High seasons, times of suicidal thoughts, attempts identified

Suicidal ideation peaks during the winter, but suicide attempts are more common in late spring and early summer in the early morning hours, new research shows.

Additionally, findings from Harvard University’s Project Implicit Health also show that people are more likely to attempt suicide between 4 and 6 in the morning.

“No research has demonstrated a peak of suicidal ideation in winter until our article,” said study researcher Brian O’Shea, PhD, assistant professor of social psychology at the University of Nottingham in the UK. Medscape Medical News.

“Most people incorrectly assume that suicidal behaviors peak in the winter and are surprised, as I was when I learned of this phenomenon, that suicide actually peaks in the spring/early summer,” he added.

However, at least one expert cautioned that the database, which primarily includes responses from younger women, doesn’t capture responses from those most likely to attempt suicide: older men with substance abuse.

The results were published online on May 12 Translational psychiatry.

New insight into suicide risk

Previous studies looking at the seasonality of suicides and suicide attempts have reported a peak in the spring and early summer, but there has been very little information about why that might be, the investigators note.

O’Shea and his University of Amsterdam colleague, Ren Freichel, mined one of the Project Implicit Health databases, which contains self-report measures of suicidal ideation, self-harm, and past suicide attempts, as well as information respondents implied biases about these subjects.

The analysis included data from 10,000 respondents from the US, UK and Canada provided between April 2012 and November 2018.

The sample was predominantly young and female, with 38% (3247) of the sample reporting having made at least one suicide attempt.

Researchers found a spike in negative mood and longing to die in December, especially among those who reported having attempted suicide (P .001)

Suicidal ideation peaked approximately 3-4 months before the annual seasonal peak of suicide attempts in early spring and summer.

“Affected individuals can become severely depressed and experience a lack of energy during the winter months. In essence, this period can bring them below a threshold of severe suicide risk as the high level of suicidal ideation coincides with a low of energy,” said O. ‘Shea.

As the days get longer, brighter and hotter, these changes likely improve an individual’s mood, he explained. “Thus, people most at risk become slightly less depressed and may gain more energy to contemplate and plan their method for attempting suicide,” O’Shea noted.

A major limitation of the study includes the fact that all responses included in the analysis were based on self-report.

To confirm the findings, future research should include a momentary ecological assessment, which involves using a large community sample to ask participants about suicidal intent at various time points, along with real-time monitoring of vital signs, he said O’Shea.

Ideally, the researchers note, the study findings will inform clinical assessments of patients at risk for suicide.

A gap in research?

Commenting on the results for Medscape Medical NewsJustin Shuster, MD, MPH, assistant professor of psychiatry at the University of Pittsburgh in Pennsylvania and medical director of two psychiatric units at Western Psychiatric Hospital, noted that the database used in the study did not include responses from those most likely to to attempt or commit suicide: older men with a history of substance abuse, who require social support and who have a family history of suicide.

Dr Justin Shuster

While Shuster agreed with O’Shea that spring might bring energy to the desire to take one’s own life, he had another theory.

“When people are depressed in the winter, they expect to feel better as the weather warms up in the spring. When they don’t feel better, they may think to themselves, ‘If I’m going to feel this way forever, it might as well lead to terminate these plans,” he said.

As for morning attempts, he noted that 4-6am is often when people are alone and there are fewer distractions.

“The other thing I see a lot clinically is intoxication,” Shuster said. “It’s either the substance or alcohol intoxication, or the fact that the intoxication is going down in those early morning hours, and people are getting desperate as they face a new day,” she said.

The study was funded by a grant from the German Academic Exchange Service and an EU Horizon 2020 grant. O’Shea reports that he is an unpaid member of Project Implicit’s scientific advisory board and serves on the executive committee of Project Implicit Health.

Translational psychiatry. Published online May 12, 2023. Full text

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