Association of holidays and the day of the week with suicide risk: multicounty, two stage, time series study

doi:10.1136/bmj-2024-077262

. 2024 Oct 23:387:e077262.

doi: 10.1136/bmj-2024-077262.

Association of holidays and the day of the week with suicide risk: multicounty, two stage, time series study

Whanhee Lee¹, Cinoo Kang², Chaerin Park², Michelle L Bell^{3

4}, Ben Armstrong⁵, Dominic Roye^{6

7}, Masahiro Hashizume⁸, Antonio Gasparrini⁹, Aurelio Tobias^{10

11}, Francesco Sera¹², Yasushi Honda¹³, Aleš Urban^{14

15}, Jan Kyselý^{14

15}, Carmen Íñiguez¹⁶, Niilo Ryti^{17

18}, Yuming Guo¹⁹, Shilu Tong^{20

21}, Micheline de Sousa Zanotti Stagliorio Coelho^{22

23}, Eric Lavigne^{24

25}, Francesca de'Donato²⁶, Yue Leon Guo²⁷, Joel Schwartz²⁸, Alexandra Schneider²⁹, Susanne Breitner^{29

30}, Yeonseung Chung³¹, Sooin Kim³², Eunhee Ha^{33

34

35}, Ho Kim³⁶, Yoonhee Kim³⁷; Multi-City Multi-Country (MCC) Collaborative Research Network

Collaborators, Affiliations

Collaborators

Multi-City Multi-Country (MCC) Collaborative Research Network:
Jouni Jk Jaakkola, Patricia Matus, Nicolás Valdés Ortega, Hans Orru, Ene Indermitte, Paola Michelozzi, Ana Maria Vicedo-Cabrera, Martina S Ragettli, Shih-Chun Pan, Haidong Kan, Xerxes Seposo, Pierre Masselot, Shanshan Li, Wenzhong Huang, Magali Hurtado Diaz, César De la Cruz Valenci, Iulian Horia Holobaca, Noah Scovronick, Fiorella Acquaotta, Antonella Zanobetti, Tran Ngoc Dang, Paulo Hilario Nascimento Saldiva

Affiliations

¹ School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Yangsan, South Korea.
² Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea.
³ School of the Environment, Yale University, New Haven, CT, USA.
⁴ Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea.
⁵ Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
⁶ Climate Research Foundation, Madrid, Spain.
⁷ Spanish and Consortium for Research on Epidemiology and Public Health (CIBERESP), Santiago de Compostela, Spain.
⁸ Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
⁹ Environment and Health Modeling Lab, London School of Hygiene & Tropical Medicine, London, UK.
¹⁰ Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain.
¹¹ School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
¹² Department of Statistics, Computer Science and Applications "G Parenti", University of Florence, Florence, Italy.
¹³ Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan.
¹⁴ Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic.
¹⁵ Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic.
¹⁶ Department of Statistics and Computational Research, Universitat de València, València, Spain.
¹⁷ Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland.
¹⁸ Department of Public Health, University of Helsinki, Helsinki, Finland.
¹⁹ Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
²⁰ National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
²¹ School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
²² Laboratory of Urban Health, Faculty of Medicine of the University of São Paulo/INSPER, São Paulo, Brazil.
²³ International University Health Science, University of Medicine, Basseterre, St Kitts and Nevis.
²⁴ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
²⁵ Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada.
²⁶ Department of Epidemiology, Lazio Regional Health Service ASL Roma 1, Rome, Italy.
²⁷ Environmental and Occupational Medicine, and Institute of Environmental and Occupational Health Sciences, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan.
²⁸ Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA.
²⁹ Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
³⁰ Epidemiology, IBE, Faculty of Medicine, LMU Munich, Munich, Germany.
³¹ Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, South Korea.
³² Department of Psychiatry, Ewha Woman's University Mokdong Hospital, Ewha Woman's University College of Medicine, Seoul, South Korea yoonheekim@m.u-tokyo.ac.jp.
³³ Department of Environmental Medicine, College of Medicine, Ewha Woman's University, Seoul, South Korea.
³⁴ Institute of Ewha-SCL for Environmental Health, College of Medicine, Ewha Woman's University, Seoul, South Korea.
³⁵ System Health and Engineering Major in Graduate School (BK21 Plus Program), Ewha Woman's University, Seoul, South Korea.
³⁶ Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea yoonheekim@m.u-tokyo.ac.jp.
³⁷ Department of Global Environmental Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan yoonheekim@m.u-tokyo.ac.jp.

PMID: 39442941
PMCID: PMC11497772
DOI: 10.1136/bmj-2024-077262

Association of holidays and the day of the week with suicide risk: multicounty, two stage, time series study

Whanhee Lee et al. BMJ. 2024.

