Bio-Recovery: The R&R Interview

by Jeffrey Stouffer editor
July 19, 2010

A continually evolving and expanding segment of the remediation industry, bio-recovery – better known as “crime scene cleanup” or “trauma cleaning” – has made great strides since it first came into being as an organized segment of the business almost two decades ago. Recently, R&R spoke with Kent Berg, director of the National Institute of Decontamination Specialists and founder of the American Bio-Recovery Association, to get his take on where the industry stands today and where it’s headed in the future.

Restoration & Remediation: Briefly, what falls under the scope of work when people talk about “bio-recovery”?

Kent Berg: Bio-recovery is actually a term that was derived from the words BioHazard Cleanup and Scene Recovery. We chose that term because our industry’s scope of work is actually much broader than cleaning crime scenes. We are often thought of as the guys that will clean up anything that is nasty, repulsive, or gross, so people naturally call us to clean up human feces, animal feces, dead animals – usually rotten ones – and gross filth, as in rotting food, poor hygiene, and piles and piles of garbage. Then there’s the decomposed human body scenes, meth labs, the occasional disease outbreak, and anything else that would cause a normal person to stay a hundred feet away to keep from puking.

R&R: You’ve been part of the bio-recovery profession pretty much since before it became a profession. Since that time, what are some of the biggest changes you’ve seen, both positive and negative?

KB: When I first started, very few people in this business knew anything about cleaning and disinfecting. They just wanted to make the visible contamination go away. No one in the insurance industry had ever heard of a crime scene cleanup company, and many adjusters argued that our services were not covered. Today, the biggest changes have been in our profile. What I mean by that is the public, who had never heard of our services, now see us in TV shows, documentaries, movies, magazines, and newspaper articles. We have recognition now, and families are more aware that these services exist.

Another change has been in the performance of the cleanup itself. We as an industry are much more aware of the antimicrobials we are using, the techniques and knowledge related to home construction, vehicle dismantling, and being able to actually render a property safe on a microscopic level.

R&R: From a purely objective point of view, bio-recovery would seem to be about as “recession-proof” as any remediation specialty out there. There will always be accidents, suicides and other traumas that require a professional remediator. What are some of the pros and cons that come along with that?

KB: We know that our services will always be needed, but with a higher profile, we are seeing more and more companies starting up, and more and more fire/water restoration companies adding this service to their menus. Although the demand for our services is increasing, the individual companies’ call volumes aren’t growing as fast because there is more competition for that finite number of incidents.

The pros are that the public will have resources to respond if they need them, and that companies will have to step up their game in service quality and marketing. The cons are that the majority of these new companies are not attending training, not getting any type of certification beyond a half-day OSHA bloodborne pathogen course. It’s these companies that are dragging the good companies down when the public hears about a company throwing a bloody mattress in a dumpster, etc.


R&R: Since hindsight is 20/20, if there was one thing you would go back and change, as far as how you operated your business, what is it, and what would you do differently?

KB: I would have marketed harder. I assumed that people would need my service and seek me out. That was true for a while, but when competitors popped up with their marketing programs, the public chose who was freshest in their minds. It’s a hard lesson to learn, but one I will never forget.

R&R: Technologically speaking, what areas have seen the greatest advances? Chemicals? PPE? Containment?

KB: One of the advancements has been our recognition as a legitimate industry. Today, vendors of specialty restoration products are targeting our industry. Kimberly-Clark markets their suits with the “Recommended by the American Bio-Recovery Association” seal on them. Other products used in our industry have similar tie-ins with our trade association or at the very least mention in their advertising that their product is great for cleaning crime and trauma scenes. Even the insurance industry no longer recognizes us under their “janitorial service” heading, opting now for a “crime scene cleanup” designation for insurance coverage.

We are also seeing new technology in the form of new disinfectants, odor-remediation technology, and devices to actually measure how clean a surface really is. The National Organization for Victim Assistance is putting on a training program this fall for teaching all interested bio-recovery technicians how to better interact with victims and their families. Meanwhile, the National Institute of Occupational Safety and Health has sought out input so they may better understand our industry.

