Suicide bereavement and recovery patterns compared with nonsuicide bereavement patterns

This study compared bereavement experiences of suicide survivors with those of other survivors. The primary focus of investigation was upon grief reactions suggested to be unique to suicide bereavement and upon quality of grief resolution 2-4 years after death. Fifty-seven women and men, between the ages of 24 and 48, who had experienced the death of a marital partner were interviewed. Subjects were assigned to one of four groups by mode of death (suicide, accident, unanticipated natural, and expected natural). Analyses of variance and Scheffe procedures indicated no significant differences among survivors on frequencies of grief reactions considered common to all bereavements. The suicide survivors were significantly different from all others on certain grief measures, including rejection and unique grief reactions. On various other grief measures, significant differences were indicated among the groups of survivors. Four primary conclusions, implications of the findings, and limitations of the study are discussed.     

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.     

Predictors and correlates of bereavement in suicide support group participants

A sample of 210 survivors of suicide, all participants in suicide support groups, was studied. Associations between demographic factors, circumstances surrounding the suicide, and overall levels of grief (using the Grief Experience Questionnaire) were calculated. Results showed that seeing the body at the scene of the death was the most significant predictor of high levels of distress, and support from family and friends was the strongest protective factor. Time since the death (for women) and attendance at Alcoholics Anonymous meetings (for those participating in nonsuicide support groups) were also significantly related to level of grief. For men, a moderate level of participation in other support groups, as compared with none, was associated with higher levels of grief. All other variables were not significant. Results suggest that a model that combines posttraumatic reactions and grief is most appropriate for the aftermath of suicide.     

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.     

Survivor-victim status, attachment, and sudden death bereavement.

This research examines the significance of the survivor-victim relationship in understanding grief following sudden death bereavement. Data for this study come from medical examiner's reports and mailed self-report surveys of survivors of suicide and accidental death. In general, the results show that survivor-victim attachment is more important than survivor's status in explaining grief reactions. Also, suicide survivors experience significantly less emotional distress and shock, but greater feelings of guilt/shame and rejection, than survivors of accidental death. This paper concludes by directing future research to explore more fully the importance of survivor-victim relationships in understanding grief following bereavement.     

Predicting Grief Symptomatology among the Suddenly Bereaved

Social scientists have long been interested in the study of grief and bereavement, but only recently has research focused on the aftereffects of sudden loss. Theory and research alike suggest that grief is multidimensional and that specific grief reactions have a unique set of predictors. The purpose of this study is to examine the relative contribution of risk factors in explaining variations in specific grief reactions following a sudden death. Data for this study come from medical examiners' reports and mail-back surveys of survivors of sudden loss from suicide or accident. The results indicate that several characteristics of the survivor, mode of death, and social support are important determinants of grief symptomatology. This research concludes by directing future theoretical and empirical endeavors to examine more fully the role of relational factors in influencing grief experiences following bereavement.     

The role of social supports in the bereavement process of surviving spouses of suicide and natural deaths.

This report examines the changing role of social supports in the bereavement of spouses of elderly suicide and natural deaths, focusing on differences and similarities in relation to gender, time, and mode of death. Measurements were obtained 4 times after death (within 2 months, at 6 months, at 12 months, and at 2 to 2 1/2 years) on 79% of the 108 survivors of elderly suicide, 89% of the 199 natural death survivors, and 79% of the nonbereaved controls. The results indicated that the suicide survivors received significantly less emotional support for their feelings of depression and grief than the natural death survivors, and that they did not confide in the persons in their network any more than the nonbereaved controls did. Women report receiving more support overall than men. A low spot in social supports occurred at the 6-month point after loss for both bereaved groups, but primarily in practical help received by natural death survivors. By the end of the second year, both practical and emotional supports had increased to at least the same level as immediately after death.     

Complicated grief and suicidal ideation in adult survivors of suicide

While the prevalence of complicated grief has been demonstrated to be elevated in survivors of suicide, the association between complicated grief and suicidal ideation among adult survivors of suicide has not been explored. The purpose of the present study is to examine the association between complicated grief and suicidal ideation in suicide survivors. The Inventory of Complicated Grief and the Beck Depression Inventory were administered to 60 adult survivors within 1 month of a death by suicide of a family member or significant other. Complicated grief was associated with a 9.68 (CI: 1.036, 90.417) times greater likelihood of suicidal ideation after controlling for depression, suggesting that syndromal complicated grief heightens vulnerability to suicidal ideation. Clinicians may provide more comprehensive assessments by recognizing the possibility of suicidal ideation in those with complicated grief.     

Parental Bereavement After Suicide and Accident: A Comparative Study

In what way is the bereavement process following suicide different from other types of bereavement? The participants were 30 survivors of suicide and 30 survivors of car accidents who were interviewed twice at an average of six months, and the second measure was taken at an average of nine months after the death, with standardized questionnaires to measure depression and grief reaction. Measures of shame, social support, family adaptation, psychological distress, and prior losses were also obtained during the second interview. All survivors were parents who had lost a son aged between 18 and 35 years. The results indicate that suicide survivors were more depressed than accident survivors at the first measure but this difference disappeared at the second measure. Survivors of suicide experienced greater feelings of shame and had experienced more life events after the death than did accident survivors. There was also a greater history of loss in parents bereaved by suicide. Parental bereavement after suicide appears to differ in several ways from other types of bereavement and appears to happen more often in vulnerable families.     

