1
|
Yuan GF, Liu C, Li X, Fung HW, Wong MYC, Lam SKK, An Y, Feng X. Hurting myself to cope: Using network analysis to understand the association between perceived stigma and non-suicidal self-injury functions among men who have sex with men in China. Arch Psychiatr Nurs 2024; 48:43-50. [PMID: 38453281 DOI: 10.1016/j.apnu.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/04/2023] [Accepted: 01/05/2024] [Indexed: 03/09/2024]
Abstract
Prior studies have demonstrated that perceived stigma is robustly associated with risky and life-threatening behaviors, including non-suicidal self-injury (NSSI), among men who have sex with men (MSM). However, studies regarding the relationship between perceived stigma and NSSI are limited. The present study aimed to investigate the network structure of perceived stigma and NSSI functions, along with bridge nodes, to elucidate how they co-exist. A sample of 2610 Chinese MSM (mean age = 23.99, age range: 18-68 years) was recruited from an online survey platform. All participants completed a web-based survey with measures of perceived stigma and NSSI functions. Results indicated that 'negative attitudes towards homosexuality' and 'disappointment in gay son' were identified as the most central nodes in the perceived stigma network, whereas 'seeking attention' and 'influencing others to change' ranked highest on centrality in the NSSI network. Two bridge connections were exhibited within the combined perceived stigma and NSSI network model: 'unwelcoming in public' and 'avoiding unpleasant tasks' from perceived stigma and NSSI communities, respectively. This is among the first studies investigating the co-occurrence between perceived stigma and NSSI from the network approach. Our findings provide an empirically-based perspective on the importance of family- and community-based interventions, with potential clinical implications for reducing NSSI among sexual and gender minority groups.
Collapse
Affiliation(s)
- Guangzhe Frank Yuan
- School of Education Science, Leshan Normal University, Leshan, China; Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Caimeng Liu
- School of Education Science, Leshan Normal University, Leshan, China.
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Hong Wang Fung
- Department of Social Work, Faculty of Social Sciences, The Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Ming Yu Claudia Wong
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong
| | - Stanley Kam Ki Lam
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
| | - Yuanyuan An
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.
| | - Xueyou Feng
- Center for Mental Health Education and Counseling, Guangzhou College of Commerce, Guangzhou, China
| |
Collapse
|
2
|
Encina-Zúñiga E, Rodante D, Agrest M, Tapia-Munoz T, Vidal-Zamora I, Ardila-Gómez S, Alvarado R, Leiderman EA, Reavley N. Development of mental health first-aid guidelines for suicide risk: a Delphi expert consensus study in Argentina and Chile. BMC Psychiatry 2023; 23:928. [PMID: 38082256 PMCID: PMC10712185 DOI: 10.1186/s12888-023-05417-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Suicide continues to pose a significant global public health challenge and ranks as one of the leading causes of death worldwide. Given the prevalence of suicide risk in the community, there is a significant likelihood of encountering individuals who may be experiencing suicidal thoughts or plans, creating an opening for non-health professionals to offer support. This study aims to culturally adapt the original Australian Mental Health First Aid Guidelines for suicide risk to the Chilean and Argentine context. METHODS A two-round Delphi expert consensus study was conducted involving two panels, one comprising individuals with personal experience in suicide thoughts/attempts or caregiving for those with such experiences (n = 18), and the other consisting of professionals specialized in suicide assessment and support for individuals at risk (n = 25). They rated a total of 179 items mainly derived from guidelines developed by Australian experts and translated into Spanish (168), and new items included by the research team (11). The panel members were requested to assess each item utilizing a five-point Likert scale. During the second round, items that received moderate approval in the initial round were re-evaluated, and new items suggested by the local experts in the first round were also subjected to evaluation in the next round. Inclusion in the final guidelines required an 80% endorsement as "essential" or "important" from both panels. RESULTS Consensus of approval was reached for 189 statements. Among these, 139 statements were derived from the English-language guidelines, while 50 locally generated statements were accepted during the second round. A significant difference from the original guideline was identified concerning the local experts' reluctance to discuss actions collaboratively with adolescents. Furthermore, the local experts proposed the inclusion of an entirely new section addressing suicide risk in older individuals, particularly focusing on suicide methods and warning signs. CONCLUSIONS A Delphi expert consensus study was conducted to culturally adapt mental health first aid guidelines for assessing suicide risk in Chile and Argentina. This study involved professionals and individuals with lived experience. While many items were endorsed, some related to inquiring about suicide risk and autonomy, particularly for adolescents, were not. An additional section for older individuals was introduced. Future research should explore the implementation and impact of these adapted guidelines in training courses. This is vital for enhancing mental health support and implementing effective suicide prevention strategies in Chile and Argentina.
