13 May Suicide A Risk Factor for Mental Health Issues, Suicide in Bereaved
MedicalResearch: What are the main findings of the study?
Answer: We conducted a systematic review of all published research comparing the experience of suicide bereavement with bereavement due to other causes, in which we considered the evidence from 57 studies evaluating the effect of bereavement on death, mental health, and social functioning of family members, friends, and other close contacts of the deceased. These studies showed that parents and children bereaved by suicide were at higher risk of mental health problems after the loss than parents and children bereaved by other causes, and that spouses and mothers bereaved by suicide were at higher risk of suicide than spouses and mothers bereaved by other causes. We also found some evidence that people from a range of kinship groups bereaved by suicide report more rejection and shame than people bereaved by other violent deaths, and that feeling stigmatised by the death is commonly experienced after any violent bereavement. It seemed that people bereaved by violent deaths, for example due to accidental death, homicide, drug-related death, motor vehicle crash, undetermined death or suicide, shared a sense of feeling blamed for the death or tainted by their association with the deceased.
The evidence from this review suggests we should determine partners’, relatives’ and friends’ needs for support after a suicide, as well as developing evidence-based guidelines for the most appropriate interventions. It is clear from reading the suicide prevention policies for the United States, and for England, that the infrastructure of support available for people bereaved by suicide is largely provided by the voluntary sector. These organisations conduct invaluable work and their services are often preferred by bereaved people. However such a heavy state reliance on the charitable sector may be unsustainable without assured funding to continue this work, or clear evidence-based national guidelines on the appropriate range of services to offer bereaved individuals at greatest risk.
MedicalResearch: Were any of the findings unexpected?
Answer: For many years a number of suicide prevention policies internationally have recommended that support should be provided to people bereaved by suicide, but this was based on weak evidence that this was a group at higher risk of adverse psychiatric or psychosocial outcomes than people bereaved by other causes. This review provides much stronger evidence that bereavement by suicide is a risk factor for suicide in spouses and mothers, and a risk factor for mental illness in parents and children bereaved by suicide. However, the review also showed many similarities between the outcomes of people bereaved by suicide and those of people bereaved by other violent deaths. One Canadian study provided evidence that parents bereaved after losing a child in a motor-vehicle crash had a higher risk of depression than parents bereaved by a child’s suicide. Overall these findings suggest that public mental health policies should recognise the needs of people bereaved by any violent deaths, and not just those bereaved by suicide.
MedicalResearch: What should clinicians and patients take away from your report?
Answer: Clinicians normally inquire about a family history of suicide in a patient being assessed for mental health difficulties. This review shows that clinicians should expand on this to inquire about a history of suicide in a partner, and indeed in any close contact, as well as a history of any other sudden or traumatic bereavement. We recommend that bereavement due to violent death is also considered as relevant in a risk assessment for suicidal behaviour or mental illness.
This report bolsters the rationale for provision of better support for people bereaved by suicide or other violent death. Family doctors may need to be vigilant to the needs of partners, relatives and friends of those who die by violent causes. However the results should not be misconstrued as signalling that suicide or mental illness is inevitable after bereavement by suicide. Suicide is a comparatively rare event, and so the increased risk described by this review is small in overall terms. The broader message is that everyone in society should be aware that people bereaved by violent causes feel stigmatised and ashamed in relation to the death, and that this can make the process of mourning even harder for them.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Answer: The next step is to use the results of qualitative research with people who have experienced a traumatic bereavement to expand the range of interventions available to them. This would need to be on a country-by-country basis, so that local services were acceptable to bereaved people. The development of clear evidence-based national guidelines will then involve well-designed trials to evaluate the effectiveness of these interventions in reducing the risk of mental health problems.
Effects of suicide bereavement on mental health and suicide risk
Dr Alexandra Pitman MSc[Econ],David Osborn PhD,Prof Michael King PhD,Annette Erlangsen PhD
The Lancet Psychiatry – 2 May 2014
Editor’s Note: Grief and Suicide Resources