However, I believe the most important advancement for the industry has been the formation of training centers. Legitimate training programs help make sure that any technician who wants to be the best at their profession can attend a school that specializes in that field. By establishing a standard training and certification program, students graduate far ahead of their competitors and benefit from years of experience from seasoned industry professionals, scientists, chemists, and pathologists that helped to design the curriculum.


Jeffrey Stouffer editor
stoufferj@bnpmedia.com

Jeffrey Stouffer is editor of Restoration & Remediation magazine

Crime-scene cleanup requires technical, personal skills

Subtle eye needed to ensure work is completed properly

By JOHN PRZYBYS
LAS VEGAS REVIEW-JOURNAL
It's a question nobody ever wants to have to ask.

What happens after the homicide, or the suicide, or the death that nobody notices for days or even weeks? There's no way to put it delicately, but who cleans up the mess?

The answer: People such as John Gardner and David O'Brien, Southern Nevadans who own companies that specialize in the unusual, technically difficult and, well, just plain icky job of cleaning up crime scenes and other situations beyond the capabilities of traditional cleaners.

Most people "think the police will clean it up or the first responder -- the fire department -- will clean it up," says O'Brien, owner of Crime Scene Clean Team. But it is the survivors who must make the arrangements.

Specialized cleaners are required because blood, bodily fluids, bodily material and other residues are biohazards that can transmit infectious diseases. Consequently, cleaners must treat everything they come into contact with as potentially infectious, either to themselves or to a home's occupants.

The cleaners' workplace attire includes gloves, protective eyewear and booties at a minimum to disposable hazardous materials suits and respirators. After the job, those materials, along with paper towels and other contaminated items ranging from bloodied bed sheets to stained mattresses have to be treated as biomedical waste.

In addition to technical expertise, the job requires empathy and interpersonal skills. Cleaners work with people who have suffered a traumatic experience and, O'Brien says, the first thing his employees do on a job is to offer "our sincere condolences for their loss."

"It's not about the bucks. It's about helping those who need our services," says O'Brien, who has worked in the field for about eight years.

Particularly in cases of suicide or other deaths, "you have to have compassion for people," adds Gardner, owner of Absolute Decon Services.

The cleaners' work begins after receiving a call from a property owner, if the crime or cleanup scene involves private property, or a law enforcement officer or similar official if it involves a street or another form of public property.

Barbara Morgan, a Las Vegas Metropolitan Police Department public information officer, says the department has contracts with two companies for crime scene and building cleanups and another for cleanups that involve motor vehicle accidents.

But, she notes, officers don't recommend specific cleanup companies to the public because such a recommendation could be seen as an endorsement. So, finding a service falls on the survivor, via the phone book or Google.

After police officers, crime scene investigators and coroner's officials have finished with their jobs, a cleaner will assess the damage and offer a cost estimate. Costs vary, but Gardner says most jobs begin at about $400. Homeowners' insurance often covers the cost, he adds.

The cleaners' arsenal includes disinfectants, disposable towels, high-pressure cleaners, vacuums, a few specialized chemicals -- one that, for instance, can reveal hidden blood on surfaces -- machines that remove smoke and odors, and ample elbow grease.

It requires a subtle eye. For example, Gardner says, "you have to make sure there's no blood under the flooring. If there's blood on the carpet, you have to take the piece of carpet up, and if there's blood in the subfloor, you have to take that piece up."

"You have to look for the invisible, because if you don't get the invisible, eventually it's going to start stinking in the house and be a health hazard," Gardner says, adding a typical job takes from one to six hours.

"We get a lot of people who pass away of natural causes and are left unattended, and several weeks go by," O'Brien says. Then, the cleaning job involves removing products of the body's natural decomposition process, and can include handling insect infestation.

Ideally, the work is done with little or no damage to the home. Ultimately, O'Brien says, "we bring it back to its pre-existing condition as if (the incident) never happened."