Collapse
Affiliation(s)
- Esteban Encina-Zúñiga
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
- Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Chile, Santiago, Chile.
| | - Demián Rodante
- Facultad de Medicina, Instituto de Farmacología, Universidad de Buenos Aires, Buenos Aires, Argentina
- Fundación Foro para la salud mental, Buenos Aires, Argentina
| | - Martín Agrest
- Proyecto Suma, Güemes 4130 (1425), Ciudad Autónoma de Buenos Aires, Argentina
- Facultad de Psicología, Universidad de Buenos Aires, Instituto de Investigaciones, Buenos Aires, Argentina
| | - Thamara Tapia-Munoz
- Department of Behavioural Science and Health, University College London, London, UK
| | - Isidora Vidal-Zamora
- Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Chile, Santiago, Chile
| | - Sara Ardila-Gómez
- Facultad de Psicología, Universidad de Buenos Aires, Instituto de Investigaciones, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Rosario, Santa Fe, Argentina
| | - Rubén Alvarado
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Departamento de Salud Pública, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - Eduardo A Leiderman
- Departamento de Neurociencias, Facultad de Ciencias Sociales, Universidad de Palermo, Buenos Aires, Argentina
| | - Nicola Reavley
- Melbourne School of Population and Global Health, Centre for Mental Health, University of Melbourne, Victoria, Australia
| |
Collapse
|
3
|
YAZGI ZG, YILMAZ M. Role of the Psychiatric Nurse in Improving the Psychosocial Health of Families After Suicide. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1138902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Suicide is defined as death that occurs as a result of deliberate self-harming behavior with the intention of ending one's life. Each suicide has many physical, economic and psychological short and long-term effects on the individual, family, friends and society. The death of an individual as a result of suicide creates a traumatic effect for family members and causes family members to experience various psychosocial problems. For this reason, it is very important to focus on the consequences of suicide in family members who have lost due to suicide, to evaluate the family's reactions to suicide, and to provide the needed psychosocial support. In this context, in this review, it is aimed to review the literature on the psychosocial problems experienced by families who have lost due to suicide and to present up-to-date information on the role of psychiatric nurse in improving the psychosocial health status of families.
Collapse
|
4
|
Mirick RG, Wladkowski SP. Suicide and Hospice Caregivers: A Case Study. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2023:1-10. [PMID: 37029910 DOI: 10.1080/15524256.2023.2198157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
In 2020, hospices supported 1.72 million Medicare patients and their caregivers. The end-of-life experience can be difficult for caregivers and many experience anxiety, depression, and suicidality. Little literature has explored the role of hospice social workers in addressing and treating caregivers' suicidal thoughts and behaviors. This paper will explore the topic of hospice caregiver suicide, using a case study to illustrate relevant issues, practices, and needs. Implications for hospice social work practice are included.
