Dating back to 1981, researchers in the field of psychology have sought to debunk seasonal holiday health myths1,6,10. Such myths include the prevailing notion of "holiday depression" and the idea that the winter months yield an increased rate of suicide among the general population7. For years, folklore has reinforced the conception that cold, lingering winters lead to introversion, loneliness, isolation and ultimate depression. Even mental health professionals may be quick to buy into holiday health myths1, but why?
Experts in the field have suggested that health professionals' susceptibility to holiday health myths (e.g., higher rates of major depression, higher rates of suicide) stems from their close exposure to acute unhappiness during the holiday season. Gloomy dispositions contrast so sharply with the publicized "spirit of the holidays" that professionals may be hypersensitive to patients who exhibit behavior that directly contracts the determined joyousness of the holiday season.2
Indeed, the rigid dichotomy between a cheerful, pervasive conception of the holidays and a demonstration of sadness or depression around the holidays perpetuates widespread belief in "holiday depression" and the holiday suicide myth. The holiday season is so commercially and socially reinforced as a meant-to-be-happy time of year that exposure to depression or thoughts of suicide during the holidays is more identifiable than it would be during a time of year when joyfulness and positivity are not so publicly anticipated.
In an effort to diffuse the holiday health myths, researchers have examined medical literature and discovered that whether the criteria was number of suicides, number of psychiatric hospitalizations, number of psychiatric emergency room visits or number of outpatient therapy sessions, December has almost always shown a relatively low level of psychopathology when compared to other months of the year. Evaluation of national suicide data has discovered a decrease in suicide around the holidays, as opposed to the increase that is popularly supposed. In research, December actually had the lowest suicide rate of the year.6
Still, this research does not diminish from the fact that other major mental health issues may be especially sensitive to the winter months. Bipolar disorder seems particularly vulnerable to seasonal variability3. In a study published in the Journal of Affective Disorders in October 2014,5 four researchers analyzed 51 research papers surveying either the hospitalization rate for bipolar disorder by season, the number of times practitioners diagnosed a patient with bipolar disorder throughout the year, or the dimensionality of symptoms in available cases (because patients with bipolar disorder experience symptoms to varying degrees).
The researchers found that manic episodes (i.e., high elation and energy) peak high during the spring and summer and to a lesser extent in autumn. Depressive episodes peak high in the early winter and to a lesser extent in summer. Approximately 25% of patients with bipolar disorder experience seasonal patterns of depression, and approximately 15% of patients experience seasonal patterns of mania. This trend is demonstrated on a global scale and has been widely replicated in research.5
According to this same study, individuals with seasonal bipolar disorder are more likely to present with a severe clinical profile (e.g., mood swings are harshly polarized), display a bipolar II disorder subtype (involves episodes of less severe mania, called hypomania), struggle with an eating disorder (patterns of bulimia nervosa have been shown to be influenced by seasonal changes3), and be vulnerable to relapse.
In addition, women are more susceptible to seasonal effects than men. This vulnerability is believed to be due in part to behavioral changes in women caused by the premenstrual cycle. Studies have revealed a significant association between symptom seasonality and premenstrual syndrome, suggesting that these two cyclic conditions share a common biological mechanism in women that supports their sustained interaction.4
Around 27% of patients with bipolar disorder fulfill the criteria for seasonal affective disorder (SAD), a subtype of depression that follows a seasonal pattern and accounts for an estimated 10-20% of recurrent depression cases. Seasonal affective disorder is a regular, seasonal pattern of major depressive episodes in the winter with periods of full improvement in the spring and summer. In United States community surveys, SAD prevalence ranges from 9.7% in New Hampshire to 1.4% in Florida.8
Interestingly enough, the extent to which members of the general population seek public information about mental health issues seems to coordinate with the same seasonal peaks as seasonal affective disorder.
In a first-of-its-kind study published in the American Journal of Affective Medicine in 20132, five researchers reported their conclusion that, across all major mental health issues (sorted here as Attention Deficit Hyperactivity Disorder, general anxiety, major depression, eating disorders, Obsessive Compulsive Disorder, schizophrenia, and suicide), information searches about mental health issues on Google peak high during the winter months and drop to a significantly lower level during the summer.
The researchers reached this conclusion by aggregating all Google search queries in the United States from 2006 to 2010, isolating searches with key terms related to mental health issues, and dividing the segments by time of year. Insight into this consumer search habit highlights the importance attributed to accessible, accurate, and relevant health information online. For more information about mental health issues and treatment services, visit our Learning Center and Resource Directory.
1 Albin, R. (1981). The holiday blues: A Christmas fable? Psychology Today, 15(12), 10-11.
2 Ayers, J.W., Althouse, B.M., Allem, J.P., Rosenquist, J.N., & Ford, D.E. (2013). Seasonality in seeking mental health information on Google. American Journal of Preventive Medicine, 44(5), 520-525.
3 Blouin, A., Blouin, J., Aubin, P., Carter, J., Goldstein, C., Boyer, H., & Perez, E. (1992). Seasonal patterns of bipolar disorder. The American Journal of Psychiatry, 149(1), 73-81.
4 Choi, J., Baek, J.H., Noh, J., Kim, J.S., Choi, J.S., Ha, K., Kwon, J.S., & Hong, K.S. (2011). Association of seasonality and premenstrual symptoms in bipolar I and bipolar II disorders. Journal of Affective Disorders, 129, 313-316.
5 Geoffroy, P.A., Bellivier, F., Scott, J., & Etain, B. (2014). Seasonality and bipolar disorder: A systematic review, from admission rates to seasonality of symptoms. Journal of Affective Disorders, 168, 210-223.
6 Hillard, J. and Buckman, J. (1982). Christmas depression. Journal of the American Medical Association, 248(23), 3175-3176.
7 Phillips, D. and Liu, J. (1982). The frequency of suicides around major public holidays: Some surprising findings. Suicide and Life-Threatening Behavior, 1980, 10(1), 41-50.
8 Roeckleion, K.A. and Rohan, K.J. (2005). Seasonal affective disorder: An overview and update. Psychiatry Edgmont, 2(1), 20-26.
9 Rohan, K.J., Sigmon, S.T., & Dorhofer, D.M. (2003). Cognitive-behavioral factors in seasonal affective disorder. Journal of Consulting Psychology, 71(1), 22-30.
10 Russ, C. (1984). The misdiagnosis of holiday and winter complaints: An unconscious shift in criteria? Psychotherapy, 21(3), 401.