Gardner estimates that about 40 percent of his business is crime-scene cleanups. The remainder involves cleaning up after suicides, industrial accidents, floods or fires and auto accidents, or dealing with what he describes on his business card as "gross filth."

"We clean up (after) hoarders," Gardner explains. "You'd be surprised. You have a lot of biohazards in some of those."

And, yes, Gardner says, "we work with some of the casinos. There are scenes their people can't clean up."

O'Brien estimates that 95 percent of his company's work involves trauma, albeit not all of the crime-related kind. He also operates a school for prospective crime scene cleaners that includes an online course and two days of hands-on training. The curriculum includes classes in such areas as hazardous materials, blood-borne pathogens and even terrorism, he says.

It's a specialized industry. There is "a lot of work out there, but there are also a lot of companies out there now," Gardner says, noting he has seen an increase from four companies when he started six years ago to "at least 10 others" now.

But it's not a job for everybody. Gardner says he has had hires who "decided they couldn't do it."

The intensity of the job can be difficult. "I guess the hardest ones for me is teenage suicide," Gardner says, "because it's a teenager, and I just feel that it's a life that shouldn't be taken."

The job can be rewarding, too, O'Brien says. "People with tears in their eyes, they come and say, 'Thank you.' That alone is priceless."

The satisfaction, Gardner says, lies in doing a job nobody wants to do, but which somebody has to, and doing it well.

"You get satisfaction that you're helping people through a dilemma they don't care to face," he says. "Whether you like it or not, it's got to be done."

6 reasons why people commit suicide

by Alex Lickerman, MD

Though I’ve never lost a friend or family member to suicide, I have lost a patient.

I have known a number of people left behind by the suicide of people close to them, however. Given how much losing my patient affected me, I’ve only been able to guess at the devastation these people have experienced. Pain mixed with guilt, anger, and regret makes for a bitter drink, the taste of which I’ve seen take many months or even years to wash out of some mouths.

The one question everyone has asked without exception, that they ache to have answered more than any other, is simply, why?


Why did their friend, child, parent, spouse, or sibling take their own life? Even when a note explaining the reasons is found, lingering questions usually remain: yes, they felt enough despair to want to die, but why did they feel that? A person’s suicide often takes the people it leaves behind by surprise (only accentuating survivor’s guilt for failing to see it coming).

People who’ve survived suicide attempts have reported wanting not so much to die as to stop living, a strange dichotomy but a valid one nevertheless. If some in-between state existed, some other alternative to death, I suspect many suicidal people would take it. For the sake of all those reading this who might have been left behind by someone’s suicide, I wanted to describe how I was trained to think about the reasons people kill themselves. They’re not as intuitive as most think.

In general, people try to kill themselves for six reasons:

1. They’re depressed. This is without question the most common reason people commit suicide. Severe depression is always accompanied by a pervasive sense of suffering as well as the belief that escape from it is hopeless. The pain of existence often becomes too much for severely depressed people to bear. The state of depression warps their thinking, allowing ideas like “Everyone would all be better off without me” to make rational sense. They shouldn’t be blamed for falling prey to such distorted thoughts any more than a heart patient should be blamed for experiencing chest pain: it’s simply the nature of their disease.

Because depression, as we all know, is almost always treatable, we should all seek to recognize its presence in our close friends and loved ones. Often people suffer with it silently, planning suicide without anyone ever knowing. Despite making both parties uncomfortable, inquiring directly about suicidal thoughts in my experience almost always yields an honest response. If you suspect someone might be depressed, don’t allow your tendency to deny the possibility of suicidal ideation prevent you from asking about it.

2. They’re psychotic. Malevolent inner voices often command self-destruction for unintelligible reasons. Psychosis is much harder to mask than depression — and arguably even more tragic. The worldwide incidence of schizophrenia is 1% and often strikes otherwise healthy, high-performing individuals, whose lives, though manageable with medication, never fulfill their original promise.

