Suicide-bereaved children and adolescents: a controlled longitudinal examination

Adolescents' primary care consultations before and after parental suicide: evidence from population-wide data

Parental bereavement is associated with distress and poorer long-term outcomes among adolescents. Adolescents who lose a parent to suicide fare worse than their peers even before bereavement. Based on the current literature, we cannot distinguish such initial differences from the medium and long-term effect of parental suicide. We study the impact of parental suicide on adolescents' General Practitioner visits for mental health or psychosocial reasons. Within-individual models account for time-invariant differences between the bereaved and non-bereaved. We investigate if effects differ from the impact of parental death from other causes, and vary with sex and socioeconomic background. Full population data on Norwegian residents aged 10-19 in the period 2006-2015 are drawn from registers (N = 1 405 suicide bereaved, 12 982 bereaved by other causes, and 1 182 819 non-bereaved controls). Records include data on use of health services, parental mortality, and sociodemographic characteristics of parent and child. Mental health consultations increase gradually in the quarters leading up to the parental suicide, significantly more for girls than for boys. Two years prior to bereavement, 2.4% of the subsequently suicide bereaved have a mental health consultation in any given quarter. In the year of bereavement, this increases with 6% points. Health care workers should be aware that boys are less likely to turn to their GP for support before parental bereavement from suicide.

Connection between maternal suicide attempt and chronic morbidity in children

BACKGROUND

Maternal suicide attempts are associated with adverse psychosocial outcomes in children, but the association with chronic morbidity is poorly understood. We examined the relationship between maternal suicide attempt and risk of hospitalization for potentially preventable conditions in offspring.

METHODS

We analyzed a longitudinal cohort of 1 032 210 children born in Quebec, Canada between 2006 and 2019. The main exposure measure was maternal suicide attempt before or during pregnancy. Outcomes included child hospitalizations for potentially preventable conditions, including infectious diseases, dental caries, atopy, and injury up to 14 years after birth. We used adjusted Cox proportional hazards regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of maternal suicide attempt with risk of hospitalization for these outcomes.

RESULTS

Compared with no suicide attempt, children whose mothers attempted suicide had an increased risk of hospitalization for infectious diseases (HR 1.11, 95% CI 1.06-1.16), dental caries (HR 1.31, 95% CI 1.15-1.48), and injury (HR 1.16, 95% CI 1.03-1.31). Risk of hospitalization for any of these outcomes was greater if mothers attempted suicide by hanging (HR 1.46, 95% CI 1.22-1.75), had their first attempt between the age of 25 and 34 years (HR 1.27, 95% CI 1.13-1.42), and had 3 or more attempts (HR 1.56, 95% CI 1.27-1.91). Maternal suicide attempts were more strongly associated with child hospitalization before 10 years of age.

CONCLUSIONS

Children whose mothers have a history of suicide attempt have an elevated risk of hospitalization for potentially preventable conditions.

Longitudinal Changes in Suicide Bereavement Experiences: A Qualitative Study of Family Members over 18 Months after Loss

Family members bereaved by their loved ones' suicidal death normally undergo a complicated and lengthy bereavement process. In this qualitative case study, we explored longitudinal changes in the suicide bereavement process by applying assimilation analysis, based on the Assimilation Model (AM) and the Assimilation of Problematic Experiences Scale (APES), to longitudinal interview data collected from two Chinese suicide-bereaved individuals within the first 18 months after their loss. The results showed that over time the participants both progressed in adapting to their traumatic losses. Assimilation analysis both effectively elaborated the difference in the inner world of the bereaved and clearly demonstrated development in their adaptation to the loss. This study contributes new knowledge on the longitudinal changes in suicide bereavement experiences and demonstrates the applicability of assimilation analysis to suicide bereavement research. Professional help and resources need to be tailored and adapted to meet the changing needs of suicide-bereaved family members.

Three Sibling Survivors' Perspectives of their Father's Suicide: Implications for Postvention Support

This qualitative case study describes three adult siblings' experiences and their perceptions of support connected with the time before and after their father's suicide. At the time of the suicide, participants were ages 1, 5, and 8 years old. We considered commonalities and disparities among the three survivors' perceptions. We also considered how their reported experiences compared to extant literature on child survivors of parent suicide. Our findings suggest that, although the siblings experienced the same traumatic event, each had unique perceptions of the parent's suicide. Immediately prior to closing each interview, to deescalate from the intense topic of suicide, participants offered their impressions of potentially therapeutic children's books and how bibliotherapy may or may not support surviving children. Participants' perceptions of selected children's picture books offer insights about opening communication and addressing challenges specific to a parent's suicide. Implications for teachers, parents, and school-based mental health professionals are provided. We conclude that postvention must consider and monitor each child's perceptions and provide individualized interventions that encourage open communication and support adaptive coping to navigate the intense grief associated with a parent's suicide.

Ethnic Minority Groups' Experiences of Suicide Bereavement: A Qualitative Exploratory Study

It is estimated that between 36,000 and 360,000 people are affected by suicide every year in the UK, and a proportion may develop depression and post-traumatic stress disorder, or engage in high-risk behaviours. Recent systematic analyses have revealed a clear gap in research on suicide bereavement in minority ethnic groups. This study aimed to understand the experiences and support needs of individuals from ethnic minority backgrounds bereaved by suicide and was the first in the UK to investigate this matter. The study was a secondary analysis of data. Participants were 7158 people residing in the UK who completed an online survey about their experiences of suicide. Free-text qualitative responses of 227 participants who did not identify as White British were analysed using thematic analysis. Four themes were identified: maladaptive coping strategies, emotional processes following suicide, lack of support from agencies, and the importance of mental health awareness. Ethnic minority groups reported a lack of support despite attempts to engage with services, noted the prevalence of stigma within ethnic minority groups, and expressed a need to tackle this. These preliminary results suggest that ethnic minority individuals require visible and accessible services that can successfully engage with and support them.

A systematic review of controlled studies of suicidal and self-harming behaviours in adolescents following bereavement by suicide

BACKGROUND

Research suggests that being exposed to the suicide of others increases risk of subsequent suicidal or self-harming thoughts or behaviours. What is less clear is whether this applies to adolescents, and if the risk exceeds that following other causes of death, which has implications on suicide prevention approaches. This study aimed to systematically review the evidence on adolescent bereavement experiences by different causes to address this gap.

METHODS

A comprehensive literature search using four databases (MEDLINE, PsycInfo, Web of Science, and Embase) identified 21 studies which measured suicidal or self-harm outcomes among bereaved adolescents aged between 12 to 18 years old. The literature was screened, data was extracted using pre-piloted forms, and risk of bias was assessed using versions of the Newcastle-Ottawa Scale; a proportion of papers were double extracted and assessed for bias. The review has been registered with PROSPERO (CRD42016051125).

