Suicide and the Holidays: Myths and Facts-- John McIntosh, PhD-- 12/17/03
By John McIntosh
Everyone knows about the holiday blues, and many of us feel a kind of letdown after the New Year. But do these feelings lead to more suicides? We discussed the causes and prevention of one of our country's leading causes of death when psychologist John McIntosh, PhD, was our guest.
The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: Welcome to WebMD Live, Dr. McIntosh. There's always a lot of media mentions of "the holiday blues" this time of year. It's supposed to be the "most wonderful time of the year," as the old song goes, but for some people it's not. I'm sure "holiday blues" is not an official diagnosis, but is it a real phenomenon?
McIntosh: Well, it is a real phenomenon, but not necessarily the way that most people imagine. There are some individuals who actually do experience seasonality in their depression. But winter is not the most common time for most. The most common time is more often spring or summer.
Moderator: Any reason for that?
McIntosh: There are some individuals with a specific depressive disorder who experience highest times during the winter. That disorder is called seasonal affective disorder (SAD). But it affects very small numbers compared to depressions generally. There are multiple reasons for that, and what I'd like to do is move to suicide and depression and seasonality.
There have been three primary explanations for high levels of suicide and depression during warm months. As long ago as the 1800s people have recognized that suicide in particular peaked during warm months. Emile Durkheim studied European suicide in the 1800s. He observed that "suicide reaches its maximum during the fine season, when nature is most smiling and the temperature mildest."
Now, Durkheim is the father of sociology, so his explanation is social. He believed that during the winter we are around other people more frequently. So if that's true, there are more people there to hear our problems, to share with, and just to be with when the weather is cold. So we're more likely to recognize pain and depression and either give help or get help for that person.
A second explanation is related to the weather itself. Again, various writers, during the early 1900s, argued that the heat actually increases suicide. It's not clear whether it is mental or physical effects they really focused on. The heat causes you to be uncomfortable and irritated more easily.
I believe the most important reason relates to unmet expectations. Specifically, we associate spring and, to a lesser extent, summer with new beginnings and life. People who are depressed may well make it through the bleak winter by looking forward to that new beginning. However, when they reach that expected point, that is spring, their life doesn't change positively the way they may have expected. The disparity of those expectations with reality may be the proverbial straw that broke the camel's back. This person in great psychological pain may now feel they can no longer tolerate that pain. So suicide is increased.
Moderator: That's a surprising answer to me, and if you asked, most people would probably believe that suicide numbers go up in the winter, since people are feeling so much stress and those without families to be with are more lonely at the holidays. But it seems we all hold onto a big misconception!
McIntosh: Being around our families actually lifts our mood during those seasons. It may, in fact, magnify our loneliness after the season is over.
Member question: Do you think we should lessen our expectations for the holidays so we aren't as disappointed when they don't match up to the media version of a perfect holiday? Would that reduce the post-holiday blues?
McIntosh: I think it very well might, but we look forward to that season and it's built up so much that it's probably a difficult change for us to make in our own expectations.
Member question: What are some warning signs that a loved one is depressed?
McIntosh: There are multiple warning signs of depression:
Moderator: How long does that depressed mood, for example, have to last to be a sign of clinical depression? We all get down sometimes.
McIntosh: We're generally talking about from several weeks to as much as two months, keeping in mind that there are several kinds of depression. You're looking for a pattern of these clues, meaning it is nearly always there.
Moderator: Are there signs that someone may be contemplating suicide, and if so are they different from those signs of depression?
McIntosh: They are generally the same signs. A major reason for that is that the majority of suicides are also depressed. Other warning signs of suicide would include talking about suicide specifically, or talking about death generally. Essentially we should take verbal statements seriously and seek help if a person talks about killing himself or herself.
Member question: Is suicide usually a rash decision, or do people who try to kill themselves think about it a lot before they try?
McIntosh: Most typically suicide is not impulsive. There are exceptions, but generally speaking a person is suicidal and thinking about suicide over a period of time.
Moderator: What about age variations? Do young people commit suicide more often than people in their 40s and 50s? How about the elderly?
McIntosh: Unknown to most individuals, suicide is actually highest among older adults. There has been a significant increase in youth suicide comparing the 1950s to today. That increase is approximately a 200% increase. Even with that increase, youth suicide is still almost 50% lower than for older adults.
What really demands our attention for young people is first that increase, but secondly young people make large numbers of nonfatal suicide attempts at higher levels than at any other age group.
Moderator: By nonfatal, I assume you mean nonfatal on purpose?
McIntosh: Most of these nonfatal attempts were not intended to result in death, but that doesn't lessen the importance of responding to and getting help for that individual.
Suicide among the middle-aged is lower than that for older adults, and currently comparable to or slightly lower than that for young people.
Member question: Where do we turn for help if someone we know is showing those signs of depression and/or suicide you mentioned? Do we confront the person directly, or do we ask a pro for help first? And how do you convince someone they need help?
