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How Do the Young Suicide Survivors Wish to Be Met by Psychologists? A User Study



Little user-knowledge has been documented on the experiences of young suicide bereaved with psychosocial assistance and therapy. Thirty-two adolescents who had lost a close family member or friend by suicide participated in a research project by filling in questionnaires and participating in focus group interviews. The article explores the young people's experiences with and wishes for help from psychologists, and shows that the young bereaved do not receive the psychological assistance they wish for and need. The shortcomings are discussed in relation to the organization, form, and contents of the help. In order to reach youth with adequate assistance in an extreme life situation, it is worth listening to their opinions about how they want to be approached in the wake of a suicide.
OMEGA, Vol. 59(3) 221-238, 2009
Center for Crisis Psychology, Bergen/
Norwegian Institute of Public Health, Oslo
Little user-knowledge has been documented on the experiences of young
suicide bereaved with psychosocial assistance and therapy. Thirty-two
adolescents who had lost a close family member or friend by suicide
participated in a research project by filling in questionnaires and participating
in focus group interviews. The article explores the young people’s
experiences with and wishes for help from psychologists, and shows that the
young bereaved do not receive the psychological assistance they wish for and
need. The shortcomings are discussed in relation to the organization, form,
and contents of the help. In order to reach youth with adequate assistance in an
extreme life situation, it is worth listening to their opinions about how they
want to be approached in the wake of a suicide.
Norway is a small, wealthy, Western country with a population of only 4.7 million
people, but as most Western countries, Norway has a large number of suicides per
*This article was originally published in the Journal of the Norwegian Psychological
Association (Tidsskrift for norsk psykologforening), 2006; 43, 787-794, and has been trans-
lated to English with their kind permission. Also, the author acknowledges The Norwegian
Foundation for Health and Rehabilitation, The Norwegian Organization for Suicide Survivors,
and the Norwegian Sudden Infant Death Society for their support.
Ó2009, Baywood Publishing Co., Inc.
doi: 10.2190/OM.59.3.c
year. In 2003 when the study was carried out, 502 people took their own lives,
of these 374 men and 128 women. The suicide rate (number of suicides per
100,000 residents) was 16.5 for men and 5.6 for women and the total suicide
rate was 11. The most recent records do not deviate much from this.
Each and every suicide will affect the close bereaved for a long period
of time. Shneidman (1972) expressed this metaphorically: “The person who
commits suicide puts his psychological skeleton in the survivor’s emotional
closet.” The large number of annual suicides around the world implies that very
many bereaved persons, among these many young people, are left in a state of
shock and grief. In addition, their family, friends, schoolmates, and colleagues
are also deeply affected.
Young People Struggle After a Suicide
The Support and Care project, carried out at the Center for Crisis Psychology
(SfK) in Norway from 1996 to 2003 (Dyregrov & Dyregrov, 2005a, 2005b), and
other studies have documented that children and young people struggle to a
significant degree in the aftermath of the suicide of a close friend or family
member (Brent, Moritz, Bridge, Perper, & Canobbio, 1996; Cerel, Fristad, Weller,
& Weller, 1999; Rakic, 1992; Sethi & Bhargava, 2003). Pfeffer, Martins, Mann,
Sunkenberg, Ice, Damore, et al. (1997) came to the conclusion that child suicide
survivors were at greater risk for specific forms of psychosocial dysfunction
than children who had experienced other types of deaths. The most important
difference, in comparison with other studies, was that posttraumatic symptoms
were only observed in children who had experienced suicide and not in connection
with non-dramatic deaths. Brent et al. (1993) found that young siblings bereaved
by suicide more frequently suffered from depression, anxiety, and posttraumatic
stress disorder (PTSD) than did a control sample. The young suicide survivors
experienced a lack of energy, sleep disturbances, appetite and body weight
disorders, an increase in emotional and physical agitation, guilt, social withdrawal,
concentration problems, and suicidal thoughts. Rakic’s study (1992) and the
Support and Care project (Dyregrov & Dyregrov, 2005a, 2005b) confirm these
findings. In a related study, Nelson and Frantz (1996) point out that suicide can
lead to prolonged/complicated processing of grief due to the fact that many
of the young survivors are incapable of sharing their experiences and thoughts,
particularly any feelings of guilt with which they may be struggling. Sethi and
Bhargava (2003) found that 50% of the young bereaved fulfilled the criteria
for serious depression on the average nine and a half months after the suicide of a
close friend or family member, while only 6.6% in the control sample fulfilled
these criteria. Both Rakic’s study (1992) and the Support and Care project showed
that many young people experienced great difficulties in expressing their grief
openly within the family. In Demi and Howell’s study (1991), adult survivors
expressed extreme frustration 15 years after the suicide of a sibling, in connection
with what they had experienced as the keeping of secrets, silence, and blocked
family communication after the death. A serious consequence of the difficult
overall situation of the young suicide survivor is widespread learning and con-
centration difficulties in the context of schooling (Dyregrov, 2006; Dyregrov
& Dyregrov, 2008).
In 1988 McIntosh and Wrobleski (1988) referred to the young suicide sur-
vivors as “the forgotten bereaved,” and much indicates that this remains the
case today. The Support and Care project showed that parents bereaved by
suicide were extremely worried about their living children and wanted far
more and better help for them than that which had been offered. In particular,
they wanted help from psychologists for young people (Dyregrov, 2002). They
emphasized that it was difficult to acquire help from a psychologist, and in
cases where they had received such help the contact was too brief in its duration,
allegedly because the young people found the benefits to be of limited value.
Also, clinical practitioners working with young crisis-stricken individuals have
argued that helpers within the psychological health care sector must meet young
people in another manner than that which was the current practice (A. Dyregrov,
2004). Research projects have shown that many young people criticize “the
silent therapists—those who do not say very much and put pressure on young
people to take responsibility for the counseling session” (A. Dyregrov, 2004,
p. 723; Dyregrov, 2008).
Despite documentation of the serious ramifications of current conditions, little
research has been carried out on the type of follow-up that the young bereaved
by suicide find they need, the type of help offered and how any help that is offered
is received by young people. In order to acquire such knowledge, it is necessary
to listen to the users of such services so these may be performed to a larger extent
on the terms of the user. The survivor should have a right to influence the help
offered to them, being of therapeutic value as well as a means of improving and
quality-assuring the services. The client’s experience of the therapeutic relation
and the client’s experience of change early in the course of treatment appear to
be the factors that best determine the outcome of the treatment. With an objective
of contributing to critical discussion and proposals for improvement, a social
science research approach has been applied in different areas of psychological
health care to connect the users’ experiences to features of the health care service
scheme and professional practitioners’ processes of reflection and interpretation.