Schizophrenics are just as likely to talk freely about the voices commanding them to kill themselves as not, and also, in my experience, give honest answers about thoughts of suicide when asked directly. Psychosis, too, is treatable, and usually must be for a schizophrenic to be able to function at all. Untreated or poorly treated psychosis almost always requires hospital admission to a locked ward until the voices lose their commanding power.

3. They’re impulsive. Often related to drugs and alcohol, some people become maudlin and impulsively attempt to end their own lives. Once sobered and calmed, these people usually feel emphatically ashamed. The remorse is usually genuine, and whether or not they’ll ever attempt suicide again is unpredictable. They may try it again the very next time they become drunk or high, or never again in their lifetime. Hospital admission is therefore not usually indicated. Substance abuse and the underlying reasons for it are generally a greater concern in these people and should be addressed as aggressively as possible.

4. They’re crying out for help, and don’t know how else to get it. These people don’t usually want to die but do want to alert those around them that something is seriously wrong. They often don’t believe they will die, frequently choosing methods they don’t think can kill them in order to strike out at someone who’s hurt them—but are sometimes tragically misinformed. The prototypical example of this is a young teenage girl suffering genuine angst because of a relationship, either with a friend, boyfriend, or parent who swallows a bottle of Tylenol—not realizing that in high enough doses Tylenol causes irreversible liver damage.

I’ve watched more than one teenager die a horrible death in an ICU days after such an ingestion when remorse has already cured them of their desire to die and their true goal of alerting those close to them of their distress has been achieved.

5. They have a philosophical desire to die. The decision to commit suicide for some is based on a reasoned decision often motivated by the presence of a painful terminal illness from which little to no hope of reprieve exists. These people aren’t depressed, psychotic, maudlin, or crying out for help. They’re trying to take control of their destiny and alleviate their own suffering, which usually can only be done in death. They often look at their choice to commit suicide as a way to shorten a dying that will happen regardless. In my personal view, if such people are evaluated by a qualified professional who can reliably exclude the other possibilities for why suicide is desired, these people should be allowed to die at their own hands.

6. They’ve made a mistake. This is a recent, tragic phenomenon in which typically young people flirt with oxygen deprivation for the high it brings and simply go too far. The only defense against this, it seems to me, is education.

The wounds suicide leaves in the lives of those left behind by it are often deep and long lasting. The apparent senselessness of suicide often fuels the most significant pain survivors feel. Thinking we all deal better with tragedy when we understand its underpinnings, I’ve offered the preceding paragraphs in hopes that anyone reading this who’s been left behind by a suicide might be able to more easily find a way to move on, to relinquish their guilt and anger, and find closure. Despite the abrupt way you may have been left, those don’t have to be the only two emotions you’re doomed to feel about the one who left you.

Alex Lickerman is an internal medicine physician at the University of Chicago who blogs at Happiness in this World.

Disaster and then Disease

By Elizabeth Batt

The International Federation of Red Cross and Red Crescent Societies, describes a natural disaster as a “sudden, calamitous event that seriously disrupts the functioning of a community or society and causes human, material, and economic or environmental losses that exceed the community’s or society’s ability to cope using its own resources.”

The earthquake in Haiti that occurred on January 12, 2010, caused death and destruction, the extent of which has yet to be realized. Sadly, Haiti’s problems might be only just beginning. Often following the initial aftermath of any natural disaster there follows a second wave of deaths, caused by disease.

Types of Disease Prevalent in the Aftermath of a Natural Disaster
When a natural disaster strikes to the extent that it did in Haiti, the infrastructure of a country is decimated. Fresh water supplies, sewage disposal and power is destroyed or severely interrupted. What remains is often contaminated, initiating a vicious cycle that cultivates communicable diseases. In a third world country like Haiti, where resources are already stretched thin and immunizations are not standard practice, the loss of life is certain to be much higher because they’re simply not equipped to deal with an incident of this magnitude.

