Dr Simon Hatcher
The July 20th death of Chester Bennington, the lead singer of Linkin Park, was a tragedy. His story is familiar to anyone who works with suicidal men – a history of childhood neglect, sexual abuse and drug use – one that he was somehow able to overcome, and front a successful band. The question remains, however, why now? Chester Bennington was 41 years old. The band was about to go on tour, and he had a wife and children.
There has been some speculation in the media about the significance of his death occurring on the birthday of his good friend Chris Cornell (the lead singer of Soundgarden), who died by suicide in May. It is suggested that Mr. Cornell’s death may have left Mr. Bennington grieving, and that he deliberately chose his friend’s birthday as a significant date to die.
The issue of anniversary reactions – or more generally emotional and physical reactions on important dates – has received more attention in the lay literature than in the academic literature. This is partly because it is a difficult subject to study, requiring large cohorts of people. One study recently published in 2015 looked at the issue in parents in Sweden who’d lost a child (Rostila et al. 2015)[i]. The authors followed nearly 49,000 parents and found that, for women, there was a significantly increased death rate from cardiovascular disease and suicide on the anniversaries of the death of their child. However, for men, there was no increased rate. This illustrates two things: first, anniversaries of important losses are significant, and second, that anniversaries affect us both physically and emotionally. It also seems, unsurprisingly, that the nature of the loss is important, with the mothers in this study affected by the death of a child, but not fathers. For men, losses such as fathers and male friends may have more impact. Further confirmation of the importance of anniversaries comes from a study in 2016 Japan (Matsubayashi et al. 2016)[ii], which found that people were more likely to die on their birthday from suicide, traffic accidents, accidental falls, drowning, and choking. The idea of birthdays as times of reflection, and perhaps depression from considerations of lost opportunities, is not unfamiliar to clinicians.
Why anniversary reactions occur is something that has not been extensively studied. One idea is that they trigger a fresh round of grief, accompanied by a wish to join the person who has died. The influence on cardiovascular deaths could be due to the increased stress on the heart caused by the physiological effects of strong feelings.
So, where does that leave us with the BEACON study, which is focused on preventing suicide in men? Clearly an important part of any history is to identify important dates, and to always ask the question “why now” during clinical interviews when someone presents to the hospital after an incident of self-harm. Naming and identifying the strong feelings around certain important dates may be enough to stop men acting on them.
[i] Rostila M, Saarela J, Kawachi I, Hjern A. Testing the Anniversary Reaction: Causal Effects of Bereavement in a Nationwide Follow-Up Study from Sweden. Eur J Epidemiol. 2015 Mar; 30(3): 239-247.
[ii] Matsubayashi T, Ueda M. Suicides and Accidents on Birthdays: Evidence From Japan. Soc Sci Med. 2016; 159: 61-72.