The above-mentioned perspective and research approach comprise the framework
for the study presented in this article.
A Norwegian Study
In order to give young suicide survivors the requisite voice, in relation to
society and the public assistance scheme, the Norwegian Organization for Suicide
Survivors (LEVE) carried out the project “An improved care scheme for the young
bereaved by suicide.” The project consisted of three phases. The first phase
involved weekend gatherings of young suicide bereaved. The second phase was
a research segment to outline and analyze the young people’s personally felt
situation, whereas the third phase involved dissemination, in order to inform
potential support communities of how they can support young people during the
period following a suicide. Only the research part, carried out by the author, is
addressed in this article. The objective of this was, among other things, to outline
the young people’s wishes and needs for help, how they experienced being met
by the social network and assistance scheme, and whether offers of help were
successful. Self-help strategies and personal growth were also registered. This
article discusses the type of help that the young people wanted from a psychol-
ogist, in terms of content, scope and quality.
The sample consisted of young people who participated in LEVE’s youth
gatherings. These participants had been recruited through notices in the daily
newspaper, schools, and nursing service, and through LEVE’s membership publi-
cation. The youth survivors are therefore presumed to be representative of the
type of young people who would consent to this kind of participation. A total of
32 young people, out of a total population of 33 that were asked to participate,
filled out questionnaires and took part in qualitative focus group interviews.
Ten (31%) of the participants were boys/men and 22 (69%) were girls/women.
Their ages varied from between 13 and 24 years, with an average age of almost
18 years (M= 17.8; SD = 3.20). The young people were in elementary school
(25%), high school (50%), college/university (16%), or working (9%). They
represented all of the health regions of Norway; 69% were from urban areas
while 31% lived in rural areas. Only five (16%) of the young people were present
when the individual who had committed suicide was found. Six (20%) had lost
a mother or father, 22 (69%) had lost a brother or sister, while the others had
lost other close relatives or friends (11%). The ages of the deceased varied from
12 to 56 years of age, with an average of almost 27 years of age (M= 26.69;
SD = 12.49). The amount of time that had passed since the deaths varied from
1 month to 7 years (84 months), with an average of around 3 years (M= 35.5 mos;
SD = 23.58).
Data Collection
Data collection took place following the youth gatherings, whereupon young
people filled out questionnaires and took part in focus group interviews. A total
of 11 group interviews, with two (one group) to four participants per group were
carried out either in connection with a gathering, at the researcher’s office, or in
the young person’s home. Approvals were acquired from the Privacy Ombudsman
for the Norwegian universities (NSD) and the Regional Committee for Medical
Research Ethics (University of Bergen).
Perspective and Procedure
The study was based on a user perspective, where the informant is considered
to be an expert on own experiences and knowledge. Moreover, mixed methods
were used (questionnaires and in-depth interviews; Coyle & Williams, 2000) to
outline the young people’s needs for help and support from the public assistance
scheme, the school, and the social network. A four-page “help form” produced by
SfK outlined the scope of the help received and wanted, and consisted of 172
standardized questions and five open questions. In order to ensure the validity and
reliability of the form, the form was reviewed critically by two young bereaved
and an adult version of the form has been translated into English, discussed with
researchers, and used on comparable groups in several other countries.
While the help form outlined the scope of the help received, the focus group
interview was chosen as a method for the exploration of individual experiences.
The interviews were based on a phenomenological approach where the objective
was to acquire descriptions of the interviewee’s life-world, with an eye toward
interpretation of the described phenomena (Giorgi, 1975; Kvale, 1996). By dis-
closing the scope and variation of the young people’s subjective experiences of
their encounter with the public assistance scheme, the method provided an oppor-
tunity to illuminate experiences of importance for the young people, of which
assistance professionals could be unaware. The use of a theme guide ensured that
certain subjects were addressed systematically. The qualitative data was analyzed
according to Kvale’s (1996) five-step analysis for qualitative data. The method is
designed to condense expressed opinions in order to find basic units of meaning
and processes in relation to the issues under investigation. The researcher specifies
the main theme for the units of meaning before the analyzed material is interpreted
in relation to the issues under investigation, relevant theory, and former research.
Descriptive analyses (frequency distributions, average, and standard deviation) of
the questionnaire data were carried out using STATISTICA 7. In a social science
perspective, the results of the analyses are connected with the informants’ subjec-
tive experiences in order to say something about the assistance scheme and the
psychologist’s approach.
The majority of the young people were of the opinion that young suicide
survivors will need support and help from outside the family:
There are very few who can go through such things without receiving help.
I believe that most need to have help. I believe so. I believe regardless
that it is important to speak with someone from outside of the family.
(17 year-old girl)
All of 69% (22) of the young informants indicated that they experienced a need
for help from professionals to an extremely large/quite large/certain extent, while
a respective 19% and 12% to a small extent or not at all had experienced a need
for such help (Dyregrov, 2008; Dyregrov & Dyregrov, 2005a, 2005b).
In the interviews, the young people gave the impression that there was a large
variation in the type of help that they had received. According to them, it appeared
to be quite random who happened to receive help and why they received it. But a
few informants, who previously had been in touch with the public health care
scheme for problems, experienced receiving better follow-up than others. The
helpers whom the informants most frequently had spoken with/had some contact
with after the suicide were psychologists (52%), teachers (35%), public health
nurses (35%), and clergymen (29%). The psychologist was also the one who
gave the greatest number in the study information (23%) and help of a practical
nature (16%), and the one who was considered to be the most important helper,
along with public health nurses, clergymen, and doctors.
In spite of the key role that the young bereaved wished the psychologist
to play, there was a great deal of frustration in connection with help from
psychologists. The majority had broken off contact with their psychologist after
a relatively short period of time or was dissatisfied with the relation, while
others had wished for this type of help without having received an offer. A few
reported having received good and important help from a psychologist. In order
to be able to learn from the young people’s frustrations, the subsequent findings
will present some of their reflections regarding why many young bereaved by
suicide do not receive adequate psychological help.
Barriers to Establishment of Contact
with Psychologist
Both the young people who had succeeded in getting an appointment with a
psychologist and those who had not, indicated a number of different reasons for an
inadequate “establishment of contact.” They mentioned factors that were not only
due to the helpers, but also to themselves, to the way the help was organized or the
result of a combination of different factors. Because they did not have the strength
or did not manage to take contact personally, the lack of an automatic assistance
program was a barrier to help. Also, they did not know who or what could help.
Moreover, lack of offers when the young people were “ready” prevented them
from adequate professional help. Finally, the young people pointed out that they
did not make further attempts after disappointing encounters, or they might also
refuse offers of help due to lack of motivation and support.
