Spouses bereaved by suicide: A population-based longitudinal cohort comparison of physician-diagnosed mental disorders and hospitalized suicide attempts

The role of depression and use of alcohol and other drugs after partner suicide in the association between suicide bereavement and suicide: cohort study in the Danish population

BACKGROUND

Although suicide bereavement is associated with suicide and self-harm, evidence regarding mechanisms is lacking. We investigated whether depression and substance use (alcohol and/or other drugs) explain the association between partner suicide bereavement and suicide.

METHODS

Linkage of nationwide, longitudinal data from Denmark for the period 1980-2016 facilitated a comparison of 22 668 individuals exposed to bereavement by a partner's suicide with 913 402 individuals bereaved by a partner's death due to other causes. Using causal mediation models, we estimated the degree to which depression and substance use (considered separately) mediated the association between suicide bereavement and suicide.

RESULTS

Suicide-bereaved partners were found to have a higher risk of suicide (HRadj = 1.59, 95% CI 1.36-1.86) and of depression (ORadj 1.16, 95% CI 1.09-1.25) when compared to other-bereaved partners, but a lower risk of substance use (ORadj 0.83; 95% CI 0.78-0.88). An increased risk of suicide was found among any bereaved individuals with a depression diagnosis recorded post-bereavement (ORadj 3.92, 95% CI 3.55-4.34). Mediation analysis revealed that depression mediated 2% (1.68%; 95% CI 0.23%-3.14%; p = 0.024) of the association between suicide bereavement and suicide in partners when using bereaved controls.

CONCLUSIONS

Depression is a partial mediator of the association between suicide bereavement and suicide. Efforts to prevent and optimize the treatment of depression in suicide-bereaved people could reduce their suicide risk. Our findings might be conservative because we did not include cases of depression diagnosed in primary care. Further work is needed to understand this and other mediators.

Qualitative inquiry into the experience of suicide loss, aftereffects and coping strategies of suicide-bereaved Greek-speaking parents in Cyprus

PURPOSE

Studies on suicide-bereaved parents are scarce in South European and Eastern Mediterranean countries. We explored the experiences of Greek-speaking suicide-bereaved parents in Cyprus, with emphasis on the interpretations of their child's suicide, its aftereffects and their coping strategies.

METHODS

A qualitative methodology based on inductive content analysis of the interviews of ten mothers and two fathers was applied.

RESULTS

The participants described their efforts to make sense of the senseless, reporting numerous interpretations of their child's suicide. Some participants had achieved to move on by trying to keep the remaining family together. Others felt detached from their social network. The different coping strategies and support systems described, reflected participants' efforts to escape from obsessive, enduring and deeply traumatizing thoughts about their child's suicide. The analysis mirrored participants' ultimate desire to find existential relief and serenity through the management of distressing reminders of their child's suicide, and alleviate the burden of their own negative self-judgement and the criticism of others. They sought physical and emotional comfort in the inner realm of their psyche, through spiritual and psychological coping processes.

CONCLUSION

Further exploration is suggested about intervention planning aiming to strengthen effective coping strategies and external supportive resources in mourning parents.

Investigating Whether Bereavement by Suicide and Other Unnatural Causes Has a Deterrent Effect on Alcohol or Drug Use in Young Adults

Bereavement by suicide and other unnatural causes is associated with suicide but evidence regarding risk of substance misuse is inconsistent. This may be due to heterogeneity in patterns of alcohol or drug use after traumatic bereavement; some increasing use to cope with the loss and others reducing use. To highlight the problems of focussing on diagnostic thresholds when investigating substance use after traumatic loss, we aimed to test whether people bereaved by suicide or other unnatural causes are more likely to reduce or stop their substance use than people bereaved by sudden natural causes. Using multivariable logistic regression and data from an online survey of 1854 UK-based bereaved adults, we tested the association between bereavement by suicide and other unnatural causes and post-bereavement reduction/cessation in (i) alcohol and (ii) drug use. There were no group differences in the proportions who reduced/stopped alcohol use, but a significantly greater proportion of people bereaved by sudden unnatural causes reduced/stopped drug use post-bereavement than people bereaved by sudden natural causes (AOR = 2.61; 95% CI = 1.44-4.71; p = 0.001; 4.1% versus 1.7%). In sub-group analyses this applied separately to people bereaved by suicide and non-suicide unnatural causes. Research into post-bereavement substance use should accommodate apparent divergent sub-diagnostic patterns.