Community responses following suicide, homicide, and other deaths: the perspective of potential comforters

Does prolonged grief or suicide bereavement cause public stigma? A vignette-based experiment

Prolonged grief disorder (PGD), characterized by severe, persistent and disabling grief, is newly included in the International Classification of Diseases 11 (ICD-11). Receiving a PGD diagnosis could lead to stigmatizing public reactions (i.e. public stigma), yet research on this topic is limited. Additionally, while there is evidence that experiencing suicide bereavement causes public stigma, no studies to date have investigated the interaction between PGD and cause of death on public stigma. To fill these knowledge gaps, this experimental study tested if a PGD diagnosis (vs. no diagnosis) and experiencing suicide bereavement (vs. homicide and natural loss) cause public stigma. Three hundred and seventeen adults from the general population were randomly assigned to read one of 6 different vignettes of a person with and without PGD who had lost a spouse through a suicide, homicide or a stroke. After reading a vignette, negative attributions, emotional reactions, and desire for social distance were assessed. Notably, only persons with PGD were attributed relatively more negative characteristics, and elicited more anger, anxiety and pro-social emotions, and a larger preferred social distance in participants. This study supports the claim that PGD causes public stigma, but nuances claims that suicide bereavement induces public stigma.

Attitudes About Suicide Ideation Among Suicide Loss Survivors: A Vignette Study

This study aimed to examine the attitudes of college students toward suicide and nonsuicide loss survivors’ future suicide intent—specifically the degree to which each is believed to be suicidal based on the characteristics of the loss and relationship to the deceased. Participants were asked to read a descriptive vignette about a bereaved individual and assess their judgment about the survivor’s current state of suicide-related ideation. The results revealed that the likelihood of indicating suicide-related ideation was decreased by 5.9% for each year that the participant aged. This study provides useful knowledge about the perception of suicidal ideation among bereaved individuals.

Social support following bereavement: The role of beliefs, expectations, and support intentions

Social support is one of the strongest determinants of bereavement outcomes, yet little is understood about the community's recognition of grief and intentions to provide social support to grieving persons. A total of 476 adults responded to an online vignette and questionnaire measuring grief norms and supportive intentions. Respondent gender, age, and bereavement status all had some association with expectations of grief, intentions to support, perceived helpfulness of support attempts, and opinions toward the diagnostic classification of grief. Given that most bereavement support is informal, this study informs the development of community capacity to provide constructive, timely bereavement support.

What determines supportive behaviors following bereavement? A systematic review and call to action

Very few factors that impact the grieving process can be modified after the fact to the extent that social support can. However, social support has received limited research attention, resulting in little conceptual understanding of the mechanisms behind perceptions of, and intentions to support, grieving persons. This systematic review aimed to explore bereaved, decedent, and respondent-related determinants of the provision of social support. The review yielded 42 studies impacted by various methodological and sampling limitations. This review poses a call to the field for more rigorous study of social support determinants to better assist the bereaved and their natural supporters.

The stigma associated with bereavement by suicide and other sudden deaths: A qualitative interview study

Quantitative studies have found that suicide bereavement is associated with suicide attempt, and is perceived as the most stigmatising of sudden losses. Their findings also suggest that perceived stigma may explain the excess suicidality. There is a need to understand the nature of this stigma and address suicide risk in this group. We aimed to describe and compare the nature of the experiences of stigma reported by people bereaved by suicide, sudden unnatural death, and sudden natural death, and identify any commonalities and unique experiences. We conducted a population-based cross-sectional survey of 659,572 staff and students at 37 British higher educational institutions in 2010, inviting those aged 18-40 who had experienced sudden bereavement of a close contact since the age of 10 to take part in an on-line survey and to volunteer for an interview to discuss their experiences. We used maximum variation sampling from 1398 volunteer interviewees to capture a range of experiences, and conducted individual face-to-face semi-structured interviews to explore perceptions of stigma and support. We continued sampling until no new themes were forthcoming, reaching saturation at n = 27 interviews (11 participants bereaved by suicide). We employed thematic analysis to identify any distinct dimensions of reported stigma, and any commonalities across the three groups. We identified two key themes: specific negative attitudes of others, and social awkwardness. Both themes were common to interviewees bereaved by suicide, sudden unnatural death, and sudden natural death. All interviewees reported the experience of stigmatising social awkwardness, but this may have been experienced more acutely by those bereaved by suicide due to self-stigma. This study provides evidence of a persistent death taboo in relation to sudden deaths. There is potential for anti-stigma interventions to reduce the isolation and social awkwardness perceived by people bereaved suddenly, particularly after suicide loss.