The Need for Help is Not Recognized
The most important barrier to psychological help that the young people men-
tioned was the lack of any system to identify their need for help. They emphasized
that after a suicide one is in complete shock, and one “can’t tell up from down
in the situation” and as such, one does not have the energy to take contact and
ask for help. In addition, the young people were uncertain of the type of help
they needed, or of the type of help available, but they nonetheless believed that
psychologists were the professional group most appropriate to offer assistance
with all of their exhausting thoughts. Many parents neither managed to encourage
the young bereaved to accept help or to find them adequate help because they
had problems enough in coping with their own grief, particularly immediately
following the death. In addition, there were young people who had had poor
or disappointing meetings with helpers that resulted in their not taking further
initiative, in spite of the fact that they experienced a need for help. Others
mentioned that they had wanted contact with another professional group than
that from which the offer of help had come (e.g., with a psychologist rather than
a clergyman).
Two of the young people who had not received early offers of help spoke of
having such great difficulties in acquiring help quickly from a psychologist when
they suddenly needed it that this had resulted in involuntary hospitalization in a
psychological health care institution. Some of the oldest informants pointed out
that it is also difficult to ask for help when in adolescence. One is concerned about
what other people think and experiences having to receive help as a personal
failure, and the young suicide survivors are therefore reluctant to accept the help
that is offered:
I think it was worse (seeing a psychologist) when I was 17 years old than
now. Yes, obviously. I think that I was more worried about what others
would think of me. It was that kind of high school set-up and you were not
supposed to be different. (23-year-old boy)
Insufficient Offers of Help When the Young
People are “Ready”
The young people had also experienced that it was difficult to find counseling
at a later point in time if they had turned this down the first time it was offered.
A lack of available capacity on the part of the psychologist made it impossible
to get an appointment when the young people were “ready” to accept help,
either because adults had worked with them or they had personally gradually
acknowledged that they needed help:
When I called the office at Vinderen (to make an appointment) after having
received a referral, I got the answer: “No, we receive from 20-30 phone
calls on this here every day, so I really don’t know. You can send in the
referral and we’ll see what we can do.” My referral went into a pile . . .
I don’t know. The referral has probably expired now. (19-year-old girl)
Some young survivors had spent a long time motivating themselves to seek
help from a psychologist and said that they needed to be asked several times,
so that the idea could mature in conjunction with a gradually experienced need
for help. But then it was also important that the helpers understood this and
subsequently did not stop making offers of help too soon.
Discontinuation of Contact
Due to the stressful situation stemming from having concentration difficulties,
there were some young people who had failed to turn up for scheduled counseling
sessions because they had not had the strength to show up or had forgotten
appointments. This had embarrassed them to the extent that they had not dared
to take further contact and if the psychologist neither took contact that was the end
of their psychological assistance. Some young people had discontinued group
counseling sessions with their families because they had not felt sufficiently
taken care of, in that the main focus had been on the parents. Others who had
been offered counseling together with other close family members had declined,
because they wanted a more private type of counseling or to protect their parents
from learning how much pain they were in. Most of the young people who had
broken off contact with a psychologist did so because they were disappointed and
dissatisfied with the offer of help they had received. The criticism predominantly
addressed the contents of the help and the style of the helper.
Why were These Young Suicide Survivors
Not Satisfied with the Psychologist?
The young people who were dissatisfied with the help from a psychologist
indicated different reasons for this. Moreover, they experienced that the psychol-
ogists did not sufficiently address their problems, and signaled professional and
emotional uncertainty. Finally, the young persons claimed that too many lacked
empathy and true compassion, which did not inspire trust.
Did Not Address the Problems
Through the interviews many of the young people stated that they did not
receive the type of help that they had needed qualitatively speaking. One quickly
noticed if the psychologist used an approach that helped or not, and many stated
that they “did not see the point of” speaking with the psychologist. A number
stated that they would have liked the psychologist to have been more active, and
perhaps ask individual questions that they could have answered but without
pressuring them too much, too quickly. They had often felt pressured to tell
the story of what had happened while they in fact were not able to put their pain
into words. They neither saw the point in telling “their entire life story.” Here is a
sample of what the young people reported in the interviews:
I was at BUP (the National Psychiatric Polyclinic for Children and Adoles-
cents) in . . . and I stopped going there after only a short while because I felt
like I was not getting anything out of it. When I went there I had to start
explaining and then I did not know what to say, so there was a lot of silence,
like. And maybe it was just the wrong day, that I didn’t want to talk about it
and then felt pressured to do so because I had gotten an appointment there.
(14-year-old boy)
The one (the psychologist) I went to, I had to explain like everything I
could remember from the beginning of my life, no point to it whatsoever.
(17-year-old girl)
She (the psychologist) said very, very little, I would have preferred that
she told me a bit about the normal reactions after having lost someone by
suicide. She didn’t do that at all. During the first session she sat and answered
a couple of question, a lot of awkward silences and cookie eating and such
and the next time was not any better. (18-year-old girl)
So I received an offer of some kind of psychologist thing, but it was just
foolishness. I went in there and I did not think there was any point in sitting
there and listening to those two strangers talking all kinds of nonsense
about my brother, and it was like . . . it was much easier for me to talk with
those who knew him, than with two tricky strangers. (17-year-old boy)
I went to see the psychologist just a couple of times and then I couldn’t
be bothered to go any more. So I just talked to my friends, which was a lot
better. (16-year-old boy)
I went to the counselor at school and the health nurse at school, who contacted
PPT (the National School Psychology Service) for me. So when I went to
see that psychologist at PPT, it was like she wanted to get it all out, what I
thought and bla, bla, bla, it’s like totally . . . like presenting my whole life
story to a complete stranger, it doesn’t work. (17-year-old girl)
A number of informants were critical about the fact that the psychologist did
not address what really bothered them: thoughts of guilt, questions about why,
anger toward the deceased, anxiety about further losses, frightening dreams
and nightmares about suicide, or problems handling daily life because so much
time and energy went toward keeping the pain at bay. They emphasized that
psychologists dwelled too much on the past, either the young person’s or the
deceased person’s, while they would have preferred for the psychologists to have
instead been more focused on the things that were bothering them and that had
turned their lives upside down. Some therefore had some thoughts regarding the
kind of help a psychologist should give young people:
It is very important that they think about the individual sitting in front of
them and not the individual who is dead. Even though you perhaps can give
a description and talk about the deceased person, what they were like, I
believe it is important that they in a way make real contact with you and
find out how you are doing. And then they need knowledge to straighten
that out, which is very important. Because if you just sit there and talk about
the weather, as I have heard that they do, and about the deceased, it wouldn’t
help me particularly at any rate. It would not. (17 year-old girl)
Other young people were disappointed over having been met with a lack
of understanding for their problems being serious enough to merit psycho-
logical help:
It was a strain going to the psychologist because he made me feel that my
problems were trivial. (22 year-old girl)
Lack of Empathy and Sincere Compassion—
Does Not Inspire Trust
The young people who had taken the step and made an appointment with a
psychologist, imposed strict requirements with regard to the importance of there
being a ”chemistry” based on trust, empathy, and sincere compassion between
themselves and the psychologist if they were to continue attending. If their trust in
the psychologist was violated, because they did not sense that he/she had a true
interest and empathy for them in their extremely vulnerable situation, then they
quickly stopped going:
I had a psychologist and when I came in, he did not pay attention when I
started talking. And I had not told very many people then, so it was like
baring your soul and then he did not fully pay attention and did not catch
really what I said and so on. I think he had another opinion regarding what
I was there for, and otherwise his body language expressed that he was not
really there, not really listening. It really irritated me, and I got even angrier.
