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Control Group Studies of Suicide Survivors: A Review and Critique
Abstract
Empirical studies of suicide survivors with designs that include control groups are reviewed. Investigations are discussed individually with respect to those in which participating survivors are friends or a combination of many different relationships to the deceased, parents of the deceased child, and spouses. Following the review is a brief discussion of the commonalities of the findings and the most frequent methodological difficulties. Concluding comments suggest methodological improvements as well as issues and groups for which additional investigations are needed.
... Personality factors, in particular anankastic traits, are likely to determine how an individual reacts to life problems (see case vignette 5, Appendix 6) (Duberstein, 1995;Williams & Pollock, 2000) and demographic variables, such as living alone and being widowed may be predisposing factors to certain life problems as well as psychiatric disorder (Shah & De, 1998 Angeles (Farberow et al, 1987(Farberow et al, and 1992a(Farberow et al, , 1992b. Post-suicide bereavement research has tended to focus on spousal bereavement (McIntosh, 1993;Clark & Goldney, 2000) despite the fact that any suicide affects many other relatives and friends, and a high proportion o f older suicide victims are living alone (Cattell & Jolley, 1995 However, because o f limited information on non-participants, other variables, such as social disadvantage, which influence participation in bereavement research, could not be examined (Boyle et al, 1996, McIntosh, 1993. There was a clinical impression that some people took part in the study because they wished to discuss unresolved issues about their relative's death. ...
... Personality factors, in particular anankastic traits, are likely to determine how an individual reacts to life problems (see case vignette 5, Appendix 6) (Duberstein, 1995;Williams & Pollock, 2000) and demographic variables, such as living alone and being widowed may be predisposing factors to certain life problems as well as psychiatric disorder (Shah & De, 1998 Angeles (Farberow et al, 1987(Farberow et al, and 1992a(Farberow et al, , 1992b. Post-suicide bereavement research has tended to focus on spousal bereavement (McIntosh, 1993;Clark & Goldney, 2000) despite the fact that any suicide affects many other relatives and friends, and a high proportion o f older suicide victims are living alone (Cattell & Jolley, 1995 However, because o f limited information on non-participants, other variables, such as social disadvantage, which influence participation in bereavement research, could not be examined (Boyle et al, 1996, McIntosh, 1993. There was a clinical impression that some people took part in the study because they wished to discuss unresolved issues about their relative's death. ...
... 1.3.8) kinship to the deceased is an important determinant o f grief reactions (Cleiren et al, 1994, McIntosh, 1993, which leads to problems in interpreting the findings o f the study. However, although most sub-samples (eg spouses) are too small for meaningful subgroup analysis, the results from comparison o f children in the two groups partly confirm the results from the overall case-control comparison. ...
... Four of the articles are reviews (e.g., McIntosh, 1993) and the majority (8/12) have several authors. However, while soleauthored articles were at a disadvantage for being cited relative to multiauthored articles, four sole-authored articles made it into the most-cited list. ...
... However, while soleauthored articles were at a disadvantage for being cited relative to multiauthored articles, four sole-authored articles made it into the most-cited list. These included two by Reed (1993Reed ( , 1998 and one each by McIntosh (1993) and Jordan (2001). In only two cases, the first authors are females (Kolodny, Binder, Bronstein, & Friend, 1979;S eguin, Lesage, & Kiely, 1995). ...
... These included two by Reed (1993Reed ( , 1998 and one each by McIntosh (1993) and Jordan (2001). In only two cases, the first authors are females (Kolodny, Binder, Bronstein, & Friend, 1979;S eguin, Lesage, & Kiely, 1995). ...
Citation analysis has been neglected in suicidology. The present note applies a mixed-methods approach to both test and suggest hypotheses for the variation in article impact in the bereavement literature. One hundred three articles from three core suicidology journals met the criteria for inclusion in the investigation. Citations to the articles were obtained from the Web of Science. Predictor variables included structural characteristics of the author (e.g., gender) and the article itself (e.g., years since publication). A multivariate regression analysis determined that, controlling for the other variables, the most important predictor of citations was the review article (β = .461), followed by year of publication (β = -.414), the multiauthored article (β = .302), publication in Suicide and Life-Threatening Behavior (SLTB) (β = .161), and male gender (β = .156). The 12 most cited articles were published between 1979 and 2004 in SLTB. The majority of these papers was written by males, were U.S. authors, and had more than one author. Four of the most cited articles were reviews. The study concludes that structural characteristics of articles and authors explained 41% of the variance in citations. The qualitative analysis determined that review papers, and papers on characteristics of suicide bereavement and psychological autopsies have been most frequently cited. Replication studies are needed for other subfields of suicidology.
... Four of the articles are reviews (e.g., McIntosh, 1993) and the majority (8/12) have several authors. However, while soleauthored articles were at a disadvantage for being cited relative to multiauthored articles, four sole-authored articles made it into the most-cited list. ...
... However, while soleauthored articles were at a disadvantage for being cited relative to multiauthored articles, four sole-authored articles made it into the most-cited list. These included two by Reed (1993Reed ( , 1998 and one each by McIntosh (1993) and Jordan (2001). In only two cases, the first authors are females (Kolodny, Binder, Bronstein, & Friend, 1979;S eguin, Lesage, & Kiely, 1995). ...
... These included two by Reed (1993Reed ( , 1998 and one each by McIntosh (1993) and Jordan (2001). In only two cases, the first authors are females (Kolodny, Binder, Bronstein, & Friend, 1979;S eguin, Lesage, & Kiely, 1995). ...
Citation analysis has been neglected in suicidology. The present note applies a mixed methods approach to both test and suggest hypotheses for the variation in article impact in the bereavement literature. 103 articles from three core suicidology journals met the criteria for inclusion in the investigation. Citations to the articles were obtained from the Web of Science. Predictor variables included structural characteristics of the author (e.g., gender) and the article itself (e.g., years since publication). A multivariate regression analysis determined that, controlling for the other variables, the most important predictor of citations was the review article (Beta=.461), followed by year of publication (Beta= -.414), the multi-authored article (Beta=.302), publication in SLTB (beta=.161), and male gender (Beta=.156). The 12 most cited articles were published between 1979-2004 in SLTB. The majority of these papers was written by males, USA authors, and had more than one author. Four of the most cited articles were reviews. The study concludes that structural characteristics of articles and authors explained 41% of the variance in citations. The qualitative analysis determined that review papers, and papers on characteristics of suicide bereavement, and psychological autopsies, have been most frequently cited. Replication studies are needed for other subfields of suicidology.
... Despite the current knowledge about the experiences of suicide loss survivors, there is surprisingly little research on attitudes toward suicide loss survivors (Cvinar, 2005;Jordan, 2001;McIntosh, 2003). Existing literature shows that suicide loss survivors are highly stigmatized simply due to their association with a suicide decedent (Cvinar, 2005;McIntosh, 2003). ...
... Despite the current knowledge about the experiences of suicide loss survivors, there is surprisingly little research on attitudes toward suicide loss survivors (Cvinar, 2005;Jordan, 2001;McIntosh, 2003). Existing literature shows that suicide loss survivors are highly stigmatized simply due to their association with a suicide decedent (Cvinar, 2005;McIntosh, 2003). The few studies that have explored attitudes toward those grieving a death by suicide found that participants had more difficulty talking with and showing compassion for suicide loss survivors (Calhoun, Selby, & Abernathy, 1984) and were more likely to place blame on a bereaved individual when the cause of death was suicide as compared to other forms of death (Range & Thompson, 1987). ...
This study aimed to examine the attitudes of college students toward suicide and nonsuicide loss survivors’ future suicide intent —specifically the degree to which each is believed to be suicidal based on the characteristics of the loss and relationship to the deceased. Participants were asked to read a descriptive vignette about a bereaved individual and assess their judgment about the survivor’s current state of suicide-related ideation. The results revealed that the likelihood of indicating suicide related ideation was decreased by 5.9% for each year that the participant aged. This study provides useful knowledge about the perception of suicidal ideation among bereaved individuals.
... These additional challenges and risk factors faced by military suicide loss survivors may result in an unwillingness to seek social support and involve others in the grief process. This will reduce the likelihood that survivors will seek help (McIntosh, 1993). It is generally estimated that only one in four suicide loss survivors seek help (Aguirre & Slater, 2010). ...
... Complications in grief and stigma may be compounded by exhaustion and a loss of energy (Dyregrov, 2002), resulting in an unwillingness to involve others in the grief process as well as reducing a survivor's capability and likelihood that they will initiate help-seeking (McIntosh, 1993). In working with family survivors of a military suicide, Leenars & Wenckstern (1998) emphasize the need to begin working with survivors as soon after the death as possible, and within the first 24 h if feasible. ...
The United States military began to experience a steady increase in suicide rates across all service branches at the inception of the wars in Afghanistan (2001) and Iraq (2003). As the number of suicide deaths increased, so did the number of affected survivors who seek postvention support. Unique issues that accompany suicide death may expose survivors to a more distressing and complicated grief process. Peer support has clinically been observed to be widely utilized by suicide loss survivors. This article explores unique issues accompanying military suicide loss, potential benefits of postvention peer-based support, clinical considerations, and future directions.
