Why the holiday suicide myth persists

By Kim Painter, USA TODAY

You could blame George Bailey. In the 1946 holiday film It's a Wonderful Life, that fictional character contemplated suicide on Christmas Eve, possibly giving birth to the idea that suicides climb during the winter holidays.
But moviemaker Frank Capra had it wrong: Study after study shows no such link; in fact, suicide numbers peak in the spring and may even dip in December, according to the U.S. Centers for Disease Control and Prevention. Still, the holiday suicide myth has amazing staying power.

For the past decade, Dan Romer, a researcher at the Annenberg Public Policy Center of the University of Pennsylvania, has been tracking mentions of suicide and the holiday season in stories published in U.S. newspapers from mid-November to mid-January. His first study, covering the 1999 holiday season, found that just 23% of stories debunked the myth and the rest reinforced it. By 2006, 91% of stories debunked the myth, and Romer took some credit: Publicizing the facts had nearly killed the myth, he thought.

He was wrong. In the 2007 season, the myth was back in half of stories, he says. And Romer just completed his analysis of 2008 holiday coverage. He found that 38% of stories supported the myth and 62% debunked it – an improvement he attributes partly to a myth-busting report published last December in the British Medical Journal.

He can't explain why nearly four in 10 stories still linked suicide and the holidays. "No one does it maliciously," he says. "I think they are trying to help people."

But the myth may harm people instead.

"It might unnecessarily put people on their guard or increase their anxiety," says Ronald Pies, a psychiatrist at Tufts University School of Medicine, via e-mail. Worse, he says, some people "on the brink" of self-harm might feel encouraged to follow through when they read or hear that holiday suicides are common. The myth might become a self-fulfilling prophecy.

Romer agrees: "You don't want to convey the message that this is acceptable or that there's a good reason to do it."

But why does this particular myth persist?

One reason may be that the holidays fall during a time of year that can be trying for many people, says Paula Clayton, medical director of the American Foundation for Suicide Prevention. People with seasonal affective disorder (SAD) tend to become depressed as days get shorter and darker. They come out of their depression in the spring.

Meanwhile, some people do suffer short-term blues linked directly to the hubbub and stress of the holidays, she says. People in mourning for a loved one can feel especially sad as special days come and go without that person, she says.

Pies adds: "I certainly would expect that, in the present financial crisis, the usual blues would be intensified for many families facing loss of savings, unemployment, etc."

But, experts say, suicide is almost always the act of someone who has endured deep depression or another mental illness for months or years – not someone with a passing case of the blues.

The holiday suicide myth may detract attention from the real needs of people who might consider suicide at any time of year, Clayton says: "There are a lot of untreated people out there."

Meanwhile, researchers continue to look for the real patterns in suicidal behavior, says Alexander Crosby, a CDC researcher. "That can help us in terms of finding protective factors," he says.

And one protective factor, he says, is "connectiveness" – that is, how connected people are to friends, families and communities.

Fittingly enough, that was the very thing (along with an angel) that saved George Bailey after all.

Copycat effects after media reports on suicide: A population-based ecologic study.

Authors: Niederkrotenthaler, D., Till, B., Kapusta, N., Voracek, M., Dervic, K., & Sonneck, G. (2009). Social Science and Medicine, 69(7), 1085-1090.

The authors explored whether the risk of an increased number of suicides after a media report on suicide is associated with the social characteristics of the person whose suicide was reported. Celebrity status of the person whose suicide was reported was the only variable associated with an overall increase in the number of suicides after the media report of a suicide. That is, a suicide report involving a celebrity resulted in an increase in the total number of suicides in the 29 days following the report. However, the study also revealed three factors associated with an increase in the risk of “similar” suicides (that is, suicides of persons of the same sex, in the same age group, or who use the same method as the person whose suicide was reported in the media) over that same time period.

• The first factor is celebrity status.

• The second factor is whether the person who was reported to have died by suicide was in the same age group as the people exposed to the support (that is, people seem to be more likely to imitate a suicide if the person who died by suicide was in their age group).

• The third factor was definitiveness. Definitively labeling a death as a suicide in a media report (rather than reporting it as a suspected suicide) increased the risk for similar suicides.

