Sense of Solidarity Among Parents of Sons or Daughters Who Have Attempted Suicide: An In-depth Interview Study

Experiences and needs of adult informal carers of adults at risk of suicide: A systematic review with mixed methods analysis

AIM

To systematically review and synthesize primary research on experiences and needs of adult informal caregivers of adults at risk of suicide.

DESIGN

Systematic review with a data-based convergent synthesis.

DATA SOURCES

MEDLINE, PsychINFO and CINAHL were searched in April 2022 and February 2023. English language research focusing on experiences of adult carers of adults was included.

METHODS

Articles were screened by title (n = 9077) and abstract (n = 132) with additional articles (n = 6) obtained via citation and hand searching. Thirty-one included studies were quality assessed using the Mixed Methods Appraisal Tool and study data were systematically extracted prior to thematic synthesis.

RESULTS

Five interconnected themes resulted: transitions; living with fear and uncertainty; changing relationships; interface with healthcare professionals and services; what carers need and want. Caring impacts mental, physical and social wellbeing. Relationships are affected in ways which might not be evident when caring for a minor. Repeated suicidal behaviour is particularly challenging with ongoing hypervigilance contributing to burden, burnout and interpersonal strain. Poor carer support exacerbates negative effects; carers need to feel informed, educated, involved and holistically supported.

CONCLUSION

Timely support for carers is essential. Interventions should address emotional responses, relational changes and effective care recipient support. Longitudinal research is required to understand effects of ongoing caring where there are multiple suicide attempts.

IMPLICATIONS

Nurses can provide carers with early support and information and longer term psychosocial interventions. If carers are adequately equipped and supported patient safety and wellbeing will be improved.

IMPACT

Findings of this systematic review include relational changes due to carer hypervigilance reducing autonomy and living with the possibility of suicide. Clinician awareness of the potential for relational shifts will help them prepare and support carers.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution.

The experiences of living with a suicidal family member, and the impact on daily life: A systematic review and meta-aggregation

INTRODUCTION

Because of the pivotal role that family members play in caring for their suicidal relative, insight into their experiences is necessary to develop good support for them.

AIM

This systematic review aimed to aggregate qualitative research examining the experiences of family members living with their suicidal relative, and their impact on daily life.

METHODS

Systematic searches, covering the period 2000-2022, were conducted in Medline, Embase, PsycINFO, Ovid Nursing database and CINAHL. The JBI-QARI meta-aggregation approach and the PRISMA guidelines were followed.

RESULTS

Eleven studies met the inclusion criteria. Six themes were identified: The hard job of managing the risk of suicide; contributing to the relative's survival; struggling with professional care; being in a lonely position; pressure on relationships; and disruption of well-being.

DISCUSSION

The constant worry of losing their relative and ever-present vigilance dominates their lives in such a way that their well-being may be decreased. Professionals often overlook family members, which leads to feelings of powerlessness and loneliness.

IMPLICATIONS FOR PRACTICE

Collaborating with families in treatment, allowing them to share information and supporting them in the care at home may lead to better outcomes for both the family and their suicidal relative.

Caring for a friend or family member who has experienced suicidal behaviour: A systematic review and qualitative synthesis

PURPOSE

Friends and family members can be important sources of support for people who are or have been suicidal. This review aimed to synthesise qualitative evidence regarding carers' perspectives of supporting someone who has experienced suicidal behaviour.

METHODS

Five electronic databases (Web of Science, CINAHL, PsychINFO, MEDLINE, and SocINDEX) were searched from inception to May 2022. Eligible qualitative studies were published in English and investigated the caring experiences of friends or family members of people who had experienced suicidal behaviour, defined as any form of suicidal ideation and/or attempts. Studies focused on non-suicidal self-injury or suicide bereavement were excluded. Data from 19 eligible studies were analysed using thematic synthesis.

RESULTS

Initial carer reactions to suicidal behaviour included profound anxiety and intensive monitoring for signs of increased suicide risk amongst those they supported. Carers also reported significant challenges with understanding how to provide effective interpersonal support following suicidal crises. Professional support was perceived to be most effective when provided in a timely, interpersonally sensitive and safety-focused manner. However, several studies detailed carers' difficulties accessing appropriate support and challenges managing their own distress.

CONCLUSIONS

Carers face significant challenges with knowing how to respond to suicidal behaviour, where to find appropriate help, and how to manage their own distress. Future research should seek to investigate the effectiveness of easily accessible methods of information provision and support tailored for carers of people who have experienced suicidal behaviour.

Re-constructing parental identity after parents face their offspring's suicidal behaviour: An interview study

INTRODUCTION

Parents are affected when their offspring engages in non-fatal suicidal behaviour. Although research exists on parents' mental and emotional state when they realise this behaviour, relatively little attention has been devoted to exploring how their parental identity is affected.

PURPOSE

To explore how parents re-constructed and negotiated their parental identity after realising that their offspring was suicidal.

METHOD

A qualitative exploratory design was adopted. We conducted semi-structured interviews with 21 Danish parents who self-identified as having offspring at risk of suicidal death. Interviews were transcribed, analysed thematically and interpreted by drawing on the interactionist concepts of negotiated identity and moral career.

