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Abstract
Purpose: The problem of time distribution of suicide has aroused the interest of various investigators in the past. A population-based study
on the association of the birthday in relation to the time of suicide taking into account sex and the chosen suicide method was conducted.
Methods: The study included all residents of Bavaria who died between 1998 and 2003 and whose death was classified as suicide by the
death certificate. In sum, 11 378 deaths from suicide were included. The suicide ratios in various time frames around the individuals'
birthdays were compared with expected suicide ratios.
Results: The occurrence of suicide did not vary around the birthday. Different time frames (3, 7, 14, 30, and 90 days) before as well as after
the individuals' birthdays were taken into account. Even after dichotomization regarding the chosen method as well as sex differences, no
significant association between birthdays and dates of suicide could be found.
Conclusion: There is no evidence for a birthday blues effect on suicide.
2007 Elsevier Inc. All rights reserved.
the individual's birthday and the chosen time for self- All statistical tests were 2-sided. Calculations were
inflicted death in a population-based study. performed by using the statistical package SPSS 10 for
Windows (SPSS, Chicago, IL).
2. Materials and methods
3. Results
2.1. Samples
The study included all residents of Bavaria who died Concerning the means of suicide, 9679 suicides were
between January 1, 1998, and December 31, 2003, whose committed choosing a violent method (85.1%; 7397 male
deaths were classified as suicide by the death certificate. subjects and 2282 female subjects) and 1699 suicides
Bavaria is a federal state of Germany and has about 12.3 (14.9%; 972 male subjects and 727 female subjects)
million inhabitants. Data from the death certificate concern- through a nonviolent method. The choice of a violent or
ing time of death, sex and, birthday were obtained from the nonviolent method was significantly associated with sex
Bavarian State Office for Statistics and Data Processing (2 = 274.3, P b .001).
(Munich, Germany). Because of the obligations of secrecy of The distribution of suicides within 3, 7, 14, 30, and
the German law, we were not provided with information 90 days preceding as well as after the individuals' birthdays
concerning the individual's age and year of death. Data did not differ significantly from the expected values (as
concerning occupation, marital status, and actual impairment shown in Tables 1 and 2). No sex differences could be
through alcohol or drugs and medical history were therefore observed, either. However, after stratification regarding the
not available, too. chosen method (nonviolent vs violent), some ratios did differ
In total, in the present study, 11 378 suicides (8369 men significantly from 1 in the explorative analysis. The ratio of
and 3009 women; male: female ratio, 2.8:1) were included. nonviolent suicides was significantly lower in the week
From these subjects, detailed data concerning exact time of before the birthday (ratio, 0.73; P = .049). This was the sole
birth and death were available. significant ratio in the time frames before the birthday. The
To obtain the observed number of deaths occurring ratios for nonviolent methods were significantly higher in
either before or after 3 days, 1 week, 2 weeks, 1 month, the time frames 3 days (1.50, P = .015), 2 weeks (1.19,
and 3 months around the individuals' birthdays, we P = .050), and 1 month after the birthday (1.14, P = .041). In
calculated the shortest time interval between the date of contrast, the ratio for a violent method was significantly
each death and birthday. The shortest time was the birthday lower 1 week after the birthday (0.89, P = .05).
itself, the longest time 182 days. Afterwards, the number of
deaths and the suicide ratios for each aforementioned
interval were calculated. This was done under the
Table 1
assumption that the time difference between the day and
The occurrence of suicide within specific time frames before the individual's
month of death due to suicide and the day and month of birthday
birthday has a uniform distribution.
3d 1 wk 2 wk 1 mo 3 mo
Furthermore, suicides were categorized with regard to birthday birthday birthday birthday birthday
sex differences and the chosen suicide method as well,
Violent method
which was classified into violent and nonviolent. n 102 215 399 833 2458
Violent methods included hanging, drowning, shooting, SR 0.96 1.01 1.00 1.01 1.02
vehicle accidents, and stabbing (International Statistical Men 72 160 300 628 1861
Classification of Diseases, 10th Revision, ICD-10 X70-84) SR 0.89 0.99 0.99 1.00 1.01
nonviolent methods were composed of self-poisoning by Women 30 55 99 205 597
SR 1.20 1.10 1.06 1.06 1.05
poison or gas (ICD-10 X60-69). Nonviolent method
n 13 27 64 138 429
2.2. Statistical methods
SR 0.7 0.73 0.92 0.96 1.01
Men 9 16 37 79 239
The univariate analysis was performed by applying the
SR 0.85 0.75 0.93 0.96 0.99
2 test statistic and by calculating suicide ratios in relation to Women 4 11 27 59 190
the length of each considered time frame. Ratios were SR 0.5 0.69 0.9 0.96 1.05
evaluated for statistical difference from 1 (ratio, observed vs Total
expected suicides) by assuming a binomial distribution. Five n 115 242 463 971 2887
SR 0.92 0.97 0.99 1.01 1.02
time frames before and after birthdays were used. In
Men 81 176 337 707 2100
addition, strata for method and sex were computed. There- SR 0.88 0.96 0.98 1.00 1.01
fore, 90 ratios were calculated. For the first step of an Women 34 66 126 264 787
explorative analysis, the significance level was set at = .05. SR 1.03 1.00 1.02 1.03 1.05
In a second step, all P values were corrected for multiple SR indicates suicide ratio.
testing by using the method of Bonferroni. P b.05, statistically significant before correction for multiple testing.
556 U. Reulbach et al. / Comprehensive Psychiatry 48 (2007) 554557
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