If you’re mentally struggling during the holidays, here’s how to cope

By Kristen Rogers, CNN

(CNN) — For many people, celebrating New Year’s Day can include reflecting on a life well lived or a chance to start anew. But for some, the holiday may have dark undertones, according to a recent large study.

More than 700,000 deaths by suicide were reported globally in 2019, accounting for roughly 1.3% of deaths that year, according to the World Health Organization. The study authors, consequently, wanted to better understand how the risk for suicide may vary depending on the day of the week or holidays. Multiple studies have assessed these relationships in the past, but findings were mixed or limited in geographical scope, the authors said — so they analyzed more than 1.7 million suicides in 740 locations in 26 countries that occurred from 1971 to 2019.

“We found that Mondays and New Year’s Day were associated with a higher risk of suicide in most countries,” said Dr. Yoonhee Kim, lead author of the study published October 23 in the journal The BMJ, in a news release. Mondays accounted for about 15% to 18% of suicides, the report found. “However, the risk on Christmas was generally less pronounced and varied across regions,” he added.

“Other national holidays, aside from New Year’s Day and Christmas, were generally linked to a lower risk of suicide,” said Kim, an associate professor of global environmental health at the University of Tokyo, but that wasn’t the case for Central and South American countries. Additionally, men had a more pronounced risk of suicide on New Year’s Day.

Overall suicide rates were highest in South Korea, Japan, South Africa and Estonia, and lowest in the Philippines, Brazil, Mexico and Paraguay, the authors found.

On weekends, suicide risk was lowest in many countries in North America, Asia and Europe, but highest in Finland, South Africa, and Central and South American countries.

Experts not involved in the research said although the study does add to important conversations about suicide prevention, the findings point to just a couple of many factors that form the large web of what contributes to suicide risk. Below, experts contextualize the findings and share how you can cope or support someone else.

Potential links between holidays and suicide

The holidays can bring up several ideas about what one’s life should look like as well as increased stress, substance use and painful memories, said Dr. Jill Harkavy-Friedman, senior vice president of research at the American Foundation for Suicide Prevention, who wasn’t involved in the study.

Any increases on New Year’s Day and Mondays may also be due to the “broken-promise effect theory,” the authors wrote, which posits that people may postpone suicide attempts until after the holidays, then “be prone to suicidal reactions when they encounter a sense of hopelessness from a new cycle.”

However, the study has several shortcomings and caveats, limiting how universal or practical the conclusions are, some experts said.

For one, the research combines multiple holidays and data sources, but these sources aren’t all equal, Harkavy-Friedman said — some countries have 20 to 40 years’ worth of data, while the findings for the United States, for example, are based on data from 2001 to 2006. That disparity is because, due to privacy concerns, the US National Center for Health Statistics has discontinued providing the date of death on its public mortality documents since the 2010s, according to the study.

Secondly, the researchers focused on relative risk of suicide by, for instance, looking at New Year’s Day relative to the two days before and the three days after the holiday, Harkavy-Friedman said. That risk analysis is not as reliable or significant in size as absolute risk, she added, which would be based on a review of daily suicides throughout the whole year, and therefore paint a truer, more comprehensive picture.

The study also lacks sufficient data for rural areas, which are known to have higher rates of reported suicides, the authors said.

“While it’s important to look at national rates and to have a national strategy for suicide prevention, when you’re looking at actually preventing suicide, you have to look at the smaller units of the communities, because different communities need different things,” Harkavy-Friedman said.

The results may also reflect the known tendency for many people to feel generally less upbeat during the winter months due to seasonal affective disorder, said Dr. Dan Romer, psychologist and research director of the Annenberg Public Policy Center at the University of Pennsylvania, via email. Romer wasn’t involved in the study.

Knowing these details about New Year’s Day and Mondays may be more helpful for public health officials — especially those working helplines — than for individuals in need of care or those wanting to help them, said Dr. Ken Duckworth, chief medical officer of the National Alliance on Mental Illness and author of “You Are Not Alone: The NAMI Guide to Navigating Mental Health — With Advice From Experts and Wisdom From Real People and Families.”

Duckworth wasn’t involved in the research.

How to cope or support someone else

If you’re feeling suicidal this holiday season, you may have a mental health condition that needs self-care and professional help, Harkavy-Friedman said. Social support is important, especially for combating loneliness, but avoid spending time with people who make you feel worse, she recommended. Also ensure you get enough sleep, hydrate, feed yourself nutritious food, refrain from substance use and keep your body moving.

You can also call or text the 988 Suicide & Crisis Lifeline at any time of day to receive free and confidential support during a crisis or assistance in finding professional help, Duckworth said. Support groups can be useful and comforting as well.

Having a religious faith, spirituality or strong sense of purpose in life can provide hope and resilience, said Dr. Urszula Klich, an Atlanta-based health psychologist and president of the Southeast Biofeedback and Clinical Neuroscience Association. Klich wasn’t involved in the study.

“If you’re worried about someone, take action,” Harkavy-Friedman said. “Don’t wait for things like holidays or birthdays or special occasions — check in right away. … It’s really about learning suicide risk factors, warning signs and finding out … how they’re doing and if there are any changes in their thoughts and feelings around the holidays.”

Some of those risk factors and signs include the following:

• Comments about wanting to die — by suicide or otherwise — or lacking reasons to live
• Extreme mood swings
• Substance abuse
• Mental disorders such as depression or anxiety, schizophrenia, and personality disorders, especially when untreated
• Familial or personal history of suicide
• Job or financial loss
• Relationship problems or loss
• Loss of interest in activities or school
• Prolonged stress from other causes
• Easy access to potentially fatal means
• Insufficient social support or sense of isolation

However, not every person considering suicide exhibits these signs.

“Talking openly about suicide does not plant the idea,” Klich said. “Instead, it opens the door to a conversation that can prevent a tragedy.”

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