The impact of children on a parent's risk of suicide following death of a spouse, Belgium 1991-96

Surviving after the Death of a Spouse: A Phenomenological Study of Young and Low-Income Mothers in Turkey

The aim of this study is to examine psychosocial adjustment of low-income mothers who lost their spouses at a young age. The study was conducted using a qualitative research method with a phenomenological approach. The data was collected through focus group interviews. Thirteen women between the ages of 26 and 43 participated in the study. In this study, manifest content analysis was carried out with an inductive perspective. In this scope, five interrelated themes emerged as loss, initial reactions, difficulties, coping ways, and change. For the participants, the death of their spouse was perceived as the loss of a loved one, the loss of their children's father, a loss of security, and the loss of an abusive spouse. The initial reactions that emerged as a result were shock, helplessness, anxiety, and ambivalence. Participants faced social pressure, exclusion, parenting an orphaned child, insufficient basic life skills, and economic difficulties after their spouses' deaths. In order to cope with these difficulties, they sought social support, applied for social assistance funds, focused on their motherhood roles, used religious coping mechanisms, and set boundaries. It was determined that participants learned new skills, gained self-confidence, and developed helping behaviors toward others during the post-loss change process. Findings revealed that participants are unable to access adequate social, economic, and psychological resources in society. This circumstance caused them to withdraw from their social environment and reevaluate their existential goals. The new identity created by these women could be interpreted as a challenge to the culture that marginalizes them.

Marital status, educational attainment, and suicide risk: a Norwegian register-based population study

Background

The presence and quality of social ties can influence suicide risk. In adulthood, the most common provider of such ties is one’s partner. As such, the link between marital status and suicide is well-documented, with lower suicide risk among married. However, the association between marital status and educational level suggest that marriage is becoming a privilege of the better educated. The relationship between educational attainment and suicide is somewhat ambiguous, although several studies argue that there is higher suicide risk among the less educated. This means that unmarried with low education may concurrently experience several risk factors for suicide. However, in many cases, these associations apply to men only, making it unclear whether they also refer to women. We aim to investigate the association between marital status, educational attainment, and suicide risk, and whether these associations differ across sexes.

Methods

Our data consist of Norwegian residents aged 35–54, between 1975 and 2014. Using personal identification-numbers, we linked information from various registers, and applied event history analysis to estimate suicide risk, and predicted probabilities for comparisons across sexes.

Results

Overall, associations across sexes are quite similar, thus contradicting several previous studies. Married men and women have lower suicide risk than unmarried, and divorced and separated have significant higher odds of suicide than never married, regardless of sex. Low educational attainment inflates the risk for both sexes, but high educational attainment is only associated with lower risk among men. Being a parent is associated with lower suicide risk for both sexes.

Conclusions

Higher suicide risk among the divorced and separated points to suicide risk being associated with ceasing of social ties. This is the case for both sexes, and especially those with low educational attainment, which both healthcare professionals and people in general should be aware of in order to promote suicide prevention.

Sociodemographic Antecedent Validators of Suicidal Behavior: A Review of Recent Literature

Suicidal behavior and its prevention constitute a major public health issue. Etiology of suicidal behavior is multifactorial. Whereas current research is mostly focused on clinical and biological risk factors, the sociodemographic risk factors for suicidal behavior, first highlighted by Durkheim, have received less attention. Besides the well-known impact of age and gender, sociodemographic variables such as marital and parental status, education, occupation, income, employment status, religion, migration or minority status, and sexual orientation are repeatedly reported to play an important role in suicidal behavior. This narrative review aimed to summarize recent research on sociodemographic risk factors for suicidal behavior and to elicit possible implications for suicide prevention.

Inter-rater reliability of the Bereavement Risk Assessment Tool

Objective:

The Bereavement Risk Assessment Tool (BRAT) was designed to consistently communicate information affecting bereavement outcomes; to predict the risk for difficult or complicated bereavement based on information obtained before the death; to consider resiliency as well as risk; and to assist in the efficacy and consistency of bereavement service allocation. Following initial development of the BRAT's 40 items and its clinical use, this study set out to test the BRAT for inter-rater reliability along with some basic validity measures.

Method:

Case studies were designed based on actual patients and families from a hospice palliative care program. Bereavement professionals were recruited via the internet. Thirty-six participants assessed BRAT items in 10 cases and then estimated one of 5 levels of risk for each case. These were compared with an expert group's assignment of risk.

Results:

Inter-rater reliability for the 5-level risk scores yielded a Fleiss’ kappa of 0.37 and an intra-class correlation (ICC) of 0.68 (95% CI 0.5-0.9). By collapsing scores into low and high risk groups, a kappa of 0.63 and an ICC of 0.66 (95% CI 0.5-0.9) was obtained. Participant-estimated risk scores yielded a kappa of 0.24. Although opinion varied on the tool's length, participants indicated it was well organized and easy to use with potential in assessment and allocation of bereavement services. Limitations of the study include a small sample size and the use of case studies. Limitations of the tool include the subjectivity of some items and ambiguousness of unchecked items.

Significance of results:

The collapsed BRAT risk levels show moderately good inter-rater reliability over clinical judgement alone. This study provides introductory evidence of a tool that can be used both prior to and following a death and, in conjunction with professional judgment, can assess the likelihood of bereavement complications.