (1988-1990 and 1998-2000). The highest proportion of suicides occurred on Mondays and during the first days after the major public holidays, especially in men. Suicide mortality in rural areas was significantly higher in comparison to urban; nevertheless, daily variation was more marked in urban areas. Developing market economy and rising unemployment did not increase daily variation in suicides.

A suicide peak after weekends and holidays in patients with alcohol dependence

This paper analyzes the variation of suicide by day of the week in alcohol dependence, with public holidays taken into consideration. From 1949 through 1969, 1,312 patients with alcohol dependence were admitted to the Department of Psychiatry in Lund. By 1997, a total of 102 (99 men) alcoholic patients had taken their own life. Suicide victims with severe depression and other diagnoses were compared. There was a suicide peak on the first two days after weekends and holidays in patients with alcohol dependence (p < .05). Alcohol withdrawal is proposed as a contributor to the suicide peak.

Psychiatric emergency rates during the Christmas season in the years 1991 to 1997

We compared the number of psychiatric admissions from the emergency room during the Christmas season, defined as the rate for the month of December, with those in other months. The psychiatric emergency rates were recorded for each month over six consecutive years, 1991 to 1997. The average number of emergency patients in none of the 12 months differed significantly from any of the remaining months (ANOVA, p > .05). Our data and those of other authors do not support the clinical lore that Christmas season is associated with higher rate of psychiatric emergencies.

Attempted suicide and major public holidays in Europe: findings from the WHO/EURO Multicentre Study on Parasuicide

OBJECTIVE

The aim of the study was to examine the relationship between suicide attempts and major public holidays in Europe.

METHOD

The analysis was based on data on 24 388 suicide attempts by persons aged 15 years or older in the period 1989-1996. Data from 13 centres (representing 11 countries) participating in the WHO/EURO Multicentre Study on Parasuicide were analysed. The analysis of the fluctuation of suicide attempts around public holidays was based on the daily number of suicide attempts for each centre. For each day in the period under examination a mean number of suicide attempts (mu) was calculated. The analysis was based on the assumption that the data followed a Poisson distribution. The observed number of daily suicide attempts was compared with the expected number of attempts. A multiplicative model for the expected number in each centre was developed.

RESULTS

Before Christmas there were fewer suicide attempts than expected, and after Christmas there were approximately 40% more attempts than expected. In addition, more attempts than expected were registered on New Year's Day. In countries where people have the day off work on Whit Monday there were significantly fewer attempts during the 3 days before, but where Whit Monday is a normal working day significantly fewer attempts occurred on the Monday to Wednesday after Whit Sunday.

CONCLUSION

There appears to be a transposition of a significant number of suicide attempts from before (and during) a major public holiday until after it. The division of holidays into non-working and working days showed that a 'holiday effect' could only be found around major public holidays, particularly Christmas, Easter and Whitsun. These findings support the theory of the 'broken-promise effect' for major public holidays.

FEELINGS ABOUT CHRISTMAS, AS REPORTED BY PSYCHIATRIC EMERGENCY PATIENTS

Data from 55 psychiatric emergency patients between December 1 and January 13 indicate that the most common stressors reported by the patients during the Christmas season were loneliness (40.0%) and being without a family (38.2%). When asked how they feel about Christmas, most patients in this group reported negative feelings.

Seasonal variation in suicide occurrence in Finland

The aim of this study was to investigate the age-, gender- and suicide method-related seasonality of suicide occurrence by using the largest database examined so far (n=21,279). The Chi-square test for multinomials was used as the overall measure of deviation. The monthly observed and expected numbers of suicides were calculated and classified by year, month, gender, age groups and suicide methods. To identify the statistically significant peak and trough months, the ratio of observed numbers of suicides to expected numbers with 95% confidence intervals was calculated. For males, there was a suicide peak from April to July, while for females the distribution was bimodal (with peaks in May and October). In elderly people there was a significant excess in the number of suicides in autumn, and the troughs were deeper in winter. For violent suicides there was a unimodal spring peak, but for non-violent suicides the distribution was bimodal. The results indicate that suicides among elderly subjects, as well as non-violent suicides, occur significantly more often during autumn than would be expected.

Timing of completed suicides among residents of Olmsted County, Minnesota, 1951-1985

Previous studies of suicide timing may have been biased by incomplete ascertainment of suicides and by delays between the suicidal act and subsequent death. Those potential biases were assessed and minimized in this population-based study by using the unique resources of the Rochester Epidemiology Project in Olmsted County, Minnesota. Using these more accurate data, we confirmed previous reports of no excess suicides on birthdays (+/- 3 days), or during 3 United States national holidays. While most prior reports found excess post-holiday suicides and suicide peaks on Mondays, those findings were not observed in Olmsted County. Because 93% of deaths occurred on the date of the suicidal act, using date of death instead of the actual date of suicide is sufficient for most research purposes.

Can Death be Postponed?—The Death-Dip Phenomenon in Psychiatric Patients

The authors explored the “death-dip phenomenon,” the previously-reported decrease in deaths occurring before significant dates, with a cohort of 4800 psychiatric patients. The dates of death were compared with each individual's birthday, with Christmas, and with New Year's Day. These comparisons were done for the total group of deaths and separately for suicide, homicide, accidental deaths, deaths from circulatory diseases, and deaths from all other causes. In general, the findings were negative. No death-dip phenomenon was identified in any group, with any grouping of cause by date. There was a significant increase in accidental death preceding birthdays. There was a suggestion that suicide deaths increased just before Christmas. Total deaths increased during the winter quarter; all other findings were negative.

