Effective communication with bereaved child survivors of suicide

Communication on familial suicide: development of the Family Communication on Suicide Questionnaire

Introduction: Each suicide affects about five close family members, potentially heightening risk for psychopathology and suicide. Communication style is a key factor in mental health and psychosocial wellbeing of families. Family communication after suicide, however, is insufficiently conceptualised and studied. This study aimed to identify different factors of familial communication after suicide of a relative and to develop a questionnaire assessing the functionality of familial communications following the suicide of a family member.Method: Through literature review, categories for the functionality of family communication after a familial suicide were developed. Items assessing family communication strategies were formulated and reviewed for comprehensibility and classification. Based on this review, the FCSQ (Family Communication on Suicide Questionnaire) was then tested in a multistep exploratory factor analysis on a cohort of suicide-bereaved relatives, utilising principal axis factor extraction. Construct validity of the FCSQ was assessed through correlation analysis and internal consistency via coefficient alpha.Results: Fifty-nine participants were enrolled in the study. Psychometric analyses indicated that family communication after a suicide can be divided into three factors, Honest and Emotional, Derogatory, and Stigmatising. Honest and Emotional formed functional communications, while Derogatory and Stigmatising communications formed two dysfunctional dimensions.Conclusions: The FCSQ is a first-of-a-kind questionnaire to assess functionality of family communications after suicide. Factor analysis indicated good factor structure and internal consistency, especially regarding functional communication patterns, while the Derogatory factor requires further analysis. This questionnaire has the potential to fill a crucial gap in clinical and research practice and can help to identify families and family members at risk after the experience of a family suicide.

Breaking the news of the violent death of a close person to children under 18 years of age: A qualitative interview study

Children who lose a close person to suicide or homicide will most likely receive this news from a carer. The caregiver's personal beliefs and approaches to addressing the topic will influence the child. A total of 10 interviews were conducted with carers of children aged 0-17 years, and the data were analyzed using reflexive thematic analysis. Four themes were developed, exploring: (1) how carers attempted to manage the task of delivering the news of death to the child and discussing it using careful wording; (2) how some carers' desire to protect the child from the truth hindered honesty and open conversations; (3) how and why some carers deliberately challenged societal taboos; and (4) how external influences prompted conversations about the topic. The discussion projects potential consequences for the children and their families. It also derives necessary societal changes, support measures, and further research suggestions.

I occasionally wear his huge sweaters… but I often prefer not to think about it: Bereaved children talking and not talking about parental loss

The unique perspective of children communicating about the loss of a parent has rarely been studied. In this qualitative research, we interviewed 12 children aged 7-12 and asked them about their experience communicating their loss. The children's verbal and non-verbal communication was characterized by constant movements away from and closer to various aspects of their loss, illustrated by three main themes: (a) children either talking about the loss or not talking about it; (b) first talking about the loss and then stopping to talk about it; and (c) simultaneously talking and not talking about the loss. Based on Stern's interpersonal relational thinking, our findings indicate that children wish to talk about the loss but also to avoid talking about it. The possibility of choosing to talk and not to talk with themselves and close individuals about the loss allows children to think about and articulate their feelings and thoughts.

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.

Very Young Child Survivors' Perceptions of Their Father's Suicide: Exploring Bibliotherapy as Postvention Support

Each year in the United States, 7000 to 30,000 children experience their parent's suicide. Due to the stigma associated with suicide, feelings of guilt, and intense grief, surviving family members avoid talking about suicide. Over time, children struggle with confusion and intense emotions associated with their parent's suicide. In this study, seven adults, who reported being younger than six years old at the time of their father's suicide, participated in individual semi-structured interviews. Participants' responses highlight the challenges that young children face due to limited memories of their deceased parent. Interviews concluded with an opportunity for participants to review and express their impressions of 10 children's picture books. Participants offered impressions about how these books may or may not be helpful in supporting young child survivors. Implications for applied practice include considering how children's literature may open communication and assist children in navigating Worden's tasks of grief: (a) accepting the reality of their parent's death; (b) facing the grief and pain; (c) adapting to life changes due to their father's suicide, in particular adapting to altered family relationships; and (d) building memories of the deceased loved one, when possible, to ensure healthy attachment to the deceased parent. Participants' insights provide considerations for selecting children's literature for bibliotherapy. Due to young child survivors' increased risk for attempting and completing suicide, supporting child survivors of parent suicide not only addresses postvention needs but aligns with suicide prevention.

