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So, we all know that suicide attempts and suicidal thinking and even the tragedy of dying by suicide increase around the winter holidays.
I mean, that’s, like, a given. Its all over newspapers, Its all over our popular culture, it is in fact THE driving force behind the weighty despair in both Dickens’ A Christmas Carol as well as It's a Wonderful Life.
The problem is that it's not true.
People attempt suicide and die more often due to suicide far more often in springtime. That’s been known for more than 50 years.
“April is the cruelest month,” Mr. Eliot tells us in The Wasteland. His depiction of the rebirth of spring as a desolate emotional landscape is more accurate than many of us may realize. He probably knew that May and June aren’t so hot either…its just that “April, May and June are the cruelest months” doesn’t have quite the same gravitas.
Still, ask anyone who works in mental health. Ask anyone who works in an emergency room. Ask anyone who suffers from a psychiatric syndrome. Things tend to get really, really tough just as the tulips start blooming.
Obviously we’re going to worry about suicide anytime of the year; if people say they feel that life isn’t worth living, I’m certainly not advocating ignoring this sentiment just because it is expressed in the winter months. But, just as we worry more about asthma during seasons when pollen increases, it behooves us to be more vigilant for suicidal thinking and behavior as the season changes from cold to warm. In fact, this appears to be especially the case in areas where the seasons are more pronounced. Something about all that change seems to cause as much trouble as it does delight.
What’s going on?
No one is entirely sure. There are, however, some pretty compelling theories. One of the most commonly cited is the increase in manic behavior in springtime. This theory suggests that the mood activation triggered by warmer weather brings about the development of more self-destructive behavior. Certainly there is evidence that bipolar disorder worsens during springtime.
Still, there are some other, less commonly considered but potentially even more compelling theories to explain this unexpected phenomenon.
It's All About Connection
If you live in a place with a harsh winter, think about how you feel on those dark, cold days. Do you want to exercise? Do you want to go out to dinner with friends? Do you want to be with anyone?
Some of us do. But it turns out that for many people, both with and without psychiatric syndromes, winter promotes a kind of emotional hibernation. We wall ourselves us in, we binge-watch Netflix, we rush from the car to the office to our houses.
We just don’t interact as much with others when the days are cold and dark.
The pressure of social interaction increases dramatically as the weather warms. In studies of developed nations, this effect seems even more pronounced in agricultural areas. From a social perspective, this makes sense. During the winter, there are no crops to plant and no plants to harvest. But come spring, and its time to go into town, buy your supplies, and eventually take what you grow or raise to market. All of this forces a level of social engagement that can for many be a source of significant stress.
Indeed, suicidal behavior in the spring and summer might stem directly from the fact that more social interactions bring as well the opportunity for more potent disappointments. Suicidal thinking emerges, therefore, from the pain of social disconnection precisely when those connections are increasingly possible. In fact, an interesting study in Austria showed that inmates in the Austrian penal system had no discernable increase in suicidal behavior from season to season. If we decide to buy into the social theory of springtime suicidal increase, then this makes sense. Regardless of the weather, inmates have their social interactions tightly monitored and largely decoupled from the seasons.
But are these social theories the only explanations?
It's in the Air
Think about that wonderful time when the leaves on the once naked branches become nascent and downy. Breath deeply the dust storms of fluorescent yellow pollen as it floats like an alien swarm off of increasingly fertile pine trees.
Just look around if you live in a place where spring looks a lot different from winter. There are flowers and inhalers alike, blooming with equal exuberance. Spring is a time of rebirth and a hailstorm of itchy eyes. In other words, it is a time of increased physiological inflammation.
According to the Asthma and Allergy Foundation of America, about 40 million Americans suffer indoor-outdoor allergies. That means that about 40 million Americans suffer the wheezing and hives and runny noses that come with changes that occur between being indoors and outdoors, and these changes are most pronounced in spring. Most importantly, these allergic symptoms are potent markers of inflammation, the body’s immunological response to irritants.
There have long been associations between mood disorders and inflammation. Injecting animals with inflammatory agents causes those animals to care less for themselves. Treating patients with medications that deliberately increase inflammation (interferon for Hepatitis C, for example) is associated with a very high risk of depression and suicidal thinking. It makes sense, therefore, that the another prevailing theory around the suicidal risks of warmer weather is the increased rate of inflammatory responses that the season’s allergens inflict.
There’s good research to back up these claims as well. One study showed that the suicide rate significantly increased when the pollen count increased. Other studies have shown that depression, anxiety and sleep disturbances are higher in families who suffer runny noses that are brought about by allergies.
Conclusions
I’m not trying to disparage spring. Goodness knows that this has been a tough winter.
But I also want to accomplish two things with this blog. I’d love for the myth of winter being the worst months for suicidal behavior to be challenged. It just isn’t true, and it really never has been born out by ample data. The Annenberg Foundation made an impassioned plea in 2010 that as a society we move away from this misguided notion.
At the same time, I’d like to remind everyone that spring brings with it its own psychiatric risks. Those longer days are a good time to be perhaps even more vigilant for suicidal behavior.
Most importantly, and perhaps THE take home of this post? No matter what the season, be wary. Suicide is a significant public health threat throughout the year. If you’re worried, ask the person you’re worried about. You won’t regret asking.
Steve Schlozman, MD, is the associate director of The Clay Center for Young Healthy Minds at Massachusetts General Hospital and Harvard Medical School. He is also the author of the novel The Zombie Autopsies.
