WASHINGTON: As the holidays came and went, a public policy group released a study last month that counters the common perception that suicides rise between Thanksgiving and New Year's.

Working on a grant from the Robert Wood Johnson Foundation, the Annenberg Public Policy Center found that two out of three newspaper stories incorrectly linked suicides to the holidays in late 1999 and early 2000. The research pointed out that November and December actually ranked the lowest in the number of monthly suicides while the spring and fall months ranked the highest, according to 1994 and 1996 data from the National Center for Health Statistics.

In compiling their data, the Annenberg researchers examined 67 news articles written between November 8, 1999 and December 15, 2000. They found that 53 of the stories identified a potential link between suicide and the holidays and only 13 per cent clearly attempted to debunk the association. "What I think confuses people is many have a common sense view that people who don't have family or have lost people during the previous year, will avoid Christmas because of the consciousness of it," said Dr. Herbert Hendin, medical director of the American Foundation for Suicide Prevention (AFSP) and a physician-psychiatrist for 40 years. "The holidays make you conscious of people who are missing in your life."

But although someone may be more conscious of loss on the holidays, Dr. Hendin said the clinical view is that it doesn?t lead to suicide. He also said it's a mistake to connect only one event to a suicide. "If you just imply it's some single event, it's written up without a sense of the illnesses that underlie the suicide so the public doesn?t get an accurate impression," he said.

Major depression, bipolar (manic depression) illness and depression complicated by substance abuse are the primary factors in suicide, Dr. Hendin said. Almost 10 per cent of people with schizophrenia die of suicide and about 15 per cent of manic-depressives take their own lives, he said. "Sixty to seventy per cent of all suicides in a given year have major affective depression," he said. "Most often it is lethal when they are depressed and manic. The second most common diagnosis you?ll see is 15 to 20 per cent have a primary diagnosis of alcoholism."

These figures contrast sharply with the suicide rate (.4 to .9 per cent) among the U.S. general population, according to the Centers for Disease Control and Prevention.

Study Data

Of the news articles that connected suicides with the holidays, only eight cited research that suggested an association, the study reported. The most common explanations for an association in the 53 stories were the "holiday blues", "millennium madness", disappointment, problems that came to a head or excessive drinking.

The study cited several quotes from the stories that fed the perception that suicides are related to the holidays. "We do kind of dread this time of year, because the holiday season brings with it an increase in casualty reports, people being depressed and a rise in suicides," said a police sergeant quoted in a New England newspaper.

A Tennessee paper contained a quote saying the holidays are traditionally hard times for lonely people and the suicide rate goes up. But according to the Annenberg study, the media tends to imply that suicides that occur on a holiday are attributable to things like the holiday blues whether there is a relationship to the holiday or not. "Only 25 per cent of the stories identified depression or other chronic mental health conditions as the most common underlying cause of suicide," the study states. "Only 34 per cent gave accurate advice for the prevention of suicide, such as looking for signs of depression, encouraging depressed people to seek treatment, and not shying away from the discussion of suicide with family members who appear suicidal."

Dr. Hendin said people who are suicidal are often indifferent to Christmas or the holidays. "Their depression is so big that they are beyond caring about Christmas," he said. "People who kill themselves put a gun to their head, most of them, not a pill. They are beyond feeling or caring what other people feel. They are past being motivated that someone will be hurt by their suicide."

The person's breakdown has developed over a long period of time so that the holidays seem really minor to them, Dr. Hendin added. They have stopped caring about family and friends long before the holidays.

Arlene Krohmal, executive director of CrisisLink, a hotline service that serves the Washington, D.C. metropolitan area, said the majority of suicidal people call them because they have some level of ambivalence inside. "They want the pain to stop," she said. "They don't want to be dead. So if they can come up with another way, they call hoping to come up with another option. A very small percentage call to say goodbye."

Krohmal said the latter calls are especially frustrating because they often have no caller I.D. "They stay anonymous and the calls are usually very fast," she said.

The Cruellest Month

Dr. Hendin said that rather than the holiday months, April often seems to have the highest suicide rate. He sides with T.S. Eliot's premise in his masterpiece The Waste Land. In the first line of the book's poem entitled "The Burial of the Dead", Eliot writes that "April is the cruellest month".

Krohmal also agrees with the Annenberg study's conclusion that suicide rates are higher in the spring. While the number of anxiety calls to CrisisLink increase over the holidays, Krohmal advised, actual suicide calls that require dispatching emergency services peak in the spring.

The reasons for the higher suicide rate in the spring are unclear. "People have hypothesized about it," Dr. Hendin said. "We know there is a seasonal quality to certain disorders."

Although light is often used to treat depression and the spring represents a period of coming out of the cold, dark days of winter, seriously depressed people may begin to have suicidal feelings because they see that everybody else is being stimulated by spring while they aren't. "April arouses expectations that are destined to be disappointed," Dr. Hendin said.

Krohmal has a similar take. "There are certain things in the environment that normalize our feelings," she said. "If you're depressed in the winter, you?re supposed to be. It's dark. But in the spring when you see people (experiencing a) higher functioning (level), the contrast is more extreme of how you're feeling _ now I'm out of sync with the rest of the world. Another thing is people commit suicide when their depression is starting to lift, which is why many family members don't understand."

Krohmal said suicidal people need to overcome some of the weight of their depression in order to have the energy and focus to plan and carry out a suicide.

Krohmal said CrisisLink received 12 suicide calls between last March 1 and April 30 that were so severe and with a high likelihood of completion that some intervention was required. Between November 1 and December 30, they received seven similarly serious calls.

Despite an apparent difference in serious suicide attempts between the holiday and spring months, there is still a heightened number of anxiety calls before Christmas and contemplated suicide calls before New Year's, Krohmal said. "It's been pretty constant," she said. "We get a whole lot of calls from people who are upset and anxious about being with their relatives. If they had a dysfunctional upbringing, or divorce, and they have to spend days with them, it conjures up the past. Just before Christmas there is an escalation in anxiety calls, but not that media perception."

Krohmal also said CrisisLink received a burst of contemplative suicide calls just prior to this past New Year's. "Approaching New Year's, the calls go up and I think people take stock of where they are going. All of us, whether we?re depressed or not, kind of look at where (we) are (in life). It's a more intense examination. Contemplative suicides peaked before New Year's when people take stock and assess."

Krohmal said CrisisLink also received a lot of anxiety calls about family dysfunctional issues before Thanksgiving. "People have a lot of trepidation, a lot of stress, but have hope that it will work out," she said.

Dr. Hendin said AFSP organized a conference in New York last month with the Centers for Disease Control and Prevention, the National Institute of Mental Health and the Annenberg School of Communications to develop a national set of consensus guidelines on how the media can avoid harmful stories about suicide and what they can do to help prevent suicide.

Among the suggestions offered on AFSP?s website are for the media to question whether a given suicide is newsworthy and not to portray it in a heroic or romantic fashion. It cautions against extensive media coverage because such coverage is associated with a significant increase in suicide rates. AFSP also reports that suicides should be represented as most often the result of a fatal complication of different types of mental illness _ many of which are treatable.

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