RESULTS

A narrative synthesis of the literature demonstrated divergent findings depending on the outcome being measured. Suicide bereavement appears to be strongly associated with suicide mortality among parentally bereaved youth, while self-harm or non-fatal suicide attempts (either presenting to hospital or self-reported) showed mixed evidence. Suicidal ideation was not uniquely associated with suicide bereavement. An exploration of circumstances surrounding the death, characteristics of the person who died, and characteristics of the young person across each outcome measure suggested that earlier experiences of loss, shorter timeframes following the death, and maternal death are associated with particularly elevated risk of suicidal outcomes.

CONCLUSIONS

Findings suggest that suicide loss is associated with subsequent suicide, and may be associated with non-fatal self-harm. A detailed account of the risk and protective factors surrounding suicide bereavement among young people is crucial to understand the pathways through which suicidal behaviours develop. Researchers, policy makers and practitioners with an interest in suicide prevention will benefit from clarity around the needs of young bereaved individuals.

Non-Parental Investment in Children and Child Outcomes after Parental Death or Divorce in a Patrilocal Society

Children rely on support from parental helpers (alloparents), perhaps especially in high-needs contexts. Considerable evidence indicates that closer relatives and maternal relatives are the most likely to provide this care, as inclusive fitness theory suggests, but whether this is equally true across different family types and in culturally patrilocal societies requires investigation. This structured interview study (N = 208 respondents with 323 dependent children) focuses on who helps raise children in rural Bangladesh after the father’s or mother’s death, or divorce, in comparison to families with both parents present or the father temporarily a migrant laborer. Family types differed in where and with whom children resided, who served as their primary and secondary caregivers, and who provided material support, but mother’s kin played a major role, and were the primary providers of material resources from outside the child’s household in all family types. Despite the patrilineal ideology, only one-quarter of children of divorce lived with the father or his family, and even after the death of the mother, only 59% remained with father or other paternal kin. Household income varied by family type and was a strong predictor of child height and weight. The children of deceased mothers moved between successive caregivers especially frequently, and were uniquely likely to have no schooling. The typology of Bangladeshi society as patrilocal obscures the extent to which matrilateral family support children’s well-being.

Association between family history of suicide attempt and neurocognitive functioning in community youth

BACKGROUND

Suicidal behavior is highly familial. Neurocognitive deficits have been proposed as an endophenotype for suicide risk that may contribute to the familial transmission of suicide. Yet, there is a lack of research on the neurocognitive functioning of first-degree biological relatives of suicide attempters. The aim of the present study is to conduct the largest investigation to date of neurocognitive functioning in community youth with a family history of a fatal or nonfatal suicide attempt (FH).

METHODS

Participants aged 8-21 years from the Philadelphia Neurodevelopmental Cohort completed detailed clinical and neurocognitive evaluations. A subsample of 501 participants with a FH was matched to a comparison group of 3,006 participants without a family history of suicide attempt (no-FH) on age, sex, race, and lifetime depression.

RESULTS

After adjusting for multiple comparisons and including relevant clinical and demographic covariates, youth with a FH had significantly lower executive function factor scores (F[1,3432] = 6.63, p = .010) and performed worse on individual tests of attention (F[1,3382] = 7.08, p = .008) and language reasoning (F[1,3387] = 5.12, p = .024) than no-FH youth.

CONCLUSIONS

Youth with a FH show small differences in executive function, attention, and language reasoning compared to youth without a FH. Further research is warranted to investigate neurocognitive functioning as an endophenotype for suicide risk. Implications for the prevention and treatment of suicidal behaviors are discussed.

Cause of parental death and child's health and education: The role of parental resources

Early parental death has been linked to problems in health and educational path. We added to the literature by examining disability pension and various educational outcomes after external (accident, violence, suicide) or natural parental death during childhood or adolescence, taking into account possible heterogeneous associations by parental resources. Using Finnish register data and linear random-effects models, we analysed outcomes of 90,620 and 88,859 children (paternal and maternal death samples, respectively) born between 1982 and 1990. Results indicated lower educational performance and attainment, and a higher probability of disability pension in the bereaved offspring, especially after external parental death. Half of these connections were explained after adjusting for childhood family characteristics. Having a highly educated surviving parent might protect from negative educational and health outcomes. The findings were partly similar for father's and mother's deaths. We demonstrated that the negative associations between parental death and child wellbeing differ by cause of death and parental resources. Cause of death and overall family circumstances should both be considered when analysing child outcomes after parental loss.

Suicide and sudden death bereavement in Australia: A longitudinal study of family members over 2 years after death

OBJECTIVE

Grief reactions change over time. However, only a limited number of studies, and none in Australia, have analysed changes in individual grief reactions longitudinally. The aim is to examine changes in grief reactions, mental health and suicidality of close family members bereaved by suicide, 6, 12 and 24 months after their loss compared with those bereaved by other forms of sudden death, adjusting for confounding factors.

METHOD

Participants were 142 adult family members bereaved by suicide and 63 by other sudden death, followed up at 6, 12 and 24 months in Queensland, Australia. The Grief Experience Questionnaire, Depression Anxiety Stress Scale and Beck Scale for Suicide Ideation were used as main outcomes. Mixed-effects linear and logistic regressions were utilized for statistical analyses.

RESULTS

There were significant differences in rejection, stigmatization, shame and responsibility between the suicide and sudden death bereaved over the 2-year period, after adjusting for potential confounding factors. Rejection, stigmatization, search for explanation, somatic reactions and symptoms of depression and anxiety (Depression Anxiety Stress Scale) declined significantly over time in both groups. Rejection and somatic reactions showed group-by-time interaction effects, with a decrease in the suicide bereaved and no change in the sudden death bereaved. Loss of social support and suicidal ideation did not show a group or time effect.

CONCLUSION

Although our findings confirm that there are several common dimensions to experiencing a sudden death of a family member, several differences were found between the suicide and non-suicide sudden death bereaved including significantly higher levels of rejection, stigmatization, shame and responsibility remaining in the suicide compared to sudden death bereaved 2 years after their loss. These findings should be considered in clinical practice and when designing postvention services in Australia.

Survivors' perceptions of support following a parent's suicide

Children who experience a parent's suicide are vulnerable to an increased risk for mental health disorders and suicide attempts. In this study, 17 adults, each a child survivor of their parent's suicide, shared their perceptions of support following the suicide. Helpful experiences included opening communication about suicide and offering individualized support. Unhelpful experiences included judgment and blame, silence regarding suicide, and a heightened awareness of the surviving parent's challenges. Individuals most helpful in meeting the child's needs included those with preexisting relationships. In particular, our findings emphasize the critical need for honest, open, and age-appropriate communication about the parent's suicide.

