Table 6
Author, date and countryPatient groupStudy type (level of evidence)OutcomesKey resultsStudy weaknesses
Phillips SP and Wills JS, 1987, USSuicides in the US from 1973–1979. 188,047 suicides included in databaseRetrospective database analysisRates at ChristmasFewer (up to 15%) suicides before Christmas (p <0.05)
Masterton G, 1991, UKAll parasuicide admissions between January 1969 and December 1987 involving people in Edinburgh. Aged >16. 22169 admissions were includedRetrospective database analysisParasuicide incidence at Christmas in womenAbout 20% decrease in rates for the 4 weeks from 4 Dec until 1 Jan. This was followed by an 11% increase in the first week of the New Year. (comparisons made with average rate over year)Only one centre. Only admitted patients. Long time span of study may result in a number of confounding factors (for example, need for admission)
Parasuicide incidence at Christmas in menNo statistical difference over the Christmas period.
Cullum SJ et al, 1993, UKCases of deliberate self harm presenting to three EDs in London. Rates on Christmas day were compared with rates on 7 Feb and 15 AugRetrospective database analysisTotal cases on Christmas day over 7 years12 cases 25 cases 25 casesAlthough a statistical difference was found (p <0.05) these are still small numbers. There is no account for the effect on incidence on days before and after Christmas as seen in other papers
Total cases on 7 Feb
Total cases on 15 Aug
Jessen G and Jensen BF, 1999, DenmarkDatabase of suicides between 1970 and 1994. 32291 suicides includedRetrospective database analysisIncidence of suicide at ChristmasDecreased in week around Christmas
Lowest rate of suicide30% less than expected on Christmas Eve. 20% less than expected on Christmas day
Overall rate in December6% less than expected
Jessen G et al, 1999, Multicentre WHO study24388 suicide attempts in patients over 15 years between 1989–1996. Data from 13 European centres. Holidays around Christmas and New Year (20 Dec to 6 Jan)CohortBefore ChristmasStatistically fewer attempts on the 20, 21, and 23 DecData collection may suffer during public holidays. This study only examined suicide attempts rather than deaths that reached health service care
After ChristmasStatistically more than expected on the 27 Dec (39% increase) and on New Year’s day
General fluctuationThere was a greater degree of fluctuation around all public holidays
Ajdacic-Gross V et al, 2003, SwitzerlandSwiss mortality data from 1969–1994. 37158 suicides included in databaseRetrospective database analysisSuicide rates in December10% less than average for year
Dates with lowest rates of suicide23, 25, and 30 Dec