The study, “Management of dead bodies in disaster situations.” PAHO; 2004, indicates that little threat for communicative disease outbreak is posed by actual human remains. The threat comes from the survivors themselves, the destruction of their surroundings and an inevitable crowding situation caused by displacement. Without a continuous fresh water supply, survivors are forced to drink polluted water just to stay alive. Aided by the lack of adequate sanitary conditions, these pollutants are ingested and then defecated back into the water source. It becomes a breeding ground for communicable diseases.

Water-related Diseases
Water-related diseases include infectious diarrhea or norovirus, salmonella and cholera. Noroviruses are transmitted through the fecal-oral route after the ingestion of contaminated food and water. Once infected, a person-to-person transmission can occur. Noroviruses cause diarrhea and vomiting that without adequate sanitization amenities, continue to perpetuate.

Salmonella is often referred to as food poisoning. It causes the same symptoms as norovirus and can be present in almost any type of food. Salmonella is transmitted through infected feces that come into contact with a food source. People can become carriers of salmonella, transmitting the disease for life.

Cholera, transmitted by the fecal-oral route has an extremely brief incubation period of just 2-5 days. It can cause acute diarrhea, dehydration and kidney failure. Of all water-related diseases, cholera is perhaps the most insidious and can kill an adult within hours.

Crowding-related Diseases
The three most common crowding-related diseases are meningitis, measles and acute respiratory failure (ARF). Meningitis causes an inflammation of the membranes surrounding the brain and spinal cord and can lead to permanent neurological damage. Measles is a highly contagious viral disease that can cause seizures and coma. The complications of measles can include blindness and brain inflammation. ARF has a high morbidity rate of 50-70% in both children and adults. Caused by inadequate gas exchange, oxygen levels drop and carbon dioxide levels rise. An effect of displacement, over-crowding issues and poor nutrition, ARF is a major cause of death.

Vectorborne Diseases
Vectorborne diseases are caused by “vectors” such as mosquitoes that carry malaria. Earthquakes and other natural disasters can change a habitat, as evidenced in Saenz R, Bissell RA, Paniagua F. "Post-disaster malaria in Costa Rica." Prehospital Disaster Med. 1995;10:154–60. This change in habitat can create conditions that are ripe for breeding, causing an upsurge in outbreaks of malaria. Children are particularly at risk of contracting malaria, a virus that in its most dangerous form, can affect the brain and kidneys. Dengue, also carried by mosquitoes, can develop into dengue haemorrhagic fever. The spread of dengue can be directly related to inadequate solid waste disposal and water storage. Without treatment, fatality rates can exceed 20%.

Haiti's challenges are far from over and despite aid being sent to this ravaged country, the death toll as it stands now, is certain to rise.

Teen Suicide Risk Factors: Parents Are Too Often Clueless

By Nancy Shute

Suicide is the third leading cause of death among teenagers, and it's a tragedy that can be prevented. Given that almost 15 percent of high school students say they've seriously considered suicide in the past year, parents and friends need to know how to recognize when a teenager is in trouble and how to help.

Parents can be clueless when it comes to recognizing suicide risk factors, or at least more clueless than teens. In a new survey of teenagers and parents in Chicago and in the Kansas City, Kan., area, which appears online in Pediatrics, both parents and teenagers said that teen suicide was a problem, but not in their community. Alas, teen suicide is a universal problem; no area is immune.

The teenagers correctly said that drug and alcohol use was a big risk factor for suicide, with some even noting that drinking and drug use could be a form of self-medication or self-harm. By contrast, many of the parents shrugged off substance abuse as acceptable adolescent behavior. As one parent told the researchers: "Some parents smoke pot with their kids or allow their kids to drink."

Both teenagers and parents said that guns should be kept away from a suicidal teen. But since parents said they didn't think they could determine when a teenager was suicidal, parents should routinely lock up firearms, the researchers suggest. That makes sense. Firearms are used in 43.1 percent of teen suicides, according to 2006 data, while suffocation or hanging accounts for 44.9 percent.

