Surviving the suicides of significant others: a case study

The Experience of Adults Bereaved by the Suicide of a Close Elderly Relative: A Qualitative Pilot Study

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.

Prevalence and associated factors of suicidal ideation and attempt among undergraduate medical students of Haramaya University, Ethiopia. A cross sectional study

INTRODUCTION

Suicide is a disastrous act which has a significant effect on the global burden of disease, contributing yearly to 1.4% of the total burden with the foremost role played by a people aged between 15 and 35 years. Medical students are one of the high-risk groups for suicide. This increased risk may begin during medical school and leads to premature death. But, there is a paucity of epidemiologically reliable data on the issue. Therefore, the current study was aimed to assess the prevalence and associated factors of suicidal ideations and attempt among undergraduate medical students of Haramaya University.

METHOD

An institutional based cross-sectional study was conducted from May 13 to June 12, 2019 at College of Health and Medical Science, Haramaya University. Stratified sampling technique was used and a total of 757 participants were selected by using simple random sampling technique. Data were collected using a self-administered questionnaire. Suicidal ideation and attempt were assessed by using suicidal module of world mental health survey initiative version of the World Health Organization, composite international diagnostic interview. Data were analyzed using Statistical Package for Social Science Version 20. Descriptive results were presented by tables and graphs. Bivariate and multivariate logistic regression analyses were done to identify factors associated with suicidal ideation and attempt. P-values less than 0.05 were considered statistically significant and the strength of association was presented by an adjusted odds ratio with 95% confidence interval.

RESULT

The study showed that the prevalence of suicidal ideation and attempt were 23.7% (95%CI, 20.5-26.8) and 3.9% (95%CI, 2.6-5.5), respectively. Cumulative grade point average (AOR = 0.30, 95% CI: 0.18-0.49), current alcohol use (AOR = 2.26, 95%CI: 1.45-3.55), depression (AOR = 3.58, 95%CI: 2.23-5.76), anxiety (AOR = 3, 95%CI: 1.88-4.77), and poor social support (AOR = 2.57, 95%CI: 1.41-4.68) were the factors statistically associated with the suicidal ideation. Depression (AOR = 5.4, 95%CI: 1.45-20.14) and anxiety (AOR = 3.19, 95%CI: 1.01-10.18) were associated with the suicidal attempts.

CONCLUSION

This study showed that the high prevalence of suicidal ideation and attempt as compared to the prevalence of suicidal behavior among other university students who were studying in other fields. Cumulative Grade Point Average, current alcohol use, depression, anxiety and poor social support were the factors statistically associated with the suicidal ideation. Depression and anxiety were the ones associated with the suicidal attempt. Early screening, detection and management of suicidal behavior and associated mental health problems were recommended for undergraduate medical students.

Exposure to Suicide in the Family: Suicidal Ideation and Unmet Interpersonal Needs in Young Adults Who Have Lost a Family Member by Suicide

The aims of the present study were to compare a sample of individuals exposed to suicide in their families with a control group, on suicidal ideation, and to test possible potentiating effects for unmet interpersonal needs. Three hundred eighty-six young Portuguese adults participated. Two groups were defined: a group exposed to suicide in the family (n = 38) and a control group (n = 335). Groups differed significantly on suicidal ideation, on depressive symptoms, and on perceived burdensomeness and tended to differ on thwarted belongingness. Results from a hierarchical multiple regression analysis demonstrated that having lost a family member by suicide and perceived burdensomeness each provided a significant unique contribution to explaining variance in suicidal ideation when controlling for levels of depressive symptoms and having had a psychiatric diagnosis. The interaction between group membership and perceived burdensomeness provided a further enhancement to the statistical prediction of suicidal ideation.

Attachment Styles and Posttraumatic Growth Among Suicide-Loss Survivors

Abstract. Background and aims: The world loses approximately one million people to suicide every year, leaving behind many suicide-loss survivors, family members and friends, who are significantly affected by the traumatic loss. Yet some suicide-loss survivors not only manage to cope with the loss, but actually experience posttraumatic growth (PTG). To date, no studies have fully examined the psychological processes that underlie this personal positive change. We hypothesized that attachment style would predict PTG and this association would be mediated by self-disclosure and social support. Method: A community sample of 131 suicide-loss survivors (108 women), aged 18–70, self-reported on attachment style, self-disclosure, social support, and PTG. Results: Securely attached individuals scored highest on PTG compared with other attachment styles. A structural equation model confirmed that self-disclosure and social support mediated the association between attachment and PTG. Suicide-loss survivors with secure attachment tended to self-disclose more and to perceive greater support from others than did suicide-loss survivors with insecure attachment, thus enhancing their chances of PTG. Limitations: The sample comprised mostly female participants, and the findings may not be directly generalizable to male suicide-loss survivors. Conclusion: Our results suggest that different psychological interventions should be utilized for suicide-loss survivors with particular attachment styles. Psychotherapies aiming to modify internal working models may be useful for enhancing PTG among survivors characterized by insecure attachment styles.

Relationship with the deceased as facilitator of posttraumatic growth among suicide-loss survivors

This study aimed to investigate the role of ongoing relationships with the deceased in facilitating posttraumatic growth among suicide-loss survivors. The sample comprised 58 suicide-loss survivors, 48 sudden-death, and 53 natural-death bereaved individuals, who completed questionnaires assessing the two-track model of bereavement, grief, and growth-related characteristics. Suicide-loss survivors reported lower levels of positive relationships with the deceased than did the other groups. An interaction was found between relational-active grieving and type of death in predicting posttraumatic growth. The study concluded that intense grief along with preoccupation with the deceased lessened positive personal transformation, especially among those struggling with a loved one's suicide.

