HIGH expectations of happiness at Christmas time can serve to emphasise the sadness of those who spend the holiday alone and can put them at risk of the onset of depression, a Bermuda psychiatrist said yesterday.

Dr. David Price, of St. Brendan's Hospital, said friends and family of the lonely could lessen the risk of them falling prey to depression by showing consideration.

And family get-togethers and a widespread neglect of physical health over the holidays could leave us all prone to added anxiety, he added.

Therapist Sarah White, of the Transitions counselling firm, said the incidence of suicide attempts and depression rose during the Christmas period universally.

And she laid much of the blame for that on the "gross commercialism" that led to unrealistic expectations.

"The media and society in general put so much emphasis on Christmas as a time when everyone should be completely happy," said Dr. Price.

"If people are alone, the feeling that they should be happy when they are not can reinforce those feelings of loneliness and people do get depressed.

"We certainly see some patients who get upset at the prospect of Christmas coming up, because they know they are going to feel that others are having a good time and that they are missing out on something.

"We also notice an effect after Christmas, when we usually get a lot of extra referrals for depression."

Those most susceptible to feeling low during the holiday season included the alone and those who had endured a bad year, had lost somebody through a broken relationship or suffered a bereavement, added Dr. Price. "The first thing people can do to help them is to acknowledge that this can be a difficult time for some people," said Dr. Price. "Sometimes we expect people to be happy, when they can't be happy.

"We need to get rid of the 'you are a humbug' type philosophy if someone does not appear to be in a state of ecstasy at Christmas. And we need to understand that some people have reason to dread Christmas.

"Some people may wish to withdraw or retreat and we can help by not expecting that person to come forward, but by paying them a visit or making a phone call. If you are aware of a neighbour or a relative in this situation, pay them a visit."

Christmas could also provoke anxiety and stress, added Dr. Price.

"One of the things that makes people anxious is that families come together and everyone is expected to get on with one another," he said.

"Often people have to spend time with family members they don't get on with and that can lead to tensions, worry, distress and anxiety.

"It's amazing how many marriage break-ups and separations there are during the holiday period. Christmas puts people into a hot-pot situation.

"What doesn't help anxiety is that people traditionally do a lot of drinking and run their health down at Christmas and that makes it more likely that they'll blow up."

Ms White agreed with Dr. Price's conclusions.

"Depressions and suicide attempts elevate during Christmas and this is our busiest time of year," she said.

"Certainly some of that is down to the gross commercialism leading to totally unrealistic expectations.

"A lot of the depression comes from people missing others who have passed away and not being able to realise dreams, that part of us that wanted to do that vacation in San Francisco that we never did and now we never can. There can be self-blame, I should have done this or that.

"There is a positive here, in that it is a time to contemplate, a time we can re-evaluate our own priorities and values and think about what is really important to us."

Ms White said Transitions expected a noticeable increase in its workload after January 1.

Dr. Price added that Christmas could be beneficial to our mental health and emotional state as well.

"Christmas is traditionally thought of as a time to alleviate the winter blues," he said. "There is a positive side in that it brings people together who may not normally spend time together and it can build great relationships."