I did not go back anymore. (18-year-old girl)
The young people were also very sensitive about whether the deceased was
spoken about with respect and had strong reactions if the psychologist became too
“buddy-like,” such as by speaking as if they knew the deceased very well when
they did not:
They (the psychologists) must be careful not to talk as if they knew the person
they are speaking about for the past 30 years. Because it is like ...itistrust
that is needed and that they focus on the right things. (16-year-old boy)
Signaled Lack of Experience and
Authority in the Field
The young people’s stories could also indicate that a number of psychologists
did not have much experience with the young bereaved by suicide and did
not inspire sufficient trust because they were personally uncertain about how to
meet young people in grief and crisis. A young person who had been struggling
a great deal and personally sought out the help of a psychologist, stated:
So I went to see the psychologist and she had just graduated and she could
not help me at all. She did not understand why I was there and the only thing
that she asked me about was why I did not want to use the name of the
deceased. That was the only thing that she asked about and why I had
suddenly decided that I needed to see a psychologist. She did not ask about
anything else whatsoever. And then she said that no, I don’t think it’s
necessary for you to come here. She could not help me with grief; I would
have to get over it myself. She did not ask me how I was feeling. . . .
(18-year-old girl)
Other therapists had lectured young people on the basis of theoretical
knowledge and disclosed that they “did not know really what the point was in
It is no help for me whatsoever to sit and tell a person what is happening
when the other person does not know what in fact occurs but has only read
about it. (17-year-old girl)
Some young people emphasized the importance of professionals daring to be
direct in their communication about the suicide and not sugar coating things:
Why can’t they say instead: When your mother hung herself . . . because when
they say the words, time after time, that helps to take the sting out of it. It
hurts like anything to hear it, but there’s something about facing what actually
happened, that one speaks frankly. (18-year-old girl)
Push Us a Bit More!
Many young people admitted that they personally had certainly contributed
to their not receiving the help that they later would have liked to have received.
They were not always so adept at expressing themselves and informing helpers
that they were not doing well and some had rejected offers of help. Because the
young people for various reasons tried to hide their problems, they understood
that it was not easy for others around them to help. Most of them stated in this
regard: “push us a bit more” and repeat the offers of help. They emphasized that
helpers must dare to be a bit more on the offense and not just accept the first refusal
at face value. Other young persons who had not received help believed it would
have been difficult to accept an offer, particularly from adult strangers, but stated
that they would have accepted had the right person encouraged them to do so.
At the same time, several stated that they were skeptical about being pressured
too quickly to open up (too much) and then it is a matter of, as one young person
put it, “finding the traction point”:
The psychologist I had was all about getting me to say absolutely everything.
I really did not want to say so very much, but he actually got me to say a lot.
So that is surely what destroyed it, that I did not receive the kind of help that
I needed. Maybe not pressure, but in a way, a little push . . . like find the
traction point. But we must have a say in deciding. (17-year-old girl)
The young people understood that it was not always easy for professionals or
family members to “find the traction point” or to know how much they should
push the individual young person in order to provide the help they might need or
manage to accept at any given time. Many of the informants stated that they in the
beginning had suppressed their reactions in order to be able to keep functioning.
Just after the suicide, they were obliged to absorb the reality little by little and then
they were not able to deal with well-meaning helpers or family members who so
desperately wanted to help them. Proximity and repeated, tactful offers of help and
support would therefore be the solution. It would also be a great help if family
members or others could give the psychologist some insight into what had
happened, so young people could be spared having to tell the whole story again at
the first session. They also wanted psychologists who, on the basis of previous
experience with and insight to the young bereaved by suicide, could offer concrete
advice on expected reactions, about what they could do to alleviate the difficulties
particular to the situation and how they could best give support to parents and
siblings. In particular, they emphasized that their experiences had taught them the
importance of follow-up and involvement over time. The young people therefore
sought a routine, professional offer of help, adapted to the individual young
person’s particular help-needs, which is offered repeatedly at different points in
time. They emphasized that the helpers must not ask whether one needs help—that
it must simply be offered because one does not manage to ask for help personally
(Dyregrov, 2008; Dyregrov & Dyregrov, 2005a, 2005b).
The significance of listening to users of health care services is an important
principle in the study. It is in particular of importance to illuminate the young,
vulnerable groups’ experiences of meetings with helpers because the accounts of
such experiences for various reasons are often not heard. Hopefully, young
people’s subjective experiences and researchers’ interpretations of these will
comprise a contribution to critical reflection upon clinical practice. The discussion
of the young people’s meeting with the psychologist/counselor and other helpers
must therefore be viewed in the light of the user perspective and methodological
Methodological Discussion
Although it is a nationwide selection, the sample is small in order to generalize
from the quantitative analyses. Still, I think that the following discussions may
apply for many, especially Westernized, cultures.
The selection can be distorted, because the study followed youth gatherings
where the young bereaved by suicide met others in the same situation. Accord-
ingly, one may have recruited persons to the study who are more interested in
the problems addressed there, because they are struggling or who have a greater
awareness of their own reactions. The young people in the study can be more
resourceful or more confrontational than other young bereaved. Although it
is difficult to conceive of the possibility of the informants constructing new
experiences in connection with their unique situation after having heard the
accounts of others, it is likely that the group interviews, gatherings, and the
preliminary questionnaire may have influenced the interviews, in the sense of
causing the young people to develop further reflections and associations to own
thoughts and experiences (Bloom, Frankland, Thomas, & Robson, 2001). The
qualitative material’s validity and generalizability, both theoretically and analyt-
ically speaking, will be connected with degree of its plausibility and to which it
is confirmed through recognition on the part of the young bereaved, in theory
and by clinicians (Kvale, 1996). It is a strength that the qualitative material is
comprehensive in relation to the focus of the article. Two young bereaved read
through and “validated” the final report without objections to the presentations;
psychologists at the Center for Crisis Psychology recognized the young people’s
problems, while there is little literature to support the findings. Despite group
differences on available basic background variables for this and a previous study
(Dyregrov & Dyregrov, 2005a, 2005b) with young suicide survivors, great simi-
larities in wishes for help were seen. This may reduce the likelihood for biased
findings due to recruitment method. Also, as earlier studies have shown that
the non-participants might even be worse off than those who do participate in
such studies (Paykel, 1983), it is possible that those who do not seek or are
receptive to help (the group gatherings) may want even more, rather than less,
support from psychologists.
