Qualitative inquiry into the experience of suicide loss, aftereffects and coping strategies of suicide-bereaved Greek-speaking parents in Cyprus

PURPOSE

Studies on suicide-bereaved parents are scarce in South European and Eastern Mediterranean countries. We explored the experiences of Greek-speaking suicide-bereaved parents in Cyprus, with emphasis on the interpretations of their child's suicide, its aftereffects and their coping strategies.

METHODS

A qualitative methodology based on inductive content analysis of the interviews of ten mothers and two fathers was applied.

RESULTS

The participants described their efforts to make sense of the senseless, reporting numerous interpretations of their child's suicide. Some participants had achieved to move on by trying to keep the remaining family together. Others felt detached from their social network. The different coping strategies and support systems described, reflected participants' efforts to escape from obsessive, enduring and deeply traumatizing thoughts about their child's suicide. The analysis mirrored participants' ultimate desire to find existential relief and serenity through the management of distressing reminders of their child's suicide, and alleviate the burden of their own negative self-judgement and the criticism of others. They sought physical and emotional comfort in the inner realm of their psyche, through spiritual and psychological coping processes.

CONCLUSION

Further exploration is suggested about intervention planning aiming to strengthen effective coping strategies and external supportive resources in mourning parents.

Trying to keep alive a non-traumatizing memory of the deceased: A meta-synthesis on the interpretation of loss in suicide-bereaved family members, their coping strategies and the effects on them

WHAT IS KNOWN ON THE SUBJECT?: Losing a family member due to suicide has been described as a traumatic experience, as suicide-bereaved relatives grapple to accept the particular character of death and the core elements of guilt, self-criticism and stigma it inflicts. There are long-term consequences for those who bereave due to the suicide of their beloved on, a high risk for mental and physical health problems included. Feelings of guilt and self-stigma influence help-seeking behaviour among suicide-bereaved individuals. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Coping mechanisms adopted by suicide-bereaved individuals mediate the impact of suicide on their family, and especially on the quality of relationships among them. Supporting others in need can help alleviate guilt and self-blame for the suicide while it enables the bereaved to fulfil their need to keep a non-traumatizing, or even positive bond with the deceased. WHAT THE IMPLICATIONS FOR PRACTICE ARE?: Nursing interventions to facilitate suicide-bereaved family members' participation in self-help support groups and promote their engagement in supporting others in need are important. Mental health nurses need to facilitate the replacement of dysfunctional coping strategies, such as substance use or self-blame with more adaptive ones focused on the personal needs of the bereaved, in order to help them embrace a non-traumatizing memory of the deceased while being in peace with the social environment. Screening for mental health problems and management of shame, self-stigma and guilt during the grieving period needs to be a priority in nursing interventions.

ABSTRACT

INTRODUCTION: Losing a family member to suicide is a traumatic experience which includes guilt and self-stigma. Yet, there is lack of data synthesis on the survivors' experience.

AIM

A meta-synthesis of qualitative data on the interpretation of loss in suicide-bereaved family members, their coping strategies and the effects on family.

METHOD

A meta-ethnographic synthesis following a systematic literature search and evaluation of the methodological quality of the selected studies was applied.

RESULTS

The narratives of 326 individuals (parents/siblings/children/spouses) reported in sixteen studies were analysed. Trying to achieve a balance between keeping alive a non-traumatizing memory of the deceased, destigmatizing and liberating themselves from self-blame, self-criticism and guilt while being able to transform this experience into support towards others in need, was identified as the essence of the experience of the bereaved.

DISCUSSION

Although suicide within a family is a traumatic experience, spiritual and existential implications among the bereaved have been reported; their coping mechanisms mediate the impact of suicide on family sustainability.

IMPLICATIONS FOR PRACTICE

Nursing interventions to facilitate adoption of coping strategies centred on keeping a non-traumatizing memory of the deceased among the bereaved and promote their participation in self-help groups and activities to support others in need are important.