Collapse
Affiliation(s)
| | - Stephanie P Wladkowski
- College of Health and Human Services, Bowling Green State University, Bowling Green, OH, USA
| |
Collapse
|
5
|
Chen M, Zhang X, McCormack B. The lived experience of family members of older people who have died by suicide in rural China. Nurs Open 2023. [PMID: 36840633 DOI: 10.1002/nop2.1684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 02/26/2023] Open
Abstract
AIM The aim of the study is to provide insight and facilitate a deeper understanding of family members who have experienced their older family member's suicide. DESIGN Interpretative phenomenological analysis (IPA) study. METHODS Semi-structured individual interviews with five family members of older people who died by suicide recruited from a rural area of Shanxi Province, China. Smith's (2009) six steps of IPA was used for data analysis. RESULTS Three main themes emerged from the study: (a) Initial psychological reactions; (b) Long-term life effects; (c) Social attitudes. The study shows how the family members of older people who died by suicide have experienced stigmatization and felt largely ignored. A suicide event poses a challenge to the future living quality of the family members. The study also highlights that it is necessary to pay attention to families of older people who died by suicide and providing support is required to improve the quality of life of these family members in rural China. CONCLUSION The study adds to the understanding of the lived experience of family members of older people who died by suicide in less economically developed rural areas. PATIENT OR PUBLIC CONTRIBUTION Patients and the public were not involved in the design, conduct or reporting of this study. Participants of this study helped with recruitment via snowball sampling.
Collapse
Affiliation(s)
- Mengyun Chen
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Xiubin Zhang
- Imperial College London, National Heart and Lung Institute, London, UK
| | - Brendan McCormack
- Susan Wakil School of Nursing and Midwifery (inc. Sydney Nursing School), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
6
|
Lee YJ, Kweon YS, Hong HJ. Suicidal Ideation, Depression, and Insomnia in Parent Survivors of Suicide: Based on Korean Psychological Autopsy of Adolescent Suicides. J Korean Med Sci 2023; 38:e39. [PMID: 36747364 PMCID: PMC9902662 DOI: 10.3346/jkms.2023.38.e39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/27/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND This study aims to evaluate suicidal ideation, depression, and insomnia among parent survivors of adolescents who died by suicide and their relevant risk factors using psychological autopsy results from South Korea. METHODS The participants were 42 parent survivors (10 fathers and 32 mothers) of 35 adolescents who died by suicide. We used the Patient Health Questionnaire-9 and the Korean version of the Insomnia Severity Index to evaluate the mental health of the bereaved parents. We used the Korean Psychological Autopsy Checklist for Adolescents, the Korean Beck Depression Inventory, the Korean Version of the Barratt Impulsiveness Scale-II, and the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime-Korean versions to evaluate the mental health of deceased adolescents before their deaths. RESULTS The results showed that many parent survivors of suicide had developed clinically significant suicidal ideation, depression, and insomnia (75.6%, 73.2%, and 42.9%, respectively). Furthermore, the higher the incidence of traumatic events experienced by the deceased adolescents, the higher the severity of depression and insomnia experienced by surviving parents. CONCLUSION We should pay attention that parent survivors of suicide can suffer mental disorders after their offspring's death. In future studies, long-term follow-up studies with larger samples need to generalize our findings and clarify the causal relationship.
Collapse
Affiliation(s)
- Yeon Jung Lee
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yong-Sil Kweon
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Hyun Ju Hong
- Suicide and School Mental Health Institute, Hallym University, Anyang, Korea
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Korea.
| |
Collapse
|
7
|
Nicholas A, Haregu T, Henderson C, Armstrong G. Suicide stigma measures: A scoping review. J Affect Disord 2023; 321:114-125. [PMID: 36283535 DOI: 10.1016/j.jad.2022.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/13/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Worldwide, approximately 800,000 people die by suicide every year, and non-fatal suicidal thoughts and behaviours are common. Stigma is likely a major barrier to preventing suicide. The purpose of our review is to scope the development, psychometric properties and use of measures that explicitly seek to measure the construct of suicide stigma. METHODS We conducted a scoping review. We searched PubMed, PsycINFO, Embase and CINAHL using search terms related to suicide, stigma and measures/scales with no date limits. We included any measure the authors defined as measuring suicide-related stigma. Only peer-reviewed articles published in English were included. RESULTS We included 106 papers discussing 23 measures of suicide stigma; 82 provided data on psychometric properties. Measures assessed personal or public stigma; and stigma toward a range of suicidal phenomena (e.g., suicidal thoughts, those bereaved by suicide). 'Stigma' definitions varied and were not always provided. The Grief Experience Questionnaire, Suicide Opinion Questionnaire and Stigma of Suicide Scale were the most commonly cited. Measures varied in the strength of their psychometric properties. LIMITATIONS We only included papers in English. Because we included any measures authors defined as measuring suicide stigma, we may have included measures not commonly considered as measures of suicide stigma, and conversely we might have excluded relevant measures because they did not use the term 'stigma'. DISCUSSION This review aimed to assist in better understanding available suicide stigma measures, their strengths and weaknesses and current uses, and will inform the development of future suicide stigma measures.