... These additional challenges and risk factors faced by military suicide loss survivors may result in an unwillingness to gain social support and involve others in the grief process, thus reducing the likelihood that survivors will seek help (McIntosh, 1993). It is estimated that only one in four suicide survivors seek help (Aguirre & Slater, 2010). ...
... These risk factors, which also can be compounded by exhaustion and a loss of energy (Dyregrov, 2002), result in an unwillingness to involve others in the grief process, as well as reducing survivors capability and likelihood that they will initiate help-seeking (McIntosh, 1993). ...
SURVIVORS OF A MILITARY SUICIDE DEATH:
EXPLORING DISTRESS AND POSTVENTION PEER SUPPORT
In the past decade, as the rate of suicides among United States (U.S.) Armed Services members have steadily risen, so too has the number of survivors impacted by military suicide death. When a loved one, friend, family member, or co-worker dies as a result of a suicide, the ensuing shock and trauma -- along with unique issues accompanying suicide bereavement -- may compromise the mental and physical health of survivors. This leaves them vulnerable to a more distressing and complicated grief process. Those bereaved by suicide are at higher risk for completing suicide themselves. Peer support, an acknowledged basis of recovery from mental illness and addictions, has been clinically observed to be widely utilized by suicide loss survivors. Researchers have paid little attention to efficacious interventions for survivors of suicide loss in the general population of the U.S., even less is known about the efficacy of peer support among survivors of a U.S. military suicide death.
In order to assess this gap in clinical knowledge, fifty-two (N=52) survivors of military suicide loss were administered two self-report instruments to evaluate the association between exposure to peer support and perceived distress. This exploratory study with an at-risk bereaved population has yielded a number of new insights and conclusions. Recommendations for clinical practice and future research are discussed.
... My interviewees' experience of their mother's premature death reverberated throughout their lives, shaping narratives that circled, spun around, and included past, present, and future in any number of configurations that helped them to make sense of their experiences. (Davidman, 2000, p. 167) While some scholars conclude that there is no significant empirical evidence to indicate that suicide bereavement does not impact survivors more than other modes of death (Cleiren & Diekstra, 1995;McIntosh, 1993). Other scholars argue that some questions remain open. ...
... For example, in a telephone survey study of 144 next-of-kin suicide grievers, only twenty-five percent indicated that they received any help since their bereavement, while seventy-four percent reported a desire for help (Provini, Everett, & Pfeffer, 2000). Other studies report that suicide grievers seem to encounter difficulty initiating or searching for formal assistance with their grief (McIntosh, 1993). These findings suggest that there is a potential mismatch between desired support in peer suicide grievers and available mental health or services. ...
... The literature on suicide bereavement identifies survivors as highly stigmatized (McIntosh, 2003;Jordan, 2001;Dunne, McIntosh, & Dunne-Maxim, 1987;Harwood, Hawton, Hope, & Jacoby, 2002;Cvinar, 2005). Historical records show that during the Middle Ages suicide stigmatization was fully institutionalized: suicide corpses were regularly mutilated to prevent the unleashing of evil spirits; suicides were denied burials in church cemeteries and the property of their families was confiscated and put into the control of local agents, with the excommunication of these families from the community (Cvinar, 2005). ...
... Today some analysts suggest that the stigmatization experienced by survivors may greatly complicate their bereavement experiences (McIntosh, 2003;Jordan, 2001;Dunne, et al., 1987;Cvinar, 2005). One early empirical study based on medical examiner records and a mailback survey of survivors found evidence consistent with these assertions. ...
With survey data collected primarily from peer support group participants, we compared stigmatization responses of 462 parents losing children to suicide with 54 other traumatic death survivors and 24 child natural death survivors. Parents who encountered harmful responses and strained relations with family members and non-kin reported heightened grief difficulties. After controlling for time since the death and whether a child's death was traumatic or not, stigmatization continued to be associated with grief difficulties, depression and suicidal thinking. Suicide survivors reported little differences in stigmatization from other-traumatic- death survivors, a result consistent with other recent studies, suggesting more convergence between these two populations than divergence.
... Suicide survivors are people who have lost a significant other to suicide. The literature identifies suicide survivors as highly stigmatized (Dunne et al., 1987;Jordan, 2001;Harwood et al., 2002;Mcintosh, 2003;Cvinar, 2005). In the past, customs such as the mutilation of suicide corpses (to prevent the release of evil spirits), burials outside church cemeteries, confiscation of the suicide's family property and the excommunication of these families from the community, fueled stigmatization of suicide (Cvinar, 2005;Dunne-Maxim, 2007). ...
... The stigmatization experienced by survivors has been sparsely investigated (Dunne et al., 1987;Jordan, 2001;Mcintosh, 2003;Cvinar, 2005). However, until now, only a few researchers have explicitly quantified stigmatization. ...
This study aimed at validating two new assessment tools, the Stigma of Suicide Attempt (STOSA) scale and the Stigma of Suicide and Suicide Survivor (STOSASS) scale. The Devaluation-Discrimination scale of Link et al. was translated into Italian and adapted to measure stigma towards suicidal behavior. Both scales were administered to a mixed sample including members of the general population (n=282), patients with a mental disorder (n=113), suicide attempters (n=57) and people who had lost a significant other to suicide (n=75). Reliability of the scales was good in terms of both internal coherence and test-retest stability. Factor analysis produced an acceptable solution for the STOSA-scale. Items were distributed into two factors, one grouping items to measure supportive, respectful and caring attitudes, the other factor grouping items oriented towards stigmatizing attitudes and beliefs. The clinical populations were more inclined towards stigmatization of suicide than were people from the general population, who might be less aware of the stigma attached to suicide. The two scales may be helpful to quantify stigma at individual level in order to provide targeted supportive interventions, and at population level to measure changes in the beliefs and attitudes of the general population.
... Bereavement by suicide may lead to a range of complex emotions, including grief, shock, denial, anger, guilt, shame, and relief (Dunne-Maxim, 1986;McIntosh, 1993). While most survivors of suicide are able to navigate the grieving phase without support from professionals, for some, the grief may take on a pathological or chronic character, also referred to as complicated grief (Shear & Shair, 2005). ...
Objective
The loss of a friend or family member to suicide, i.e., surviving suicide, can be devastating. Yet, little is known regarding the support received by survivors of suicide. We aimed to examine the characteristics of survivors of suicide who sought counseling from a Danish volunteer organization.
Method
Data on all users of the Danish Network for those Affected by Suicidal Behavior (NASB) were obtained during 2012–2018. Information on age, sex, relation, time of loss, municipality was analyzed, and geographical driving distances calculated.
Results
Altogether, 1,268 survivors of suicide (mean age 43.3; 29.8% of all suicides) received counseling from NASB. In all, 81.8% of service users had lost a partner or first-degree relative; those being spouses/partners (15.3%), parents (28.5%), children (19.0%), and siblings (15.4%). Female service users (71.1%) outnumbered males (28.7%). A third of users sought counseling within 6-months of the death. A help-seeking rate of 6 users per 10 suicide deaths was found within close proximity to a counseling venue; equivalent of 5.5 (95% CI: 5.0–6.0) users per 100,000 inhabitants. Each additional 10 km of driving distance was associated with a 15% lower rate of use (b: −0.015; 95% CI: 0.027 to 0.003; p = 0.013).
Conclusion
Geographical proximity to help centers was important and could suggest that support might be lacking in some parts of the country. It seems likely that more than 0.6 persons per suicide might seek counseling from volunteer organizations if services were available within short driving distance.
•
HIGHLIGHTS
• More than one out of three who sought support after a suicide death were partners or first-degree relatives and only a third of users who sought counseling did so within 6-months of the death. Also, female sought counseling more frequently than males.
• Approximately 5.5 people per 100,000 inhabitants sought help after a suicide in areas where a counseling venue was within short driving distance.
• Based on the region with most counseling venues, 6 survivors would seek support per 10 suicide deaths.
... Bereavement by suicide may lead to a range of complex emotions, including grief, shock, denial, anger, guilt, shame, and relief (Dunne-Maxim, 1986;McIntosh, 1993). While most survivors of suicide are able to navigate the grieving phase without support from professionals, for some, the grief may take on a pathological or chronic character, also referred to as complicated grief (Shear & Shair, 2005). ...
Objective
Little is known about people who have been exposed to a suicide attempt by someone they know. The purpose of this study was to examine how many people have been exposed to a suicide attempt by someone they knew and whether the exposure was associated with general well‐being and suicidal ideation.
Method
A population‐based online survey was conducted during 2019 in Denmark (n = 6,191). The associations between exposures to suicide attempt and general well‐being (WHO‐5) and suicidal ideation (Suicidal Ideation Attributes Scale) were examined using linear regression analyses.
