Suicidal Behaviors in Surviving Monozygotic and Dizygotic Co‐Twins: Is the Nature of the Co‐Twin's Cause of Death a Factor?

Genetically informative samples can address hereditary and experiential influences on suicide‐related behaviors. The frequency of suicide‐related behaviors was compared in twins from two survivor groups: (1) those whose co‐twins' deaths were suicides (monozygotic [MZ]: n = 47; dizygotic [DZ]: n = 31), and (2) those whose co‐twins' deaths were nonsuicides (MZ: n = 347; DZ: n = 170). The frequency of suicide attempts among suicide survivors was significantly higher in MZ than DZ twins, while the frequency of suicide attempts among nonsuicide twin survivors did not differ between MZ and DZ twins. Twin concordance for suicide attempts more likely reflects a genetic predisposition than a behavioral reaction to the loss.     

A Call for Research: The Need to Better Understand the Impact of Support Groups for Suicide Survivors

Support groups for suicide survivors (those individuals bereaved following a suicide) are widely used, but little research evidence is available to determine their efficacy. This paper outlines the pressing public health need to conduct research and determine effective ways to identify and meet the needs of suicide survivors, particularly through survivor support groups. After describing the various approaches to survivor support groups, we explain the need for further research, despite the inherent challenges. Finally, we pose several questions for researchers to consider as they work with survivors to develop a research agenda that sheds more light on the experiences of survivors and the help provided by survivor support groups.     

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.     

What do Suicide Survivors Tell Us They Need? Results of a Pilot Study

Few studies have examined the natural coping efforts used by suicide survivors, or have identified specific problems and needs survivors experience following the death of a significant other by suicide. In the present study, we used a newly developed needs assessment survey to examine four areas of natural coping efforts: practical, psychological, and social difficulties; formal and informal sources of support; resources utilized in healing; and barriers to finding support since the loss. Sixty-three adult survivors of suicide were recruited from suicide survivor conferences and support groups. Results indicate that participants experienced high levels of psychological distress since the suicide, including elevated symptoms of depression, guilt, anxiety, and trauma. Participants experienced substantial difficulties in the social arena (e.g., talking with others about the suicide). The majority of the sample viewed professional help as beneficial; although many informal sources of support were also valued (e.g., one-to-one contact with other survivors). Depression and a lack of information about where to find help served as barriers to help-seeking behaviors for our participants. Participants who reported higher levels of functional impairment were more likely to report higher levels of psychological distress, social isolation, and barriers to seeking help. Future research with a longitudinal and more inclusive sample is needed to build on these preliminary findings and to provide a solid foundation for evidenced-based interventions with survivors.     

Is Exposure to Suicide Beyond Kin Associated with Risk for Suicidal Behavior? A Systematic Review of the Evidence

Suicide bereavement and postvention literature often espouses risk for subsequent suicidal behavior among those previously exposed to a suicide death. Most often risk is discussed in relation to kin; however, many more individuals are exposed to suicide, and the impact of this exposure is important to understand in relation to targeting postvention. This review examined the research literature (1990–2014) to determine the evidence base for risk among those exposed to suicide. The findings demonstrate that risk of suicidal behaviors among those exposed to the suicide is significantly higher than those unexposed. These results are discussed within the context of current research in the field of postvention, and suggestions for future research are suggested.     

Estimating the population of survivors of suicide: seeking an evidence base

Shneidman (1973) derived an estimate of six survivors for every suicide that, in the ensuing years, has become an assumed fact underlying public health messaging campaigns in support of suicide prevention and postvention programs worldwide, in spite of it lacking either empirical testing or validation. This report offers a first test designed to derive estimates of suicide survivors and raises an array of empirical questions needing further study to reasonably address the impact of suicide on others.     

Variation in functioning, psychosocial characteristics, and six-month outcomes among suicidal youth in comprehensive community mental health services

In this study we compared the psychosocial (n = 7,896) and clinical (n = 4,664) characteristics and 6-month functional outcomes (n = 2,594) of suicidal and nonsuicidal youth. Repeat and previous attempters were more likely than first-time and never attempters to experience psychosocial problems and to be functionally impaired in a variety of domains. Differences in functional impairment persisted at 6 months. Among those who were not severely functionally impaired at baseline, repeat attempters were more likely to be severely impaired at 6 months. Subgroups of suicide attempters may present to treatment differently, have a different expression of problems over time, and have different treatment needs.     