The stigma associated with bereavement by suicide and other sudden deaths: A qualitative interview study

Quantitative studies have found that suicide bereavement is associated with suicide attempt, and is perceived as the most stigmatising of sudden losses. Their findings also suggest that perceived stigma may explain the excess suicidality. There is a need to understand the nature of this stigma and address suicide risk in this group. We aimed to describe and compare the nature of the experiences of stigma reported by people bereaved by suicide, sudden unnatural death, and sudden natural death, and identify any commonalities and unique experiences. We conducted a population-based cross-sectional survey of 659,572 staff and students at 37 British higher educational institutions in 2010, inviting those aged 18–40 who had experienced sudden bereavement of a close contact since the age of 10 to take part in an on-line survey and to volunteer for an interview to discuss their experiences. We used maximum variation sampling from 1398 volunteer interviewees to capture a range of experiences, and conducted individual face-to-face semi-structured interviews to explore perceptions of stigma and support. We continued sampling until no new themes were forthcoming, reaching saturation at n = 27 interviews (11 participants bereaved by suicide). We employed thematic analysis to identify any distinct dimensions of reported stigma, and any commonalities across the three groups. We identified two key themes: specific negative attitudes of others, and social awkwardness. Both themes were common to interviewees bereaved by suicide, sudden unnatural death, and sudden natural death. All interviewees reported the experience of stigmatising social awkwardness, but this may have been experienced more acutely by those bereaved by suicide due to self-stigma. This study provides evidence of a persistent death taboo in relation to sudden deaths. There is potential for anti-stigma interventions to reduce the isolation and social awkwardness perceived by people bereaved suddenly, particularly after suicide loss.

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Explores stigma after suicide, unnatural deaths and sudden natural deaths.

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First qualitative study internally comparing these three groups' experiences.

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All three groups described stigmatising social awkwardness.

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The death taboo in relation to sudden deaths is particularly marked after suicide.

Postvention is prevention-The case for suicide postvention

There is now convincing empirical evidence that exposure to suicide increases the risk of subsequent suicide, as well as other negative mental health sequelae, in those who have been exposed. This article provides a review of this empirical evidence. It also concludes that this substantial evidence base makes the compelling case that all suicide prevention programs need to include postvention services as a direct form of suicide prevention with a population of people known to be at heightened risk for suicide themselves: suicide loss survivors.

Survivors of Suicide: A Comprehensive Bibliography Update, 1986–1995

An update of a 1985–86 Omega bibliography of the literature on survivors of suicide is presented. Following brief introductory comments, including the identification of research and therapy needs and unresolved issues, the bibliography listings are organized by the following subtopics: general references on family members and friends as suicide survivors; children, adolescents, youth, and parents as survivors; school and educational settings; parental suicide; elderly suicide survivors; mental health professionals and clinicians in training as survivors; survivors of professionals' suicides; and research on attitudes toward survivors. Published works in professional journals, books, book chapters, and doctoral dissertations on the topic of survivor-victims are included.

Acceptability of Suicide: Attitudes in Taiwan and in the United States

The Suicide Opinion Questionnaire was administered to two samples, one from Taiwan ( n = 291) and one from the United States ( n = 218). Mean scores on the Acceptability scale were significantly higher for the Taiwanese sample, indicating greater acceptance. A chi-square analysis indicated significant response rates for ten of the eleven items, with eight of the eleven items showing greater agreement in the Taiwanese sample. Taiwanese are less accepting of suicide in cases of incurable illness, and agree less that suicide may be the only escape from life's problems. They are, however, more accepting of suicide for the elderly infirm, for captured soldiers, as a reasonable solution, as a normal behavior, agree with non-interference, with the option of suicide clinics, and passive suicide.