Results
Overall, 24.6% reported having experienced a suicide attempt by someone they knew. Of those, 46.5% had experienced a suicide attempt of a close relation and this group reported having been more affected by the event. Those exposed scored lower on general well‐being (b: −3.0; 95% CI: −4.2 to −1.8; p > 0.001) and higher on suicidal ideation (b: 1.6; 95% CI: 1.3 – 1.9; p = 0.001) than those not exposed. Half of the exposed reported not having received sufficient support after the event.
Conclusion
Suicide attempt affects a substantial share of the population, and it might be relevant to ensure that support is available for those exposed perceived to be in need of support.
... Qualitative studies of older adults who ended their life are rare as are those that investigate the impact of this event on close family members. Therefore, the preliminary results of this qualitative study fill some gap in the literature on survivors of older adults' suicide which tended to focus mainly on the spouse (McIntosh, 1993;Clark and Goldney, 2000). The present study explored the effects of the suicide of an older person on other members of the family, in this case, a daughter, a grandson, and a great niece. ...
Suicide in older persons is a serious issue in many countries. The act of intentionally causing one’s own death is often associated with lack of social support, thwarted belongingness, or chronic interpersonal difficulties. Therefore, suicide has a significant interpersonal dimension that can influence those left behind. However, studies that have investigated the impact of older adults’ suicide on their family are scarce. The objective of this pilot study was to assess the feasibility of a qualitative research on the psychosocial experience of adults bereaved by the suicide of an elderly relative. This research could recruit three participants (daughter, grand-son, and grand-niece) who had lost to suicide a close family member aged between 75 and 90. The analysis of the content of the semi-structured interviews revealed seven main themes: (1) finding an explanation to the suicide, (2) give meaning to the loss, (3) the emotional processes of mourning, (4) the repercussions of the suicide on the individual and the family, (5) looking for support, (6) the taboo and secrecy of suicide, and (7) perceptions of aging and the end of life. To explain the suicide of their loved one, the bereaved mentioned various factors related to aging, such as loss of autonomy, illness, and fear of placement. Although the older relative was perceived to be approaching death because of his/her age, the suicide was still unexpected and shocking and led to various emotions (shock, anger, and guilt) and to family conflicts. Suicide remains a taboo subject, but the newly legalized medical assistance in dying is seen as a potential solution to suffering in old age. Further investigation is clearly needed on this topic and this pilot study indicates that the main difficulties will lie in the choice of selection criteria for participants and in the recruitment process.
... The suicide-bereaved also perceive pervasive stigma toward themselves and their loved one's death (e.g., Cvinar, 2005) and this stigma is associated with increased grief-related difficulties (Feigelman, Jordan, & Gorman, 2009). Importantly, other studies have failed to find differences between suicide-bereaved adults and adults bereaved by other causes of death (e.g., Feigelman, Jordan, & Gorman, 2009;Murphy, Johnson, Wu, Fan, & Lohan, 2003;McIntosh, 1993) or have found differences in specific domains (e.g., grief experiences) but not in others (e.g., post-traumatic stress disorder; Sveen & Walby, 2008). Inconsistent results suggest that more research is needed to understand the specific grief experiences of the suicide-bereaved. ...
Previous research has shown that bereavement following the loss of a loved one can often produce a variety of physical and psychological effects for the individuals left behind. Specifically, the suddenness and violence of a death may be particularly important determinants of subsequent negative psychological functioning. The purpose of this study was to gain a better understanding of the grief experiences of individuals bereaved by different causes of death, specifically focusing on the suddenness of the death. Adult participants completed an online survey including demographic questions and psychological measures. The results suggest that individuals who lost someone to a sudden death reported more negative outcomes and impairment than individuals who lost someone to a more expected death. These results suggest that the cause and circumstances surrounding the death may play an important role in an individual’s grief and bereavement experiences.
... Researchers have called for a more specific focus on de-pathologizing bereavement and improving the understanding of those trajectories that appear more typical versus those that may require clinical intervention (Bonanno, 2001). Research suggests that suicide bereavement outcomes are generally nonpathological and more similar than dissimilar to other forms of bereavement (McIntosh, 1993) when considering overall mental health, mental illness symptoms, and suicide-related behavior (Sveen & Walby, 2008). However, few studies have investigated for mechanisms that positively influence the course traversed by the loss survivor. ...
Background:
Although suicide loss has been associated with several negative outcomes, numerous studies have shown that loss survivors can experience posttraumatic growth (PTG) following the suicide loss of a significant other. However, few studies have explored the mechanisms of such growth.
Aims:
The aim of this study was to identify predictors of PTG among a sample of adult suicide loss survivors and to explore whether the amount of time since the suicide loss moderated the relation between self-reported coping and PTG.
Method:
Suicide-bereaved adults (n = 307) completed online questionnaires measuring personality, coping, help-seeking attitudes, social support, and PTG.
Results:
Hierarchical regression analyses showed five independent associations with PTG: time since loss, perceived closeness, help-seeking attitudes, social support, and problem-focused coping. Time since loss did not moderate the relation between any of the self-reported coping styles and PTG.
Limitations:
The limitations of this study include a cross-sectional design, potential selection bias, no comparison or control group, and unrepresentative sample demographics of suicide loss survivors.
Conclusion:
Problem-focused coping showed the strongest association with PTG, independent of time since loss, suggesting that this coping style may facilitate growth throughout the grief trajectory.
... There have been mixed results regarding how suicide bereavement differs from other forms of bereavement [9,10]. A seminal review [10] posited that suicide bereavement can be differentiated by three over-arching themes. ...
Background:
Little research has been conducted into the physical health implications of suicide bereavement compared to other causes of death. There is some evidence that suicide bereaved parents have higher morbidity, particularly in terms of chronic illness. This systematic review aims to examine the physical and psychosomatic morbidities of people bereaved by a family member's suicide and compare them with family members bereaved by other modes of death.
Methods:
MEDLINE, EMBASE, CINAHL, and PsycINFO were searched from 1985 to February 2016. The search was re-run in March 2017. Peer-reviewed English language articles comparing suicide-bereaved family members to non-suicide bereaved family members on measures of physical or psychosomatic health were eligible for inclusion. Cohort, cross-sectional, case-control and cohort-based register studies were eligible for inclusion. A modified version of the Newcastle Ottawa Scale was used for quality assessment. Results were synthesised using narrative synthesis.
Results:
The literature search located 24 studies which met the inclusion criteria. Seven studies found statistically significant associations between physical health and suicide bereavement. Five of the studies found that suicide-bereaved family members were more likely to experience pain, more physical illnesses and poorer general health. They were also at increased risk of cardiovascular disease, hypertension, diabetes and chronic obstructive pulmonary disease. In contrast, another study in Denmark found that those bereaved by suicide had a lower risk of a number of physical health disorders, including cancers, diabetes, cardiovascular and chronic lower respiratory tract disorders compared to those bereaved by other causes of death. Additionally, a further study conducted in the United States found that suicide-bereaved children visited a GP less frequently than non-suicide bereaved children.
Conclusions:
Review findings are relevant for clinicians working with people bereaved by suicide as they highlight that such clients are at increased risk of several adverse physical health outcomes. Future research should examine health risk behaviours of suicide-bereaved and non-suicide bereaved family members as they may confound the association between exposure and outcome.
Trial registrations:
The review protocol has been registered on PROSPERO, registration number CRD42016030007 .
... Many suicide survivors (42%) exhibit high levels of shame and 22% exhibit suicidal thoughts of their own ( McMenamy, Jordan, & Mitchell, 2008). Many people bereaved after suicide of a friend or family member also feel strongly that they could and should have done something to prevent the suicide, believing intellectually and emotionally that they could have changed the outcome ( Hunt & Hertlein, 2015), thus compounding their grief with a sense of failure and shame ( McIntosh, 1993). Therefore, family members of a person who died by suicide may experience higher levels of shame than family members who died of natural causes ( Allen, Calhoun, Cann, & Tedeschi, 1994). ...
While many single factors of prolonged grief have been identified in the literature, a comprehensive understanding of predictors is still lacking. This paper argues that shame and low self-esteem, present risk factors in prolonged grief after spousal loss, based on a review of correlational studies. Using a practitioner-scientist approach a developmental model of shame as a core factor in prolonged grief is proposed, outlining the progression from childhood relational trauma, to insecure attachment, shame, self-esteem contingent on spousal approval to eventual prolonged grief.
... The need to improve suicide bereavement research has been addressed by several scholars over time (Cain, 1972;Clark, 2001;Farberow, 1991;Maple, Cerel, Jordan, & McKay, 2014;McDaid, Trowman, Golder, Hawton, & Sowden, 2008;McIntosh, 1993;. Their recommendations include the need to apply sound research and recruitment methodologies, use of adequate samples sizes, involvement of control groups, and reliable instruments. ...
Background:
Suicide can have a lasting impact on the social life as well as the physical and mental health of the bereaved. Targeted research is needed to better understand the nature of suicide bereavement and the effectiveness of support.
