Suicide bereavement

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Suicide bereavement is the experience of those who are grieving the loss of someone to suicide. [1] Over 800,000 individuals die by suicide every year. It was stated by Shneidman (1978) that every suicide leaves behind 6 "survivor-victims". However, new research shows that each suicide leaves behind approximately 135 who personally knew the decedent. [2] The #not6 hashtag has been used by Cerel and colleagues to represent that suicide bereavement is many more than publicly portrayed.

Contents

Individuals experiencing suicide bereavement experience different challenges than those otherwise bereaved. Across 41 studies that examined these differences, the suicide bereaved experienced higher levels of blaming, stigma, shame and rejection. [3] Those who lose someone to suicide may experience delays in the healing process. [3]

Complicated grief

Complicated grief is grief whose symptoms do not decline over time. 10% to 20% of individuals survivors develop complicated grief. Individuals who develop complicated grief are likely to experience physical impairments to their daily functioning, with accompanying suffering. These symptoms persist without proper treatment, which became Complicated Grief Treatment. [4]

Grief stages

Elisabeth Kübler-Ross, a Swiss-American psychiatrist, developed a model that encapsulates five stages of grief that an individual is likely to experience after a loss:. [5] However, there is no support for people going through these stages in order or experiencing all of them.

  1. Denial: Can help the individual minimize the overwhelming pain of loss. This stage allows the individual to slow the processing of painful imagery, potentially reducing the pain.
  2. Anger: The individual adjusts to their new reality while likely experiencing extreme emotional discomfort. Anger tends to be the first feeling the individual experiences when they realize that their emotions are related to their loss.
  3. Bargaining: In this stage, the individual attempts to negotiate with a higher power.
  4. Depression: During the grieving process, bargaining has failed and the individual faces the facts of their loss. They are more likely to internalize their feelings and experience extreme sadness. They may find it difficult to reach out to others and experience isolation.
  5. Acceptance: In this last stage, the individual no longer resists the reality of their situation, leaving mostly sadness and regret.

Suicide risk

Compared to other bereaved, the suicide bereaved are at a higher risk of experiencing suicidal ideation. [6] According to a 2002 study, results showed that suicide bereaved individuals were 1.6 times more likely to experience thoughts of suicide, 2.9 times more likely to have a suicide plan, and 3.7 times more likely to have made a suicide attempt. [7] These individuals may conclude that suicide is the only viable solution to their pain. Other suicide bereaved may want to feel closer to the person they lost by ending their life the same way their loved one did.

Stigma

Despite efforts to de-stigmatize suicide, unlike other types of death, suicide remains stigmatized. Individuals who have lost their loved ones to suicide have reported difficulty with talking to others about their loss due to feeling uncomfortable talking about the topic. [8] Additionally, certain religions reject those who have committed suicide. The suicide bereaved individuals may feel shame, making them uncomfortable sharing their loss in their religious group. Insurance policies may exclude death benefits for suicides. [9] Survivors of suicide often experience difficulty healing due to this stigma. [10]

Treatment

Support groups

Support groups can be beneficial for the suicide bereaved, because this is a nonthreatening place where they can experience catharsis among others in a similar situation. Homogeneous support groups are typically more helpful than broader bereavement support groups. [11] Such groups offer reassurances that feelings are acceptable. Individuals also may receive coping recommendations for holidays, talking to others and other now-difficult situations.