Collapse
Affiliation(s)
- Angela Nicholas
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Tilahun Haregu
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Claire Henderson
- Health Service and Population Research, Kings College London, UK
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
| |
Collapse
|
8
|
Asgari Z, Naghavi A, Abedi MR. Grief Interventions: A Qualitative Review of Systematic Reviews. JOURNAL OF LOSS & TRAUMA 2022. [DOI: 10.1080/15325024.2022.2102304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Zahra Asgari
- Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
| | - Azam Naghavi
- Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
| | - Mohammad Reza Abedi
- Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
| |
Collapse
|
9
|
Erlangsen A, Fleischer E, Gunnell D, Nordentoft M. Characteristics of Survivors of Suicide Seeking Counseling From an NGO in Denmark: Analyses of a National Database. Arch Suicide Res 2022; 26:1362-1377. [PMID: 33794124 DOI: 10.1080/13811118.2021.1903636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The loss of a friend or family member to suicide, i.e., surviving suicide, can be devastating. Yet, little is known regarding the support received by survivors of suicide. We aimed to examine the characteristics of survivors of suicide who sought counseling from a Danish volunteer organization. METHOD Data on all users of the Danish Network for those Affected by Suicidal Behavior (NASB) were obtained during 2012-2018. Information on age, sex, relation, time of loss, municipality was analyzed, and geographical driving distances calculated. RESULTS Altogether, 1,268 survivors of suicide (mean age 43.3; 29.8% of all suicides) received counseling from NASB. In all, 81.8% of service users had lost a partner or first-degree relative; those being spouses/partners (15.3%), parents (28.5%), children (19.0%), and siblings (15.4%). Female service users (71.1%) outnumbered males (28.7%). A third of users sought counseling within 6-months of the death. A help-seeking rate of 6 users per 10 suicide deaths was found within close proximity to a counseling venue; equivalent of 5.5 (95% CI: 5.0-6.0) users per 100,000 inhabitants. Each additional 10 km of driving distance was associated with a 15% lower rate of use (b: -0.015; 95% CI: 0.027 to 0.003; p = 0.013). CONCLUSION Geographical proximity to help centers was important and could suggest that support might be lacking in some parts of the country. It seems likely that more than 0.6 persons per suicide might seek counseling from volunteer organizations if services were available within short driving distance.HIGHLIGHTSMore than one out of three who sought support after a suicide death were partners or first-degree relatives and only a third of users who sought counseling did so within 6-months of the death. Also, female sought counseling more frequently than males.Approximately 5.5 people per 100,000 inhabitants sought help after a suicide in areas where a counseling venue was within short driving distance.Based on the region with most counseling venues, 6 survivors would seek support per 10 suicide deaths.
Collapse
|
10
|
Knipe D, Padmanathan P, Newton-Howes G, Chan LF, Kapur N. Suicide and self-harm. Lancet 2022; 399:1903-1916. [PMID: 35512727 DOI: 10.1016/s0140-6736(22)00173-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/23/2021] [Accepted: 12/20/2021] [Indexed: 12/21/2022]
Abstract
Suicide and self-harm are major health and societal issues worldwide, but the greatest burden of both behaviours occurs in low-income and middle-income countries. Although rates of suicide are higher in male than in female individuals, self-harm is more common in female individuals. Rather than having a single cause, suicide and self-harm are the result of a complex interplay of several factors that occur throughout the life course, and vary by gender, age, ethnicity, and geography. Several clinical and public health interventions show promise, although our understanding of their effectiveness has largely originated from high-income countries. Attempting to predict suicide is unlikely to be helpful. Intervention and prevention must include both a clinical and community focus, and every health professional has a crucial part to play.