Suicide bereavement: piloting a longitudinal study in Australia

OBJECTIVES

The pilot study were (1) to test the technical and administrative feasibility of a full-scale study, including recruitment process, response and retention rate, questionnaire design for an investigation to improve understanding of the suicide bereavement processes compared with bereavement by sudden deaths and (2) to present the differences and changes in the main outcomes-grief reactions of close relatives exposed to suicide and sudden death over 2 years.

DESIGN

A longitudinal prospective study comparing bereavement by suicide to other types of sudden deaths over time (6, 12 and 24 months).

SETTING

Queensland, Australia.

PARTICIPANTS

25 suicide-bereaved and 15 sudden-death-bereaved persons.

OUTCOME MEASURES

Grief reactions (measured with the Grief Experience Questionnaire).

RESULTS

The response rate was 52.1% in the suicide bereaved and 45.5% in the sudden-death group. There was a small number of dropouts, with the retention rate over 85% for both groups. Linear mixed modelling for repeated measures showed a significant group effect (higher in suicide bereaved) for total grief, responsibility, rejection and unique reactions. A significant time effect (reduction) was measured for total grief, somatic reactions, general grief reactions and search for explanation. One significant time and group interaction was measured; rejection showed a decline in suicide and an increase in sudden-death bereaved.

CONCLUSIONS

The pilot study presented the appropriateness of the study methodology. This type of study has implications for counselling and treating people bereaved by suicide and for designing postvention activities.

Physical and psychosomatic health outcomes in people bereaved by suicide compared to people bereaved by other modes of death: a systematic review

Background

Little research has been conducted into the physical health implications of suicide bereavement compared to other causes of death. There is some evidence that suicide bereaved parents have higher morbidity, particularly in terms of chronic illness. This systematic review aims to examine the physical and psychosomatic morbidities of people bereaved by a family member’s suicide and compare them with family members bereaved by other modes of death.

Methods

MEDLINE, EMBASE, CINAHL, and PsycINFO were searched from 1985 to February 2016. The search was re-run in March 2017. Peer-reviewed English language articles comparing suicide-bereaved family members to non-suicide bereaved family members on measures of physical or psychosomatic health were eligible for inclusion. Cohort, cross-sectional, case-control and cohort-based register studies were eligible for inclusion. A modified version of the Newcastle Ottawa Scale was used for quality assessment. Results were synthesised using narrative synthesis.

Results

The literature search located 24 studies which met the inclusion criteria. Seven studies found statistically significant associations between physical health and suicide bereavement. Five of the studies found that suicide-bereaved family members were more likely to experience pain, more physical illnesses and poorer general health. They were also at increased risk of cardiovascular disease, hypertension, diabetes and chronic obstructive pulmonary disease. In contrast, another study in Denmark found that those bereaved by suicide had a lower risk of a number of physical health disorders, including cancers, diabetes, cardiovascular and chronic lower respiratory tract disorders compared to those bereaved by other causes of death. Additionally, a further study conducted in the United States found that suicide-bereaved children visited a GP less frequently than non-suicide bereaved children.

Conclusions

Review findings are relevant for clinicians working with people bereaved by suicide as they highlight that such clients are at increased risk of several adverse physical health outcomes. Future research should examine health risk behaviours of suicide-bereaved and non-suicide bereaved family members as they may confound the association between exposure and outcome.

Trial Registrations

The review protocol has been registered on PROSPERO, registration number CRD42016030007.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4930-3) contains supplementary material, which is available to authorized users.

Association Between Spousal Suicide and Mental, Physical, and Social Health Outcomes: A Longitudinal and Nationwide Register-Based Study

IMPORTANCE

Bereavement after spousal suicide has been linked to mental disorders; however, a comprehensive assessment of the effect of spousal suicide is needed.

OBJECTIVE

To determine whether bereavement after spousal suicide was linked to an excessive risk of mental, physical, and social health outcomes when compared with the general population and spouses bereaved by other manners.

DESIGN, SETTING, AND PARTICIPANTS

This nationwide, register-based cohort study conducted in Denmark of 6.7 million individuals aged 18 years and older from 1980 to 2014 covered more than 136 million person-years and compared people bereaved by spousal suicide with the general population and people bereaved by other manners of death. Incidence rate ratios were calculated using Poisson regressions while adjusting for sociodemographic characteristics and the presence of mental and physical disorders.

MAIN OUTCOMES AND MEASURES

Mental disorders (any disorder, mood, posttraumatic stress disorder, anxiety, alcohol use disorders, drug use disorders, and self-harm); physical disorders (cancers, diabetes, sleep disorder, cardiovascular diseases, chronic lower respiratory tract diseases, liver cirrhosis, and spinal disc herniation); causes of mortality (all-cause, natural, unintentional, suicide, and homicide); social health outcomes; and health care use.

RESULTS

The total study population included 3 491 939 men, 4814 of whom were bereaved by spousal suicide, and 3 514 959 women, 10 793 of whom were bereaved by spousal suicide. Spouses bereaved by a partner's suicide had higher risks of developing mental disorders within 5 years of the loss (men: incidence rate ratio, 1.8; 95% CI, 1.6-2.0; women: incidence rate ratio, 1.7; 95% CI, 1.6-1.8) than the general population. Elevated risks for developing physical disorders, such as cirrhosis and sleep disorders, were also noted as well as the use of more municipal support, sick leave benefits, and disability pension funds than the general population. Compared with spouses bereaved by other manners of death, those bereaved by suicide had higher risks for developing mental disorders (men: incidence rate ratio, 1.7; 95% CI, 1.5-1.9; women: incidence rate ratio, 2.0; 95% CI, 1.9-2.2), suicidal behaviors, mortality, and municipal support. Additionally, a higher level of mental health care use was noted.

CONCLUSIONS AND RELEVANCE

Exposure to suicide is stressful and affects the bereaved spouse on a broad range of outcomes. The excess risks of mental, physical, and social health outcomes highlight a need for more support directed toward spouses bereaved by suicide.

The Associations Between Children's and Adolescents' Suicidal and Self-Harming Behaviors, and Related Behaviors Within Their Social Networks: A Systematic Review

Social influences-including the suicidal and self-harming behaviors of others-have been highlighted as a risk factor for suicidal and self-harming behavior in young people, but synthesis of the evidence is lacking. A systematic review of 86 relevant papers was conducted. Considerable published evidence was obtained for positive associations between young people's suicidal and self-harming behavior and that of people they know, with those reporting knowing people who had engaged in suicidal or self-harming behaviors more likely to report engaging in similar behaviors themselves. Findings are discussed in relation to a number of methodological and measurement issues-including the role of normative perceptions-and implications for the prevention of suicidal and self-harming behavior are considered.