Support groups can be found by visiting the International Association for Suicide Bereavement (IASP) website, which is affiliated with the World Health Organization. The American Association of Suicidology (AAS) and the American Foundation for Suicide Prevention (AFSP) also has a list of 400+ support groups across the United States. [12]

Psychotherapy

Support groups on their own may not help individuals who develop a mental illness, such as Major Depressive Disorder (MDD) or Posttraumatic Stress Disorder (PTSD). The suicide bereaved are encouraged to seek clinicians who specialize in psychotherapy and/or medication management. [13] A combination of education, psychotherapy and medication have been shown to be the most effective treatments. [13]

Complicated grief treatment

Complicated grief treatment (CGT) incorporates elements of cognitive behavioral therapy (CBT), exposure and motivational interviewing. This type of psychotherapy facilitates the essential process of accepting loss. The combination of exposure techniques with cognitive restructuring has been shown to help individuals experience life satisfaction and engage in meaningful relationships. [13]

Related Research Articles

<span class="mw-page-title-main">Grief</span> Response to loss in humans and other animals

Grief is the response to the loss of something deemed important, particularly to the loss of someone or some living thing that has died, to which a bond or affection was formed. Although conventionally focused on the emotional response to loss, grief also has physical, cognitive, behavioral, social, cultural, spiritual and philosophical dimensions. While the terms are often used interchangeably, bereavement refers to the state of loss, while grief is the reaction to that loss.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

<span class="mw-page-title-main">Psychological pain</span> Unpleasant feeling of a psychological nature

Psychological pain, mental pain, or emotional pain is an unpleasant feeling of a psychological, non-physical origin. A pioneer in the field of suicidology, Edwin S. Shneidman, described it as "how much you hurt as a human being. It is mental suffering; mental torment." There is no shortage in the many ways psychological pain is referred to, and using a different word usually reflects an emphasis on a particular aspect of mind life. Technical terms include algopsychalia and psychalgia, but it may also be called mental pain, emotional pain, psychic pain, social pain, spiritual or soul pain, or suffering. While these clearly are not equivalent terms, one systematic comparison of theories and models of psychological pain, psychic pain, emotional pain, and suffering concluded that each describe the same profoundly unpleasant feeling. Psychological pain is widely believed to be an inescapable aspect of human existence.

A postvention is an intervention conducted after a suicide, largely taking the form of support for the bereaved. Family and friends of the suicide victim may be at increased risk of suicide themselves. Postvention is a term that was first coined by Shneidman (1972), which he used to describe "appropriate and helpful acts that come after a dire event." In Schneidman's view, "the largest public health problem is neither the prevention of suicide nor the management of suicide attempts, but the alleviation of the effects of stress in the survivors whose lives are forever altered." Postvention is a process that has the objective of alleviating the effects of this stress and helping survivors to cope with the loss they have just experienced.

Suicide intervention is a direct effort to prevent a person or persons from attempting to take their own life or lives intentionally.

Complex post-traumatic stress disorder (CPTSD) is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Mental distress or psychological distress encompasses the symptoms and experiences of a person's internal life that are commonly held to be troubling, confusing or out of the ordinary. Mental distress can potentially lead to a change of behavior, affect a person's emotions in a negative way, and affect their relationships with the people around them.

<span class="mw-page-title-main">Grief counseling</span> Therapy for responses to loss

Grief counseling is a form of psychotherapy that aims to help people cope with the physical, emotional, social, spiritual, and cognitive responses to loss. These experiences are commonly thought to be brought on by a loved person's death, but may more broadly be understood as shaped by any significant life-altering loss.

Youth suicide is when a young person, generally categorized as someone below the legal age of majority, deliberately ends their own life. Rates of youth suicide and attempted youth suicide in Western societies and other countries are high. Youth suicide attempts are more common among girls, but adolescent males are the ones who usually carry out suicide. Suicide rates in youths have nearly tripled between the 1960s and 1980s. For example, in Australia suicide is second only to motor vehicle accidents as its leading cause of death for people aged 15 to 25.

Self-embedding is the insertion of foreign objects either into soft tissues under the skin or into muscle. Self-embedding is typically considered deliberate self-harm, also known as nonsuicidal self-injury, which is defined as "deliberate, direct destruction of tissues without suicidal intent."

Suicide and the Internet have increasingly important relationships as Internet use becomes more ubiquitous.

