Clinical scenario

You are planning for winter pressures in your emergency department. You wonder if you will need additional psychiatric support over the Christmas period to cope with a perceived increase in the number of suicide attempts. When you bring this up at a senior team meeting a colleague suggests that in fact the number of suicides decreases over the Christmas period. You wonder if this is true.

Three part question

[In patients at risk of suicide/parasuicide] is [Christmas] a [high risk period]?

Search strategy

Medline(R) In-Process, Other Non-Indexed Citations, Medline 1966-07/2004 using the Ovid interface. [christmas.mp] AND [suicide.mp OR exp suicide OR exp suicide, attempted OR parasuicide.mp].

Search outcome

Altogether 15 papers were found of which six were relevant to the clinical question. These papers are shown in table 6.

Comment(s)

Although the papers presented show a mix of suicide and parasuicide statistics it is apparent that there is a general trend for such events to reduce in December and in particular around the days preceding Christmas day. As with all studies in this area there may be difficulties in gauging the true incidence as a result of under reporting. This is unlikely to be significantly different at Christmas so overall trends should be valid. The perception of many is that rates go up around Christmas. This has resulted in a greater awareness and access to services at this time. It is an interesting question to ponder whether the reductions seen here are attributable to an overall reduction in need, or the effectiveness of available help services.

CLINICAL BOTTOM LINE

Suicide and parasuicide rates go down around Christmas.