Ethnic Minority Groups' Experiences of Suicide Bereavement: A Qualitative Exploratory Study

It is estimated that between 36,000 and 360,000 people are affected by suicide every year in the UK, and a proportion may develop depression and post-traumatic stress disorder, or engage in high-risk behaviours. Recent systematic analyses have revealed a clear gap in research on suicide bereavement in minority ethnic groups. This study aimed to understand the experiences and support needs of individuals from ethnic minority backgrounds bereaved by suicide and was the first in the UK to investigate this matter. The study was a secondary analysis of data. Participants were 7158 people residing in the UK who completed an online survey about their experiences of suicide. Free-text qualitative responses of 227 participants who did not identify as White British were analysed using thematic analysis. Four themes were identified: maladaptive coping strategies, emotional processes following suicide, lack of support from agencies, and the importance of mental health awareness. Ethnic minority groups reported a lack of support despite attempts to engage with services, noted the prevalence of stigma within ethnic minority groups, and expressed a need to tackle this. These preliminary results suggest that ethnic minority individuals require visible and accessible services that can successfully engage with and support them.

Support Needs and Experiences of People Bereaved by Suicide: Qualitative Findings from a Cross-Sectional British Study of Bereaved Young Adults

People bereaved by suicide are at increased risk of suicide, but evidence is lacking that available interventions reduce suicide risk. Few large-scale studies have described the views of suicide-bereaved people regarding their needs for support. Our objective was to explore the nature of young adults' experiences of support after bereavement by suicide and their views on valued and unhelpful aspects. We conducted a cross-sectional study of staff and students aged 18-40 at 37 United Kingdom (UK) higher educational institutions in 2010, eliciting qualitative responses to two questions probing experiences of support and unmet needs after the suicide of a close contact. We conducted thematic analysis of responses from 420 adults bereaved by suicide, of whom 75% had received support after the loss. We identified three broad descriptive areas corresponding to important aspects of support: value and experiences of the support received; views on specific support needs; and reasons for not seeking support. We found that needs for emotional support exist throughout the social networks of people who die by suicide but are often hidden. Our findings suggest a need for proactive offers of support from family, friends, and professionals after suicide, repeated regularly in case a bereaved person does not feel ready for support early on.

The experiences of attempt survivor families and how they cope after a suicide attempt in Ghana: a qualitative study

BACKGROUND

Ghana's socio-cultural landscape proscribes suicidal behaviour, and this has serious ramifications for attempt survivors and their families. The objective of this qualitative study was to understand the experiences of the families of attempt survivors and how they cope with the aftermath of the attempt.

METHODS

Ten families with attempted suicides agreed to participate in the study, hence they were interviewed. The information gathered was manually analyzed according to Interpretative Phenomenological Analysis (IPA) resulting in three major thematic areas.

RESULTS

Three major themes emerged two of which addressed negative experiences and reactions towards the attempts: Experiencing shame and stigma, and Reactive affect. The third theme addressed the coping resources of these informants under the theme: Surviving the stress of attempt. The specific coping resources included personalized spiritual coping, social support, and avoidance.

CONCLUSIONS

Family systems theory is used to explain some of the findings of this study, and the implication for clinical practice and designing postvention programs for families after a suicide attempt are addressed.

Prominent Feelings and Self-Regard Among Survivors of Suicide

This cross-sectional study explores associations between elapsed time since the loss and outcomes of main feelings surrounding the loss and self-regard among 187 help-seeking survivors bereaved by suicide. Chi-square tests were conducted to examine the aforementioned relationships. In examining suicide survivors' main feelings over time, this study found mixed results in early bereavement. This study showed that at 25 to 59 months of elapsed time since the loss, both fear and happiness were significant for suicide survivors. No significance was found before 25 to 59 months, suggesting a change in suicide survivors' main emotions following 2 years of elapsed time since the loss. In later bereavement (i.e., 5 + years), suicide survivors' experiences of happiness was significant. The aforementioned results suggest that following 2 years of elapsed time since the loss, this sample of survivors bereaved by suicide experienced a change in their grief experience.

Representations of African Americans in the Grief and Mourning Literature from 1998 to 2014: A Systematic Review

The authors examined representations of African Americans in the grief literature to assess (a) frequencies; (b) content; and (c) use of universalist or a contextualized framework. They conducted searches in 3 databases that target the grief literature published in the last 15 years. Fifty-nine articles met the criteria. There are a small number of studies published on African Americans and these tend to focus on homicide. Many studies had incomplete methods. Comparison studies were common and pathological grief outcomes that were validated on White populations were used as outcome variables with African American participants.