The Help Desired had Difficulties
Getting Through
The young suicide survivors’ wishes for an automatic, proactive, and qualified
offer of help with an orientation toward the individual’s unique situation over
time corresponds with the wishes of an adult bereaved with regard to help after
a suicide (de Groot, de Keijser, & Neeleman, 2006; Dyregrov & Dyregrov, 2005a,
2005b; McMenamy, Jordan, & Mitchell, 2008; Wilson & Clark, 2005). Like
the adults, the young people also view the psychologist as one of their most
important potential helpers in the period after the suicide. It is therefore par-
ticularly problematic that so many young people experience that this type of help
does not get through. The main problem in the meeting between the young
bereaved by suicide and the psychologist appears to be twofold. Either the young
people for different reasons do not manage to establish a therapeutic relation to the
psychologist or the contact is experienced as not being particularly meaningful
and many stop going. The failure on the part of the assistance scheme, as
experienced by the young people, is interpreted as having explanatory variables
connected with organization, form, and content.
Psychological Services Lacking in Organization?
The young people’s descriptions indicating that the desired help from a
psychologist had not gotten through to them to the degree required and
desired, can have a connection with the assistance scheme’s organization and
ideology not being adapted to the unique situation of the young bereaved.
Despite the experience that they need therapeutic help, the young people state
that they cannot bear to contact the assistance scheme, lack knowledge about
who or what can help, are not “ready” when psychologist help is there, or
refuse offers of help because they lack motivation and support. The young
people, however, emphasize the need for being contacted with an offer of
help for their situation. A lack of the necessary organized measures to
accommodate the young people can be connected with large parts of the
assistance scheme functioning according to a traditional patient-therapist
model, where it is up to the patient to define his/her problem and
subsequently seek help. The variation between municipalities, as indicated by
the young people, can thus be connected with the existence of different ideologies
with regard to the follow-up of the crisis-stricken—shall one think prevention,
treatment or let it be exclusively up to the social network to help the bereaved
by suicide (K. Dyregrov, 2004)?
When one evaluates the young people’s descriptions of the help they
received, it is only right to take into consideration that most of the suicides
discussed here took place a few years ago. There are tendencies in the
material indicating that following more recent suicides young people are more
frequently offered help. It can in such a case reflect that many municipalities
are now working more actively with psychosocial follow-up after suicide than
was the case previously, both in Norway and other countries. When the
municipalities’ psychosocial follow-up of the bereaved by suicide was
mapped out in 1998 in the Norwegian nationwide Support and Care study, a
mere one-third of the municipalities had established crisis teams, 43% had
written routines for follow-up, while only 16% had such a formal system
between primary and secondary services (Dyregrov, 2002). The municipalities
themselves indicated that such organizational measures, in particular written
routines and crisis teams, were crucial to ensuring good follow-up of the bereaved
by sudden death. This was also confirmed in the study, in that the bereaved who
received follow-up in the municipalities through organized measures were more
satisfied with the help and received better offers of help (Nordanger, Dyregrov, &
Dyregrov, 2003).
Inadequate Knowledge About Crises
Leads to an Uncertain Form?
It can also appear as if a lack of knowledge about suicide, trauma, and crises can
contribute to uncertainty in the therapeutic relation with young people. The young
people’s stories indicate that a number of psychologists were inexperienced with
regard to the young suicide survivors and did not adequately inspire trust because
they were personally uncertain about how to receive young people in this type of
grief and crisis. The uncertainty is compounded by the fact that most psychologists
are seldom in contact with the young suicide bereaved and that such contact
involves an emotional strain. The young people confirm a number of previous
reflections in a former journal article (A. Dyregrov, 2004), where the significance
of active and sensitive relation-building in the first encounter with crisis-stricken
young people is indicated. As a number of the young bereaved emphasized: the
therapist must not expect the young person to “tell all” in the first session and to
take responsibility for keeping the conversation going. If the therapist is expectant
and passive, they push the young person away. The young people’s frustration
over the therapeutic alliance can accordingly be connected with a therapeutic
tradition that is inexpedient with regard to the particular issues with which the
young people are struggling.
Adequate Therapeutic Tradition?
Some features of traditional therapeutic practice can seem meaningless to the
young bereaved in relation to the issues with which they are struggling and want
help. There can be a contradiction between their need for information about and
an active relation to what has happened, own reactions and possibilities for
mastery, and the psychologist’s more passive, expectant, and retrospective attitude
in their meeting with the young people. When the psychologist expects the young
person to take control of the conversation and speak, this can be connected with
a lack of professional knowledge about young suicide survivors. In accordance
with crisis psychology, being active and helping the young people to create
structure and order in a chaotic life situation is central (Dyregrov, 2001). Psycho-
education will be an important tool (Pfeffer, Jiang, Kakuma, Hwang, & Metsch,
2002). By taking as a point of departure information about common reactions
following a suicide, the psychologist will also contribute to creating the necessary
confidence and belief that he or she can help the young person. Crisis psychology
emphasizes the importance of the therapy taking as a point of departure from the
experiences which the young people find most disturbing, and early on provide
self-help advice (Dyregrov & Dyregrov, 2005a, 2005b; Murray, Terry, Vance,
Battistutta, & Connolly, 2000). Subsequent to this, one can implement more
trauma-therapeutic methods such as exposure therapy, cognitive therapy and
EMDR, to address the problems they are struggling with (Bryant, Harvey, Dang,
& Sackville, 1998; Cohen, Mannarino, & Knudsen, 2004).
When the therapist serves as an active and advisory teammate, young people’s
belief in their own resources and mastery is strengthened. Many young suicide
survivors need and wish for help from a psychologist and hereby contribute
with their advice.
The young people claimed that good care giving on the part of a psychologist
would entail:
I. automatic offer of help so that they would not need to seek out and ask for
II. early offer of help, which is repeated according to changing needs/
resistance over time; and
III. stand-by help if and when one needs it.
Moreover, they asked for the following connected to the form of the help:
1. flexibility a rule of thumb, nothing should be “shoved down one’s throat”;
2. an empathetic and interested helper—the chemistry must be right; and
3. a personal focus or individual sessions so they can speak freely.