Suicide Exposure in the Population: Perceptions of Impact and Closeness

Recent studies of people exposed to suicide point to a continuum of effects moderated by a perception of closeness to the deceased. We investigated the importance of perception of impact of the death on mental health outcomes of those exposed to suicide. Female sex, younger age, and multiple exposures to suicide were associated with greater risk for poorer outcomes. Suicide exposed with high impact was more likely to have depression, anxiety, posttraumatic stress disorder, prolonged grief, and suicide ideation. Findings can help focus postvention resources for suicide‐exposed individuals.     

Suicides among family members of elderly suicide victims: an exploratory study

This exploratory study compares elderly suicides with (n=13) and without (n=72) family member suicide. Previous episodes of suicidal behavior were more common among suicides who lost first-degree relatives by suicide (100% vs. 65%, p = .009). Six persons had lost an offspring by suicide prior to their own deaths. Substance use disorder was more prevalent among those with offspring suicide than those without (100% vs. 25%, p = .000). While informants reported that offspring suicides played a central role in the suicide of the elderly study case, sibbling suicides were not considered precipitating factors.     

Self-cutting: patient characteristics compared with self-poisoners

A large ( n = 14,892) consecutive sample of deliberate self-harm (attempted suicide) patients who presented to a general hospital in the United Kingdom during a 23-year study period was examined (over two consecutive time periods) in order to compare the characteristics of those who used self-cutting ( n = 428) and those who self-poisoned ( n = 11,065). Patients who used different methods on other occasions, or were not assessed by the psychiatric service, were excluded. In the first time period (January 1976-June 1988), the self-cutters were distinguished from the self-poisoners by more often being male, single, not employed, and having a history of previous deliberate self-harm. In the second time period (July 1988-December 1998) the self-cutters were again distinguished by more often being male and having a history of previous deliberate self-harm, but also by being more likely to live alone, misuse alcohol, and have low suicidal intent scores. The finding of an excess of males among the self-cutters is contrary to the impression in the literature that self-cutting presentations to general hospitals more often involve females. It also indicates that the treatment needs of those who deliberately cut themselves are likely to differ from those of self-poisoners.     

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.     

AIDS-related factors predictive of suicidal ideation of low and high intent among gay and bisexual men.

AIDS-related stressors were studied in relationship to suicidal ideation and suicide intent among 778 gay and bisexual men (none with AIDS). Over the previous six months, 27% (n = 212) reported suicidal ideation. Subjects who reported suicidal ideation (compared to those who did not) were more likely to report recent (last 6 months) bereavement of partner, recent ARC diagnosis, and multiple close friends with ARC. Suicide ideators were divided by a median split on a self-report scale of suicide intent into low (n = 105) and high (n = 107) intent suicide ideators. News of HIV seropositivity was specifically related to low intent suicidal ideation. High intent suicidal ideation was associated with having a partner with AIDS or ARC, or multiple close friends with AIDS, or having ARC. Generally speaking, while temporally discrete AIDS-related events were associated the report of suicidal ideation, ongoing stressors which may more greatly challenge adaptational capacities were more associated with high intent suicidal ideation.     

Characteristics and VA health care utilization of U.S. Veterans who completed suicide in Oregon between 2000 and 2005

Oregon Violent Death Reporting System data were linked with Veterans Affairs (VA) administrative data to identify and describe veterans who completed suicide in Oregon from 2000 to 2005 (n = 968), and to describe their VA health care utilization in the year prior to death. Twenty-two percent had received health care in the VA system. Of these, 57% did not have mental health diagnoses and 58% had not seen mental health professionals. A larger proportion of those who accessed care were VA-enrolled and received service-connected disability benefits. Fifty-five veterans were hospitalized during the year prior to death. Of these, 33% completed suicide within 30 days of a hospitalization. Further development of suicide prevention strategies for veterans in the community, including general medical treatment settings, is indicated.     

Survivors of suicide do grieve differently: empirical support for a common sense proposition.

Previous empirical investigations have produced mixed results on the question of whether mode of death differentially affects grief. To further investigate the influence of suicide on grief, 350 previously bereaved university students completed a questionnaire package consisting of several standardized measures. Participants were separated into four groups based on the mode of death experienced as either survivors of suicide (n = 34), accident (n = 57), unanticipated natural (n = 102), or anticipated natural (n = 157) deaths. Hierarchical multiple regression analyses indicated that suicide survivors, compared against the other groups, experienced more frequent feelings of rejection, responsibility, "unique" reactions, and more total grief reactions. Trends indicating increased levels of shame and perceived stigmatization were also evident. Aggregate factors of death "naturalness" and "expectedness" showed less influence than mode of death in influencing grief. Overall, results support previous clinical and research findings and intuitive logic in demonstrating that the grief experienced by suicide survivors includes elements that are less frequently seen in the case of nonsuicidal deaths.     