Guilt and Bereavement: Effect of the Cause of Death, and Measuring Instruments

Guilt is a common reaction in bereavement. Our aim is to explore the guilt in bereavement depending on the cause of death. The sample involved 73 participants who had lost a family member to a terminal illness, suicide, sudden illness, accident, or perinatal death. Guilt was measured using the items of self-blame and regret in the Tübingen Bereavement Symptoms Questionnaire, the SC-35, and the Bereavement Guilt Scale (BGS). The results reveal significant differences in suicide bereavement on the self-blame subscale compared with unexpected natural death. Further there are significant differences in suicide bereavement in the regret subscale compared with unexpected natural death, and in the BGS as regards both an expected and an unexpected natural death. There are no significant differences in guilt when it is measured through the SC-35. These data suggest that the measurement of guilt in bereavement calls for the use of specific scales for this context.

Exposure to Suicide in the Community: Prevalence and Correlates in One U.S. State

OBJECTIVE

Suicide has been identified as a major public health issue. Exposure to suicide (i.e., knowing someone who died by suicide) is far more pervasive than previously considered and might be associated with significant adverse outcomes. As suicide becomes more commonly discussed in the public arena, a compelling need exists to determine who is exposed to suicide and how this exposure affects those left behind. This study estimated the proportion of the population exposed to suicide and delineated factors that predict significant psychiatric and psychosocial morbidity following that exposure.

METHODS

A dual-frame random-digit-dial survey was conducted on a sample of 1,736 U.S. adults in the Commonwealth of Kentucky. Depression and anxiety were compared in suicide-exposed and suicide-unexposed individuals. Relationships were examined between psychiatric outcomes and perceptions of closeness to the decedent.

RESULTS

Forty-eight percent of weighted participants (n=816/1,687) reported lifetime exposure to suicide. Current depression and anxiety symptoms were higher in suicide-exposed than in suicide-unexposed individuals. Suicide-exposed individuals were twice as likely as suicide-unexposed individuals to have diagnosable depression and almost twice as likely to have diagnosable anxiety. Suicide-exposed individuals were more likely than suicide-unexposed individuals to report suicide ideation (9% vs. 5%). Closeness to the decedent increased the odds of depression and anxiety and almost quadrupled the odds of posttraumatic stress disorder.

CONCLUSION

Exposure to suicide is pervasive and occurs beyond family; as such, it is imperative to identify those with perceived closeness to the decedent. This hidden cohort of suicide-exposed people is at elevated risk for psychopathology and suicidal ideation.

Prominent Feelings and Self-Regard Among Survivors of Suicide

This cross-sectional study explores associations between elapsed time since the loss and outcomes of main feelings surrounding the loss and self-regard among 187 help-seeking survivors bereaved by suicide. Chi-square tests were conducted to examine the aforementioned relationships. In examining suicide survivors' main feelings over time, this study found mixed results in early bereavement. This study showed that at 25 to 59 months of elapsed time since the loss, both fear and happiness were significant for suicide survivors. No significance was found before 25 to 59 months, suggesting a change in suicide survivors' main emotions following 2 years of elapsed time since the loss. In later bereavement (i.e., 5 + years), suicide survivors' experiences of happiness was significant. The aforementioned results suggest that following 2 years of elapsed time since the loss, this sample of survivors bereaved by suicide experienced a change in their grief experience.

Pre- and postloss features of adolescent suicide bereavement: A systematic review

Despite increasing clinical and research interest in suicide bereavement the impact of suicide on adolescents is still poorly understood. This systematic review aims to disentangle pre- and postloss features that affect response to grief in this age group. The literature was analyzed after a systematic search and hand-check of retrieved articles. The impact of suicide is affected by (a) preloss features related to personal/family history of mental health, family life, suicidal behavior, and type and emotional closeness of relationship; and (b) postloss issues such as quality of remaining relationships. Future research and bereavement support should consider these broader contexts.

The Perceived Experience of Children Bereaved by Parental Suicide

Children whose parent died by suicide are a vulnerable and underserved population. This phenomenon will be described, as well as implications for practice and research. “Double Whammy,” a conceptualization of the overall experience of this marginalized group, emerged through two in-depth interviews from a phenomenological qualitative study with professionals who facilitate support groups for children bereaved by parental suicide. It was corroborated with current literature and practice experiences of the authors and their colleagues. Stigma was the largest contributor to the “Double Whammy,” and the following themes emerged as well: feeling isolated, feeling abandoned, and feeling responsible. The self-volition of suicide challenges how bereaved children make meaning and internalize feelings about the deceased parent, one’s self, and others. Developmentally appropriate education about suicide grief, depression, and normalizing the grief process is pivotal in helping children to effectively cope and manage their feelings.

The “How” and “When” of Parental Loss in Adulthood

In order to evaluate the role of cause of death on the grief responses of parentally bereaved young and middle-aged adults, 400 individuals completed measures assessing their experiences and feelings surrounding the loss of a parent. Respondents included 247 young adults and 155 middle-aged adults. Cause of death was categorized as acute or anticipated with 209 participants reporting the parent’s death as acute, while anticipated death was reported by 191 individuals. Results suggested that gender of the adult child and age level of the participant were important factors contributing to the grief response, and women were found to have more difficulty adjusting to the loss of a parent as well as demonstrating a more intense grief response. Young adults were found to be more impacted by the loss of a parent than were middle-aged adults. Those who were single or separated were similarly more impacted versus those who were married, where more young adults were single/separated and more middle-aged adults were married. Cause of death was only mildly influential in influencing responses to parental loss and did not interact with other studied variables. These results point to the importance of support from others in coping with a parent’s death as well as for the counseling of bereaved persons who may be at risk for difficulties in coping with the death of a parent and enable a more precise understanding of individual grief processes across the adult lifespan.

Risk of adolescent offspring's completed suicide increases with prior history of their same-sex parents' death by suicide

BACKGROUND

To investigate the risk of completed suicide in offspring during adolescence in relation to prior history of the same-sex parent's death by suicide and other causes.

METHOD

A total of 500 adolescents who died by suicide at age 15-19 years between 1997 and 2007 were identified from the Taiwan Mortality Registration (TMR). For each case, 30 age- and time-matched controls were selected randomly from all adolescents registered in the Taiwan Birth Registry (TBR). A multivariate conditional logistic regression model was used to assess the risk of adolescent completed suicide in relation to their same-sex parent.

RESULTS

Adolescent suicide risk was positively associated with both paternal [odds ratio (OR) 5.38, 95% confidence interval (CI) 2.17-13.33] and maternal suicide (OR 6.59, 95% CI 1.82-23.91). The corresponding risk estimates associated with paternal and maternal deaths from non-suicidal causes were much lower, at 1.88 and 1.94 respectively. The risk of suicide in male adolescents was significantly associated with prior history of paternal death by suicide (OR 8.23, 95% CI 2.96-22.90) but not of maternal death by suicide (OR 3.50, 95% CI 0.41-30.13). On the other contrary, the risk of suicidal death in female adolescents was significantly associated with prior history of maternal suicide (OR 9.71, 95% CI 1.89-49.94) but not of paternal suicide (OR 2.42, 95% CI 0.30-19.57). However, these differences did not reach statistical significance.