The good news: Both parents and teenagers in this small survey (66 teenagers and 30 parents) said they'd like more help learning how to know when someone is at risk of committing suicide and what to do. Schools and pediatricians should be able to help, but we can all become better educated through reliable resources on the Web. These authoritative sites list typical signs of suicide risk, and they also provide questions a parent or a friend can ask a teenager to find out if he is considering killing himself. Here are good places to start:

The American Academy of Child and Adolescent Psychiatry lists signs and symptoms of suicidal thinking, such as saying things like "I won't be a problem for you much longer."

The American Academy of Pediatrics urges parents to ask the child directly about suicide. "Getting the word out in the open may help your teenager think someone has heard his cries for help."

The National Suicide Prevention Lifeline provides free advice to someone considering suicide, as well as to friends and relatives, at 800-273-TALK.

The National Alliance on Mental Illness's teenage suicide page makes the point that talking with someone about suicide will not "give them the idea." "Bringing up the question of suicide and discussing it without showing shock or disapproval is one of the most helpful things you can do," the NAMI site says. "This openness shows that you are taking the individual seriously and responding to the severity of his or her distress."

How Suicide Cleanup is Undertaken

Suicide cleanup is a part of the broad based service of Crime Scene Cleanup which involves crime and trauma decontamination and restoring it to its previous state. It is a a niche market in the cleaning industry and involves cleaning the biologically contaminated scene of ones death like suicide, homicide or accidental death. or a scene of a methamphetamine lab.

Broadly speaking, crime scene cleanup and suicide cleanup is almost same but there are few exeptions to this rule. Suicide cleanup requires some extra physical effort and psychological sensitivity that the technicians should be able to handle.

Following are some examples illustrating this. A suicide generally involves close range of weapon to body and so in-depth decontamination and thorough cleaning is required. The cleaners also have to handle family members who might be present at the scene searching for answers that why their beloved person decided to end his/her life. The technicians need to remove all traces of any evidence of a suicide so that no remains are present for family members and friends that might remind them of the tragedy.

Restoring of a suicide scene also means clean and restore sentimental items that mean the lot to the family of the deceased and requires additional time and effort.

On a visual inspection of any suicide scene you will generally find a lot of blood and bodily fluids, but invisible to the eye, a great amount of biohazard contamination is also bound to be there. The suicide cleanup technicians have to search thoroughly in all areas, even those that can not be seen or accessed easily and remove all traces of them from the scene. Most suicide cleanup services have their staff trained in not only dealing up with decontaminating and cleaning up issues but also about dealing with family and friends with sensitivity and compassion. Since most of such companies work in association with leading insurance companies so they can even help you to bill the insurance company directly thus saving you all the hassles.

A suicide cleanup consists of the following steps.
Firstly the scene should be evaluated. Next all contaminates should be located and decontaminated. A thorough search should me made again to decontaminate any traces of contaminates that might have been left out. All types of bio hazardous agents should be properly disposed of. Any microscopic remains should be treated with chemicals and the environment should be treated for odors. Last but not the least all tools and equipments should be disinfected. But before you attempt to clean a suicide scene on your own it is always better to consult a trained professional first.

National Study Finds Highest Rate Of Suicide On Wednesdays

By ARIELLE LEVIN BECKER

The Hartford Courant

July 11, 2009

Nearly a quarter of suicides in the U.S. occur on Wednesdays, about twice as many as almost every other day of the week, a new study has found.

The study, published in the journal Social Psychiatry & Psychiatric Epidemiology, contradicts earlier findings that suicides are more common on Mondays and left experts puzzling over what may be behind Wednesday's grim distinction.

Is it something about the middle of the week? Job stresses piling up, potentially overwhelming people who already see their problems as insurmountable?

"It may be just that it feels like there's no way out on Wednesday, [it's] too long to wait for the weekend," said Theodore Mucha, medical director at the Institute of Living at Hartford Hospital. Like other experts, he cautioned that his explanation was just a guess.

Researchers Augustine J. Kposowa and Stephanie D'Auria at the University of California, Riverside, examined data from U.S. death records from 2000 to 2004, focusing on adult suicides.