Methods of Suicide Among Cancer Patients: A Nationwide Population‐Based Study

A 3‐year nationwide population‐based data set was used to explore methods of suicide (violent vs. nonviolent) and possible contributing factors among cancer patients in Taiwan. A total of 1,065 cancer inpatients who committed suicide were included as our study sample. The regression shows that those who had genitourinary cancer were 0.55 times (p = 0.047) less likely to use violent methods to commit suicide than those who had respiratory cancer. Among those who committed suicide out of town, the odds of using violent methods were 1.39 (p = 0.015) of their counterparts who had committed suicide in their hometowns. Those who had income between NT$15,841～NT$25,000 were 0.70 (p = 0.042) times less likely to use violent methods to commit suicide than those who had no income.     

Support Groups for Suicide Survivors: Results of a Survey of Group Leaders

To update and expand Rubey and McIntosh's (1996) survivors of suicide support groups report, SPAN USA completed a survey of U.S. support group leaders (n = 100; 24% completion). There are now more survivor groups (from 280 to 417), and the majority of groups now have a survivor leader (78% vs. 25%). Groups continue to be small (88% < 10 members per session) and meet on a monthly basis (55%). Sharing continues to be a universal experience in groups, which tend to be open‐ended (85%). Current groups are newer, and more operate without a sponsor. Further research is needed to examine group member perspectives and effectiveness of groups.     

Family survivors of suicide and accidental death: consequences for widows

The impact of completed suicide on the surviving family was studied. Thirteen widows whose husbands had died through suicide were compared with 13 widows whose husbands had died in accidents. The widows' views of their families' functioning, and the extent of life stress and psychiatric symptoms experienced by the widows, were assessed. Interview data suggested more guilt and blaming in suicide survivor families. However, on standardized questionnaires, suicide survivors showed no more family dysfunction, life stress, or psychiatric symptomatology than accident survivors. Both groups acknowledged clinically significant levels of symptoms. The findings raise questions about the validity of generalizations based on the clinical literature regarding the uniquely pathogenic impact of suicide on family functioning.     

Spared at Random: Survivor Reactions in the Gay Community1

Many gay men who have tested negative for HIV were sexually active prior to a general awareness of how HIV is transmitted. Based on the work of Lifton (1980), such HIV-negative gay men may be considered “survivors” since they have witnessed the deaths of many members of their community and have been spared. Survivors may be expected to manifest one or more of three survivor reactions: guilt about surviving (HIV-related guilt), anxiety about dying (AIDS-related death anxiety), and blunted affect. The present study employed structural equation modeling in samples of HIV-negative (N= 129) and HIV-positive (N= 95) gay men to assess psychological and behavioral variables predictive of the presence of a survivor reaction. Survivor reactions were uniquely predicted among HIV-negative gay men. The larger the number of sexual partners HIV-negative gay men reported having had prior to 1984, the more likely they were to experience a survivor reaction. Greater satisfaction with social support from gay friends, and, indirectly, gay-related community group involvement, was associated with being less likely to experience a survivor reaction.     

Suicide among police in a federal force

Suicide among police has gained the attention of numerous police forces over the past two decades. The great variation in reported police suicide rates and caveats concerning such statistics are addressed. The paper reports the results of a study of suicide among members (n = 35) of the Royal Canadian Mounted Police (RMCP) between 1960 and 1983. The average annual rate (14.1 per 100,000) of suicide in this force was approximately half that of the comparable general population, and the most common means of suicide was by service revolver (77% of cases). Recommendations are made for suicide prevention and postvention actions in police forces. Finally, the need for reliable, long-term police suicide data bases is stressed.     

Instructions for Authors

SUICIDE AND LIFE‐THREATENING BEHAVIOR is devoted to emergent theoretical, clinical, and public health approaches related to violent, self‐destructive, and life‐threatening behaviors. It is multidisciplinary and concerned with a broad range of related topics including, but not limited to, suicide, suicide prevention, biology of suicide, death, accidents, epidemiology, crisis intervention, postvention with survivors, nomenclature, standards of care, clinical training and interventions, violence, euthanasia, and assisted suicide.