Christmas Eve Is the Most Depressing Day of the Year

For some, the Christmas season is the opposite of joyful.

For some, it’s definitely not the most wonderful time of the year.

The holidays can be particularly challenging for people who suffer from depression. And during this most recent holiday season, Christmas Eve may have been the most depressing day of all. That’s according to Iodine, a health care information website which offers an iOS application called Start that helps users track the effects of their antidepressants.

From December 18th of last year to January 3rd, over 3,000 people took a PHQ-9 survey—an instrument that measures the severity of depressive symptoms on a scale from 0 to 27—either through Iodine’s online Depression Test or through Start. The information they recorded is by no means nationally representative but it’s still an indication that, for people with depression, Christmas Eve can be more of a hurdle than it is a holiday. Iodine found that average PHQ-9 scores fluctuated significantly over the holidays with a spike of 15.2 on Christmas Eve and a dip of 13.6 on New Year’s Day. Iodine has only been running the Depression Test since early last December but, so far, Christmas Eve is the most depressed day they have on record.

The PHQ-9 survey is a standard clinical instrument asking respondents to reflect on the past two weeks and rate, on a scale from 0 to 3, how frequently they’ve experienced nine symptoms of depression including: taking “little interest or pleasure in doing things,” experiencing “trouble concentrating on things,” or having “thoughts that you would be better off dead or hurting yourself in some way.” These scores are then tallied to produce a total PHQ-9 score. Below 10, depression is considered “mild” or “minimal.” From 10 to 14, it is “moderate.” Between 15 and 19—the range in which Iodine’s average fell last December 24th—depression is “moderately severe.” Over 20, it is considered “severe.” Physicians use this scale to determine the best course of treatment and to decide if and when to prescribe antidepressants.

Why might Christmastime be one of the least cheery times for people with depression? Perhaps because there is so much cultural pressure to experience the holiday as a holly jolly fun fest, says one physician. “A lot of people feel like they’re supposed to be happy during the holidays,” psychiatrist Dr. Steve Koh told CBS News on the day before Christmas Eve 2015. “Everyone around them is telling them they’re supposed to be happy, and yet inside they don’t [feel happy.] So there’s this friction between what’s happening inside versus what everybody else is telling you to feel and that can increase depressive symptoms and anxiety.” Contrary to popular belief and many inaccurate newspaper stories, the suicide rate does not rise during the holiday season and there are no reliable population-level statistics to suggest that rates of depression increase in late December. As the CDC notes, the suicide rate is actually lowest in December, peaking during the spring and the fall. But Iodine’s users, as the company told The Daily Beast, “do not reflect the general public, in that they either have been diagnosed with depression and are being treated for it, or they likely believe they are depressed.” In other words, the overall rate of depression might not go up during the holidays, but if you already struggle with the condition and observe the holiday, there’s a strong chance Christmas Eve could be your most difficult day.

More not-so-fun facts from the service’s data set: Iodine users in Utah were the most depressed over the holidays, with an average score of 17, followed by Nebraska, Oregon, and Louisiana. Part of this finding, at least, seems consistent with several studies that have found alarmingly high rates of depression and suicide in Utah, often described as the “most depressed state.” Users in West Virginia were the least depressed through the year-end celebrations, followed closely by New Mexico, Nevada, and Kentucky.