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.

Center for Environmental and Respiratory Health Research University of Oulu Oulu Finland

Climate Air Quality Research Unit School of Public Health and Preventive Medicine Monash University Melbourne VIC Australia

Climate Research Foundation Madrid Spain

Department of Environmental Health Harvard TH Chan School of Public Health Boston MA USA

Department of Environmental Medicine College of Medicine Ewha Woman's University Seoul South Korea

Department of Epidemiology Lazio Regional Health Service ASL Roma 1 Rome Italy

Department of Global Environmental Health Graduate School of Medicine University of Tokyo Tokyo Japan

Department of Global Health Policy Graduate School of Medicine University of Tokyo Tokyo Japan

Department of Mathematical Sciences Korea Advanced Institute of Science and Technology Daejeon South Korea

Department of Psychiatry Ewha Woman's University Mokdong Hospital Ewha Woman's University College of Medicine Seoul South Korea

Department of Public Health Environments and Society London School of Hygiene and Tropical Medicine London UK

Department of Public Health Science Graduate School of Public Health Seoul National University Seoul South Korea

Department of Public Health University of Helsinki Helsinki Finland

Department of Statistics and Computational Research Universitat de València València Spain

Department of Statistics Computer Science and Applications G Parenti University of Florence Florence Italy

Environment and Health Modeling Lab London School of Hygiene and Tropical Medicine London UK

Environmental and Occupational Medicine and Institute of Environmental and Occupational Health Sciences National Taiwan University and NTU Hospital Taipei Taiwan

Environmental Health Science and Research Bureau Health Canada Ottawa Canada

Epidemiology IBE Faculty of Medicine LMU Munich Munich Germany

Faculty of Environmental Sciences Czech University of Life Sciences Prague Czech Republic

Faculty of Health and Sport Sciences University of Tsukuba Tsukuba Japan

Institute of Atmospheric Physics Czech Academy of Sciences Prague Czech Republic

Institute of Environmental Assessment and Water Research Barcelona Spain

Institute of Epidemiology Helmholtz Zentrum München German Research Center for Environmental Health Neuherberg Germany

Institute of Ewha SCL for Environmental Health College of Medicine Ewha Woman's University Seoul South Korea

Interdisciplinary Program in Precision Public Health Department of Public Health Sciences Graduate School of Korea University Seoul South Korea

International University Health Science University of Medicine Basseterre St Kitts and Nevis

Laboratory of Urban Health Faculty of Medicine of the University of São Paulo INSPER São Paulo Brazil

National Institute of Environmental Health Chinese Center for Disease Control and Prevention Beijing China

School of Biomedical Convergence Engineering College of Information and Biomedical Engineering Pusan National University Yangsan South Korea

School of Epidemiology and Public Health Faculty of Medicine University of Ottawa Ottawa ON Canada

School of Public Health and Social Work Queensland University of Technology Brisbane QLD Australia

School of the Environment Yale University New Haven CT USA

School of Tropical Medicine and Global Health Nagasaki University Nagasaki Japan

Spanish and Consortium for Research on Epidemiology and Public Health Santiago de Compostela Spain

System Health and Engineering Major in Graduate School Ewha Woman's University Seoul South Korea

BMJ. 2024 Oct 28;387:q2373. doi: 10.1136/bmj.q2373. PubMed

See more in PubMed

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

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

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. PubMed DOI PMC

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. PubMed DOI PMC

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 PubMed DOI

Ajdacic-Gross V, Bopp M, Eich D, Gostynski M, Rössler W, Gutzwiller F. Historical change of suicide seasonality in the canton of Zurich, Switzerland. Suicide Life Threat Behav 2005;35:217-26. 10.1521/suli.35.2.217.62880 PubMed DOI

Yu J, Yang D, Kim Y, et al. . Seasonality of suicide: a multi-country multi-community observational study. Epidemiol Psychiatr Sci 2020;29:e163. 10.1017/S2045796020000748. PubMed DOI PMC

Jessen G, Jensen BF, Arensman E, et al. . Attempted suicide and major public holidays in Europe: findings from the WHO/EURO multicentre study on parasuicide. Acta Psychiatr Scand 1999;99:412-8. 10.1111/j.1600-0447.1999.tb00986.x PubMed DOI

Corcoran P, Reilly M, Salim A, Brennan A, Keeley HS, Perry IJ. Temporal variation in Irish suicide rates. Suicide Life Threat Behav 2004;34:429-38. 10.1521/suli.34.4.429.53735 PubMed DOI

Beauchamp GA, Ho ML, Yin S. Variation in suicide occurrence by day and during major American holidays. J Emerg Med 2014;46:776-81. 10.1016/j.jemermed.2013.09.023. PubMed DOI

Ajdacic-Gross V, Lauber C, Bopp M, et al. . Reduction in the suicide rate during Advent—a time series analysis. Psychiatry Res 2008;157:139-46. 10.1016/j.psychres.2006.07.014. PubMed DOI

Phillips DP, Wills JS. A drop in suicides around major national holidays. Suicide Life Threat Behav 1987;17:1-12. 10.1111/j.1943-278X.1987.tb00057.x PubMed DOI

Panser LA, McAlpine DE, Wallrichs SL, Swanson DW, O’Fallon WM, Melton LJ, 3rd. Timing of completed suicides among residents of Olmsted County, Minnesota, 1951-1985. Acta Psychiatr Scand 1995;92:214-9. 10.1111/j.1600-0447.1995.tb09571.x PubMed DOI

Su MK, Chan PY, Hoffman RS. The seasonality of suicide attempts: a single poison control center perspective. Clin Toxicol (Phila) 2020;58:1034-41. 10.1080/15563650.2020.1733591. PubMed DOI

