An unexpected new explanation of seasonality in suicide attempts: Grey's Anatomy broadcasting
AAn unexpected new explanation of seasonality in suicideattempts: Grey’s Anatomy broadcasting
Luca Perri , , Om S. Salafia , Universit`a degli Studi dell’Insubria, Via Valleggio, 11, I-22100 Como, Italy Universit`a degli Studi di Milano-Bicocca, Piazza della Scienza 3, I-20126 Milano, Italy INAF - Osservatorio Astronomico di Brera Merate, via E. Bianchi 46, I–23807 Merate, Italy
April 1, 2016
Abstract
Seasonality is one of the oldest and most elucidation-resistant issues in suicide epidemiologicalresearch. Despite winter depression (also known as Seasonal Affective Disorder, SAD) is known andtreated since many years, worldwide cross-sectional data from 28 countries show a lower frequencyof suicide attempts around the equinoxes and a higher frequency in spring (both in Northern andSouthern Hemisphere). This peak is not compatible with the SAD explanation. However, in recentyears epidemiological research has yielded new results, which provide new perspectives on the matter. Infact, the discovery of a new pathology called Post-Series Depression (PSD) could provide an explanationof the suicide attempts pattern. The aim of this study is to analyse weekly data in order to comparethem with the TV series broadcasting. Since medical observations in our sample are distributed overmany years, in order to compare them as best as we can with the television programming, Grey’sAnatomy series was chosen. This medical drama has been in the top 10 of most viewed TV seriessince 12 years and it is broadcast all over the world, so that it can be considered a universal andhomogeneous phenomenon. A full season of the series is split into two separate units with a hiatusaround the end of the calendar year, and it runs from September through May. Data analysis wasmade in order to prove the correlation between PSD and the increase of suicide attempts. Surprisingly,the data analysis shows that the increase of rate of suicide attempts does not coincide with the breaksin Grey’s Anatomy scheduling, but with the series broadcasting. This therefore suggests that it is theseries itself to increase the viewer’s depression.
The World Health Organization estimates that 11.4every 100.000 people (15.0 for males and 8.0 for fe-males) committed suicide around the world in 2012[1]. For every suicide there are many more peoplewho unsuccessfully attempt suicide every day. It isknown that several risk factors act cumulatively toincrease vulnerability to suicidal behaviour. Someof them are associated with health system and so-ciety, alongside many other reported risk factors.Despite the complexity of factors that contributeto such behaviour, a seasonal pattern has been de- scribed [2]. Indeed, seasonality in suicide ratesis a well-known phenomenon and an importanttopic in epidemiological studies. Interestingly, ina worldwide cross-sectional data from 28 countries,a higher frequency of suicides in spring was foundcompared to other seasons [2]. Seasonal varia-tion does not apply only to completed suicides.A similar pattern was also reported in suicide at-tempt. However, some studies report suicide at-tempt peaks in autumn and/or winter. We per-formed a search for observational epidemiologicalstudies about seasonality in suicide attempts in1 a r X i v : . [ phy s i c s . pop - ph ] M a r ubMed, WebofScience, LILACS and CochraneLi-brary databases. Weekly data available were eval-uated by rhythmic analysis software. A decrease insuicide attempts in correspondence of the equinoxeswas found [2].The research question of this study is: whatcauses a higher rate of suicide attempts in springand in autumn/winter, and a lower rate by theequinoxes? The identification of a global seasonalprofile in suicide attempts would provide knowledgeto guide governments and public health organiza-tions to develop strategies that can prevent suicidemore effectively. The tilt of the Earth’s axis relative to its orbitalplane plays a big role in the weather. The Earthis tilted at an angle of approximately 23.44 ◦ to theplane of its orbit, and this causes different latitudesto directly face the Sun as the Earth moves throughits orbit. It is this variation that primarily bringsabout seasons. When Earth is at aphelion (thepoint in the orbit where our planet is nearest to theSun) it is winter in the Northern Hemisphere, whilethe Southern Hemisphere faces the Sun more di-rectly and thus experiences warmer temperatures.Conversely, winter in the Southern Hemisphere oc-curs when the Earth is at perihelion (the point inthe orbit where our planet is farthest from the Sun),and the Northern Hemisphere is better exposed tosunlight. From the perspective of an observer onEarth, the winter Sun has a lower apparent maxi-mum altitude in the sky (i.e. zenith) than the sum-mer Sun. During winter, in either hemisphere thelower zenith of the Sun causes the sunlight to hitthat hemisphere at an oblique angle. In regionsexperiencing winter, the same amount of solar ra-diation is spread out over a larger area [3].Seasonal Affective Disorder (SAD) is a type ofdepression whose symptoms vary in a seasonal pat-tern. SAD is sometimes known as ”winter depres-sion” because symptoms tend to be more severeduring the winter. Symptoms often begin in theautumn as days start getting shorter. They’re typ-ically most severe during January and February.SAD symptoms often improve or even disappear in the spring and summer, although they usuallyreturn each autumn and winter in a repetitive pat-tern. The exact cause of SAD is not fully under-stood, but it is often linked to reduced exposureto sunlight during the shorter autumn and winterdays. The most accepted explanation is that a lackof sunlight might prevent the hypothalamus fromworking properly, which may affect the productionof melatonin (a hormone that makes us feel sleepy),the production of serotonin (a hormone that affectsour mood, appetite and sleep), and the body’s in-ternal clock (circadian rhythm) [4].This could explain the higher rate of suicide at-tempts in autumn/winter and the lower one by theequinoxes, when day and night hours are approxi-mately equal. But SAD cannot explain the springpeak in suicide attempts, when the duration of thedaytime is increasing. For this reason, we seek adifferent interpretation that could integrate the ex-planation of the seasonal pattern. The Post-Series Depression, also known as PSD, isthe