Do They Suffer More? Reflections on Research Comparing Suicide Survivors to Other Survivors

This article contrasts public perceptions of suicide survivors with conclusions based on comparative studies of suicide, fatal accident survivors, and other survivors. Although suicide is commonly thought to cause a particularly burden-some grief, quantitative studies have often failed to support this. We then offer some interpretations of these findings and suggest future pathways for research.     

Bereavement after a Physician-Assisted Suicide: A Speculation Based on Theory

Despite the recent Supreme Court ruling upholding the ban on physician-assisted suicide, the practice continues in the United States. A majority of Americans support physician-assisted suicide, and several surveys document its use by physicians and nurses. This article explores the anticipated bereavement experience of significant survivors following a physician-assisted suicide. Theoretical approaches to bereavement frame the discussion of possible reactions to suicidal death: (1) psychodynamic, (2) attachment theory, (3) crisis theory, and (4) cognitive theory. Three case scenarios illustrate potential survivor reactions, with suggested intervention approaches.     

In Honor of My Father and My Son

The author advises survivors on the four tasks of grief and reflects on the suicide of her college-age son in 1977 and the recent death of her father, a suicidologist, from age-related causes. She describes current collaborative efforts by organizations dedicated to the prevention and aftermath of suicide.     

TWO FACES OF THE CULTURE OF DEATH: RELATIONSHIP BETWEEN GRIEF WORK AND HUNGARIAN PEASANT SOUL BELIEFS

This article aims to demonstrate that peasant death culture–as a part of the social construction of reality–does not only support the grief work of survivors, but sometimes also interferes with and encumbers it. This destructive aspect of death culture is rooted in its this-worldly normative and order preservative role. If the deceased pursued a norm-following life course, peasant culture offers him or her a positive otherworldly perspective of existence, and supports the reorganization of the survivors in various ways. On the other hand, certain infringements of norms (e .g., suicide) are associated with deterrent otherworldly perspectives and are penalized with sanctions falling on the survivors. These sanctions increase survivors' bitterness and shelterlessness and make more difficult the finding of meaning, as well as a comforting closing of the relation to the deceased and its transition into an inner representation.     

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.     

CYBER COMMUNITY IN THE VALLEY OF THE SHADOW OF DEATH

This article provides an examination of the communicative needs and practices of those who have survived the loss of a loved one to suicide. Based on a study of a face-to-face support group for parents of children lost to suicide, and over 10,000 e-mails from a number of online support groups for survivors of the loss of a loved one to suicide, this article discusses intense communicative relations, exclusion from the general society, self-accrediting of experts in grief, reconstruction of identity to include the loss, ownership of the suicide, and rebuilding community.     

Creative ritual: Bridge between mastery and meaning

Many adults who have survived the death by suicide of one or both parents remain victims of unresolved grief responses far into adulthood. This is all too frequently true, despite years of psychotherapy and or/consultations with representatives of various religious persuasions. Adult survivors of childhood parental suicide require an intervention which bridges the psychotherapeutic issues of parental loss and the spiritual issues raised by a sucidal death. The use of creative rituals is just such a response. By linking psychodynamic and spiritual issues, while simultaneously providing a current experiential process, a creative mourning ritual blends the needs of the inner child for mastery of the parental loss and the adult needs for a spiritual/meaning response. Mastery and meaning can concomitantly evolve through the process of designing, and then enacting, a ritual of grief completion. This is particularly effective, since the ritual is designed by the survivor to meet that person's unique needs. This presentation is an example of just such a ritual and will also include a very brief outline for ritual design. This approach would be useful to anyone working with survivors as well as to survivors themselves.     

Sudden Death and Bereavement Outcomes: The Impact of Resources on Grief Symptomatology and Detachment

The study of sudden bereavement focuses almost exclusively on its impact on psychological well-being. This research broadens our understanding of bereavement outcomes by exploring the effect of grief on family detachment following sudden bereavement. Moreover, this study examines the relative contributions of resources in alleviating grief symptoms and reducing detachment. Data are collected from medical examiner records and mail-back surveys from family members of victims of suicide and accidental deaths in a large metropolitan area of the United States. A covariance structural equation model allowing for correlated measurement error is estimated using LISREL VII. The results indicate that the most grief-stricken survivors are more detached from family than those who are least grief-stricken. Examination of the direct and indirect influences of resources on bereavement outcomes reveals that self-esteem is the strongest predictor of grief and that it also plays a decisive role in mediating the influences of religious participation and exercise on grief. Expressive support exerts direct effects on both grief and detachment. This research concludes by directing future research to examine more fully the impact of sudden bereavement on marital and family relationships.     

Christian-based counseling for the suicide survivor: a guide for pastoral therapy

This article addresses the history of stigmatization experienced by suicide survivors, specifically through biblical and theological thought evolving from the Christian Church. Contemporary understandings and attitudes are then assimilated. Four grief stages specific to the grief experience of the suicide survivor are introduced--anger, guilt, shame, and loss--with suggested approaches at each state intended to aid the pastoral counselor in better understanding and ministering to the suicide survivor. A summary of a recommended congregational response is also provided.