Finally, considering the content of the help, the suicide survivors asked for
counseling from therapists with knowledge about suicide/crisis psychology. They
needed help with specific problems in the aftermath of a suicide, as well as
information about reactions, how to support others, and advice about self-help.
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Kari Dyregrov
Center for Crisis Psychology
Fortunen 7. 5013 Bergen
... Accordingly, grief counseling may provide critical support that is lacking in other support domains. Indeed, among research with bereaved adolescents and emerging adults, those receiving counseling reported a positive and supportive relationship with their mental health provider (Andriessen et al., 2019;Dyregrov, 2009). This was enhanced among patients who experienced validation and empathy from their provider (Andriessen et al., 2019;Dyregrov, 2009). ...
... Indeed, among research with bereaved adolescents and emerging adults, those receiving counseling reported a positive and supportive relationship with their mental health provider (Andriessen et al., 2019;Dyregrov, 2009). This was enhanced among patients who experienced validation and empathy from their provider (Andriessen et al., 2019;Dyregrov, 2009). Of note, most research in this area focuses solely on the effectiveness of specific interventions in reducing psychopathology or grief symptoms (Sandler et al., 2015) rather than the ability for therapeutic relationships to serve as a form of support. ...
... Still, this was not a universal sentiment, given that four youth expressed a desire to discontinue counseling. While previous research provided more information regarding reasons for dissatisfaction with counseling (Dyregrov, 2009), participants in this study reported that therapy did not provide added benefit and was therefore unhelpful. Current knowledge regarding grief therapy focuses almost solely on specific interventions and their effectiveness, rather than universal factors that lead clients to feel supported in therapy and can be applied across treatments. ...
Through reflexive thematic analysis, this study explored three forms of social support in the lives of parentally bereaved youth: support derived from one's spirituality, caregiver support via parent-child communication, and therapist support from grief counseling (N = 30 youth, Mage = 12.5 years, SD = 2.8 years). Results showed that these sources of support serve varied and vital functions in the lives of parentally bereaved youth. Namely, the benefits of grief counseling and spirituality were consistently identified by youth as critical in facilitating their coping with the loss of a parent; while parent-child communication regarding the deceased varied widely, highlighting the need for additional supports beyond their surviving caregiver. Findings also revealed differences among these supports across youth gender, race, ethnicity, and age. Adolescents were more likely to disengage from counseling services and reported less parental and spiritual support. Males and minoritized youth experienced more benefits from spiritual and therapist supports.
... Overall, panellists placed a high value on helping professionals having knowledge and being skilled through appropriate training in working with bereaved adolescents. This finding is in line with previous studies that have reported that bereaved adolescents want to be supported by skilled and knowledgeable professionals, who can offer them guidance and learning opportunities to deal with their grief [15,20,27]. However, studies have also reported that bereaved adolescents experience important barriers (e.g., opening hours, travel distances) in accessing services and a shortage of adolescent bereavement counselors [20,27]. ...
... This finding is in line with previous studies that have reported that bereaved adolescents want to be supported by skilled and knowledgeable professionals, who can offer them guidance and learning opportunities to deal with their grief [15,20,27]. However, studies have also reported that bereaved adolescents experience important barriers (e.g., opening hours, travel distances) in accessing services and a shortage of adolescent bereavement counselors [20,27]. Together, these findings point to a tension between the needs of bereaved adolescents and the availability of skilled adolescent grief counselors. ...
... Panellists strongly endorsed recommendations about helping professionals listening to bereaved adolescents and providing reassurance and empathic support. This finding is supported by research with bereaved adolescents underlining the importance of the therapeutic relationship with a counselor, being listened to, and receiving validation, which contribute to normalisation of the bereaved adolescents' grief experiences [15,20,27]. The finding is also in line with research in the health and mental health field indicating the importance of the helping professionals having a collaborative approach based on respect, being non-judgemental, and open and informal engagement with the young person [29,30]. ...
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Background Many adolescents struggle with their grief and mental health issues after the death of a close person, such as a family member or a friend. Given the potentially devastating impact of the loss on the adolescent and their family, professional help can be warranted. However, little is known about how to best help these adolescents. This study aimed to address this gap by determining what help professionals (i.e., counselors) should provide to bereaved adolescents. Methods The Delphi method was used to achieve consensus regarding the importance of statements that describe actions a helping professional can take to help a bereaved adolescent. Statements were compiled through a systematic search of the scientific and grey literature, and reviewing interview data from a recent related research study with bereaved adolescents, parents and counselors. An expert panel ( N = 49) comprising 16 adolescents, 14 parents and 19 helping professionals, rated each statement. Statements that were endorsed by at least 80% of panellists were considered consensus recommendations. Results Panellists endorsed 130 out of 190 statements as appropriate actions. These included help for a bereaved adolescent being offered on an ongoing basis, with support to be provided flexibly to meet individual adolescent needs and to acknowledge the agency of the adolescent. Support after a loss by suicide should be tailored to address specific suicide-related issues. Parents of bereaved adolescents should also be offered support so that they are better equipped to help their bereaved adolescent. Conclusions This study identified consensus recommendations on how a helping professional might best help bereaved adolescents. It is hoped that these recommendations will guide helping professionals and enhance adolescent grief interventions.
... Over the last decades, various types of adolescent grief support have become available, such as counseling, support groups, grief camps, and family interventions Bergman et al., 2017). However, adolescents bereaved by suicide have reported important barriers in help-seeking, such as high levels of self-reliance, shame, low levels of literacy about grief and mental health (e.g., perceiving symptoms as transient thus not requiring professional attention), lack of knowledge of services or where to go for help, previous disappointing experiences with services, and lack of services (Andriessen, Lobb, et al., 2019;Dyregrov, 2009). ...
... This differs from Gibson et al. (2016) where some participants thought that texting was a useful addition to in-person counseling, especially when it was embedded in a trustworthy relationship. Overall, our participants emphasized the helpfulness of feeling understood, being able to talk, and feeling listened to, whereas not feeling understood and listened to results in adolescents discontinuing the help and losing their motivation to seek help elsewhere (Dyregrov, 2009). Adolescents bereaved by suicide may particularly need the closer interpersonal connection provided by inperson services to feel able to disclose their complicated feelings. ...
... Adolescents in our study strongly preferred receiving help outside the realm of family and disliked family sessions, a finding also reported in previous adolescent suicide bereavement (Dyregrov, 2009) and adolescent mental health research (Gibson et al., 2016). This finding is concerning given the emerging evidence regarding the effectiveness of family-oriented support for adolescents bereaved by suicide (Pfeffer et al., 2002;Sandler et al., 2016), and the growing evidence of a family approach for a variety of adolescent mental health issues (Carr, 2019). ...
