title: Does suicide have a stronger association with seasonality than sunlight?
abstract: OBJECTIVE
  Suicide rates have widely been reported to peak in spring and summer. A frequent hypothesis is that increased sunlight exposure alters biological mechanisms. However, few attempts have been made to systematically untangle the putative suicidogenic risk of sunlight exposure from that of seasonality. We examined whether average hours of daily sunlight in a month confer additional risk over month of year when predicting monthly suicide rates.
  
  
  METHODS
  Historical population-based ecological longitudinal study.
  
  
  METHODS
  We used 3 longitudinal studies (n=31,060 suicides) with monthly suicide and meteorological data from Greece (1992-2001), Victoria, Australia (1990-1998) and Norway (1969-2009).
  
  
  METHODS
  We used a negative binomial regression to observe (1) the association of month of year with suicides, adjusting for different sunlight exposures, and (2) the association of sunlight exposure with suicides, adjusting for month of year. We then investigated claims that suicides were associated with daily sunlight exposures, defined by us as 2550 sunlight exposure combinations corresponding to a 1-50 days exposure window with lags of 0-50 days.
  
  
  RESULTS
  Using monthly data, the association between month of year and suicides remained after adjusting for mean daily hours of sunlight and change in the mean daily hours of sunlight. Adjusted for month of year, the associations between sunlight exposure and suicides became non-significant and attenuated towards the null (the coefficient estimate for mean daily hours of sunlight decreased in absolute magnitude by 72%). The findings were consistent across all 3 cohorts, both when analysed separately and combined. When investigating daily sunlight exposures, we found no significant results after correcting for multiple testing.
  
  
  CONCLUSIONS
  Using monthly data, the robustness of our month of year effects, combined with the transient and modest nature of our sunlight effects, suggested that the association between sunlight exposure and suicide was a proxy for the association between seasonality and suicide.
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Richard A
authors.initials: RA
authors.lastname: White
authors.affiliation: Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Azrael
authors.affiliation: Department of Neuroscience, Psychiatry, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Fotios C
authors.initials: FC
authors.lastname: Papadopoulos
authors.affiliation: Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia Central Clinical School, Monash University, Melbourne, Australia.
authors.forename: Gavin W
authors.initials: GW
authors.lastname: Lambert
authors.affiliation: Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Miller
mesh_terms: D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D009664:Norway / Q000453:epidemiology; D012621:Seasons; D013405:Suicide / Q000706:statistics & numerical data*; D013472:Sunlight; D014739:Victoria / Q000453:epidemiology
keywords: EPIDEMIOLOGY; PSYCHIATRY