. 2024 Oct 23:387:e077262.

doi: 10.1136/bmj-2024-077262.

Authors

Collaborators

Multi-City Multi-Country (MCC) Collaborative Research Network:
Jouni Jk Jaakkola, Patricia Matus, Nicolás Valdés Ortega, Hans Orru, Ene Indermitte, Paola Michelozzi, Ana Maria Vicedo-Cabrera, Martina S Ragettli, Shih-Chun Pan, Haidong Kan, Xerxes Seposo, Pierre Masselot, Shanshan Li, Wenzhong Huang, Magali Hurtado Diaz, César De la Cruz Valenci, Iulian Horia Holobaca, Noah Scovronick, Fiorella Acquaotta, Antonella Zanobetti, Tran Ngoc Dang, Paulo Hilario Nascimento Saldiva

Affiliations

¹ School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Yangsan, South Korea.
² Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea.
³ School of the Environment, Yale University, New Haven, CT, USA.
⁴ Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea.
⁵ Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
⁶ Climate Research Foundation, Madrid, Spain.
⁷ Spanish and Consortium for Research on Epidemiology and Public Health (CIBERESP), Santiago de Compostela, Spain.
⁸ Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
⁹ Environment and Health Modeling Lab, London School of Hygiene & Tropical Medicine, London, UK.
¹⁰ Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain.
¹¹ School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
¹² Department of Statistics, Computer Science and Applications "G Parenti", University of Florence, Florence, Italy.
¹³ Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan.
¹⁴ Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic.
¹⁵ Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic.
¹⁶ Department of Statistics and Computational Research, Universitat de València, València, Spain.
¹⁷ Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland.
¹⁸ Department of Public Health, University of Helsinki, Helsinki, Finland.
¹⁹ Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
²⁰ National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
²¹ School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
²² Laboratory of Urban Health, Faculty of Medicine of the University of São Paulo/INSPER, São Paulo, Brazil.
²³ International University Health Science, University of Medicine, Basseterre, St Kitts and Nevis.
²⁴ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
²⁵ Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada.
²⁶ Department of Epidemiology, Lazio Regional Health Service ASL Roma 1, Rome, Italy.
²⁷ Environmental and Occupational Medicine, and Institute of Environmental and Occupational Health Sciences, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan.
²⁸ Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA.
²⁹ Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
³⁰ Epidemiology, IBE, Faculty of Medicine, LMU Munich, Munich, Germany.
³¹ Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, South Korea.
³² Department of Psychiatry, Ewha Woman's University Mokdong Hospital, Ewha Woman's University College of Medicine, Seoul, South Korea yoonheekim@m.u-tokyo.ac.jp.
³³ Department of Environmental Medicine, College of Medicine, Ewha Woman's University, Seoul, South Korea.
³⁴ Institute of Ewha-SCL for Environmental Health, College of Medicine, Ewha Woman's University, Seoul, South Korea.
³⁵ System Health and Engineering Major in Graduate School (BK21 Plus Program), Ewha Woman's University, Seoul, South Korea.
³⁶ Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea yoonheekim@m.u-tokyo.ac.jp.
³⁷ Department of Global Environmental Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan yoonheekim@m.u-tokyo.ac.jp.

PMID: 39442941
PMCID: PMC11497772
DOI: 10.1136/bmj-2024-077262

Erratum in

Association of holidays and the day of the week with suicide risk: multicountry, two stage, time series study.
[No authors listed] [No authors listed] BMJ. 2024 Oct 28;387:q2373. doi: 10.1136/bmj.q2373. BMJ. 2024. PMID: 39467603 Free PMC article. No abstract available.

Abstract

Objectives: To assess the short term temporal variations in suicide risk related to the day of the week and national holidays in multiple countries.

Design: Multicountry, two stage, time series design.

Setting: Data from 740 locations in 26 countries and territories, with overlapping periods between 1971 and 2019, collected from the Multi-city Multi-country Collaborative Research Network database.

Participants: All suicides were registered in these locations during the study period (overall 1 701 286 cases).

Main outcome measures: Daily suicide mortality.

Results: Mondays had peak suicide risk during weekdays (Monday-Friday) across all countries, with relative risks (reference: Wednesday) ranging from 1.02 (95% confidence interval (CI) 0.95 to 1.10) in Costa Rica to 1.17 (1.09 to 1.25) in Chile. Suicide risks were lowest on Saturdays or Sundays in many countries in North America, Asia, and Europe. However, the risk increased during weekends in South and Central American countries, Finland, and South Africa. Additionally, evidence suggested strong increases in suicide risk on New Year's day in most countries with relative risks ranging from 0.93 (95% CI 0.75 to 1.14) in Japan to 1.93 (1.31 to 2.85) in Chile, whereas the evidence on Christmas day was weak. Suicide risk was associated with a weak decrease on other national holidays, except for Central and South American countries, where the risk generally increased one or two days after these holidays.

