What Comes Upon the Midnight Clear

With so much focus on how the holidays impact people with depression, many overlook what comes after the gifts are unwrapped, the trees come down, and we ring in another new year.

Illustration showing a person's depression returning after the holiday season
Tayrine Cruz

For people living with depression or other behavioral health disorders, the holiday season can be isolating, lonely, and stressful — and can even act as a trigger for recurring issues and intensify feelings of depression, stress and anxiety. The candles, illuminated trees, gingerbread houses, and nostalgic songs come packaged and wrapped with a slew of expectations and memories that don’t always evoke the “merry” many hope for.

In the days and weeks leading up to the holidays and their arrival, people living with depression and other behavioral health disorders certainly need additional support, attentiveness, and compassion from their loved ones and community. Scheduling sessions with behavioral health professionals can help people develop a plan to navigate the season with special consideration for their well-being. Family members and friends also serve as crucial allies for maneuvering through events and managing the stress of the holidays. On top of the attentiveness from family and friends, charitable and community organizations and outreach programs offer additional care to prevent affected people from feeling alone or forgotten. The efforts of all of these people prove successful; because of these special steps and outreach, the holiday season tends to be a time where, contrary to popular belief, suicide rates actually decrease.

The Dana Foundation shared a statistic from a 2014 analysis by the Annenberg Public Policy Center which found that 70% of news reports perpetuate the myth that suicide increases over the holidays. This myth and emphasis on depression during the holidays can affect the way behavioral care resources are allocated during and after the holidays, placing a greater emphasis on what happens during and neglecting what can also happen after. Though, as previously-mentioned, people with depression and behavioral health issues do require extra care before the winter season, the holidays themselves act as a “protective bubble” from suicide, in which Christmas essentially shields people from engaging in self-harm.

A Swedish study examined the cause of death data from 2006-2015 and discovered that the suicide rate did not increase during Christmas, but instead rose during the New Year. Similarly, in a literature search conducted by Randy A. Sansone and Lori A. Sansone, the doctors mention a study which discovered a 30-40% decrease in self-harming behavior between December 19-26, with the reduction reaching 60% among younger people. Sansone and Sansone also cite a Danish study that looked at the number of suicide attempts during the holiday season versus afterwards, and found that there were fewer suicides attempts before Christmas, but 40% more attempts afterward. Deaths by suicide also decreased during December, at a rate of 10%, when compared to the rest of the year, as Sansone and Sansone note from a Swiss Study. Deaths by suicide drop in the weeks leading up to Christmas as well, according to additional research.

Research by Randy Hillard corroborates this. In a 2003 note in Current Psychiatry, Hillard says, “most similar studies show that hospital admissions, suicide attempts and completions, and even letters to advice columnists go down just before Christmas, then go back up immediately afterwards.” With an emphasis on extensive outreach prior and during the holidays, depression loses the spotlight once the gifts are opened, the lights taken down, and the vacations end. The luster of the holidays eventually dims, and people with depression are left approaching the new year with less support than available in the weeks prior.

Jerry Kennard considers this occurrence in an article for HealthCentral, postulating that while Christmas suggests a certain degree of hope, “[t]he reality is typically very different. The promise of Christmas quickly becomes dashed and despair resumes or is perhaps even amplified as a result.” The holiday season may have allowed people with depression to feel a slight “uplift”, but with the new year, that depression rebounds. “The promise of a New Year holds up hope and optimism for some and abject misery for others,” says Kennard, who explains it with the “broken promise theory”.

The broken promise theory (or effect) is commonly associated with springtime, but is especially prevalent on New Year’s Day, or right after the dawn of the new year. For many people, a new year and the outlook toward spring elicits optimism and the “promise” of emotionally sunnier days. “For people suffering with depression, however, this collective joy and optimism may contrast sharply with their internal pain and unhappiness, leading to a sense of increased despair,” explains the Carrier Clinic in one of their resources. Motivation levels may have increased, coming off of the slight uplift from the holidays, but the sharp contrast between holiday hopefulness and the unchanged reality come New Year’s Day can prompt suicidal thoughts from people with depression. Kennard shares some insight on this as well: “During the uplift from depression, the sense of hopelessness continues but levels of motivation have actually increased. This helps to explain a seeming paradox where the most deeply depressed are actually less likely to attempt suicide than those with moderate depression.” People with depression, then, can feel more motivated after the holidays, and when confronted with disappointment of a new year that failed to deliver the same happiness everyone else seems to experience, those people become more likely to attempt and die by suicide.

The holidays might leave a path of tinsel and holly in its wake for some; but for others, the holidays cast a shadow over an impending new year. The expectation of a fresh start inevitably meets the harsh reality of continuing depression - turning a page in the calendar is not the cure for ongoing depression. However, the ongoing help and support of others can be, as they accompany people with depression on their journey into the days, weeks, and months after the holidays. Ultimately, the promise for change will come from within, aided by an invested community as compassion in the new year offers hope for the spring ahead.