<span class="mw-page-title-main">Prolonged grief disorder</span> Medical condition

Prolonged grief disorder (PGD), also known as complicated grief (CG), traumatic grief (TG) and persistent complex bereavement disorder (PCBD) in the DSM-5, is a mental disorder consisting of a distinct set of symptoms following the death of a family member or close friend. People with PGD are preoccupied by grief and feelings of loss to the point of clinically significant distress and impairment, which can manifest in a variety of symptoms including depression, emotional pain, emotional numbness, loneliness, identity disturbance and difficulty in managing interpersonal relationships. Difficulty accepting the loss is also common, which can present as rumination about the death, a strong desire for reunion with the departed, or disbelief that the death occurred. PGD is estimated to be experienced by about 10 percent of bereaved survivors, although rates vary substantially depending on populations sampled and definitions used.

Suicide and Life-Threatening Behavior is a peer-reviewed academic journal published six times per year by Wiley-Blackwell on behalf of the American Association of Suicidology. The journal was established in 1971 by Edwin S. Shneidman. Its current editor-in-chief is Thomas Joiner. The journal covers scientific research on suicidal and other life-threatening behaviors, including risk factors for suicide, ethical issues in intervention research, and mental health needs of those bereaved by suicide.

<span class="mw-page-title-main">Meaning-making</span> Process of understanding changes in life

In psychology, meaning-making is the process of how people construe, understand, or make sense of life events, relationships, and the self.

The dual process model of coping is a model for coping with grief developed by Margaret Stroebe and Henk Schut. They studied grief in their work "The Dual Process Model of Coping with Bereavement: A Decade On". It examines this model of coping and how it could be of benefit compared to others.

Suicide awareness is a proactive effort to raise awareness around suicidal behaviors. It is focused on reducing social stigmas and ambiguity by bringing attention to suicide statistically and sociologically, and by encouraging positive dialogue and engagement to prevent suicide. Suicide awareness is linked to suicide prevention as both address suicide education and the dissemination of information to ultimately decrease the rate of suicide. Awareness is the first stage that can ease the need for prevention. Awareness signifies a fundamental consciousness of the threat, while prevention focuses on stopping the act. Suicide awareness is not a medical engagement but a combination of medical, social, emotional and financial counseling. Suicide awareness in adolescents focuses on the age group between 10–24 years, beginning with the onset of puberty.

Child bereavement occurs when a child loses someone of importance in their life. There is substantial research regarding grief in adults, but there is less focus in literature about grief among children. Children will experience instances in their life that could involve losing a parent, sibling, or friend through suicide, unintentional injury, homicide, or natural causes. The levels of grief and bereavement differ among children, including uncomplicated and complicated bereavement. Unlike adults, children may experience and express their grief and bereavement through behaviors, and are less likely to outwardly express their emotions. The children who experience bereavement and grief can receive treatment involving group intervention, play therapy, and cognitive behavioral therapy. Different forms of treatment for children experiencing bereavement and or grief can help to reduce symptoms of anxiety, depression, social adjustment, and posttraumatic stress. Research has shown that it is important to be aware of the difficulties in predicting how losing a closed one can impact a child’s emotionality and how their coping abilities will differ across ages and cultures.

Suicide and trauma is the increased risk of suicide that is caused by psychological trauma.

Youth suicide in India is when young Indian people deliberately end their own life. People aged 15 to 24 years have the highest suicide rate in India, which is consistent with international trends in youth suicide. 35% of recorded suicides in India occur in this age group. Risk factors and methods of youth suicide differ from those in other age groups.

Bereavement groups, or grief groups, are a type of support group that bereaved individuals may access to have a space to process through or receive social support around grief. Bereavement groups are typically one of the most common services offered to bereaved individuals, encompassing both formalized group therapy settings for reducing clinical levels of grief as well as support groups that offer support, information, and exchange between those who have experienced loss.