CONCLUSIONS

Although limited by sample size, our study indicates that adolescent offspring suicidal death is associated with prior history of their same-sex parent's death by suicide.

Effects of suicide bereavement on mental health and suicide risk

Between 48 million and 500 million people are thought to experience suicide bereavement every year. Over the past decade, increased policy attention has been directed towards suicide bereavement, but with little evidence to describe the effect of exposure or to provide appropriate responses. We used a systematic approach to carry out a narrative review of studies of the effect of suicide bereavement on mortality, mental health, and social functioning, and compared them with effects from other bereavements. We found 57 studies that satisfied strict inclusion criteria. Results from these studies suggested that exposure to suicide of a close contact is associated with several negative health and social outcomes, depending on an individual's relationship to the deceased. These effects included an increased risk of suicide in partners bereaved by suicide, increased risk of required admission to psychiatric care for parents bereaved by the suicide of an offspring, increased risk of suicide in mothers bereaved by an adult child's suicide, and increased risk of depression in offspring bereaved by the suicide of a parent. Some evidence was shown for increased rejection and shame in people bereaved by suicide across a range of kinship groups when data were compared with reports of relatives bereaved by other violent deaths. Policy recommendations for support services after suicide bereavement heavily rely on the voluntary sector with little input from psychiatric services to address described risks. Policymakers should consider how to strengthen health and social care resources for people who have been bereaved by suicide to prevent avoidable mortality and distress.

Symptoms of post-traumatic stress disorder in bereaved children and adolescents: factor structure and correlates

This study investigated the factor structure and correlates of posttraumatic stress-disorder (PTSD) symptoms among children and adolescents confronted with the death of a loved one. Three hundred thirty-two bereaved children and adolescents (aged 8-18; 56.9 % girls) who all received some form of psychosocial support after their loss, completed self-report measures of PTSD, together with measures tapping demographic and loss-related variables, depression, prolonged grief, and functional impairment. Parent-rated indices of impairment were also collected. We first evaluated the fit of six alternative models of the factor structure of PTSD symptoms, using confirmatory factor analyses. Outcomes showed that the 4-factor numbing model from King et al. (Psychological Assessment 10, 90-96, 1998), with distinct factors of reexperiencing, avoidance, emotional numbing, and hyperarousal fit the data best. Of all participants, 51.5 % met DSM-IV criteria for PTSD. PTSD-status and scores on the PTSD factors varied as a function of age and gender, but were unrelated to other demographic and loss-related variables. PTSD-status and scores on the PTSD factors were significantly associated symptom-levels of depression, prolonged grief, and functional impairment. Findings complement prior evidence that the DSM-IV model of the factor structure of PTSD symptoms may not represent the best conceptualization of these symptoms and highlight the importance of addressing PTSD symptoms in children and adolescents seeking help after bereavement.

Time to hospitalization for suicide attempt by the timing of parental suicide during offspring early development

CONTEXT Previous studies have suggested that children who experience parental suicide at earlier ages are at higher risk of future hospitalization for suicide attempt. However, how the trajectories of risk differ by offspring age at the time of parental suicide is currently unknown. OBJECTIVE To study time at risk to suicide attempt hospitalization among offspring of suicide decedents as compared with offspring of unintentional injury decedents by their developmental period at the time of parental death. DESIGN Population-based retrospective cohort study. SETTING Sweden. PARTICIPANTS Twenty-six thousand ninety-six offspring who experienced parental suicide and 32 395 offspring of unintentional injury decedents prior to age 25 years between the years 1973 and 2003. MAIN OUTCOME MEASURE Parametric survival analysis was used to model the time to hospitalization for suicide attempt among offspring who lost a parent during early childhood (0-5 years old), later childhood (6-12 years old), adolescence (13-17 years old), and young adulthood (18-24 years old). RESULTS The risk in offspring who lost a parent to suicide or an unintentional injury during childhood surpassed the other age groups' risk approximately 5 years after the origin and, for the youngest group, continued to rise over decades. Offspring who lost a parent during adolescence or young adulthood were at greatest risk within 1 to 2 years after parental death, and risk declined over time. Offspring who lost a parent to suicide in childhood and young adulthood had earlier onset of hospitalization for suicide attempt compared with offspring who lost a parent to an unintentional injury. CONCLUSIONS The hospitalization risk for suicide attempt in offspring who lost a parent during their childhood is different from those who lost a parent later in development. The results suggest critical windows for careful monitoring and intervention for suicide attempt risk, especially 1 to 2 years after parental death for the older age groups and over decades for childhood survivors of parental death.

The association of parental fatal and non-fatal suicidal behaviour with offspring suicidal behaviour and depression: a systematic review and meta-analysis

BACKGROUND

Children whose parents die by, or attempt, suicide are believed to be at greater risk of suicidal behaviours and affective disorders. We systematically reviewed the literature on these associations and, using meta-analysis, estimated the strength of associations as well as investigated potential effect modifiers (parental and offspring gender, offspring age).

METHOD

We comprehensively searched the literature (Medline, PsycINFO, EMBASE, Web of Science), finding 28 articles that met our inclusion criteria, 14 of which contributed to the meta-analysis. Crude odds ratio and adjusted odds ratio (aOR) were pooled using fixed-effects models.

RESULTS

Controlling for relevant confounders, offspring whose parents died by suicide were more likely than offspring of two living parents to die by suicide [aOR 1.94, 95% confidence interval (CI) 1.54-2.45] but there were heterogeneous findings in the two studies investigating the impact on offspring suicide attempt (aOR 1.31, 95% CI 0.73-2.35). Children whose parents attempted suicide were at increased risk of attempted suicide (aOR 1.95, 95% CI 1.48-2.57). Limited evidence indicated that exposure to parental death by suicide is associated with subsequent risk of affective disorders. Maternal suicidal behaviour and younger age at exposure were associated with larger effect estimates but there was no evidence that the association differed in sons versus daughters.

CONCLUSIONS

Parental suicidal behaviour is associated with increased risk of offspring suicidal behaviour. Findings suggest that maternal suicidal behaviour is a more potent risk factor than paternal, and that children are more vulnerable than adolescents and adults. However, there is no evidence of a stronger association in either male or female offspring.

Young people's risk of suicide attempts in relation to parental death: a population-based register study

BACKGROUND

The objective of this study was to examine the association between the death of a biological parent and subsequent suicide attempts by young people (aged 10-22 years), and to explore sociodemographic factors as modifying factors in the process.