Aims:
To take stock of ongoing studies, and to inquire about future research priorities regarding suicide bereavement and postvention.
Method:
In March 2015, an online survey was widely disseminated in the suicidology community.
Results:
The questionnaire was accessed 77 times, and 22 records were included in the analysis. The respondents provided valuable information regarding current research projects and recommendations for the future.
Limitations:
Bearing in mind the modest number of replies, all from respondents in Westernized countries, it is not known how representative the findings are.
Conclusion:
The survey generated three strategies for future postvention research: increase intercultural collaboration, increase theory-driven research, and build bonds between research and practice. Future surveys should include experiences with obtaining research grants and ethical approval for postvention studies.
... The stigmatization experienced by suicide survivors has been sparsely investigated [33,34,35,26,36]. The literature on suicide bereavement indicates that survivors are the target of negative stereotypes, prejudice or discrimination [26,37,36] and that the stigma experienced by survivors themselves may in turn complicate their grief [26,38], negatively affecting their psychological wellbeing [36]. ...
Background: Suicide bereavement is frequently related to clinically significant psychological distress and affected by stigma. This study was designed to evaluate the relationship between psychological distress by psychopathological domains and stigma, in a sample of individuals bereaved by suicide (suicide survivors). Methods: The data were collected between January 2012 and December 2014 and included information on sociodemographic variables (gender, age, marital status and education level) and responses to the Stigma of Suicide Survivor scale (STOSSS) and the Brief Symptom Inventory (BSI). One hundred and fifty-five suicide survivors completed the evaluation and were included in the study. Results: Levels of psychological distress in suicide survivors, as measured by BSI, were positively related to levels of perceived stigma toward suicide survivors, as measured by STOSSS. The association was not affected by age and gender, or by marital status, education level, days from suicide or a personal history of suicide attempt. Participants with higher scores on almost all subscales of the BSI, particularly the interpersonal sensitivity and paranoid ideation subscales, reported the highest levels of perceived stigma toward suicide survivors. Conclusion: Levels of distress in subjects bereaved by the suicide of a relative or friend were positively associated with levels of perceived stigma toward suicide survivors. Specific interventions dedicated to the bereavement of suicide survivors might help to alleviate not only psychological distress but also stigma towards loss by suicide.
... P. H. D. Cleiren & Diekstra, 1995;De Groot et al., 2006;Feigelman et al., 2009;Harwood et al., 2002). Family members that report abandonment, marital separation, chronic turmoil, and other problematic family dynamics, such as in chaotic families, may exhibit these dysfunctional patterns prior to the suicide, but they can become worse post-suicide (Kaslow & Gilman Aronson, 2004;Kuramoto, Brent, & Wilcox, 2009;McIntosh, 1993;McIntosh, 1999;Mitchell et al., 2004). ...
The impact of service member suicides on families is not well understood. Civilian studies have demonstrated that family survivors of suicide deaths experience complicated grief, feel guilt and shame, and often do not receive sufficient social support. In this exploratory study, spouse survivors of Marines who died by suicide (N = 17), accident (N = 19), and in combat (N = 34) retrospectively reported on their immediate pre- and postmortem and current personal and family functioning. Nonparametric analyses revealed that several between-group differences existed. Observation of the means suggested that the spouses and families of Marines who died by suicide exhibited significantly poorer pre- and postmortem functioning compared with those whose spouses died in combat. Specific challenges included low family cohesion, high family conflict, perceived stigma, and shame. There were no differences in current spouse or family functioning, and there was weak evidence for posttraumatic growth among surviving spouses of those dying by suicide. These results should be considered preliminary and interpreted with caution given several methodological challenges.
... The relationship connecting the bereaved and the deceased-and the resulting impact on bereavement-has received increasing attention. The focus has moved from one of kinship relationships (Cleiren, Diekstra, Kerkhof, & van der Wal, 1994;Dyregrov et al., 2003;Mitchell, Kim, Prigerson, & Mortimer-Stephens, 2004;Rubin, 1993;Shneidman & Cain, 1972;Wijngaards-De Meij et al., 2008), close psychological connection (Brent et al., 1993;Mitchell et al., 2004) and 'loved ones' (Andriessen, 2009;McIntosh, 1993;Zinzow et al., 2009) to a more encompassing and complex view which incorporates all of these relationships (Andriessen & Krysinska, 2012;Berman, 2011;Hibberd et al., 2010;Jordan & McIntosh, 2011b;Zinzow et al., 2009). The essential feature of bereavement seems related more to self-perceived closeness to the deceased than to a specific type of relationship (Cerel, Maple, Aldrich, & van de Venne, 2013;Cerel et al., 2015;Dyregrov et al., 2012). ...
... The stigmatization experienced by suicide survivors has been sparsely investigated [33,34,35,26,36]. The literature on suicide bereavement indicates that survivors are the target of negative stereotypes, prejudice or discrimination [26,37,36] and that the stigma experienced by survivors themselves may in turn complicate their grief [26,38], negatively affecting their psychological wellbeing [36]. ...
Background:
Suicide bereavement is frequently related to clinically significant psychological distress and affected by stigma. This study was designed to evaluate the relationship between psychological distress by psychopathological domains and stigma, in a sample of individuals bereaved by suicide (suicide survivors).
Methods:
The data were collected between January 2012 and December 2014 and included information on sociodemographic variables (gender, age, marital status and education level) and responses to the Stigma of Suicide Survivor scale (STOSSS) and the Brief Symptom Inventory (BSI). One hundred and fifty-five suicide survivors completed the evaluation and were included in the study.
Results:
Levels of psychological distress in suicide survivors, as measured by BSI, were positively related to levels of perceived stigma toward suicide survivors, as measured by STOSSS. The association was not affected by age and gender, or by marital status, education level, days from suicide or a personal history of suicide attempt. Participants with higher scores on almost all subscales of the BSI, particularly the interpersonal sensitivity and paranoid ideation subscales, reported the highest levels of perceived stigma toward suicide survivors.
Conclusion:
Levels of distress in subjects bereaved by the suicide of a relative or friend were positively associated with levels of perceived stigma toward suicide survivors. Specific interventions dedicated to the bereavement of suicide survivors might help to alleviate not only psychological distress but also stigma towards loss by suicide.
... At the same time, however, research reviews of comparative studies that included control groups of different bereavement categories showed no significant differences in general mental health outcomes, such as depression, PTSD symptoms, anxiety or suicidal behaviour (excluding completed suicides) (see McIntosh 1993;Sveen and Walby 2008). Nonetheless, this might be explained by the big similarities identified between suicide bereavement and bereavement following other traumatic and violent deaths (Jordan and McIntosh 2011a). ...
Grief following a parent’s suicide has been called ‘the silent grief’: due to a prevailing stigma connected to suicide as a mode of death, the parent cannot be talked about. This silenced or distorted communication complicates grieving youths’ meaning reconstruction centred on the question of why the parent committed suicide – a question inevitably linked to queries of who the deceased parent was, and that ultimately triggers thoughts about who oneself has become in the light of this experience. Previous research has emphasized how vulnerable parentally suicide-bereaved youths are by categorizing them as ‘at risk group’ of social and psychological problems and even suicide. However, there is scant knowledge about how these young mourners perceive and manage their own grief and need for social support – knowledge that is essential from a professional perspective. The aim of this thesis is to use a narrative research approach to investigate what and how young mourners tell of their experiences in a variety of social contexts: research interviews, a theatre play and two chat contexts on the Internet. Since they actively seek to achieve something through their communication with others, mourning youths are seen as storytellers and social actors, rather than passive victims of circumstance. This thesis shows how these young mourners search for a context outside of their immediate daily networks where they can normalize and liberate themselves and their deceased parent from stigmatizing discourses. The possibility of narrating experiences in a de-stigmatizing context supports a renegotiation of how to make sense of the suicide – from a voluntary and selfish act, to an involuntary and desperate act caused by adverse life situations or ‘unbearable pain’ and depression. This knowledge is applicable to encounters with parentally suicide-bereaved youths in a professional context, such as social work practice.
... At the same time, however, research reviews of comparative studies that included control groups of different bereavement categories showed no significant differences in general mental health outcomes, such as depression, PTSD symptoms, anxiety or suicidal behaviour (excluding completed suicides) (see McIntosh 1993;Sveen and Walby 2008). Nonetheless, this might be explained by the big similarities identified between suicide bereavement and bereavement following other traumatic and violent deaths (Jordan and McIntosh 2011a). ...
... However, some have cast doubt on empirical differences existing between the suicide bereaved and those surviving the loss of loved ones to other causes of death (Clark & Goldney, 2000). In a review article, McIntosh (1993) found the suicide bereavement experience is generally nonpathological, there are more similarities than differences compared with those mourning losses due to other causes of death, and, after the 2-year mark, differences in grief from other forms of bereavement may appear minimal. Despite the lack of agreement on suicide bereavement, the search for meaning in the death or "why" is frequently a prominent feature of the suicide bereaved's journey (Barrett & Scott, 1989;Wagner & Calhoun, 1992). ...