References

  1. ↑ Andriessen, Karl; Krysinska, Karolina; Grad, Onja T., eds. (2017). Postvention in Action: The International Handbook of Suicide Bereavement Support. Hogrefe Publishing. doi:10.1027/00493-000. ISBN   9780889374935.
  2. ↑ Cerel, Julie; Brown, Margaret M.; Maple, Myfanwy; Singleton, Michael; van de Venne, Judy; Moore, Melinda; Flaherty, Chris (April 2019). "How Many People Are Exposed to Suicide? Not Six". Suicide & Life-Threatening Behavior. 49 (2): 529–534. doi:10.1111/sltb.12450. ISSN   1943-278X. PMID   29512876. S2CID   3750731.
  3. 1 2 Jordan, John R. (2008-10-01). "Bereavement After Suicide". Psychiatric Annals. 38 (10): 679–685. doi:10.3928/00485713-20081001-05. ISSN   0048-5713. S2CID   51045844.
  4. ↑ Lichtenthal, Wendy G.; Cruess, Dean G.; Prigerson, Holly G. (2004). "A case for establishing complicated grief as a distinct mental disorder in DSM-V". Clinical Psychology Review. 24 (6): 637–662. doi:10.1016/j.cpr.2004.07.002. PMID   15385092.
  5. ↑ Kübler-Ross, Elisabeth (1969). On death and dying. London: Routledge. ISBN   9780203010495. OCLC   325223194.
  6. ↑ Krysinska, Karolina E. (2003). "Loss by suicide. A risk factor for suicidal behavior". Journal of Psychosocial Nursing and Mental Health Services. 41 (7): 34–41. doi:10.3928/0279-3695-20030701-14. ISSN   0279-3695. PMID   12875181.
  7. ↑ Crosby, Alex E.; Sacks, Jeffrey J. (2002). "Exposure to Suicide: Incidence and Association with Suicidal Ideation and Behavior: United States, 1994". Suicide and Life-Threatening Behavior. 32 (3): 321–328. doi:10.1521/suli.32.3.321.22170. PMID   12374477.
  8. ↑ Kuramoto, S. Janet; Brent, David A.; Wilcox, Holly C. (2009). "The Impact of Parental Suicide on Child and Adolescent Offspring". Suicide and Life-Threatening Behavior. 39 (2): 137–151. doi:10.1521/suli.2009.39.2.137. PMID   19527154.
  9. ↑ Feigelman, William; Jordan, John R.; Gorman, Bernard S. (2009). "How They Died, Time since Loss, and Bereavement Outcomes". OMEGA - Journal of Death and Dying. 58 (4): 251–273. doi:10.2190/OM.58.4.a. ISSN   0030-2228. PMID   19435178. S2CID   8778684.
  10. ↑ Cvinar, Jacqueline G. (2005). "Do Suicide Survivors Suffer Social Stigma: A Review of the Literature". Perspectives in Psychiatric Care. 41 (1): 14–21. doi: 10.1111/j.0031-5990.2005.00004.x . ISSN   0031-5990. PMID   15822848.
  11. ↑ Jordan, John R. (2001). "Is Suicide Bereavement Different? A Reassessment of the Literature". Suicide and Life-Threatening Behavior. 31 (1): 91–102. doi:10.1521/suli.31.1.91.21310. PMID   11326773. S2CID   27897543.
  12. ↑ Krysinska, Karolina; Andriessen, Karl (2010). "On-Line Support and Resources for People Bereaved through Suicide: What Is Available?". Suicide and Life-Threatening Behavior. 40 (6): 640–650. doi:10.1521/suli.2010.40.6.640. PMID   21198333.
  13. 1 2 3 Tal Young, Ilanit; Iglewicz, Alana; Glorioso, Danielle; Lanouette, Nicole; Seay, Kathryn; Ilapakurti, Manjusha; Zisook, Sidney (2012). "Suicide bereavement and complicated grief". Dialogues in Clinical Neuroscience. 14 (2): 177–186. doi:10.31887/DCNS.2012.14.2/iyoung. ISSN   1958-5969. PMC   3384446 . PMID   22754290.
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