METHODS

The study used a nested case-control design. The full study population was obtained from the Danish longitudinal registers and included all individuals born between 1983 and 1989 (n = 403,431 individuals). The 3,465 registered suicide attempters from that group were matched with 75,300 population-based control subjects. Potentially confounding variables including age and gender were controlled for by conditional logistic regression analyses.

RESULTS

The findings indicated that young people who had lost one biological parent showed a significantly increased risk of attempting suicide (relative risk = 1.71, 95% confidence interval = 1.49-1.96). Losing the remaining parent nearly doubled the risk (relative risk = 2.7, 95% confidence interval = 1.48-5.06).

CONCLUSION

Experiencing the death of one or both biological parents increased the risk of suicide attempts in young people. Relative risk was moderated by high income of the father.

Maternal or paternal suicide and offspring's psychiatric and suicide-attempt hospitalization risk

OBJECTIVE

We examined whether the risk for psychiatric morbidity requiring inpatient care was higher for offspring who experienced parental suicide, compared with offspring of fatal accident decedents, and whether the association varied according to the deceased parent's gender.

METHODS

Children and adolescents (0-17 years of age) who experienced maternal (N = 5600) or paternal (N = 17,847) suicide in 1973-2003 in Sweden were identified by using national, longitudinal, population-based registries. Cox regression modeling was used to compare psychiatric hospitalization risks among offspring of suicide decedents and propensity score-matched offspring of accident decedents.

RESULTS

Offspring of maternal suicide decedents had increased risk of suicide-attempt hospitalization, after controlling for psychiatric hospitalization for decedents and surviving parents, compared with offspring of maternal accidental decedents. Offspring of paternal suicide decedents had similar risk of suicide-attempt hospitalization, compared with offspring of accident decedents, but had increased risk of hospitalization attributable to depressive and anxiety disorders. The magnitude of risks for offspring suicide-attempt hospitalization was greater for those who experienced maternal versus paternal suicide, compared with their respective control offspring (interaction P = .05; offspring of maternal decedents, adjusted hazard ratio: 1.80 [95% confidence interval: 1.19-2.74]; offspring of paternal decedents, adjusted hazard ratio: 1.14 [95% confidence interval: 0.96-1.35]).

CONCLUSIONS

Maternal suicide is associated with increased risk of suicide-attempt hospitalization for offspring, beyond the risk associated with maternal accidental death. However, paternal suicide is not associated with suicide-attempt hospitalization. Future studies should examine factors that might differ between offspring who experience maternal versus paternal suicide, including genetic or early environmental determinants.

Evaluation of a British child bereavement service: The user's perspective

Objective:

This article summarizes the findings from a 3-year independent evaluation of a regional Child Bereavement Service (CBS). The service was commissioned by a Primary Care Trust in Northern England, and funded by a British cancer charity, Macmillan Cancer Support. The need for a CBS was recognized by members of a Palliative Care Group who identified a gap in local services for bereaved children, who may be susceptible to short/long-term psychiatric/psychological disorders. The service was established to offer support for professionals working with bereaved children and their family.

Method:

Interventions provided by the service included pre/post bereavement support, individual work with the child and/or family, and group work. An evaluation (2004–2007), was conducted to inform service development utilizing semi-structured interviews with parents/carers of service users (n = 20), and semi-structured interviews with healthcare professionals (n = 8). Interviews were recorded, transcribed verbatim, and analyzed using grounded theory methods.

Results:

Referrals were higher than expected. Sixty per year were anticipated; however, in the first year alone, there were 255 referrals. Health and social care professionals who attended training courses, provided by the CBS staff, expressed confidence in providing bereavement support themselves, or by making appropriate referrals to the CBS. Parents and carers welcomed a service specifically for their children.

Significance of results:

The CBS is a viable organization that supports bereaved children as expressed in this article.

Health risk behaviors in parentally bereaved youth

OBJECTIVE

To investigate whether parentally bereaved offspring are more likely to engage in health risk behaviors than nonbereaved control offspring.

DESIGN

Controlled population-based study.

SETTING

Bereaved families were recruited from coroner records and by advertisement. Control families were recruited using random-digit dialing and by advertisement.

PARTICIPANTS

At 9.0 months after the death, 186 offspring aged 7 to 25 years of parents who died of suicide, accident, or sudden natural death were compared with 167 nonbereaved control offspring.

MAIN OUTCOME MEASURES

The association of bereavement with health risk behaviors was examined. The prevalences of health risk behaviors on the Youth Risk Behavior Questionnaire were compared between bereaved and nonbereaved offspring. Risk behaviors surveyed were related to unintentional injury, violence, sexual behavior, cigarette smoking, and alcohol or other drug use.

RESULTS

No statistically significant difference was noted in the examined health risk behaviors between bereaved and nonbereaved offspring.

CONCLUSIONS

Bereaved offspring did not engage in more health risk behaviors compared with nonbereaved offspring. Primary care physicians counseling youth should inquire about health risk behaviors in general.

Psychiatric morbidity, violent crime, and suicide among children and adolescents exposed to parental death

OBJECTIVE

This retrospective cohort study examined the risk for suicide, psychiatric hospitalization, and violent criminal convictions among offspring of parents who died from suicide, accidents, and other causes.

METHOD

Population-based data from multiple Swedish national registers were linked from 1969 to 2004. Participants were 44,397 offspring of suicide decedents, 41,467 offspring of accident decedents, 417,365 offspring of parents who died by other causes, and 3,807,867 offspring of alive parents. We estimated risk by mode of parental death (suicide, accident, other) and offspring age at parental death (childhood, adolescence, young adulthood).

RESULTS

Offspring of suicide decedents were at greater risk for suicide than offspring of alive parents (incidence rate ratio [IRR] = 1.9; 95% confidence interval [CI] = 1.4 to 2.5), whereas offspring of accident decedents and other parental death were not at increased risk (p < .001). The risk for offspring suicide differed by the developmental period during which parental suicide occurred. Child and adolescent offspring of suicide decedents were at threefold greater risk for suicide (IRR = 3.0; 95% CI = 1.7 to 5.3; IRR = 3.1, 95% CI = 2.1 to 4.6, respectively). Young adults were not at increased risk for suicide (IRR = 1.3; 95% CI = 0.9 to 1.9). Offspring of suicide decedents had an especially high risk of hospitalization for suicide attempt, depressive, psychotic, and personality disorders. Child survivors of parental suicide were at particularly high risk for hospitalization for drug disorders and psychosis. All offspring who experienced parental death, regardless of mode or age, were at increased risk for violent criminal convictions.

CONCLUSIONS

Mode of parental death and offspring age at parental death are associated with offspring long-term risk for suicide and hospitalization for specific psychiatric disorders.

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.

