Holiday Blues? Not so much. Trends in Psychopathology over the Holidays.

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The idea of “holiday blues” or “holiday stress” has been discussed extensively in popular culture and in the psychiatric literature. Interestingly, the majority of these articles presume its existence, yet do not cite data. Most of the literature comes from case studies or psychoanalytic teachings (as opposed to higher-quality research papers). As early as 1955, a psychiatrist described a “holiday syndrome” characterized by feelings of “helplessness, possessiveness, and increased irritability, nostalgic or bitter ruminations about the holiday experiences of youth, depressive affect, and a wish for magical resolution of problems.2 Not a small number of articles inundating my newsfeed are about how to “cope” with the added stress of holidays instead of how to enjoy a lovely season. Suggestions for how to manage this stressful time include living in the present (Oprah via HuffPo), making a budget and focusing on your breathing (US News), and just shaking it off (Today).

shake-off

You’d think that with all of this stress surrounding the holidays, psychopathology would increase. People would be visiting the psychiatric emergency room more frequently, people would be committing suicide, and there would be higher rates of depression, right? Wrong.

This is what we know from research: though your mood may worsen, overall utilization of psychiatric services goes down. There are fewer visits to the Psychiatric Emergency Room in the days and week before Christmas. The psychiatric wards are emptier, suicide rates go down, and people engage in less self-injurious behavior (i.e., cutting and face-picking).1

Theories abound as to this apparent discrepancy. Perhaps the hope inherent in the Christmas season leads to the belief that problems will be fixed.2 Perhaps increased contact with family members bolsters social support, which is protective against psychopathology.2 Or, perhaps there needs to be a greater distinction: demoralization, disappointment, and merely revisiting intrapsychic conflicts do not a disorder make.3

Maybe the idea of Christmas blues is merely that, “blues,” and most people cope appropriately.

My first impulse when researching holiday stress was to assume that people struggle and that there would be increased utilization of psychiatric services. I was pleasantly surprised to find that the majority of people tolerate the holiday season and many even fare better during the month of December than other months of the year. Older adults, those who are single or widowed, people who struggle with alcoholism, and those who have had traumatic past holiday experiences may be at increased risk of having a difficult time during the holidays. Furthermore, those who have a prior or current diagnosis of depression or other mental illness may experience shame when surrounded by [presumably happy] family members.4 If you’re a member of one of these groups, I encourage you to seek out appropriate supports in the form of family, friends, or a trusted therapist or psychiatrist. [You can also take a look at this infographic from Happify, which did actually have some great suggestions for coping with holiday stress.]

The take home? While the holidays might be tough for some, in general mental health pathology and utilization decrease. Though people may feel intermitently blue, let’s allow the hope of the season to seep into our psyche, and let’s enjoy the season as we continue to show each other love and compassion.

References:
1. The Christmas Effect
2. Holiday Blues as a Stress Reaction
3. What is it About the Holidays?
4. A Season of Hope