The Meaning Behind Popular Myths about Suicide

The realization that another person chooses to end his life is both horrifying and mysterious to most human beings, because suicide defies the prime law of nature (i.e., survival) and raises doubts about the worth of living. In order to reduce psychological perturbation, we develop a set of myths (or false beliefs) about suicide which serve to deflect us from facing basic issues about life and death and thus maintain a sense of inner comfort. Several common human-serving fallacies about suicide are examined as to their validity and are discussed in terms of how they operate to reduce anxiety about questions of life and death.

Birth Dates and Death Dates: An Examination of two Baseline Procedures and Age at Time of Death

The present study continues analyses of variations in the frequencies of death in the near temporal proximity of decedents' birthdays. Observed frequencies were compared with expected frequencies as ascertained from two baseline distributions. One distribution was the usual rectangular distribution, based on summing the number of deaths across all frequency categories and then dividing by the number of categories. The other distribution was constructed by pairing one person's birth date with another person's death date. This latter distribution was intended to provide a true baseline, and provide a better gauge for assessing the likelihood that any obtained relationship reflected coincidence or chance. Two weeks before and two weeks after the birthday there were more deaths, and one week after the birthday there were fewer deaths, than would be expected on the basis of either baseline distribution. Day-by-day analyses within the birthweek confirmed earlier reports of high followed by low frequencies of death. Compared to relatively old men, relatively young men were more likely to die on the eve of their birthdays or on their birthdays themselves. Compared to relatively young men, relatively old men's death dip begins at an earlier point in time. Methodological and theoretical implications are discussed.

A comparison of injury date and death date in 42,698 suicides

The date of death was compared with the date of injury (the onset of the suicidal act) for 42,698 California suicides, 1973-85. Findings revealed 92.6 per cent of all California suicides occurred within one day of the injury date. Graphs of daily suicides by injury date and by death date displayed essentially identical patterns around the holidays, by date of the week, and after publicized suicide stories. These findings suggest that the difference between date of death and date of injury need not be taken into consideration in the analysis of temporal fluctuations, as was previously supposed.

A drop in suicides around major national holidays

To study the fluctuation of suicides around the holidays, we examined 188,047 U.S. suicides from 1973 to 1979. Correcting for the effects of extraneous variables, such as seasons and days of the week, we found that suicides dropped by an annual average of -102.5 in the period surrounding the holidays. One set of holidays (Memorial Day, Thanksgiving, and Christmas) was associated with an unusually low risk of suicide before, during, and after the holiday. Another set of holidays (New Year's Day, July 4th, and Labor Day) was associated with a low risk of suicide before the holiday and a high risk just afterwards. Almost all demographic groups experienced a low risk of suicide around the holidays: whites, blacks, males, females, retired persons, and persons of working age. Only white teenagers deviated from this pattern. Thus, the evidence does not support the widespread popular assumption that holidays are a risk factor in suicide.

The difference between date of suicidal act and recorded death certificate date in 204 consecutive suicides

The date of death recorded on death certificates (DCD) was compared to the date of the suicidal act (DA) in a consecutive series of 204 suicides. The DA was known to be the same as the DCD in only 46 per cent of the cases. The DA was different from the DCD in 22 per cent of the cases. The difference between the DA and DCD should be taken into consideration in the analysis of temporal trends.

Temporal variations in mortality: A comparison of U. S. suicides and motor vehicle fatalities, 1972–1976

Among the various types of mortality, motor vehicle fatalities (MVF) and suicides are two that are very responsive to social, economic, and psychological factors. The analysis of the temporal patterns of suicides and MVF points to important but neglected forces affecting them. This paper examines the daily patterns of MVF and suicides for the United States from 1972 to 1976. The effects of the day of the week, month, year, and holidays on these types of mortality are estimated. Total MVF and suicides, as well as daily differentials by sex, age, and race, are analyzed with regression techniques. The results show that temporal variations are stronger in MVF than in suicides but are present in both. MVF tend to peak on Saturday, in the summer months, in 1972 and 1973, and on holidays. Suicides are generally highest on Monday, in the spring months, in 1975 and 1976, and on nonholidays. Differentials in the temporal patterns are evident. For instance, whites generally have a sharper decline in suicides on holidays than do nonwhites. The holiday peak in MVF for the 60 and over population is Christmas, while it is New Year’s for the younger age groups. Males exhibit a greater increase in suicides from March to May than do females. Finally, the results of a comparison of the daily patterns of MVF and suicides revealed a negative correlation. This contrasted with the strong positive relationship between MVF and suicides generally found in cross-sectional studies. The implications of these findings are briefly discussed.

Myths of mid-winter depression

An investigation was conducted into the effect of a major Alaskan annual winter festival upon the rates of crisis data. Analysis of rates of suicide, attempted suicide, family disturbance calls, crisis calls, and mental health admissions indicated no significant effect of the festival. Statewide statistics over several years indicate that demands for depression-related services appear to peak in either the summer or the fall. These results do not support the widely held belief that depression is more common during the winter in the North or that mid-winter festivals help to promote psychological well-being. It is concluded that the pervasiveness of such myths may lead to misdiagnosis or mistreatment, and that other folklore should be examined for its validity.