Storybooks to facilitate children's communication following parental suicide: paraprofessional counselors' perceptions

Children often have difficulty talking openly about a parent's suicide. Bibliotherapy can help, but no bibliotherapy studies address parental suicide. We gave a focus group (5 paraprofessionals) 15 children's books addressing grief, parental suicide, and emotional expression, asking them which books were most helpful. They emphasized individualizing treatment to fit the child, recommending the books that honestly portrayed suicide, showed a way forward, provided hope, and assured children that they are not alone. The most highly recommend books were Bart Speaks Out: Breaking the Silence on Suicide and After a Suicide Death: A Workbook for Grieving Kids.

Age at Exposure to Parental Suicide and the Subsequent Risk of Suicide in Young People

Abstract. Background: We investigated the age at exposure to parental suicide and the risk of subsequent suicide completion in young people. The impact of parental and offspring sex was also examined. Method: Using a cohort study design, we linked Taiwan's Birth Registry (1978–1997) with Taiwan's Death Registry (1985–2009) and identified 40,249 children who had experienced maternal suicide (n = 14,431), paternal suicide (n = 26,887), or the suicide of both parents (n = 281). Each exposed child was matched to 10 children of the same sex and birth year whose parents were still alive. This yielded a total of 398,081 children for our non-exposed cohort. A Cox proportional hazards model was used to compare the suicide risk of the exposed and non-exposed groups. Results: Compared with the non-exposed group, offspring who were exposed to parental suicide were 3.91 times (95% confidence interval [CI] = 3.10–4.92 more likely to die by suicide after adjusting for baseline characteristics. The risk of suicide seemed to be lower in older male offspring (HR = 3.94, 95% CI = 2.57–6.06), but higher in older female offspring (HR = 5.30, 95% CI = 3.05–9.22). Stratified analyses based on parental sex revealed similar patterns as the combined analysis. Limitations: As only register-­based data were used, we were not able to explore the impact of variables not contained in the data set, such as the role of mental illness. Conclusion: Our findings suggest a prominent elevation in the risk of suicide among offspring who lost their parents to suicide. The risk elevation differed according to the sex of the afflicted offspring as well as to their age at exposure.

Comprehending childhood bereavement by parental suicide: a critical review of research on outcomes, grief processes, and interventions

The experience of bereavement by parental suicide is not well understood, as evidenced by the lack of empirically supported interventions for this underserved population. This article reviews quantitative and qualitative research on the psychopathological outcomes and thematic characteristics of childhood and adolescent suicide survivorship and moderating variables such as life stressors, stigma, the manner of communication about the suicide, and the surviving parent's functioning. The authors outline several approaches to intervention and address conceptual and methodological challenges within the field. With the ultimate goal of efficacious intervention, recommendations for future priorities and the use of unconventional research methods are offered.

The impact of parental suicide on child and adolescent offspring

Child and adolescent survivors of parental suicide experience two stressful events simultaneously: (1) the loss of a primary caregiver, and (2) suicidal death of a significant person. These youths are thought to be at increased risk for mental health problems, but a systematic review of studies on these survivors has not yet been conducted. A comprehensive search for published literature identified nine studies. The existent studies provided modest yet inconsistent evidence on the impact of parental suicide on offspring psychiatric and psychosocial outcomes. More methodologically rigorous research is needed to inform and guide postvention efforts for these survivors.

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.