Talking through the dead: the impact and interplay of lived grief after suicide

In the aftermath of suicide, grief becomes a multi-faceted experience. Traditionally, this grief was silenced where the shame attached to suicide invalidated a person's need for expression. Even now, it can be difficult for people to fully articulate their grief, let alone find an empathetic audience. How do we examine this grief to more clearly hear the voices of the bereaved, and to better understand how to support those who are grieving a suicide death? Indeed, the ripple of suicide grief touches more than those traditionally considered to be impacted by the death. Whole communities can be affected and it cannot be presumed that researchers do not have their own lived experiences of suicide bereavement. In this way, the newly-opened discourse around the experience of suicide grief needs to be dissected within more practical and appropriate research. A balance needs to be created in research where the voices of grief can be included but the experiential context understood and respected.

Suicide and homicide bereavement among African Americans: implications for survivor research and practice

Suicide and homicide are among the leading causes of death for young African-American men; however, little is known about how family members cope with these types of deaths. This exploratory phenomenological study examines the traumatic loss and coping experiences of a purposive convenience sample of 12 immediate African-American surviving family members with a combined experience of 13 deaths, 8 suicides and 5 homicides. Novel aspects of suicide and homicide survivor phenomenon were identified, including Survivor Responses and Reactions, Coping Strategies, and Survivor Service Needs. The implications for research and for those providing services to surviving African-American families are discussed.

The Impact of Specifying Suicide as the Cause of Death in an Obituary

Background: Historically, people who die by suicide and those who survive them have been perceived more negatively than those affected by other types of death (e.g., Reynolds & Cimbolic, 1988 ). Yet, it is unclear whether these negative perceptions actually lead to decreased social and emotional support for people bereaved by suicide. Aims: To examine whether specifying suicide as the cause of death in an obituary impacts perceptions of a decedent and willingness to provide support to the decedent’s family. Method: A group of 253 participants were randomly assigned to read one of three fictional obituaries that were identical except for the stated cause of death (suicide, cancer, or drug overdose). Participants responded to questions about the decedent and behaviors toward the family. Results: Consistent with our prediction, people depicted as dying by suicide were viewed more negatively than decedents depicted as dying due to cancer. Contrary to our prediction, participants endorsed similar levels of willingness to provide support to the bereaved family regardless of the type of death specified in the obituary. Conclusions: The findings suggest that, even though those who die by suicide are viewed more negatively, their survivors may receive support that is similar to people bereaved by other types of death.

What Do We Know About Needs for Help After Suicide in Different Parts of the World?

Background: “A person’s death is not only an ending: it is also a beginning – for the survivors. Indeed, in the case of suicide, the largest public health problem is neither the prevention of suicide (...), nor the management of attempts (...), but the alleviation of the effects of stress in the survivor-victims of suicidal deaths, whose lives are forever changed and who, over a period of years, numbers in the millions ...” (Edwin S. Shneidman, 1973 ). Aims: As there is no doubt that suicide postvention should be given a more prominent position on the agenda than is presently the case, this paper explores what we now know about perceived needs for help on the part of suicide bereaved in different parts of the world. Methods: A search of related literature in the field was undertaken using the PubMed/PsychInfo databases. In addition, professionals throughout the world working in the field of suicide postvention were invited to submit reports about suicide postvention measures or literature. Results: Very little research was found that reflected the perceived needs for help on the part of the bereaved – and all the studies stemmed from countries in the Western world. However, the bereaved in these studies agreed about a common need for peer and social support, and that professional help must be adapted to and offered with respect for individual needs. Thus, it seems that in societies in which the stigma about suicide has diminished, the bereaved experience very similar needs for help, whereas in other societies it is difficult to talk about their need for help because of the sanctions and taboos connected to suicide. Conclusions: We need far more culturally sensitive research in order to explore and clarify how each community understands suicide and reacts to families who have lost someone by suicide.

“We Who Are Dark . . .:” The Black Community According to Black Adults in America: An Exploratory Content Analysis

The author explored the meaning of the Black community according to a purposeful sample of 60 Black adults in the mid-Atlantic United States. Purposeful stratified sampling resulted in equal numbers of participants along the lines of locale (Brooklyn, New York; Wilmington, Delaware; and Washington, D.C.), gender, and generational affiliation (older adults, middle-aged adults, and young adults). Content analysis of responses to a single open-ended survey question resulted in 11 emergent themes around the meaning of the Black community: the Black community as cultural, the Black community as residential, the Black community as global, the Black community as supportive, the Black community as visibly distinctive, the Black community as socioeconomic, the Black community as nonactualized, the Black community as nondifferential, the Black community as nihilistic, the Black community as nondefinable, and the Black community as other. Gender and generational variations in thematic endorsement were analyzed, and implications of these findings as they pertain to research, mental health programs, and policies for Blacks are discussed.