To share or not to share? The contribution of self-disclosure to stress-related growth among suicide survivors

This study examined to what extent suicide survivors can experience growth in the aftermath of suicide loss, as well as the role of self-disclosure and coping strategies in stress-related growth (SRG) among suicide survivors, compared to bereavement following sudden and expected death types. One hundred forty-five bereaved individuals (aged 18-73) completed questionnaires measuring SRG, self-disclosure, and coping strategies. Significant interaction between self-disclosure and types of death was found, in which suicide survivors with low levels of self-disclosure manifested the lowest level of SRG compared to other subgroups. This finding suggests that sharing intimate information can be beneficial in struggling with a situation of suicide in the family.

Association between suicidal ideation and exposure to suicide in social relationships among family, friend, and acquaintance survivors in South Korea

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.

Stress-Related Growth among Suicide Survivors: The Role of Interpersonal and Cognitive Factors

Although stress-related growth had been documented in bereaved individuals, it is still not clear to what extent it can be experienced by suicide survivors or which psychological processes facilitate it. The current study examined the role of interpersonal factors-self disclosure and social supports as well as cognitive coping strategies in stress-related growth among suicide survivors. The sample consisted of 135 suicide survivors (104 women and 31 men) aged 18-70. All participants completed the stress-related growth questionnaire as well as instruments measuring interpersonal activities, cognitive strategies, and demographic characteristics concerning the bereavement. The findings showed significant positive correlations between time elapsed since death, self-disclosure, social support, adaptive cognitive strategies, and stress-related growth. Furthermore, hierarchical regression analysis revealed that together these variables accounted for over 38% of the variance in stress-related growth. Interpersonal activities such as talking and interacting with others, as well as a cognitive focus on planning for the future emerged as important factors in personal transformation after suicide loss.

Two perspectives on the needs of individuals bereaved by suicide

To qualitatively explore the needs of suicidally bereaved individuals, researchers interviewed 11 suicide bereaved individuals and 4 mental health workers. Common themes of bereaved persons included the suicide grief experience, coping, interpersonal domain, struggle with meaning, self-reflection, and moving forward. Mental health workers emphasized the nature of the helping relationship, the need to emotionally process the grief, the centrality of meaning making, importance of support groups, and the role of individual counseling. These 2 perspectives informed "best practices" for postvention (e.g., understanding the need for meaning-making while recognizing when to move on).

Bereavement after the suicide of a significant other

CONTEXT

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.

AIMS

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.

MATERIALS AND METHODS

Careful MedLine and PsycINFO searches for the period 1980-2013.

RESULTS

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.

CONCLUSION

Future research should evaluate the efficacy of professional treatments and of support groups targeting suicide survivors.

PRACTICE IMPLICATIONS

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.

Qualitative psychological autopsy interviews on suicide in post-conflict Northern Uganda: the participants' perceptions

Participants' perceptions of psychological autopsy interviews were investigated in post-conflict Northern Uganda. Data were derived out of their responses in the debriefing session after the formal interviews. These responses were subjected to Interpretative Phenomenological Analysis (IPA). The majority of the participants were positive about the interview as reflected in the two broad themes: positivation of the situation through the possibility of helping others and opportunity for personal development through sharing. To some few participants the interview aroused guilt, self-reproach, and anger and reactivated painful memories. As regards suicide postvention, the findings implied that not much has been done to help the bereaved by suicide in this region, and few resources for such efforts are currently available. However, the bereaved are ready to contribute toward the fight against suicide in their communities. Hence, it is argued that a community-based mental health and Primary Health Care approaches should be encouraged in this context.

Integrating medical examiner and police report data: can this improve our knowledge of the social circumstances surrounding suicide?

BACKGROUND

Recently, suicide in the United States has begun to be viewed as a preventable public health issue. This has led to the creation of a National Violent Death Reporting System that collects and integrates data on the social circumstances surrounding suicides.

AIMS

The study examines data on social circumstances surrounding suicides as collected by the medical examiner report (ME) and police report (PR) and subsequently integrated into the state of Maryland's violent death reporting system.

METHODS

Reported data on social circumstances surrounding suicides occurring in the years 2003-2006 in Maryland (n = 1,476) were analyzed by examining their prevalence in the ME and PR, strength of association, and integration.

RESULTS

With the exception of three circumstances, there was variation among reported circumstances in the ME and PR. Furthermore, there was only a moderately strong relationship between the ME and PR for most circumstances, while a significant increase occurred in the prevalence of these circumstances when ME and PR were integrated.

CONCLUSIONS

The integration of ME and PR has the potential to increase our knowledge of the circumstances surrounding suicide and to better inform prevention efforts. However, before this potential can be reached, there are still issues that must be considered.

The Invisible Family: A Qualitative Study of Suicide Survivors in Taiwan

The purpose of this interpretive phenomenological study is to describe the commonality of the lived experience of suicide survivors and how it influences their family relationships in Taiwan from a sociocultural perspective. Thirteen suicide survivors have participated in this study. Study results reveal that some survivors blame themselves, some blame others, and some are blamed by their family as part of their need to find a reason for the death. Consequently, family members ignore each other and treat each other as if they are invisible. These Chinese suicide survivors, unlike Western survivors, maintain their strained family connections because of strong cultural influences. Therefore, health professionals should acknowledge the experiences of living with an invisible family when supporting Chinese suicide survivors.