sadness felt after watching a long series. Thebitter feeling when you know the journey is over,but you do not want it to end. This can apply toany series, e.g. TV series, cartoon series, or evenmovie series. The effect can also be felt after com-pleting a stand alone piece that is not necessarilypart of a series, although this is not as common asPSD is presumably linked to developed attachmentto the story characters. Effects include, but are notlimited to: a state of depression or sadness, the in-ability to start another story, the need to re-watchthe entire series, Internet abuse linked to the series,creating fan fiction [5].In North American television, a series is a con-nected set of television program episodes that rununder the same title, possibly spanning many sea-sons. Since the late 1960s, this broadcast program-ming schedule typically includes between 20 and26 episodes. Most new programs for the broad-cast networks debut in the “Fall Season”. Since the1980s, the “Fall Season” normally extends to May.Thus, a “Full Season” on a broadcast network nowusually runs from September through May for atleast 22 episodes. A full season is sometimes splitinto two separate units with a hiatus around the2nd of the calendar year. Since the 1990s, theseshorter seasons have also been referred to as “.5”or half seasons, where the run of shows betweenSeptember and December is labelled “Season X”,and the second run between January and May islabelled “Season X.5” [6].A “season finale” is the last show of the sea-son, usually characterized by a dramatically sus-penseful and uncertain end, called “cliffhanger”.A cliffhanger is meant to ensure the audience willreturn and see how the characters resolve thedilemma. Often, the last episode before the hia-tus around the end of the calendar year ends witha cliffhanger as well. We then wondered how thesedifficult dilemmas or shocking revelations can dis-courage the viewers, affecting the rate of suicideattempts. Since medical observations in our sam-ple were distributed over many years, in order tocompare as best as we can the television program-ming, the TV series “Grey’s Anatomy” was chosen.Since 12 years this medical drama is firmly in thetop 10 of most viewed TV series and it is broadcastall over the world [7], so that it can be considereda universal and homogeneous phenomenon.
By averaging the broadcasting dates of the last 12years, we have established that the average seasonof Grey’s Anatomy is transmitted starting from the38th week of the year, around the autumn equinoxin the Northern Hemisphere, until the winter breakof the 49th week. The second half of the seasonstarts from the 2nd week of the new year and con-tinues until the cliffhanger of the 21st week.We therefore expect an increase in the number ofsuicide attempts between the 21st and 38th week ofthe year and around the turn of the new year. Thecomparison with the data, however, totally deniesour theory based on the cliffhanger, suggesting acompletely opposite new theory.The increase in the suicide attempt rate infact does not coincide with the breaks in Grey’sAnatomy scheduling, but with the series broadcast-ing. This therefore suggests that it is the seriesitself, with its troubled love affairs and tense rela-tionships, to increase the viewer’s depression. Onthe contrary, the season finale is a liberating mo-ment for the viewers, whose suicide attempts dra- Figure 1:
Observed (black line) distribution of suicide at-tempts (both men and women) in the analyzed sample [2].The time intervals marked by the red colour are those inwhich the series is broadcast. matically decrease.As shown in Figure 1, there is a decrease of sui-cide attempts around the 12th - 13th week of theyear, that is around the vernal equinox (but onlyin the Northern Hemisphere). This peak of opti-mism related to the arrival of spring and to love inthe air, however, is quickly swept away by the firstepisode of the medical drama, full of destroyed loveaffairs. The lower rate of suicide attempts aroundthe 38th week of the year is then to be related not somuch to the arrival of spring in the Southern Hemi-sphere as to the absence of Grey’s Anatomy. Therate of suicide attempts during the hiatus aroundthe end of the year is nearly constant: the minordepression related to Grey’s Anatomy is probablybalanced by winter depression and sadness relatedto the Christmas holiday weight gain.
Our new and unexpected Grey’s Anatomy theoryis firmly supported by medical data collected overthe last decade. The theory perfectly explains theseasonal pattern in suicide attempts. The observedhighest frequency in spring coincides with the sea-son finale. The rate decrease around the equinoxesis also easily explained within the theory. Futurestudies could analyse two pending issues: if the ap-proximate constancy of the number of viewers isdue to either new addicted people balancing thosewho committed suicide, or to the poor efficiency3f suicide attempts; another interesting question isthe actual impact of Derek Shepherd’s death on theviewers’ depression.This study, along with others (e.g. the one thatfound a correlation between the number of peoplewho drowned after falling into a pool and film ap-pearances by Nicolas Cage [8]), could be a warningto scientists to be wary of spurious correlations. Aspurious correlation arises, for example, when mea-surements which depend on the same variable arecompared. In this case, the correlation is simplya consequence of the common dependence of themeasurements on that variable, rather than an ac-tual correlation between the measurements. In thiscase, conclusions would be drawn from a correla-tion which is actually an artifact of the analysismethod, rather than an actual fundamental rela-tionship. But this is obviously not the case.
L. P. and O. S. S. wish to thank Francesco Nappo,Francesca Vimercati, Cristian Consonni, AaronGaio and Shonda Rhimes.
References [1] W.H.O, 2014. Preventing Suicide: A global Im-perative. World Health Organization, Luxem-bourg.[2] D. G. Coimbra, A. C. Pereira e Silva, C. F.de Sousa-Rodrigues, et al., Do suicide attemptsoccur more frequently in the spring too? A sys-tematic review and rhythmic analysis, Journal ofAffective Disorders, 196 (2016) 125–137[3] https://en.wikipedia.org/wiki/Winter [4] [5] http://it.urbandictionary.com/define.php?term=Post-Series+Depression [6] [7] http://tylervigen.com/spurious-correlationshttp://tylervigen.com/spurious-correlations