Mental Health Matters: Suicide and the holidays
The holiday season has arrived. Time to give thanks, to gather in the warm embrace of family and good friends, to celebrate.
What could go wrong? Turns out, both less and more than we might imagine.
For many years, it has been a commonly accepted belief that suicide increases during the holiday season. Indeed, the Annenberg Public Policy Center notes that half of the articles written about the topic during 2009-2010 incorrectly state that suicide increases during the holiday season.
Suicides actually decline over the holidays, only to then show a noticeable uptick immediately afterward. Researchers don’t know why suicide rates decline during the holidays, but it is conjectured that available social support, an important risk factor in predicting suicide, increases during this festive season.
Still, much can go terribly wrong during the holidays in susceptible people. Risk factors for suicide include a past personal history of suicide attempts or a family history of suicide.
Add to these major psychiatric conditions, particularly schizophrenia and major depression. Those with schizophrenic conditions, for example, attempt suicide at a rate of 50 percent over the course of the illness and commit suicide 10 percent of the time.
More significant, in terms of absolute number, are those with histories of substance abuse, particularly alcohol abuse. Also on the list, chronic pain patients using opiate derivatives, and those who are disabled with chronic diseases.
In general, suicide is a major public health problem. There are 40,000 American suicide deaths per year, making it the 10th-leading cause of death. It is the second-leading cause of death in the 25-34 age group, and the third-leading cause in teens and young adults. Ninety percent of suicides are committed by those with a mental disorder.
One poorly understood statistic is that suicide rates are 70 percent higher in mountain communities, those living at elevations of 2,000 meters and above, compared to those who live at sea level.
Also of relevance, suicide rates are highest in old age. Twenty percent of the population is over 60, but 40 percent of suicides occur in persons over 60. After 75, the rate is three times higher than average, and white men over age 80 are six times as likely to commit suicide.
Suicide risks increase in those who are socially isolated and/or feel hopeless about the future. For some, the holidays will increase the risk occasioned by these factors.
Social media showcasing smiling families festively gathering together contributes to the poisonous conclusion by emotionally troubled people that there must be something “hopelessly wrong with me because I’m all alone” during this season.
Grieving the loss of loved ones also tends to increase during the holidays as recollections resurface about family filled holidays past.
Here, I’m reminded of a woman with whom I consulted early in my professional life. Mary, we’ll call her that for my purpose today, was a retired widow in her 70s. She had children, but they lived at some distance. She became depressed following the death of her husband of many years two years previously.
I found her to be morbidly depressed (a risk factor). She was socially isolated (a risk factor), and felt hopeless about the future (another risk factor).
I placed her on antidepressants and saw her on a weekly basis for several months. We talked about the meaning of her husband’s death. I encouraged her to get out, volunteer, attend church and, in general, spend time with other people.
The months passed. Each week she was well-groomed and arrived on time for our appointments. Her demeanor was invariably dour and downcast. No energy, no enthusiasm, no apparent interest in much of anything.
Just spending time with her would make me feel depressed, a not uncommon occurrence in treating or just being around morbidly depressed people.
Finally, seeing that weekly visits and medication were leading nowhere, I suggested we meet every other week. She passively accepted my suggestion. The next week, on the same day that we had previously been meeting for months, she committed suicide.
In retrospect, I had failed to understand just how important I had become to her. I was her point of contact with the rest of humanity and perhaps a substitute of sorts for her deceased husband.
I hypothesize that she interpreted my suggestion to make our visits less frequent as yet another loss or rejection, an ultimately untenable one.
So, during and, particularly, just after the holidays, reach out to friends and family, get in touch with people you haven’t seen in a while, and spend time in social environments like church, the gym, your seniors center, a coffee house, the laundromat, or even the mall.
Volunteer if it seems appropriate, greet people you ordinarily wouldn’t, make small talk, and watch your alcohol and/or drug intake. None of this will hurt, and you just might save a life.
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. His column focuses on drugs, mental health and substance abuse in an effort to raise better awareness. It appears every other week in the North Lake Tahoe Bonanza and Sierra Sun. He can be reached for comment at email@example.com.