The stigma perceived by people bereaved by suicide and other sudden deaths: A cross-sectional UK study of 3432 bereaved adults

OBJECTIVE

To test the hypothesis that perceived stigma scores in young adults bereaved by suicide are significantly higher than in young adults bereaved by other sudden deaths, whether blood-related to the deceased or not.

METHODS

We conducted a cross-sectional study of all staff and students aged 18-40 at 37 UK higher educational institutions in 2010, and identified 3432 respondents who had experienced a sudden bereavement of a close contact since reaching the age of 10, either due to sudden natural causes, sudden unnatural causes, or suicide. We used multivariable regression to compare scores on the stigma, shame, responsibility and guilt subscales of the Grief Experience Questionnaire, adjusting for socio-demographic factors and pre-bereavement psychopathology.

RESULTS

People bereaved by suicide (n=614) had higher stigma scores than people bereaved by sudden natural death (n=2106; adjusted coefficient=2.52; 95% CI=2.13-2.90; p=<0.001) and people bereaved by sudden unnatural death (n=712; adjusted coefficient=1.69; 95% CI=1.25-2.13; p=<0.001). Shame, responsibility and guilt scores were also significantly higher in people bereaved by suicide, whether compared with bereavement by sudden natural death or sudden unnatural death. Associations were not modified by whether the bereaved was blood-related to the deceased or not.

CONCLUSIONS

Stigma was perceived more acutely by the relatives and friends of those who died by suicide than those bereaved by other causes of sudden natural or sudden unnatural death. Their high levels of perceived stigma, shame, responsibility and guilt require qualitative investigation to identify whether these grief dimensions limit social functioning, help-seeking behaviour and/or support offered.

Predicting social support for grieving persons: a theory of planned behavior perspective

Research has consistently reported that social support from family, friends, and colleagues is an important factor in the bereaved person's ability to cope after the loss of a loved one. This study used a Theory of Planned Behavior framework to identify those factors that predict a person's intention to interact with, and support, a grieving person. Questionnaire data from 160 university students showed that together behavioral, normative, and control beliefs and past behavior significantly predicted intention after controlling for gender and past experience. Behavioral beliefs, followed by control beliefs and past behavior, were the most important predictors of intention to support a grieving person.

Attitudes towards those bereaved by a suicide: a population-based, cross-sectional study in rural Japan

BACKGROUND

Family or friends bereaved by suicide are at risk of experiencing complications because of attitudes regarding suicide. It is important that individuals close to those grieving after a death by suicide demonstrate adequate knowledge and compassionate attitudes. To this end, we examined the factors that contribute to attitudes toward persons bereaved by the suicide of a family member or friend, and perceptions of suicide prevention and the promotion of mental health.

METHODS

A total of 5154 residents of a rural town in northern Japan aged 30-69 years completed a cross-sectional questionnaire. The questionnaire gathered data about demographic variables, depressive symptoms, and issues related to suicide including personal experience of an acquaintance's suicide, attitudes towards those bereaved by suicide, and perceptions regarding suicide prevention. Factors related to these attitudes and perceptions were analysed using logistic regression models.

RESULTS

Overall, 67.5% of respondents demonstrated appropriate attitudes towards those bereaved by suicide; 30.4% of responses were undetermined, and 2.1% were inappropriate. Undetermined attitudes were associated with male gender (adjusted OR 1.42, 95%CI = 1.26-1.61), younger age (2.64, 2.12-3.29), lower education level (1.32, 1.07-1.62), greater severity of depression (3.81, 2.80-5.20), and lack of personal experience of an acquaintance's suicide (1.39, 1.22-1.57). Inappropriate attitudes were associated with male gender (adjusted OR 1.98, 95%CI = 1.33-2.94), lower education level (2.55 1.34-4.83), and greater severity of depression (6.93, 3.52-13.67). Overall, 16.0% demonstrated passive thoughts regarding suicide prevention and the promotion of mental health in the community, and were associated with male gender (1.22, 1.04-1.42), younger age (2.72, 2.03-3.65), lower education level (1.32, 1.02-1.71), and greater severity of depression (4.94, 3.58-6.82).