Gabennesch H. When promises fail: a theory of temporal fluctuations in suicide. Soc Forces 1988;67:129-45. 10.2307/2579103. DOI

Page LA, Hajat S, Kovats RS. Relationship between daily suicide counts and temperature in England and Wales. Br J Psychiatry 2007;191:106-12. 10.1192/bjp.bp.106.031948. PubMed DOI

Kim Y, Kim H, Gasparrini A, et al. . Suicide and ambient temperature: a multi-country multi-city study. Environ Health Perspect 2019;127:117007-07. 10.1289/EHP4898. PubMed DOI PMC

Armstrong B. Models for the relationship between ambient temperature and daily mortality. Epidemiology 2006;17:624-31. 10.1097/01.ede.0000239732.50999.8f PubMed DOI

Gasparrini A, Armstrong B, Kenward MG. Multivariate meta-analysis for non-linear and other multi-parameter associations. Stat Med 2012;31:3821-39. 10.1002/sim.5471. PubMed DOI PMC

Millner AJ, Robinaugh DJ, Nock MK. Advancing the understanding of suicide: the need for formal theory and rigorous descriptive research. Trends Cogn Sci 2020;24:704-16. 10.1016/j.tics.2020.06.007. PubMed DOI PMC

Erazo N, Baumert J, Ladwig K-H. Sex-specific time patterns of suicidal acts on the German railway system. An analysis of 4003 cases. J Affect Disord 2004;83:1-9. 10.1016/j.jad.2004.04.012 PubMed DOI

Hadlaczky G, Hökby S. Increased suicides during new year, but not during Christmas in Sweden: analysis of cause of death data 2006–2015. 2018;72:72-74. PubMed

Brådvik L, Berglund M. A suicide peak after weekends and holidays in patients with alcohol dependence. 2003;33:186-91. 10.1521/suli.33.2.186.22773. PubMed DOI

Sapozhnikov S, Golenkov A, Rihmer Z, et al. Weekly patterns of suicide and the influence of alcohol consumption in an urban sample. Ideggyogyaszati Szemle 2022;75:99-104. 10.18071/isz.75.0099. PubMed DOI

Loiola Ponte de Souza M, Douglas Yamall Orellana J. Suicide mortality in São Gabriel da Cachoeira, a predominantly indigenous Brazilian municipality. Br J Psychiatry 2012;34:34-7 10.1016/S1516-4446(12)70007-7. PubMed DOI

Orellana JD, Balieiro AA, Fonseca FR, Basta PC, Souza ML. Spatial-temporal trends and risk of suicide in Central Brazil: an ecological study contrasting indigenous and non-indigenous populations. Braz J Psychiatry 2016;38:222-30. 10.1590/1516-4446-2015-1720 PubMed DOI PMC

Nieto-Betancurt L, Fandiño-Losada A, Ponce de Leon A, et al. . Seasonal and temporal patterns of homicides and suicides in Cali and Manizales, Colombia: a times-series analysis 2008-2015. Arch Suicide Res 2023;27:1-20. 10.1080/13811118.2021.1967235. PubMed DOI

Partonen T, Haukka J, Viilo K, et al. . Cyclic time patterns of death from suicide in northern Finland. J Affect Disord 2004;78:11-9. 10.1016/S0165-0327(02)00236-7. PubMed DOI

Mäkelä P, Tigerstedt C, Mustonen H. The Finnish drinking culture: change and continuity in the past 40 years. 2012;31:831-40. 10.1111/j.1465-3362.2012.00479.x PubMed DOI

Lac A, Handren L, Crano WD. Conceptualizing and measuring weekend versus weekday alcohol use: item response theory and confirmatory factor analysis. Prev Sci 2016;17:872-81. 10.1007/s11121-016-0685-9. PubMed DOI PMC

Kim YO, Lee W, Kim H, Cho Y. Social isolation and vulnerability to heatwave-related mortality in the urban elderly population: a time-series multi-community study in Korea. Environ Int 2020;142:105868. 10.1016/j.envint.2020.105868. PubMed DOI

Neri AL, Yassuda MS, Fortes-Burgos ACG, et al. . Relationships between gender, age, family conditions, physical and mental health, and social isolation of elderly caregivers. Int Psychogeriatr 2012;24:472-83. 10.1017/S1041610211001700 PubMed DOI

Kim E, Cho SE, Na KS, et al. . Blue Monday is real for suicide: a case-control study of 188,601 suicides. Suicide Life Threat Behav 2019;49:393-400. 10.1111/sltb.12429 PubMed DOI

Ohtsu T, Kokaze A, Osaki Y, et al. . Blue Monday phenomenon among men: suicide deaths in Japan. Acta Med Okayama 2009;63:231-6. 10.18926/amo/31838. PubMed DOI

Borowsky IW, Ireland M, Resnick MD. Adolescent suicide attempts: risks and protectors. Pediatrics 2001;107:485-93. 10.1542/peds.107.3.485. PubMed DOI

Compton MT, Thompson NJ, Kaslow NJ. Social environment factors associated with suicide attempt among low-income African Americans: the protective role of family relationships and social support. Soc Psychiatry Psychiatr Epidemiol 2005;40:175-85. 10.1007/s00127-005-0865-6. PubMed DOI

Casant J, Helbich M. Inequalities of suicide mortality across urban and rural areas: a literature review. Int J Environ Res Public Health 2022;19:2669. PubMed PMC

Galvão PVM, Silva HRSE, Silva CMFPD. Temporal distribution of suicide mortality: a systematic review. J Affect Disord 2018;228:132-42. 10.1016/j.jad.2017.12.008. PubMed DOI