Background:
While there is evidence that suicide-bereaved individuals may be at higher risk for trauma-related outcomes, such as posttraumatic stress disorder or prolonged grief, positive psychology suggests that suicide bereavement may also promote personal growth within the confines of distress characterized as posttraumatic growth (PTG).
Aims:
The aim of this study was to investigate PTG and what variables, such as reflective rumination, resilience, personality variables, and mood states, contribute to PTG among suicide-bereaved parents.
Method:
Online survey methods were employed using a convenience sample of 154 parents bereaved by the suicide death of their child within 2 years.
Results:
Multiple regression analyses revealed that resilience inversely predicted PTG scores, but reflective rumination did not predict PTG. PTG scores were in the low-moderate range and were lower than those of parents bereaved by other causes of death. Items endorsed most strongly corresponded to the PTG factors Relating to Others, Spiritual Change, and Appreciation of Life.
Conclusion:
In this study, PTG manifests among suicide-bereaved parents, but may be complicated by the proximity to the death and by concurrent brooding and reflective rumination unique to answering the question of "why" in this population.
... This rate is much lower than those reported by many other PPD prevention programs (Stamp et al. 1995;Brugha et al. 2000;Le Strat et al. 2011), some of which describe attrition rates over 50 % (e.g., Lara et al. 2010). We attribute our 0 % attrition rate to our careful attention to the barriers to PPD treatment, including calling our intervention Bcoaching sessionst o address the stigma associated with receiving mental health care (McIntosh 1993) and improving the accessibility of this treatment by offering it at the same time women are receiving routine medical care. In addition, we hypothesize that targeting the dyad and teaching infant care techniques in addition to the use of traditional psychotherapeutic techniques may have increased engagement in the treatment. ...
Most interventions to prevent postpartum depression (PPD) focus on the mother rather than the mother-infant dyad. As strong relationships between infant sleep and cry behavior and maternal postpartum mood have been demonstrated by previous research, interventions targeted at the dyad may reduce symptoms of PPD. The goal of the current study was to examine the effectiveness of Practical Resources for Effective Postpartum Parenting (PREPP). PREPP is a new PPD prevention protocol that aims to treat women at risk for PPD by promoting maternally mediated behavioral changes in their infants, while also including mother-focused skills. Results of this randomized control trial (RCT) (n = 54) indicate that this novel, brief intervention was well tolerated and effective in reducing maternal symptoms of anxiety and depression, particularly at 6 weeks postpartum. Additionally, this study found that infants of mothers enrolled in PREPP had fewer bouts of fussing and crying at 6 weeks postpartum than those infants whose mothers were in the Enhanced TAU group. These preliminary results indicate that PREPP has the potential to reduce the incidence of PPD in women at risk and to directly impact the developing mother-child relationship, the mother's view of her child, and child outcomes.
... Many survivors also feel strongly that they could have done something to prevent the suicide, thus compounding their grief with a sense of failure and shame (McIntosh, 1993). Through this expression of guilt and implicit shame, the idea that survivors have done something wrong and have failed their loved one may begin to grow , potentially to the point where they feel like murderers (Chance, 1988) and have been demonstrated to be perceived by others as more blameworthy, less likeable, and more ashamed than persons bereaved through other means (Allen, Calhound, Cann, & Tedeschi, 1993). ...
Suicide is a devastating event for individuals, families, and societies. With a conservative estimate of 1 million deaths worldwide per year as the result of suicide, it affects every fabric of society. In addition to managing the trauma of the death, it is family structure and processes that are altered in significant ways, specifically with regard to communication around the pain of the event. This article will address intervention and conceptualization through an attachment-based therapeutic process while attending to the three key areas that correspond with suicide bereavement: shame/guilt/blame, crisis of faith, and managing internalized messages.
... The stigmatization can be painful for suicide survivors whose guilt, shame, and blame can be intensified and reinforced by the lack of discussion about suicide within a community (Fine & Myers, 2003). There has been a profusion of articles, papers, and chapters written on suicide survivorship in an effort to understand suicide bereavement (Dyregov, 2002;McIntosh, 1993;Ness & Pfeffer, 1990). However, this literature exclusively focuses on the experiences of Whites-with the exception of a few studies on suicides among the Chinese that do not focus primarily on survivors (He & Lester, 1997;Pearson & Liu, 2002). ...
This article describes an exploratory qualitative study that examined the impact of suicide on a group of 19 African American families who lost a family member to suicide. The majority of suicide survivors were women who lost children to suicide. The participants were interviewed for an average of 2.5 hours using a semi-structured interview that was developed by the author. The majority of survivors felt that they had to go through the grieving process alone. Those survivors who did receive support most often received it from family members and friends. Most of the respondents felt that the support, if any, that was offered from the church was unhelpful. Negative attitudes about suicide from the broader community and from family members made it more difficult for these families to grieve.
... There is also the possibility of projection. Studies of suicide survivors have found that they were more likely than controls to have histories of psychiatric disorders and to have close relatives with mental illness (McIntosh, 1993). ...
For more than fifty years the psychological autopsy has been used in suicide research. The most common application is to determine the incidence of diagnosable psychiatric disorders in suicide victims. These studies have consistently found that about ninety percent of the decedents who were the subjects of such inquiries had signs of mental illness based on interviews of those who knew them in life. This finding is cited to such an extent that it almost seems to be axiomatic. As a result, mental illness appears to overshadow other suicide risk factors. Individuals with mental illness have a high risk of suicide but this may be because of exposure to many other risk factors, some of which are precipitated by mental illness or which interact with it. Psychological autopsy-based studies of suicide victims have received little critical attention. Here they are examined in terms of the reliability of informants, the methodology, feasibility of diagnosis by proxy, other data, and new theories of suicide.
... The "survivors of suicides" (or "suicide survivors"; in this paper we will consider these two terms interchangeably) include family members and friends who experience the loss of a loved one. [1,2] It is estimated that approximately one in four people know someone who has taken their own life and that one suicide death leaves six or more suicide survivors. [3,4] As Shneidman noted, suicide survivors represent the largest mental health casualty area related to suicide. ...
It is estimated that approximately one in four people know someone who has taken their own life and that one suicide death leaves six or more suicide survivors.
The aim of this paper was to review the literature regarding the association between suicide and bereavement, focusing also on the supportive and therapeutic resources available for survivors.
Careful MedLine and PsycINFO searches for the period 1980-2013.
The review of the literature indicates that emotional turmoil in suicide survivors may last a long time and, in some cases, may end with their own suicide.
Future research should evaluate the efficacy of professional treatments and of support groups targeting suicide survivors.
It is crucial to understand the bereavement process after the suicide of a significant other in order to provide proper care, reduce stigma, and improve the outcomes of related psychiatric conditions.
... They focus on the fact that there existed a relationship between the deceased and the bereaved, on the closeness of this relationship and/or the impact of the loss on the bereaved. For example, McIntosh [1] defined suicide survivors as " the family members and friends who experience the suicide of a loved one " (p. 146) and Andriessen [2] defined a survivor as " a person who has lost a significant other (or a loved one) by suicide, and whose life is changed because of the loss " (p. ...
During the past decades public and research interest in postvention, i.e., support for families and communities after a suicide, has increased. However, the postvention field is still facing a number of important challenges and questions. This article aims to discuss a series of essential issues on suicide bereavement and postvention, regarding the current state of the art and future developments. Who is a suicide survivor and how many suicide survivors are there? Is suicide bereavement different from other types of bereavement? What are the needs of suicide survivors and what is postvention from a clinical perspective and from a public health perspective? Can postvention be prevention? With this last question, the article concludes with a series of recommendations in order to strengthen the potential of postvention as prevention.
Objective
We expand upon previous research examining the prevalence of exposure to suicide deaths by comparing these to natural and accidental deaths. Furthermore, we examine whether participants are more apt to lie about the cause of death for a suicide than for an accidental or natural death.
Method
The sample consisted of 1,430 respondents who were recruited via Amazon's Mechanical Turk to complete an online study. Participants completed measures to assess exposure to death, causes of death, and willingness to disclose the cause of death to others.
Results
Nearly all respondents (94.5%) had been exposed to a natural death, and most of our sample (63.2%) reported exposure to a suicide death. Among those affected by all three causes of death, RANOVA analysis also indicated that people lied about cause of suicide death to significantly more people than accidental or natural.
Conclusions
Overall, the current study presents updated prevalence rates of exposure to various types of death and replicates previous findings of a decrease in willingness to disclose suicides when compared with other causes of death.
Objectives. This study investigates whether a programme of mindfulness-based
weekend retreats (Panta Rhei) is able to improve mood states, mindfulness qualities,
and self-compassion in family members and friends of suicide victims (suicide survivors).
Design. Longitudinal prospective study.
Methods. Sixty-one suicide survivors participated in a mindful-self-compassion retreat.