Experiencing a death by suicide is a devastating event in the lives of adolescents; however, little is known about what makes help helpful according to their experiences. Thematic analysis of individual and group interview data (N = 18) yielded four themes: feeling connected with, and understood by a helper, having a sense of control over, and access to the help as needed. Findings indicate that help should be based on supportive and educational approaches with respect to the adolescents’ agency and the family context. Help must be accessible on a long-term basis while catering for flexible usage.
... Participants indicated that they needed more professional support, as well as social support. Most participants in the studies by Dyregrov (2009) andPitman et al. (2018) also indicated a need for professional help after experiencing a loss through suicide. As students are vulnerable for developing mental health problems after the death of a loved one, they may need support in navigating the grief process. ...
Full-text available
Many students have experienced the death of a loved one, which increases their risk of grief and mental health problems. Formal and social support can contribute to better coping skills and personal growth in bereaved students. The purpose of this study was to examine the support that students received or wanted to receive and its relation to students’ mental health. We also looked at students’ needs when receiving support and barriers in seeking formal and social support. Participants (N = 666) completed an online survey consisting of questions about their sociodemographic characteristics, the support they received or wanted to receive, and support needs and barriers in seeking support. The survey also included three scales assessing grief, mental health distress, and personal growth. First, we analyzed the data descriptively. Next, we used MANCOVA to examine whether students who did or did not receive or wanted more support differed in terms of their grief, mental health distress, or personal growth. About 30% of students needed more support and experienced more grief and mental health distress than students who had their support needs met. Students who received support experienced more personal growth and grief than students who did not receive support. Students indicated a need for feeling acknowledged and safe. Feeling like a burden to others and perceiving their problems as not serious enough to warrant support were common barriers to seeking support. Our results indicate that support should be provided actively to students after the death of a loved one, and support being available on an ongoing basis.
... However, children and families are seldom offered professional support in connection with a family member's suicide (16). Young mourners may also be dissatisfied with the professional support they receive, due to a perceived lack of empathy and knowledge about grief after suicide among professionals (17). ...
Full-text available
Background: Children of parents who suffer mental ill-health and die by suicide are vulnerable to developing psychological and social problems themselves; they also have a severely elevated risk of dying at a young age – particularly through suicide. This highlights the need to design supportive measures that can counteract such negative developments after a parent's suicide. Aim: This narrative evaluation of a grief support camp for families affected by a parent's suicide arranged by the non-profit organization Children's Rights in Society in Sweden investigates whether children [ N = 11] and parents [ N = 11] perceived their participation as meaningful and, if so, in what way , and the changes to which the program was said to have contributed. Methods: Family members were invited to reflect on their experiences in narratively structured interviews that took place 18 months after participation. Their narrated experiences were analyzed to examine how the program was integrated into their biographies and with what significance. Narratives of change were identified in particular in order to grasp the self-perceived effects of participation. Results: Both children and parents attributed major significance to their encounters with other suicide bereaved. This led to support exchange and normalization, which countered a perceived “suicide stigma” in everyday life. Help to narratively construct destigmatizing understandings of suicide was also said to have relieved self-blame and shame. Overall, the participants described changes in the form of a better-informed position in grief, increased manageability and enhanced family communication. The parents also reported improved ability to support their children and a more hopeful view of life ahead. Conclusion: The evaluation showcases how this psychoeducational intervention, at a relatively low cost compared to traditional approaches, has great potential to lessen the negative effects of a suicide in the family by assisting families with psychological processing and de-stigmatization. Parental resources are also strengthened, which can serve as continuing support for the children.
... Eight studies noted a change in roles within the family structure following the suicide (Adams et al., 2019;Clark & Goldney, 1995;Demi & Howell, 1991;Dransart, 2017;Dutra et al., 2018;Dyregrov, 2009aDyregrov, , 2009bPitman et al., 2018a;Van Dongen, 1991). Participants felt forced to assume caretaking roles or take on the responsibilities of the deceased. ...
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The effects of suicide are both widespread and long-lasting in the lives of those closest to the deceased. According to the World Health Organization (WHO), suicide is the third leading cause of death in adolescents. Some research has shown that families who lose someone to suicide are at a higher risk of complicated grief compared to those bereaving from other types of losses. These risks may be emphasized given the socio-cultural context surrounding suicide that may problematize the grieving process. In this review, we analyzed 58 qualitative studies describing the experiences of family who lost someone to suicide. We discuss how negative social interactions due to cultural views towards suicide impacted their grieving process. We provide an integrative interpretation of the experiences of family who lost someone to suicide across the following themes: social withdrawal, family communication approaches, role change, cultural attitudes, the role of professional support, interactions with health care providers, and interactions with religious institutions. We examine these findings using the Assumptive World Theory which proposes that humans seek preservation of their reality by using their perceptions of the past to establish expectations for the future. We find that suicide loss is an experience that challenges people's assumptive worlds; suicide loss can be an unexpected trauma that can have a “shock effect” on the assumptive worlds of the bereaved. The assumptive worlds of relatives grieving suicide loss face unique challenges compared to other forms of bereavement because of ambiguity in social norms surrounding suicide that influence interactions.
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Bereavement by suicide is different from other forms of bereavement and needs specialised support. Children and young people who lost loved ones to suicide are more likely to suffer a complicated bereavement process and have poorer mental health. This review aims to assess the evidence for the effectiveness of interventions to support children and young people bereaved by suicide. The review included evidence available up until 29 March 2023. Three studies were identified and all reported on group therapy interventions lasting between 10 and 14 weeks. Key findings and certainty of the evidence Reductions in anxiety and depressive symptoms were found in children who received the group interventions. However, due to the types of study designs used and limitations of the included studies, it is unclear if this is attributable to the interventions, so caution should be applied when generalising the results. The strongest evidence came from a non-randomised controlled study, in which children in the intervention group had significantly greater reduction of anxiety and depressive symptoms compared with children in the control group. However, this study was limited due to numbers of participants lost to follow-up. Research Implications and Evidence Gaps Further research is needed to develop interventions to support children and young people bereaved through death by suicide of a family member. Additional research is needed to evaluate the effectiveness and cost-effectiveness of planned interventions. Policy and Practice Implications It is difficult to draw firm conclusions due to the limited evidence and low quality of included studies. However, there are indications that group interventions may help to reduce anxiety and depressive symptoms in children bereaved by suicide. It will be important to develop guidance and standards of practice for these services based on best available evidence. All such services must use validated outcome measures as part of an integral evaluation process set up from service initiation. Funding statement The Specialist Unit for Review Evidence was funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government
The suicide of one person impacts 60 people, known as suicide survivors. These survivors are at an increased risk for negative mental health outcomes including PTSD, suicidal ideation, and suicide contagion. Despite these consequences, there have not been any information science studies that have explored the information behaviors of people who have recently survived the suicide of a loved one. This article takes a unique approach in combining autoethnography with traditional survey research. One hundred and ninteen participants sourced from a private Facebook suicide bereavement group responded to a survey asking them about their information-seeking after a loved one committed suicide. The qualitative data were fragmented and grouped into like-responses and thematic codes that gave explanation to the research questions. These results are coupled with the author’s ethnographic recounting of a similar experience. Brenda Dervin’s sense-making is employed as the methodological lens through which the study is conducted. It is found that suicide survivors are highly unlikely to have their informational needs met. In the immediate aftermath of their loss, they are most likely to look for information related to the suffering of the deceased. As time passes, they begin to look for information about coping with their loss and preventing suicide of other people; either those close to them or in a larger community scale. Being a survivor motivated many participants to advocacy work. Finally, the author argues that the findings of this article should compel further research and the creation of information policy to aid survivors and prevent suicide contagion.