The incidence and course of depression in bereaved youth 21 months after the loss of a parent to suicide, accident, or sudden natural death

OBJECTIVE

This study examined effects of bereavement 21 months after a parent's death, particularly death by suicide.

METHOD

The participants were 176 offspring, ages 7-25, of parents who died by suicide, accident, or sudden natural death. They were assessed 9 and 21 months after the death, along with 168 nonbereaved subjects.

RESULTS

Major depression and alcohol or substance abuse 21 months after the parent's death were more common among bereaved youth than among comparison subjects. Offspring with parental suicide or accidental death had higher rates of depression than comparison subjects; those with parental suicide had higher rates of alcohol or substance abuse. Youth with parental suicide had a higher incidence of depression than those bereaved by sudden natural death. Bereavement and a past history of depression increased depression risk in the 9 months following the death, which increased depression risk between 9 and 21 months. Losing a mother, blaming others, low self-esteem, negative coping, and complicated grief were associated with depression in the second year.

CONCLUSIONS

Youth who lose a parent, especially through suicide, are vulnerable to depression and alcohol or substance abuse during the second year after the loss. Depression risk in the second year is mediated by the increased incidence of depression within the first 9 months. The most propitious time to prevent or attenuate depressive episodes in bereaved youth may be shortly after the parent's death. Interventions that target complicated grief and blaming of others may also improve outcomes in symptomatic youth with parental bereavement.

Confirming the distinctiveness of complicated grief from depression and anxiety among adolescents

Studies in adult populations have shown that symptoms of complicated grief (CG) constitute a form of bereavement-related distress distinct from symptoms of depression and anxiety. The purpose of this article is to replicate these findings in two samples of bereaved adolescents by investigating the latent structure of symptoms of CG, anxiety, and depression measured by self-report questionnaires. The first study (N = 245) focuses on one of the most prevalent losses in adolescence, namely the death of a grandparent. In the second study (N = 351) the authors further the examination of the distinctiveness question by inspecting not only the latent structure of CG, depression, and anxiety but also whether the distinctiveness of the emerging latent structure holds across subgroups of bereaved adolescents suffering different types of losses. Confirmatory factor analyses in both studies confirm the distinctiveness of CG from depression and anxiety in a younger population.

Measures matter: the relative contribution of anxiety and depression to suicidal ideation in clinically referred anxious youth using brief versus full length questionnaires

BACKGROUND

A cross-sectional design was used to examine links between suicidal ideation, depression, and anxiety using brief [Stark and Laurent, 2001: J Clin Child Psychol 30:552-567] and full length versions of the Children's Depression Inventory [CDI; Kovacs, 1980/1981: Acta Paedopsychiatr 46:305-315] and Revised Children's Manifest Anxiety Scale [RCMAS; Reynolds and Richmond, 1985: Revised Children's Manifest Anxiety Scale. California: Western Psychological Services].

METHODS

The sample consisted of 252 children and adolescents (ages 7-16 years, M=9.94 years (SD=2.4)) seeking treatment at a childhood anxiety disorders specialty research clinic.

RESULTS

Using structural equation modeling, results indicated that the relative contribution of anxiety and depression in the presence of suicidal ideation varies depending on the measures used. Specifically, anxiety had a significant direct and indirect effect on suicidal ideation presence using a brief version of the RCMAS, but only an indirect effect using the full length version. Depression had a significant direct effect on suicidal ideation presence using both brief and full versions of the CDI.

CONCLUSIONS

These findings suggest that anxiety may play a role in predicting suicidal ideation in clinic-referred anxious youth, but whether this role is detected depends on the measurement strategy. Given that "measures matter," future studies using similar as well as different samples as the one used in this study need to consider careful measurement strategies, as different findings may emerge depending on whether brief or full length versions of questionnaires are used.

Neuroanatomic comparison of bipolar adolescents with and without cannabis use disorders

OBJECTIVE

Co-occurrence of substance use and bipolar disorders is both common and associated with poor treatment response and greater functional impairment than either disorder alone. The neurophysiological correlates of this co-morbidity however, remain unclear. In this pilot study, we compared brain morphometry between bipolar adolescents with co-occurring cannabis use disorders (CUD) and bipolar adolescents without any substance use disorder.

METHODS

Whole-brain structural magnetic resonance imaging (MRI) scans were obtained from 14 bipolar adolescents. Seven study participants were diagnosed with CUD before and/or shortly after their MR scan was obtained, and 7 subjects were free of any substance use disorder at the time of their MR scan as well as during longitudinal follow up. Morphologic differences were calculated using voxel-based morphometry implemented using statistical parametric mapping software (SPM2).

RESULTS

Bipolar adolescents with co-occurring CUD demonstrated decreased gray matter volume (GMV) in the left fusiform gyrus and increased GMV in the right caudate and precentral gyrus, as well as increased gray matter density in the right middle occipital and fusiform gyri and cerebellar vermis.

CONCLUSIONS

Bipolar adolescents with CUD demonstrate evidence of greater structural abnormalities than adolescents with bipolar disorder alone in frontal and temporal cortical regions, as well as in subcortical areas linked with emotion and motivational regulation. Although the limited prescan exposure to marijuana in these adolescents tentatively suggests that these findings may reflect underlying differences, the direct effect of cannabis exposure may also be involved.

Familial transmission of suicidal behavior

Adoption and twin studies show that familial transmission of suicidal behavior is partly attributable to genetic factors. Transmission of suicidal behavior is mediated by transmission of impulsive aggression or neuroticism and neurocognitive deficits. The most plausible explanations for nongenetic familial transmission are the intergenerational transmission of abuse and adverse familial environments. Bereavement and relationship disruption contribute to suicidal risk via the development of complicated grief, although long-term effects may be mediated by a complex chain of interrelated events. Imitation may contribute to suicidal risk, at least in attempted suicide. However, so-called family environmental factors often are related to risk factors that are heritable. Conversely, genetic factors exert their impact on depression and suicidal behavior via interaction with a stressful environment.

Substance use disorders among adolescents with bipolar spectrum disorders

OBJECTIVE

We set out to examine the prevalence and correlates of substance use disorders (SUD) in a large sample of adolescents with bipolar disorder (BP).

METHODS

Subjects were 249 adolescents ages 12 to 17 years old who fulfilled DSM-IV criteria for bipolar I disorder [(BPI), n = 154], or bipolar II disorder [(BPII), n = 25], or operationalized criteria for BP not otherwise specified [(BP NOS), n = 70], via the Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS). As part of the multi-site Course and Outcome of Bipolar Youth study, demographic, clinical, and family history variables were measured via intake clinical interview with the subject and a parent/guardian.

