I write this shortly after completing the documentation for a patient who attempted suicide. This is not an unusual event for a psychiatrist; what is significant is that the attempt occurred after the patient returned home from Christmas dinner with their children. Fortunately having survived and currently receiving treatment, I feel a full recovery is likely.
Many would hear the story as yet another example of the tyranny of “holiday blues” – the terrible imposition on all of us to be merry and enjoy forced festivities, with family feuds and workplace rivalries peppering the frivolousness. It’s intuitive that the holidays must be stressful for many. Not just for lay people; a recent informal survey by the American Psychiatric Association found as many as 60 per cent of psychiatrists believed that the Christmas period was associated with an increase in depression and suicides. Multiple mental health authorities have published how-to guides about depression management in the holiday season.
However, this is simply not true. There is no evidence that the Christmas and New Year’s period is associated with depression or suicide. Sansone reviewed this in 2011, noting multiple studies finding a reduction in self-harm behaviour over several studies – such as Karoly’s 2005 study of 140,000 suicides, which showed fewer male suicides occurred during the Christmas holidays. The overall presentation to mental health services was also shown to drop at this time. One study reviewed found a reduced number of presentations to a psychiatric emergency department for any reason – a pattern maintained over seven consecutive years.
This is, unfortunately, not all good news. Sansone also found that there was a worrying rebound in mental health presentations immediately after the Christmas period, in the new year. This increase appeared to match the decrease that was seen during Christmas. This phenomenon has also been noted independently in several different studies. A 1999 Danish study found suicide attempts rise by 40 per cent in the first two weeks after the new year.
What is often underplayed is the effect of Christmas – regardless of anyone’s opinion of the holiday – in increasing connectiveness and brings family and friends together. This social aspect may explain the drop in suicides. Similarly, when this effect ends at the termination of the holiday season, this reduction in socialisation may also explain the increase – as with my patient.
I invite you, therefore, as you enter the New Year, to spare a thought about the loved one or colleague who was surprisingly quiet at the last get-together. Has there been a change in their functioning? Are they their usual selves? If not, seek them out a second time, to see whether they may need a mental health review. At worst, it could simply be a waste of your time. At best, it could help us all to have a happy New Year.
Neil Jeyasingam is a psychiatrist and lecturer and the University of Sydney.
This article first appeared on ‘Sydney Morning Herald’ on 2 January 2015.