The Five-Facet Mindfulness Questionnaire, the Profile of Mood States (POMS), and the
Self-Compassion Scale were administered 4–6 days before and after the retreat.
Results. A significant reduction in all dimensions of the POMS (except Vigor-Activity)
and lower levels of overidentification were observed after the retreat.
Conclusions. Although further research is warranted, this study highlights the potential
beneficial effect of brief mindfulness-based weekend retreats on the well-being of suicide
survivors.
Despite the fact that a large number of people are bereaved by suicide each year, the experiences of those bereaved by suicide are poorly understood. It has been suggested that a contributing factor in relation to this lack of understanding has been the use of quantitative methods, which may not be sensitive to the bereavement process and its thematic content. Therefore, the current article outlines a systematic review of 11 qualitative studies that address issues related to the bereavement process following suicide. The results indicate that those bereaved by suicide encounter a range of difficult feelings following suicide including blame, guilt, and emptiness and that these feelings are affected by participants’ ability to make meaning of the event. The meaning-making process is a complex one that occurs within a difficult social context in which both those bereaved by suicide and members of the wider community struggle to interact with each other in a beneficial way. Clinical implications of these findings are discussed.
The suicide of a parent has life-long consequences; few more traumatic scenarios exist, and counselors often struggle for ways to help their patients deal with its effects. No individuals understand the pain and life-altering effects of these tragedies better than children who have been victims of the suicide of a parent. Despite this, there are few texts that incorporate and evaluate the first-person accounts of these individuals while advancing a method for treating these patients. Losing a Parent to Suicide analyzes these stories of parent suicide and the subsequent grief and coping, discovering the strategies, methods and modes of therapy that have succeeded in empowering grief-stricken individuals to move beyond the trauma and rebuild their lives.
Exposure to suicide in social relationships may be associated with suicidal ideation among survivors. In South Korea, which is known for having the highest suicide rate among OECD countries, exposure to suicide in social relationships can have serious consequences as social relationships are greatly emphasized in the society. The purpose of this study was to examine the association between survivors' suicidal ideation and their exposure to suicide in close relationships. Data collected through a telephone survey of a total of 1,000 men and women selected from across the nation using a stratified sampling method were analyzed. The results show that individuals who lost a family member, friend, or acquaintance in their lifetime are 4.5 times, 3.7 times, 2.2 times, respectively, more likely to have suicidal ideation in the past year compared to those without such experience. These findings suggest that special intervention for suicide survivors should be considered for those who experience suicide in close relationships.
© 2015 The American Association of Suicidology.
The objective of this study was to identify the level of awareness regarding school-based suicide prevention programs in teachers who were in charge of the suicide prevention project, and to derive plans for future improvement.
Oltre cento anni fa William James sostenne che la religione «previene certe forme di malattia, così come la scienza» 1 . Da allora numerosi studi scientifici hanno esplorato la relazione tra religiosità e salute degli individui, ma è soprattutto negli ultimi venti anni che si è assistito a una forte crescita di questi studi, soprattutto incentrati sul legame tra religione e longevità 2 . Nell'ambito della letteratura medica e psicologica sono numerosi i tentativi di esplorare la relazione tra le dimensioni religiose e la condizione medica generale 3 , la salute psichica 4 o – più in generale – il benessere psicologico 5 . Anche se la maggior parte degli studi analizzati ha rilevato una correlazione positiva tra
There has been ongoing debate regarding the bereavement process of suicide survivors and whether it differs with that of survivors of other types of deaths. No significant differences were found on mental health status between suicide survivors and survivors of those who have died from accidental death. Culture might play an important role in this lack of differences.
Suicide has become a major public health problem worldwide. For every suicide there are six suicide survivors, a term referring to family members or friends of a person who has died by suicide. Within the literature there has been ongoing debate regarding the bereavement process and if it differs in survivors of suicide as opposed to survivors of those who have died from accidental death. There are scarcely any published reports on comparison between these two groups of survivors in China. In this study, we aimed to explore the difference of mental health status between suicide survivors and survivors of accidental deaths in China. We used a cross-sectional study design to collect data of survivors. Consecutive sampling was used and 92 suicide survivors and 64 survivors of accidental deaths were interviewed. The Symptom Checklist-90-Revised was used to assess the survivors' mental health status. After controlling for demographic variables and time interval between death and interview, no significant differences were found on mental health status between these two groups of survivors. Several explanations might account for the lack of differences. Further studies employing qualitative measures and suicide-specific instruments are needed to explore the bereavement of Chinese suicide survivors.
The authors asserted the need for increased postvention efforts for suicide survivors, individuals left behind to grieve the loss of a loved one by suicide, because they have an increased risk for suicide. Indeed, Shneidman (1972) asserted that suicide postvention efforts serve the dual purpose of assisting survivors through the grief process and preventing suicide for future generations. First, the authors briefly discussed the increased risk for suicide among survivors. Second, the authors overviewed the potential benefits of postvention programs and current strategies for suicide postvention in the United States. Finally, they recommended plans for suicide postvention program development such as states should include efforts to create or expand traditional postvention services as well as active survivor outreach to link survivors to these services.
This essay highlights the author's personal journey through suicide loss and the subsequent police investigation of her spouse's death. Through a recounting of the loss itself, and details of the police interrogation and attempts at crisis counseling, the author demonstrates how current police protocol and crisis counseling initiatives may (re)victimize trauma survivors.
An update of a 1985-86 Omega bibliography of the literature on survivors of suicide is presented. Following brief introductory comments, including the identification of research and therapy needs and unresolved issues, the bibliography listings are organized by the following subtopics: general references on family members and friends as suicide survivors; children, adolescents, youth, and parents as survivors; school and educational settings; parental suicide; elderly suicide survivors; mental health professionals and clinicians in training as survivors; survivors of professionals' suicides; and research on attitudes toward survivors. Published works in professional journals, books, book chapters, and doctoral dissertations on the topic of survivor-victims are included.
Der Suizid eines nahen Angeh�rigen stellt f�r die Hinterbliebenen ein massives psychisches Trauma dar, das zu suizidalen Krisen f�hren kann. Hinterbliebene stellen so ihrerseits selbst eine Risikopopulation f�r einen Suizid dar. Nachfolgend wird zun�chst die schwierige Lebenssituation, mit der Hinterbliebene zu k�mpfen haben, vor allem aus Sicht der Praxis beschrieben. Im zweiten Teil werden spezielle Hilfsangebote diskutiert und der Bereich der Selbsthilfe anhand der Organisation �Angeh�rige um Suizid (AGUS) e.V.� dargestellt.
Loss of a spouse provokes different reactions, which depend on the mode of death, age of the deceased and bereaved, length of the relationship, personality structure of the bereaved, and the social and cultural demands required after the death. The objective of the study was to obtain the average pattern of bereavement process after different modes of death and how it changes after a period of one year. Suicide survivors group was compared to the groups of bereaved after traffic accidents and after terminal illness. All the respondents were interviewed twice: two months after the death and a year after. The instruments used were the Beck Depression Inventory, Eysenck Personality Questionnaire and Bereavement Scale. The results show fewer differences between the groups than expected. The depression level and some other emotional reactions decline over a year and some increase, especially in the group of bereaved after accident. The significant differences between the groups are discussed. The results of the study will be used as a ground for the proposed psychotherapeutic help for the bereaved spouses, if deemed necessary.
Social scientists have long been interested in the study of grief and bereavement, but only recently has research focused on the aftereffects of sudden loss. Theory and research alike suggest that grief is multidimensional and that specific grief reactions have a unique set of predictors. The purpose of this study is to examine the relative contribution of risk factors in explaining variations in specific grief reactions following a sudden death. Data for this study come from medical examiners' reports and mail-back surveys of survivors of sudden loss from suicide or accident. The results indicate that several characteristics of the survivor, mode of death, and social support are important determinants of grief symptomatology. This research concludes by directing future theoretical and empirical endeavors to examine more fully the role of relational factors in influencing grief experiences following bereavement.
The question of whether suicide bereavement is different from mourning after other types of deaths has important theoretical and clinical implications. Some recent literature reviews have argued that the differences may be minimal. In contrast, this article suggests that suicide bereavement is distinct in three significant ways: the thematic content of the grief, the social processes surrounding the survivor, and the impact suicide has on family systems. In addition, problems in the methodology used to compare different bereavement experiences are addressed. Some clinical implications of these conclusions, including the need for homogeneous support groups, psychoeducational services, and family and social network interventions are also discussed.
Previous empirical investigations have produced mixed results on the question of whether mode of death differentially affects grief. To further investigate the influence of suicide on grief, 350 previously bereaved university students completed a questionnaire package consisting of several standardized measures. Participants were separated into four groups based on the mode of death experienced as either survivors of suicide (n = 34), accident (n = 57), unanticipated natural (n = 102), or anticipated natural (n = 157) deaths. Hierarchical multiple regression analyses indicated that suicide survivors, compared against the other groups, experienced more frequent feelings of rejection, responsibility, “unique” reactions, and more total grief reactions. Trends indicating increased levels of shame and perceived stigmatization were also evident. Aggregate factors of death “naturalness” and “expectedness” showed less influence than mode of death in influencing grief. Overall, results support previous clinical and research findings and intuitive logic in demonstrating that the grief experienced by suicide surviviors includes elements that are less frequently seen in the case of nonsuicidal deaths.