RESULTS

The lifetime prevalence of SUD among adolescents with BP was 16% (40/249). Results from univariate analyses indicated that subjects with, as compared to without, SUD were significantly less likely to be living with both biological parents, and that there was significantly greater lifetime prevalence of physical abuse, sexual abuse, suicide attempts, conduct disorder, and posttraumatic stress disorder among subjects with SUD. Subjects with SUD reported significantly greater 12-month prevalence of trouble with police, and females with SUD reported significantly greater 12-month prevalence of pregnancy and abortion. Significant predictors of SUD in a logistic regression model included living with both biological parents (lower prevalence), conduct disorder and suicide attempts (increased prevalence). In logistic regression analyses controlling for demographic differences and conduct disorder, SUD remained significantly associated with trouble with police, whereas the association of SUD with pregnancy and abortion was reduced to a statistical trend. The prevalence of SUD was not significantly different among child- versus adolescent-onset BP subjects.

CONCLUSIONS

SUD among adolescents with BP is associated with profound hazards including suicide attempts, trouble with police, and teenage pregnancy and abortion.

Antecedents and sequelae of sudden parental death in offspring and surviving caregivers

OBJECTIVES

To examine the psychiatric antecedents that put parents at risk for early death, and the psychological sequelae of bereavement in offspring and caregivers.

DESIGN

A population-based study.

SETTING

Bereaved families were recruited through the coroner's records and by advertisement. Control families were recruited by random-digit dialing and advertisement.

PARTICIPANTS

Families with biological offspring from 7 to 25 years of age in which 1 parent died of suicide, accident, or sudden natural death were included (n = 140). Controls (n = 99) had 2 living parents and their biological offspring and had no death of a first-degree relative within the past 2 years.

MAIN OUTCOME MEASURES

Lifetime psychiatric history for deceased parents (probands) and new-onset psychiatric disorders, self-reported symptoms, and functional status in offspring and surviving caregivers.

RESULTS

Bipolar disorder, substance abuse, and personality disorders are more common in probands who died of suicide or accident than in control parents. Bereaved offspring and their caregivers were at increased risk for depression and posttraumatic stress disorder. Bereaved offspring had a 3-fold (95% confidence interval, 1.3-7.0) increased risk of depression, even after controlling for antecedent and concomitant risk factors. Offspring bereaved by suicide showed similar outcomes compared with those bereaved by other types of death.

CONCLUSIONS

Bereavement conveys an increased risk of depression and posttraumatic stress disorder above and beyond other vulnerability factors. Better integration of medical and psychiatric care may prevent premature parental death, but once it occurs, physicians should be alert to the increased risk for depression and posttraumatic stress disorder in bereaved offspring and their caregivers.

Suicide survivors' mental health and grief reactions: a systematic review of controlled studies

There has been a debate over several decades whether suicide survivors experience more severe mental health consequences and grief reactions than those who have been bereaved through other causes of death. This is the first systematic review of suicide survivors' reactions compared with survivors after other modes of death. Studies were identified by searching the PsychINFO and MEDLINE databases. Forty-one studies met the eligibility criteria. A qualitative data analysis was performed. There were no significant differences between survivors of suicide and other bereaved groups regarding general mental health, depression, PTSD symptoms, anxiety, and suicidal behavior. The results regarding the overall level of grief are less clear, depending on whether general grief instruments or suicide-specific instruments are used. Considering specific grief variables, suicide survivors report higher levels of rejection, shame, stigma, need for concealing the cause of death, and blaming than all other survivor groups.

The Impact of Suicide on the Family

Abstract. Little research has examined the consequences of a suicide for social or family networks. Because suicide occurs within families, the focus on the aftermath of suicide within families is an important next step to determine exactly how to help survivors. In this article, we review and summarize the research on the impact of suicide on individuals within families and on family and social networks. We begin with a discussion of family changes following suicide. Next, we discuss the effects of suicide on social networks overall and responses of children and the elderly to a suicide in the family. Finally, we identify key issues that remain to be resolved in family survivor research and make recommendations for future studies.

Health outcomes of bereavement

In this Review, we look at the relation between bereavement and physical and mental health. Although grief is not a disease and most people adjust without professional psychological intervention, bereavement is associated with excess risk of mortality, particularly in the early weeks and months after loss. It is related to decrements in physical health, indicated by presence of symptoms and illnesses, and use of medical services. Furthermore, bereaved individuals report diverse psychological reactions. For a few people, mental disorders or complications in the grieving process ensue. We summarise research on risk factors that increase vulnerability of some bereaved individuals. Diverse factors (circumstances of death, intrapersonal and interpersonal variables, ways of coping) are likely to co-determine excesses in ill-health. We also assess the effectiveness of psychological intervention programmes. Intervention should be targeted at high-risk people and those with complicated grief or bereavement-related depression and stress disorders.

A support group intervention for children bereaved by parental suicide

TOPIC

Bereavement is considered by many to be among the most stressful of life events, and it becomes particularly distressing when it concerns the suicide death of a parent. Such an event is especially traumatic for children.

PURPOSE AND SOURCES

The purpose of this paper is to present a case for support group interventions designed specifically for child survivors of parental suicide. The authors provide a theoretical framework for supportive group interventions with these children and describe the structure of an 8-week bereavement support group for this special population of suicide survivors.

CONCLUSIONS

A case is made for designing and implementing group interventions to meet the mental health needs of this important group of individuals.

Phenomenology and correlates of complicated grief in children and adolescents

OBJECTIVE

To describe the phenomenology of complicated grief (CG) in parentally bereaved children and adolescents and to examine its correlates.

METHOD

This is a preliminary report from an ongoing 5-year, population-based, longitudinal study of the impact of parental loss on family members. Analyses of cross-sectional data at intake are presented. The sample consists of 129 children and adolescents of parents who died by suicide, accident, or sudden natural death. Their average age is 13.3 +/- 3.1 years (range 7-18 years). A modified version of the Inventory of Complicated Grief-Revised (ICG-R) was administered and its factor structure, internal consistency, and convergent and discriminant validity were examined.

RESULTS

CG was significantly related to functional impairment even after controlling for current depression, anxiety, and posttraumatic stress disorder. CG was also associated with other measures of psychopathology, including suicidal ideation.

CONCLUSIONS

In this preliminary analysis, CG appears to be a clinically significant syndrome in children and adolescents. Longitudinal data will help to clarify the prognostic significance of CG as well as to examine the interrelationship of CG and other psychopathology over time.

Implications of parental suicide and violent death for promotion of resilience of parentally-bereaved children

This article considers the implications of suicide and violent deaths (including suicide, homicide, and accidents) for the development of interventions for parentally bereaved children. Analyses of data from the Family Bereavement Program find minimal differences in children's mental health problems, grief or risk and protective factors based on cause of parental death. In addition, cause of death did not substantially affect the relations between risk and protective factors and bereaved children's outcomes. It is concluded that cause of death from violence or suicide is not a very useful indicator of bereaved children's need for or likelihood of benefiting from an intervention.