Conclusions: Suicide risk was highest on Mondays and increased on New Year's day in most countries. However, the risk of suicide on weekends and Christmas varied by country and territory. The results of this study can help to better understand the short term variations in suicide risks and define suicide prevention action plans and awareness campaigns.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at URL www.icmje.org/disclosure-of-interest/ and declare no support for the present study; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. This study did not include plans to recruit participants and only used pre-existing datasets. All data used in this study were pre-recorded and completely de-identified.

Figures

**Fig 1**
Geographical locations of the 740 sites in 26 countries included in the study and the corresponding percentage of suicide counts on Monday during the study period

**Fig 2**
Risks of suicide by the day of the week with the corresponding 95% confidence intervals (vertical lines). A reference day: Wednesdays

**Fig 3**
Risks of suicide around Christmas with the corresponding 95% confidence intervals (vertical lines). Reference days: non-holidays that are not included in New Year’s day, Christmas, and other national holidays that this study addressed.

**Fig 4**
Risks of suicide around New Year’s day with the corresponding 95% confidence intervals (vertical lines). Reference days: non-holidays that are not included in New Year’s day, Christmas, and other national holidays that this study addressed)

**Fig 5**
Risks of suicide around other national holidays (except Christmas and New Year’s day) and neighbouring days with the corresponding 95% confidence intervals (vertical lines). Reference days: non-holidays that are not included in New Year’s day, Christmas, and other national holidays that this study addressed)

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References

1. World Health Organization. Suicide worldwide in 2019: global health estimates, 2021. https://www.who.int/publications/i/item/9789240026643
1. Durkheim E. Le suicide, étude de sociologie. Félix Alcan, 1897.
1. Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Suicide and suicidal behavior. Epidemiol Rev 2008;30:133-54. 10.1093/epirev/mxn002. - DOI - PMC - PubMed
1. Kleiman EM, Liu RT. Social support as a protective factor in suicide: findings from two nationally representative samples. J Affect Disord 2013;150:540-5. 10.1016/j.jad.2013.01.033. - DOI - PMC - PubMed
1. Cavanagh B, Ibrahim S, Roscoe A, et al. . The timing of general population and patient suicide in England, 1997-2012. J Affect Disord 2016;197:175-81. 10.1016/j.jad.2016.02.055 - DOI - PubMed

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[1] World Health Organization. Suicide worldwide in 2019: global health estimates, 2021. https://www.who.int/publications/i/item/9789240026643

[2] World Health Organization. Suicide worldwide in 2019: global health estimates, 2021. https://www.who.int/publications/i/item/9789240026643

[3] Durkheim E. Le suicide, étude de sociologie. Félix Alcan, 1897.

[4] Durkheim E. Le suicide, étude de sociologie. Félix Alcan, 1897.

[5] Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Suicide and suicidal behavior. Epidemiol Rev 2008;30:133-54. 10.1093/epirev/mxn002. - DOI - PMC - PubMed

[6] Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Suicide and suicidal behavior. Epidemiol Rev 2008;30:133-54. 10.1093/epirev/mxn002. - DOI - PMC - PubMed

[7] Kleiman EM, Liu RT. Social support as a protective factor in suicide: findings from two nationally representative samples. J Affect Disord 2013;150:540-5. 10.1016/j.jad.2013.01.033. - DOI - PMC - PubMed

[8] Kleiman EM, Liu RT. Social support as a protective factor in suicide: findings from two nationally representative samples. J Affect Disord 2013;150:540-5. 10.1016/j.jad.2013.01.033. - DOI - PMC - PubMed

[9] Cavanagh B, Ibrahim S, Roscoe A, et al. . The timing of general population and patient suicide in England, 1997-2012. J Affect Disord 2016;197:175-81. 10.1016/j.jad.2016.02.055 - DOI - PubMed

[10] Cavanagh B, Ibrahim S, Roscoe A, et al. . The timing of general population and patient suicide in England, 1997-2012. J Affect Disord 2016;197:175-81. 10.1016/j.jad.2016.02.055 - DOI - PubMed

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Association of holidays and the day of the week with suicide risk: multicounty, two stage, time series study

Collaborators

Affiliations

Association of holidays and the day of the week with suicide risk: multicounty, two stage, time series study

Authors

Collaborators

Affiliations

Erratum in

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

MeSH terms

Grants and funding

LinkOut - more resources

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Medical