Widowed spouses who either participated or refused to participate in a longitudinal bereavement study were compared using the Bereavement Risk Index (BRI). Also investigated were the psychometric characteristics of the BRI. The total BRI had poor internal consistency (α = .50). A principle components analysis yielded one factor with adequate reliability (α = .74), composed of five items associated with stress and coping. Correlations of BRI scores and selected items with measures of depression and stress at three and six months postmortem suggest that they may be more predictive of immediate than of longer-term bereavement adjustment. On the BRI, refusers scored significantly higher than participants on only two items, suggesting that they exercised less control over their emotionality at the time of their loss, and that they were less likely to be working outside their homes. Refusers were also significantly older than participants. Findings were viewed as suggesting little substantive difference between...
This article reviews the available literature on reactions to family members surviving another member's suicide. Three factors determining the reaction of others to persons bereaved by suicide are investigated: 1) the cause of death, 2) characteristics of the deceased, and 3) characteristics of the respondent. The perceptions that persons bereaved by suicide have of the way others view them are reviewed. Methodological flaws and limitations of the current research are noted, with suggestions for the direction of future research. Tentative generalizations and suggestions for clinical practice are also made.
In order to compare the bereavement experience following different types of death, fifty-seven university students who had recently lost a friend or relative by suicide, accident, homicide, natural anticipated death, or natural unanticipated death were interviewed about their reactions and how they were treated by others. Those bereaved through suicide appeared to share a common core of experiences with all other groups, particularly as compared to those bereaved through accidental deaths. However, those bereaved through either suicidal or accidental deaths, more than survivors of other types of death, said that people treated them differently after the death; those bereaved through accidents listed more positive responses from others than did those bereaved through suicide. Those bereaved through suicide were unique in saying they were expected to explain the nature of the death to others in the community and in saying they lied about the cause of death. These results imply that those bereaved through su...
The empirical studies on mourning after suicide were evaluated systematically with the aid of a descriptive model of grief. The starting point in the formulation of this model is the assumption that the bereaved are active in their processing of the loss. The current stages and component theories are rejected on the grounds of empirical contra-evidence and theoretical considerations. Instead, a framework of tasks of bereavement is presented in which the essential tasks confronting survivors in their adaption to the loss are formulated: detachment of the deceased, preserving a satisfactory self-image, and keeping in contact with people who can be of support during the grief process. An examination is made of what is known about the situation of survivors of suicide in this respect. Grief after suicide appears to differ on a number of qualitative aspects from grief after other causes of death. These differences probably do not, however, lead to an atypical mourning process. Generally speaking, the grief process seems to show the same course and main features as those occurring after other types of death, especially after sudden unnatural death. It can be concluded from the literature reviewed that there is no empirical evidence to support the popular notion that survivors of suicide show more pathological reactions, a more complicated and prolonged grief process, than other survivor groups.
A bibliography of the literature on survivors of suicide is presented. Journal articles, books, book chapters, abstracts in proceedings of professional meetings, and pamphlets on the topic of survivor-victims are listed. Brief annotations are provided for some citations.
This study compared the social adjustment of widows following the sudden death of a spouse by suicide with the social adjustment of widows following the sudden death of a spouse by natural or accidental causes, and identified variables related to social adjustment. A convenience sample of 40 young to middle-aged widows (20 suicide survivors and 20 non-suicide survivors) was obtained from coroners' records. Hypotheses were (a) that suicide survivors would exhibit less satisfactory overall social adjustment; (b) that suicide survivors would exhibit greater guilt and resentment; and (c) that suicide survivors would exhibit less satisfactory adjustment in the social leisure role than non-suicide survivors. The widows were interviewed in their homes during the second year of bereavement, and social adjustment was assessed with Weissman's Social Adjustment Scale.Only one of the three hypotheses was supported. Suicide survivors did not exhibit less satisfactory overall social adjustment nor less satisfactory adjustment in the social leisure role but did exhibit more guilt and resentment. Mode of death was not related to overall social adjustment but several other variables were, including suspecting the spouse might die, and employment pre-and post-bereavement. In conclusion, the suicide survivors were not at greater risk than non-suicide survivors for poor bereavement outcome; however, there were qualitative differences in their social adjustment.
The emotional distress and physical health problems of 59 parents whose children died by suicide and 61 parents whose children died by other modes were compared. The hypotheses that suicide bereaved parents would report greater emotional distress and more physical health problems than parents of children who died oj accidents and chronic disease were not supported. Both groups of parents had moderate levels of emotional distress and reported an increase in health problems including an increased use of drugs. In addition, they reported that sleep problems and appetite changes were moderately distressing.
Previous research has indicated that short-term, bereavement from suicide is different from bereavement from other causes of death, at least in part because of diminished social support. To see if the same was true of long-term bereavement, college students who had been bereaved longer than 2 years (M = 5. 75 years) from suicide or homicide were matched on age, gender, and recency of the bereavement to students who were bereaved from accidental death, natural anticipated death, or natural unanticipated death. All students completed three social support questionnaires, and other questionnaires measuring impact, recovery, and current mood. Contrary to expectations, there were no differences between groups, except that those bereaved from accidents were more likely than others to feel as though the death were not real. Apparently, over time the bereavement experience for those whose loved one died by suicide becomes similar to bereavement from other causes of death.
Based on a model of bereavement guilt developed by the investigators, this study assessed the frequency of guilt feelings, explored their sources, and compared the guilt experiences of parents whose children died by different modes–suicide, accident, and chronic disease. Of the 132 parents who participated in the study: sixty-two experienced a child's death by suicide; thirty-two by an accident; and thirty-eight by a chronic disease. Data from open-ended questions were analyzed using content analysis methods. Guilt feelings were reported by 92 percent of suicide bereaved parents, 78 percent of accident bereaved parents, and 71 percent of chronic disease bereaved parents. Furthermore, 34 percent of the suicide bereaved parents reported that guilt was the most distressing aspect of their grief, while none of the accident bereaved or chronic disease bereaved parents reported guilt as the most distressing aspect of their grief. Using the previously developed topology of guilt sources, findings supported the existence of six sources: Death Causation, Illness-related, Childrearing, Moral, Survival, and Grief Guilt. Sources differed by type of death. Death Causation and Childrearing Guilt were more prevalent among suicide and accident bereaved parents than among chronic disease bereaved parents. As expected, Illness-related Guilt was more prevalent in parents of children who died of chronic disease. Few parents reported Grief, Moral, or Survival Guilt. Implications of the findings for clinical practice with bereaved parents are discussed.
Reviews the book, Survivors of Suicide. The book invites attention to the largest mental health casualty area related to suicide: the traumatically created widows and orphans--in short, the benighted victims of someone else's suicidal act. The title page, table of contents, and a portion of the book are reproduced in this chapter. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discusses the reactions of the loved ones of a suicide (SUI) victim, especially the reactions of a child to the SUI of a parent and the reactions of an adult to the SUI of a child, adolescent, spouse, or older parent (geriatric SUI). The SUI survivor suffers the same feelings of guilt, anger, pain, and sadness that other mourners suffer, but these feelings may be more intense and last for years. These survivors are more likely to use tranquilizers and be depressed than other mourners, and they are more likely to commit SUI themselves. Interventions with these survivors are most often directed toward the day-to-day living with grief. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The development of the Grief Experience Questionnaire (GEQ) is reported. This questionnaire is an instrument for measuring various components of grief, including somatic reactions, general grief reactions, search for explanation, loss of social support, stigmatization, guilt, responsibility, shame, rejection, self-destructive behavior, and reactions to a unique form of death. Initial results with the GEQ suggest its potential to differentiate grief reactions experienced by suicide survivors from those experienced by survivors of accidental death, unexpected natural death, and expected natural death. Conclusions support its use in redressing common methodological criticisms of suicide survivor research. Six additional benefits derived from use of this instrument are discussed.
This article summarizes findings from studies concerned with the impact of a suicidal death upon surviving relatives. The
limitations of currently available data are discussed, and the need for further research is emphasized.
The present paper examined available studies concerned with the psychological aftermath of suicide. The impact of suicide in five areas was examined: affective reactions, cognitive reactions, behavioral reactions, physical reactions, family interaction, and social reactions to the survivors. Factors affecting the survivors' reactions also were examined. Several methodological limitations of the available information were noted, but some tentative generalizations were offered.