CONCLUSION

Factors that contributed to undetermined attitudes included male gender, younger age, lower education level, greater severity of depression, and lack of personal experience of an acquaintance's suicide. Passive thoughts regarding suicide prevention and the promotion of mental health were associated with male gender, younger age, lower education level, and greater severity of depression.

Social Reactions to the Survivor of a Suicide in the Family: A Review of the Literature

This article reviews the available literature on reactions to family members surviving another member's suicide. Three factors determining the reaction of others to persons bereaved by suicide are investigated: 1) the cause of death, 2) characteristics of the deceased, and 3) characteristics of the respondent. The perceptions that persons bereaved by suicide have of the way others view them are reviewed. Methodological flaws and limitations of the current research are noted, with suggestions for the direction of future research. Tentative generalizations and suggestions for clinical practice are also made.

Bereavement following Suicide and Other Deaths: Why Support Attempts Fail

To assess perceptions both of bereaved individuals and of potential comforters across five causes of death, 400 undergraduate volunteers were screened in order to find 112 who either were bereaved in the past two years, or were not but matched a bereaved individual in age and gender. Non-bereaved individuals imagined that they knew and had to talk to someone bereaved under the same circumstances as their yoked bereaved person. Bereaved individuals reported experiencing more unhelpfulness and blame and less interpersonal contact than potential comforters thought they would give, but also reported more recovery and acceptance, more helpful support, and less need for active avoidance, than potential comforters imagined. People apparently view bereaved individuals as extremely vulnerable. Across all types of death, suicide involved most variability in social support, accidents involved most blame, and homicide involved most loss of belonging support and feeling that the death was not real. Perhaps because of these misconceptions, nonbereaved comforters may hypothetically be able to provide helpful support, but in reality be unable to carry these out.

Purpose in Life: A Moderator of Recovery from Bereavement

For those with relatively low purpose in life, the experience of bereavement may induce an existential crisis, particularly if the cause of death is suicide. To assess whether this happens in recent bereavement, 122 people (31% of those who received questionnaires) recently bereaved (mode < two years) completed scales measuring life purpose, life satisfaction, reasons for living, and social support. Multivariate analysis followed by univariate analysis indicated that purpose was associated with greater life satisfaction, stronger reasons for living, more social support, and less impact. Unexpectedly, those bereaved by suicide were not different from other cause of death groups on these measures. High purpose in life apparently can buffer the negative aspects of the bereavement experience, regardless of the cause of death.

The Suicidal Death of a Child: Social Perception of Stepparents

Research has suggested that the family relationship of a survivor to the victim of suicide can affect how the survivor will be perceived, but no studies have investigated the impact of parental status (parent versus stepparent) on the perception others will have of the parents of a youngster who commits suicide. In this investigation, 210 participants (71 men and 139 women) read typeset obituaries describing the suicidal death of an 18-year-old young man or young woman. Survivors were described as mother and father, father and stepmother, or mother and stepfather. Ratings (derived from previous studies of the social perception of survivors) were obtained to reflect the impressions participants had of the stepparents. Multivariate analysis of variance indicated a main effect for status of parents (i.e., stepparents versus biological parents). Although there were no reliable differences on several items, stepparents were viewed as having been less “close” to the young person, as taking less time to “recover psychologically” from the loss, and stepmothers were rated as less “likable.” These findings suggest that even in situations (i.e., the suicidal death of a child) where social perceptions are likely to be more negative toward any bereaved parent, stepparents may face an additional burden of negative social perception.

Opinions about and reactions to suicide, and the social acceptance of a suicidal classmate among Turkish high school students

The present study investigated the opinions about suicide and reactions to a suicidal peer among 89 female and 78 male Turkish high school students. Females more than males believed that suicide should be discussed among friends. More males than females perceived suicidal persons to be mentally ill and to be punished in the other world. Females showed greater acceptance for a suicidal classmate than males. An attitude for openly discussing suicide was associated with higher acceptance of a suicidal classmate. Perceiving suicidal individuals to be mentally ill was associated with lower acceptance of a suicidal peer.