McIntosh: By all means, ask the person directly about your suspicions. You won't cause a suicide by asking about it. What you've done is open a door that we can only hope this person will enter.
There are many sources of help if one suspects suicidal behavior. Most communities have a crisis intervention center or service. They should be listed in the Yellow Pages or in the front of your phone book. If you'd like assistance finding a center in your area, there is a national help line at 1-800-SUICIDE. This service will identify the nearest certified crisis line to you. These services, these crisis lines, are vital in the case of crisis behavior.
In addition, your community will have a community mental health center that provides counseling and therapeutic intervention. Once again, those should be listed in your local phone books.
By all means, seek mental health assistance if you suspect suicide, even if you've asked about it directly.
Member question: My son attempted suicide. I live in New Hampshire and need to find a hospital that will help him. He is currently in a hospital with all old people. Are there facilities that help 20-year-old kids? How do I find the right place for him?
McIntosh: In order to obtain information for your local or regional area, particularly for a specific population group, contact the American Association of Suicidology at (202) 237-2280, or online at suicidology.org. They will try to assist you in identifying mental health resources. That 1-800-SUICIDE number should also be able to help in that regard. Since they have certified centers they can probably talk about treatment as well.
Member question: I find that in nice weather my mom can get out and see other people. With the bad weather, she is pretty much stuck inside by herself. I call her frequently, but we live 3,000 miles away from each other. She does feel worse --cold, alone, isolated -- in the winter. I'm afraid she'll stop taking her meds and just give up living. I'm most concerned about the period right after the holidays, when the fuss has died down, and the winter blues set in.
McIntosh: I would encourage continued phone contacts with your mother, but also contacting local older adult services in her community that can assist with lessening her social isolation and loneliness. These can include phone buddies as well as home visits.
Member question: You mentioned talking about death earlier as a sign of suicide. I am concerned about my grandmother. She has had some serious health issues, lost her husband, and her sister, all this past year. When I talk to her, she seems very down, and says lots of things about it being "terrible" and a "burden" to be old, and she wonders why "God hasn't taken me yet." Christmas around the corner only makes her sadder. Does this sound worrisome to you?
McIntosh: Your grandmother is in a number of high-risk situations for depression and suicide. Her losses, especially multiple ones in short time periods, represent major stressors that increase risk.
She may well have personal coping mechanisms she has developed throughout her lifetime that will get her through these losses; her faith that you've mentioned is likely one of those. However, it still seems reasonable to contact a mental health professional with your concerns so that they can determine whether depression at significant levels actually exists.
It's worth mentioning that current older adults may be more reluctant and even skeptical about mental health services. You might wish to phrase your suggestions about seeking these services with that in mind. For instance, express your concern about your grandmother and her feelings and suggest you would like for her to get help with those feelings. You might want to use the word "counselor" rather than "mental health" or "psychiatric" services, as a way to soften the suggestion.
Member question: I lost my mother at age 55 right before Christmas three years ago. The holiday season is so hard on me now I feel like I can barely make it through. Will Christmas ever feel happy again? I want it to be special for my kids, but it's hard to fake it.
McIntosh: Anniversaries of deaths at any time of year can be difficult for surviving family members. When coupled with holiday periods this anniversary may be particularly problematic.
One might wish to acknowledge the deceased person during the holidays and make the celebration of their lives a part of the holidays. This might permit the grieving to get through the holiday and deal with their feelings in a more general fashion.
I would also recommend that you seek out a grief support group in your community to help you deal with the loss generally, and particularly how you might deal with the holiday issue. There are specifically suicide survivor support groups throughout the nation. These groups will include others who have dealt with similar experiences and anniversary reactions. You can identify these support groups again by contacting the American Association of Suicidology.
Member question: I have a question about alcoholism during these times. My husband is having a hard time and it is coming from his past as a cop and seeing deaths around this time of the year. He has been drinking too much. You can't really tell. He says it calms all the images in his head. He drinks through the night to go back to sleep. Please tell me how to help him.
McIntosh: Police officers are themselves a high-risk group for suicide. The combination of alcohol with its disinhibiting effects, in other words doing something that you normally would inhibit, along with the availability and knowledge of highly lethal methods are a serious situation. I would encourage contacting mental health support in this situation.
Member question: Should we add AA to this because of the drinking?
McIntosh: In the long term a support group like AA will be particularly helpful. My main concern is for the immediate possible crisis. By all means, contact both mental health individuals as well as AA. A reminder that calling 1-800-SUICIDE will allow the identification of a certified crisis center in your area.
Moderator: Do you have any final words for us, Dr. McIntosh?
McIntosh: Just because the rates of suicide are lower in the winter doesn't mean we shouldn't take suicidal statements or behaviors seriously and get help.
Moderator: Thanks to John McIntosh, PhD, chairman and professor of the department of psychology at Indiana University South Bend, for sharing his expertise with us.
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