Comparisons are made of the impact of a suicide death on the surviving spouse (55 years and older) with that of a natural
death on spouse survivors and a married nonbereaved control group over a bereavement period of 2½ years after death. Regardless
of mode of death, the loss of a loved one is a difficult psychological trauma, accompanied by depression, confusion, and pervasive
feelings of emptiness. Few differences in the impact of the deaths in the early months of bereavement were reported, but changes
appeared over the course of the 2½-year measurement period. Compared with natural death survivors, the process of bereavement
was found to be more difficult for the survivors of a suicide death, whose severe depressive feelings do not seem to lessen
significantly and whose feelings of mental health do not seem to improve until after the first year. Women, in general, report
greater feelings than men of anxiety, tension, and apprehension, especially within the first 6 months. By the end of the observation
period, most of the differences between the two bereaved groups have disappeared, and both report functioning adequately despite
continuing feelings of sadness and loss
This report examines the changing role of social supports in the bereavement of spouses of elderly suicide and natural deaths, focusing on differences and similarities in relation to gender, time, and mode of death. Measurements were obtained 4 times after death (within 2 months, at 6 months, at 12 months, and at 2 to 2 1/2 years) on 79% of the 108 survivors of elderly suicide, 89% of the 199 natural death survivors, and 79% of the nonbereaved controls. The results indicated that the suicide survivors received significantly less emotional support for their feelings of depression and grief than the natural death survivors, and that they did not confide in the persons in their network any more than the nonbereaved controls did. Women report receiving more support overall than men. A low spot in social supports occurred at the 6-month point after loss for both bereaved groups, but primarily in practical help received by natural death survivors. By the end of the second year, both practical and emotional supports had increased to at least the same level as immediately after death.
The friends and acquaintances (N = 58) of 10 adolescent suicide victims were interviewed 6 months after the death of the victims, and the rates of psychiatric disorders that had onset after the death were compared with the 6-month incidence of psychopathology in 58 demographically and psychiatrically matched unexposed controls. The exposed group showed higher rates of any new onset major depressive disorder, but the rate of incident suicide attempts was the same in both groups. The median onset of incident depression among the exposed group was within the first month after exposure, and the majority of those exposed youth with incident depression were still depressed at interview 6 months after the death. Adolescent friends and acquaintances of suicide victims experience considerable psychiatric morbidity subsequent to exposure to suicide, most consistent with pathological grief.
The purpose of this study was to describe the long-term effects of suicide of a parent or sibling during childhood or young adulthood. A grounded theory approach was used to discover the respondents' perceptions of the meaning of the event and the effects that it had on them. The themes that emerged from the data were experiencing the pain, hiding the pain, and healing the pain. The need to hide the pain often interfered with the process of healing the pain. Findings indicate that many survivors of suicide during childhood experience painful, unresolved grief that affects their well-being in adulthood.
This research examines the significance of the survivor-victim relationship in understanding grief following sudden death bereavement. Data for this study come from medical examiner's reports and mailed self-report surveys of survivors of suicide and accidental death. In general, the results show that survivor-victim attachment is more important than survivor's status in explaining grief reactions. Also, suicide survivors experience significantly less emotional distress and shock, but greater feelings of guilt/shame and rejection, than survivors of accidental death. This paper concludes by directing future research to explore more fully the importance of survivor-victim relationships in understanding grief following bereavement.
Survivors of suicide are the family members and significant others in the life of the person who commits suicide. A recent study by the author explored the life experiences of survivors of suicide, affirmed the severity of postsuicide bereavement, and revealed the critical role of the family physician in intervention.
Thirty-five adult survivors participated in in-depth audiotaped interviews during the 3- to 9-month period after the suicide death of a family member. Demographic data and the transcribed interview data were analyzed through descriptive statistics and systematic methods of qualitative data analysis.
Subjects stressed the importance of the family physician understanding the nature of their experiences in order to intervene effectively. All survivors experienced profound disruptions in their lives, including changes in physical, emotional, cognitive, and social functioning. Variations among survivors of suicide, based on the survivor's perception of the victim before his or her death, were evident and are illustrated by three case studies. Interventions for the family physician, including specific suggestions from survivors, are proposed.
Survivors of suicide experience a very severe bereavement, yet significant variations exist among their responses. The family physician is identified as the key individual to initiate and ensure follow-up care for this bereaved population.
Fifty-eight consecutive suicides committed between 1984 and 1987 by adolescents and young adults (age 15-29 years) in an urban community were the subject of retrospective investigations by means of interviews with survivors. The outcome of the survivors' crisis reactions and the interviewees' capacity to participate in the interviews were evaluated. Two weeks after a main interview, a follow-up interview dealing with the interviewee's reactions to the investigation was performed. The cautious interview procedure seemed very acceptable to the survivors. An initial contact about 2 months after the suicide is recommended. Tape-recording was generally tolerated. There was a relationship between a satisfactory outcome of the crisis and good quality of the information given by the interviewee, but survivors in severe crisis may also cooperate well and give information with good trustworthiness and precision. An unsatisfactory crisis outcome was significantly more common in interview subjects with post-traumatic stress disorder according to DSM-III-R. Many interviewees benefit from the single interview.
Although clinical experience suggests that individuals who have been bereaved as a result of suicide may be especially vulnerable to adverse sequelae, such as unusually severe grief or increased risk of committing suicide themselves, the idea that this type of bereavement is special has received only limited systematic investigation. The authors review the literature on the subject, with special attention to the clinical and research evidence about whether bereavement resulting from suicide is different from bereavement due to other types of death, and make suggestions for further clinical and epidemiological research on this question.
This study compared bereavement experiences of suicide survivors with those of other survivors. The primary focus of investigation was upon grief reactions suggested to be unique to suicide bereavement and upon quality of grief resolution 2-4 years after death. Fifty-seven women and men, between the ages of 24 and 48, who had experienced the death of a marital partner were interviewed. Subjects were assigned to one of four groups by mode of death (suicide, accident, unanticipated natural, and expected natural). Analyses of variance and Scheffe procedures indicated no significant differences among survivors on frequencies of grief reactions considered common to all bereavements. The suicide survivors were significantly different from all others on certain grief measures, including rejection and unique grief reactions. On various other grief measures, significant differences were indicated among the groups of survivors. Four primary conclusions, implications of the findings, and limitations of the study are discussed.
Grief reactions of two types of sudden untimely deaths were compared: the loss of a child by accidental death and the loss of a child by suicidal death. Three hypotheses were tested. The degree of disturbed grief and the degree of loneliness in parents who lost a child to suicidal death were compared to those reactions in parents who lost a child to accidental death. The relationship between the degree of disturbed grief and the degree of loneliness was assessed. For suicide survivors, grief and loneliness tended to rise over time, whereas grief and loneliness decreased over time for accidental death survivors. The findings from this study indicate that the loss of a child from an accidental death places a parent at high risk for disturbed grief and loneliness, and at even higher risk when the loss is a result of suicidal death.
The impact of completed suicide on the surviving family was studied. Thirteen widows whose husbands had died through suicide were compared with 13 widows whose husbands had died in accidents. The widows' views of their families' functioning, and the extent of life stress and psychiatric symptoms experienced by the widows, were assessed. Interview data suggested more guilt and blaming in suicide survivor families. However, on standardized questionnaires, suicide survivors showed no more family dysfunction, life stress, or psychiatric symptomatology than accident survivors. Both groups acknowledged clinically significant levels of symptoms. The findings raise questions about the validity of generalizations based on the clinical literature regarding the uniquely pathogenic impact of suicide on family functioning.
The impact on mental health of survivors (n = 108) of suicides of older adult spouses (55 years of age and older) in the first
8 weeks of the bereavement process was compared with that of two control groups: older adult survivors of natural deaths (n
= 99) and a married non-bereaved group (n = 144). On all measures both survivor groups scored significantly poorer than the
non-bereaved controls. Only anxiety was reported significantly more often by suicide survivors than by natural death survivors.
Surveyed 19 spouses (mean age 37.5 yrs) of suicide and accidental death victims (representing a 61.3% response rate of all relevant cases that occurred in 1982 in a metropolitan county) concerning their health and coping strategies approximately 1 yr after their spouse's death. Results show that the more Ss discussed their spouse's death with friends and the less that they ruminated about the death, the fewer were the increases in health problems reported. A significant negative correlation was found between confiding and ruminating. Effects were independent of Ss' self-reported number of close friends. It is suggested that the sudden death of a spouse is associated with increased health problems irrespective of the cause of death, but that confiding appears to play a central role in the coping and health process. (19 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The Survivors Support Program attempts preventive intervention with a high risk population. As with most preventive efforts in psychiatry, it is difficult to predict who will be most at risk, what services will best meet their needs, and what positive effects are due to the services.
To answer these questions through properly controlled and designed experimental programs conforming to scientific methodology would require the investment of much time, personnel and money. To postpone attempts at intervention until answers are provided by such experimental programs would be to ignore the evidence of common sense and clinical experience.
The Survivors Support Program demonstrates that a volunteer self-referral service, organized through professional liaison with a community organization and committed to providing service and gathering information, can suggest interim answers to the questions while providing support and counselling to a needy population.