They found that 24.6 percent of suicides occurred on Wednesdays. The next-highest rates were 14.4 percent on Saturdays and 14.3 percent on Mondays. The fewest suicides occurred on Thursdays — 11.1 percent.

Kposowa and D'Auria also found that more suicides occurred in summer and spring than in fall or winter, contrasting with traditional thinking that winter months bring more risk of suicide.

Other parts of the study were consistent with previous research, showing that men are more likely to take their lives than women, and people who are divorced, white, educated or living in non-metropolitan areas have a higher risk of suicide.

The day of the week findings represent something new.

"This really does tell us something different," said Nina Heller, a social work professor at the University of Connecticut. "What it doesn't yet tell us is the why of that."

Heller said she had been "scratching my brain" since learning of the study, trying to think of a reason for the Wednesday peak in suicides. Maybe, she said, people who are already suffering from a mental illness and struggling to get through the week see Wednesday as a halfway point. "Perhaps they can't push any further," she said.

People who take their own lives often have lost perspective, becoming so despondent they lose track of things that might help them get through the day, said Charles Atkins, attending psychiatrist at Waterbury Hospital.

"One of the obvious speculations about Wednesday is that it's work-related, that people have become so caught up in the stress of the work week that whatever it is that's going on or is on their plate seems unsurmountable and suicide seems like a way out," he said.

Other national studies have indicated that working Americans typically list their jobs as their top source of stress, which Atkins said may lend weight to the idea that the Wednesday suicide peak could be related to the work week.

Kposowa also pointed to workplace stress as a potential explanation and believes changes in Americans' work and family life may be behind the shift in suicide's concentration from Mondays to Wednesdays.

Increased economic competition worldwide has threatened job security for many workers, heightening stress, frustration and even feelings of betrayal, said Kposowa, a sociology professor. "Individuals work harder and harder, but seem to be losing ground; they have little or nothing to show for their labor — especially among those who depend on others for wages," he wrote in an e-mail. "It is highly likely that the middle of the week (represented by Wednesday) is when these stressors and feelings of hopelessness are at their highest."

People may have once viewed Wednesday as the day you got over in order to look forward to a relaxed weekend, he said. But perhaps many Americans now see the next weekend as too far away.

Kposowa suggested that suicide prevention hot lines examine which days of the week call volumes are highest and consider placing more staff on Wednesdays, Saturdays and Mondays. Mental health workers might also consider scheduling more patient appointments on Wednesdays, he said.

Several mental health workers said they had not noticed a link between Wednesdays and an increased risk of suicide. More than 25,000 people kill themselves in the U.S. each year, an average of slightly more than one per day in each state, so trends that might be apparent from thousands of cases would not likely be noticed by individual mental health workers or programs.

A Courant analysis of Connecticut figures showed a different day distribution: from 2001 to 2004, no day stood out as sharply as Wednesday did in the national study. Most suicides — 16.7 percent — occurred on Tuesday, while 16.4 percent occurred on Monday and 14.5 percent on Wednesday. Thursday had the lowest occurrence, 12.1 percent. The data showed 966 adult suicides, a small fraction of the 131,636 in the national sample.

Seasonal suicide variations in Connecticut did reflect the national findings, with most occurring in summer and spring and fewer in winter and fall.

The seasonal figures contradict previous findings, but they didn't surprise Michael Levinson, director of clinical services at the Capitol Region Mental Health Center. He works nights in an emergency room and has gotten used to seeing more psychiatric emergencies in the spring.

"We always sort of look forward to spring gritting our teeth," he said.

While traditional thinking has focused on winter, with its cold weather and lack of sunlight, as a more common season for suicide, Levinson has a theory about why it may not be so: People think it's normal to be depressed in the winter. "Spring is the time of year when people are supposed to be rejuvenated and outside and enjoying themselves, and if you're not, it makes you feel comparatively worse than everybody else, which may make you feel more hopeless," he said.