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The knowledge on health service use, systematic follow-up, and support for families bereaved by suicide remains scarce. This scoping review includes studies from 2010 to March 2022 that investigate the follow-up and support offered by health services, peer support services, and other resources available (e.g., internet-based resources) for families bereaved by suicide. We followed the scoping review framework provided by the Johanna Briggs Institute and performed a double-blinded screening process using Covidence. Data were extracted by four researchers and a thematic analysis was performed to summarize the results. The PRISMA Extension for Scoping reviews was used for reporting results. Of 2385 studies screened by title, 190 by abstract, and 93 by full-text reading, we included 63 original articles of which 24, 29 and 10 were quantitative, qualitative, or mixed-methods studies, respectively. The review shows that we have some knowledge about the need for, and experiences with, health services and support resources for immediate family members bereaved by suicide, but a lack of knowledge about their help-seeking behaviour, patient pathways, systematic follow-up, coordination between services, and long-term outcomes. We need more longitudinal observational studies of health service use and patient trajectories for people bereaved by suicide.
Research suggests that for every suicide as many as hundreds of people are left behind to bear the loss, referred to in the literature as suicide survivors. Part of survivors’ difficulty in processing this loss is the negative emotional chaos it engenders; notably stigma, shame, blame, regret, and anger. While suppression and avoidance are commonly used to counteract these responses, some grief and trauma experts have emphasized attending to one’s emotions and thoughts, rather than working to stifle them. This phenomenological study carried out with three suicide survivors highlights the capacity of leisure, as understood philosophically, to create opportunities for survivors to lean into their loss and express their grief to transform the suicide event from a tragedy to a more positive renewal. Sitting with the pain, upholding love, and sustaining hope were all relevant to the participants’ ongoing grief journeys.
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Few studies have examined the natural coping efforts used by suicide survivors, or have identified specific problems and needs survivors experience following the death of a significant other by suicide. In the present study, we used a newly developed needs assessment survey to examine four areas of natural coping efforts: practical, psychological, and social difficulties; formal and informal sources of support; resources utilized in healing; and barriers to finding support since the loss. Sixty-three adult survivors of suicide were recruited from suicide survivor conferences and support groups. Results indicate that participants experienced high levels of psychological distress since the suicide, including elevated symptoms of depression, guilt, anxiety, and trauma. Participants experienced substantial difficulties in the social arena (e.g., talking with others about the suicide). The majority of the sample viewed professional help as beneficial; although many informal sources of support were also valued (e.g., one-to-one contact with other survivors). Depression and a lack of information about where to find help served as barriers to help-seeking behaviors for our participants. Participants who reported higher levels of functional impairment were more likely to report higher levels of psychological distress, social isolation, and barriers to seeking help. Future research with a longitudinal and more inclusive sample is needed to build on these preliminary findings and to provide a solid foundation for evidenced-based interventions with survivors.
Little research has focused upon those who survive the suicide death of a family member. Among the existing research, survivors representing only one interpersonal relationship class to the deceased (e.g., widows or parents) are usually studied or no differentiation is made with respect to this factor. The purpose of this exploratory study was to investigate some of the assumptions frequently made regarding differences among suicide survivors as a result of their kinship relation to the deceased. Questionnaires were sent to a convenience sample of survivors who had contacted the Minneapolis Suicide Survivors Grief Group. Responses from 141 individuals who survived the suicide death of a child (N = 56), spouse (N = 24), parent (N = 24), or sibling (N = 37) were studied. Few kinship group differences were observed for feelings of guilt or anger, the severity of seeing the death scene in one's mind, personal symptoms following the suicide, or aspects of social stigma or shame. When kinship group differences were observed they were often contrary to assumptions made, particularly regarding parents as survivors of offspring suicides. It is concluded, however, that, with few exceptions, suicide survivors variously related to the deceased have similar grief experiences, and pathology is not characteristic among any kinship group, and that most expectations of differences are not supported.
We studied the effects of the death of a child by suicide (N = 34) versus non-suicide (N = 46) on family dynamics of forty-one parents and thirty-nine surviving siblings. Participants were solicited through bereavement groups, flyers, and newspaper advertisements. Participants completed a demographic questionnaire, the Bloom Family Interaction Scale, and a Closeness/Distance questionnaire about four years post death. Results included: 1) disengaged or conflicted families experienced greater distance while cohesive or expressive families reported more closeness; 2) sibling survivors felt closer to their fathers after the death than before and reported more family conflict than did parents; 3) there were no differences between suicide survivors and non-suicide survivors in perceived closeness between family pairs before or after the death.
The psychiatric sequelae of loss of a family member to suicide were evaluated in parents and siblings of adolescent suicide victims and controls, who were followed up to 3 years after the suicide. Siblings did not show an increased risk for the development of depression, posttraumatic stress disorder (PTSD), or other conditions over the course of follow-up, despite showing a prolonged elevated level of grief symptomatology. Mothers showed an increased rate of recurrence of depression over follow-up, whereas fathers did not show an increased incidence of disorder compared to fathers of controls. The interrelationship of bereavement and depression for siblings, parents, and others exposed to suicide is discussed.
Twenty-five adolescent siblings of 20 adolescent suicide victims were psychiatrically assessed 6 months after the suicide, and compared to 25 demographically matched controls. Siblings were much more likely to show a new-onset major depression subsequent to exposure to suicide. New-onset depression was associated with previous psychiatric disorder, family history of any psychiatric disorder, and family history of major depression. Mothers of suicide victims, compared to the mothers ofcontrols, were also more likely to be depressed 6 months after the suicide of their child. The development of a family-based intervention for families of adolescent suicides is recommended.