FINDINGS

Parents' perspectives on their parental identity were conceptualised as a moral career encompassing three distinct stages. Each stage was negotiated through social interaction with other people and the wider society. Entry into the first stage, disrupted parental identity, occurred when parents realised that they could lose their offspring to suicide. At this stage, parents trusted their own abilities to resolve the situation and keep their offspring safe and alive. This trust was gradually undermined by social encounters, which caused career movement. In the second stage, impasse, parents lost faith in their ability to help their offspring and to change the situation. Whereas some parents gradually resigned entirely to impasse, others regained their trust in their own abilities through social interaction in the third stage, restored parental agency.

CONCLUSION

Offspring's suicidal behaviour disrupted parents' self-identity. Social interaction was fundamental if parents were to re-construct their disrupted parental identity. This study contributes with knowledge about the stages characterising the reconstructive process of parents' self-identity and sense of agency.

A Systematic Review of the Experiences and Support Needs of Informal Caregivers for People Who Have Attempted Suicide or Experienced Suicidal Ideation

Informal caregivers include family, friends, and significant others who provide important support for people who have attempted suicide or experienced suicidal ideation. Despite the prevalence of suicidal behaviour worldwide, they remain an understudied population. This review aimed to synthesise the literature on the experiences and support needs of informal caregivers of people who have attempted suicide or experienced suicidal ideation. We conducted a systematic review according to PRISMA guidelines. Searches of peer-reviewed literature in Medline, Emcare, Embase, EBM Reviews, and PsycINFO identified 21 studies (4 quantitative and 17 qualitative), published between 1986 and 2021. Informal carers commonly reported symptoms of depression and anxiety, for which they receive little assistance. They also expressed a desire for more involvement and education in the professional care of suicidality. Together, the studies indicated a need to improve the way informal caregiving is managed in professional healthcare settings. This review identified potential avenues for future research, as well as broad areas which require attention in seeking to improve the care of suicidal people and their caregivers.

The human approach to supportive interventions: The lived experience of people who care for others who suicide attempt

There is currently limited information about the impact and experiences of a suicide attempt on the well-being of a person providing care before, during, or after the attempt. Scant evidence available suggests that providing care has a profound impact on the support person or carers' own physical and psychological health; they may experience adverse health, financial, and functional outcomes, collectively described as 'caregiver burden'. This project sought to understand insights into the experience of providing care for someone who has previously attempted suicide. The larger study was designed in three phases consisting of an online survey, semi-structured interviews, and a follow-up survey. This paper reports the qualitative findings of the interviews which were thematically analysed. Two symbiotic themes emerged: the lived experience of caring and the impact of engagement and support from the healthcare system. The authors concluded that that the carer position is a multidimensional role involving informal agreements and situational or time-based support. Further, awareness of this shifting relationship needs to be embedded in the provision of care by health professionals following a suicide attempt. Recommendations for enhanced health system response are proposed.

Relatives' experiences of providing care for individuals with suicidal behaviour conceptualized as a moral career: A meta-ethnographic study

BACKGROUND

An increasing number of qualitative research articles have reported on relatives' experiences of providing care for individuals displaying suicidal behaviour. To contribute more fully to theory and practice, these reported experiences must be synthesized.

OBJECTIVES

To identify original qualitative studies of relatives' experiences of providing care for individuals with non-fatal suicidal behaviour and to systematically review and synthesize this research using a meta-ethnographic approach.

DESIGN

Systematic review and meta-ethnography.

DATA SOURCES

Literature searches were undertaken in six bibliographic databases (PubMed, CINAHL, Embase, PsycINFO, Web of Science and Scopus) and limited to peer-reviewed original studies. Eligible studies reported relatives' experiences of providing care for individuals with suicidal behaviour, published in English or a Scandinavian language.

REVIEW METHODS

One reviewer screened the titles, abstracts and full texts and then collaborated with another reviewer on excluding ineligible studies. A two-step strategy was used while reviewing publications: 1) appraising study quality, and 2) classifying study findings according to degree of data interpretation. This strategy was used for each study by two independent reviewers who subsequently reached a shared decision on inclusion. Noblit and Hare's methodology for translation and synthesis was followed in developing a novel theoretical interpretation of relatives' experiences. The concept of moral career was adopted in producing this synthesis.

RESULTS

Of 7,334 publications screened, 12 studies were eligible for inclusion. The synthesis conveyed relatives' moral career as comprising four stages, each depicting relatives' different perspectives on life and felt identities. First, relatives negotiated conventional ideas about normalcy and positioned themselves as living abnormal family lives in the stage from normal to abnormal. The first career movement could be mediated by social interactions with professionals in the stage feeling helpful or feeling unhelpful. For some relatives, this negotiated perspective of abnormality got stuck in an impasse. They did not interact with their surroundings in ways that would enable them to renegotiate these fixed views, and this stage was named stuck in abnormality. For other relatives, career movement took place as relatives re-positioned themselves as negotiating an alternative perspective of normalcy in the stage from abnormal to normal.

CONCLUSIONS

Interactions with other people facing similar difficulties enabled relatives to shift perspectives and alleviated experiences of distress.