The study also revealed that media reports of the suicide of an individual convicted of, or suspected of, crimes were associated with a decrease in similar suicides. None of the variables were found to be associated with a post-media report increase in “dissimilar” suicides (that is, suicides by people in another age group, of the other sex, or who chose a different method). Nor was the density of media suicide reports found to be associated with an increase in suicides.

The authors concluded that increases in suicides after a media report of a suicide is most pronounced for:

• (1) people with social characteristics similar to the person whose suicide was reported, because they are more likely to identify with the deceased than other people; and

• (2) persons seen as socially superior (celebrities) and thus as role models to be imitated. Reporting a suicide of persons of whom society disapproves (i.e. criminals) was associated with a lower risk of copycat suicides.

The study also found that reports of the suicide of middle-aged people were more likely to be followed by similar suicides than reports of suicides of people in other age groups. The authors speculated that this may be a consequence of the fact that the study utilized newspaper reports and that most newspaper readers are middle-aged. They suggested that additional research should be conducted on media that target children, adolescents, and the elderly. The authors also noted that only a limited fraction of suicide reports in the media were followed by an increase in suicides. The research team used data on suicides from the nonprofit information center Statistics Austria during the period July 1996–September 2006 and reports on suicide in the 13 most widely read Austrian newspapers (which reach 74.2% of that country’s population) during the same time period. Among the celebrity suicides reported during this period were those of rock stars Falco and Michael Hutchence and British weapons expert David Kelly.

Survey Reveals Big Gap in Understanding of Depression

Arlington, VA— Americans do not believe they know much about depression, but are highly aware of the risks of not receiving care, according to a survey released today by the National Alliance on Mental Illness (NAMI).

See full survey results at http://www.nami.org/depression.

The survey provides a "three dimensional" measurement of responses from members of the general public who do not know anyone with depression, caregivers of adults diagnosed with depression and adults actually living with the illness.

• Seventy-one percent of the public sample said they are not familiar with depression, but 68 percent or more know specific consequences that can come from not receiving treatment—including suicide (84 percent).
  
• Sixty-two percent believe they know some symptoms of depression, but 39 percent said they do not know many or any at all.
  One major finding: almost 50 percent of caregivers who responded had been diagnosed with depression themselves, but only about 25 percent said they were engaged in treatment.
  
• Almost 60 percent of people living with depression reported that they rely on their primary care physicians rather than mental health professionals for treatment. Medication and "talk therapy" are primary treatments—if a person can get them—but other options are helpful.
  
  Fifteen percent of people living with depression use animal therapy with 54 percent finding it to be "extremely" or "quite a bit" helpful. Those using prayer and physical exercise also ranked them high in helpfulness (47 percent and 40 percent respectively).
  

When people living with depression discontinue medication or talk therapy, cost is a common reason, but other significant factors include a desire "to make it on my own," whether they believe the treatment is actually working and in the case of medication, side effects.

"The survey reveals gaps and guideposts on roads to recovery," said NAMI Executive Director Michael J. Fitzpatrick. "It tells what has been found helpful in treating depression. It can help caregivers better anticipate stress that will confront them. It reflects issues that need to be part of ongoing health care reform."

"There are many treatment strategies," said NAMI Medical Director Ken Duckworth. "What often works is a combination of treatments that fit a person and their lifestyle. Research indicates that the combination of medication and psychotherapy are most effective. But physical exercise, prayer, music therapy, yoga, animal therapy and other practices all can play a role. The good news is that 80 percent or more of the public recognize that depression is a medical illness, affecting people of all ages, races and socioeconomic groups, which can be treated.”

Harris Interactive conducted the survey for NAMI on-line between September 29 and October 7, 2009. Participants included 1,015 persons who did not know anyone diagnosed with depression, 513 persons living with depression and 263 caregivers of a family member or significant other diagnosed with depression. The survey was made possible with support from AstraZeneca, Bristol-Myers Squibb, Eli Lilly & Co. and Wyeth. NAMI does not endorse or promote any specific medication, treatment, product or service.

The National Alliance on Mental Illness is the nation's largest grassroots mental health organization dedicated to improving the lives of individuals and families affected by mental illness. NAMI has over 1100 state and local affiliates that engage in research, education, support and advocacy.