Suicide attempts by poisoning found to be less likely around major holidays

(Press-News.org) CINCINNATI—A joint study by University of Cincinnati Department of Emergency Medicine and Cincinnati Children's Hospital Medical Center researchers has found that, in contrast to popular opinion, major holidays are associated with a lower number of suicide attempts by poisoning.

The study found that holidays like Christmas and Thanksgiving may actually be protective against suicide attempts, possibly due to the increased family or social support structures present around those times. In contrast, New Year's Day had significantly higher numbers of suicide attempts by overdose.

"There are multiple studies out showing that there's a worsening suicide epidemic internationally, and numbers for suicide attempts are rising as well, says co-author and third-year emergency medicine resident Gillian Beauchamp, MD. "Researchers have observed a seasonality and daily variations in completed suicides, and because of that, it's been suggested that environmental factors and their effect on mood may play a role."

According to the Centers for Disease Control and Prevention, suicide rates among adults 25 to 64 years old have risen every year since 1999, with the fastest increase in people between 45 to 64 years old.

Beauchamp says the team conducted the study to determine if particular days of the week, months or holidays were associated with increased number of suicide attempts by poisoning. They analyzed calls recorded in the National Poison Database System made between Jan. 1, 2006, and Dec. 31, 2010, that were coded as "suspected suicide." While overdoses themselves may be accidental or intentional, the study included only patients who provided a history concerning for intentional overdose.

There were a total of 1.06 million attempts during the time period, with each year leading to a significant increase in the number of exposures. There were 198,806 attempts in 2006 and 219,849 in 2010. Beauchamp says overdoses and attempts lead to high morbidity in patients and a high cost to society.

The study compared exposures occurring on various holidays to three control dates. Researchers also included a three- to seven-day window around each study dates to capture related attempts.

They found that, with the exception of New Year's Day, holidays had relatively little effect on suicide attempts. In contrast, more periods around holidays had a lower number of recorded attempts.

Holidays found to be protective against attempts were Thanksgiving, Christmas and the Fourth of July. Other holidays measured, but found to be neutral, were Easter, Mother's Day, Father's Day and Memorial Day.

"This is possibly reflective of family or other social support systems which may be more available during holidays," says Beauchamp. "The one exception was New Year's Day, when there was a spike in attempts."

Additionally, the beginning of the week, and the beginning of spring, were associated with higher number of suicide attempts, which Beauchamp says has been similarly seen in studies on completed suicides.

Beauchamp says studying the temporal nature of suicide attempts could lead to a better understanding of when prevention techniques could be best utilized in terms of either counseling patients or staffing crisis centers.

"By showing times of the year when counseling services or drug and poison centers would see more demand," she says, "we can help hospitals who receive these patients be better prepared for spikes in suicide attempts."

As these are preliminary findings, Beauchamp cautioned that further research is needed to definitively mark the correlation between holidays and reduced attempts.

### Co-authors include Mona Ho, Cincinnati Children's Hospital Medical Center, and lead author Shan Yin, MD, MPH, UC assistant professor of clinical pediatrics and medical director at Cincinnati Children's Drug and Poison Information Center.

Beachamp, Ho and Yin presented their work at the North American Congress of Clinical Toxicology held Oct. 4-5 in Las Vegas.