Collapse
Affiliation(s)
- Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka.
| | - Prianka Padmanathan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Nav Kapur
- Centre for Mental Health and Safety, University of Manchester, Academic Health Science Centre, Manchester, UK; National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, UK
| |
Collapse
|
11
|
Griffin E, O’Connell S, Ruane-McAteer E, Corcoran P, Arensman E. Psychosocial Outcomes of Individuals Attending a Suicide Bereavement Peer Support Group: A Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074076. [PMID: 35409760 PMCID: PMC8998629 DOI: 10.3390/ijerph19074076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/25/2022] [Accepted: 03/27/2022] [Indexed: 11/17/2022]
Abstract
Individuals bereaved by suicide represent an important group in terms of postvention. While peer support groups are often accessed by those bereaved, few studies have examined their impact in terms of physical and mental health wellbeing. The aim of this study was to examine psychosocial outcomes of individuals attending suicide bereavement peer support groups in Ireland. Between August 2020 and June 2021, all members were invited to complete a survey, with new members also surveyed at three- and six-month follow-up, to examine changes in wellbeing, depressive symptoms and grief reactions. Results were analyzed using descriptive statistics and mixed linear regression models. The 75 participants were mostly female, with lower levels of overall wellbeing and a higher prevalence of depressive symptoms and suicidal ideation than the general population. Participants also reported high levels of social adjustment difficulties and grief reactions, which were more pronounced for those more recently bereaved. At follow-up (n = 28), a significant improvement in wellbeing and a reduction in grief reactions were found, adjusting for time since bereavement. Participants identified the groups as creating a safe space and providing a sense of belonging and hope. Notwithstanding the small number of participants at follow-up, these findings underline the enduring mental health challenges for those bereaved by suicide and provide further evidence for the role of peer support in postvention.
Collapse
Affiliation(s)
- Eve Griffin
- School of Public Health, University College Cork, T12 XF62 Cork, Ireland; (S.O.); (E.R.-M.); (E.A.)
- National Suicide Research Foundation, T12 XF62 Cork, Ireland;
- Correspondence:
| | - Selena O’Connell
- School of Public Health, University College Cork, T12 XF62 Cork, Ireland; (S.O.); (E.R.-M.); (E.A.)
- National Suicide Research Foundation, T12 XF62 Cork, Ireland;
| | - Eimear Ruane-McAteer
- School of Public Health, University College Cork, T12 XF62 Cork, Ireland; (S.O.); (E.R.-M.); (E.A.)
| | - Paul Corcoran
- National Suicide Research Foundation, T12 XF62 Cork, Ireland;
| | - Ella Arensman
- School of Public Health, University College Cork, T12 XF62 Cork, Ireland; (S.O.); (E.R.-M.); (E.A.)
- National Suicide Research Foundation, T12 XF62 Cork, Ireland;
| |
Collapse
|
12
|
Reflections on Experiencing Parental Bereavement as a Young Person: A Retrospective Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042083. [PMID: 35206275 PMCID: PMC8872611 DOI: 10.3390/ijerph19042083] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/06/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023]
Abstract
Background: It is estimated that approximately 41,000 children and young people experience the death of a parent each year. Grief responses, such as anxiety and depression, can follow. This research investigated the adult reflections of experiencing parental death as a young person. Methods: Semi-structured interviews were conducted with adults (N = 14; female n = 8) who experienced parental death as a young person, which occurred over 5 years ago (time since death, M = 12.9 years; age at death, M = 16.4 years; age at interview, M = 30.9 years). The data were analysed inductively using thematic analysis. Results: Seven themes revealed that parental bereavement can lead to (1) “Distance and isolation” and is an (2) “Emotional journey” with (3) a “Physical impact”. Many experienced (4) “Post-traumatic growth” but acknowledged that (5) “Life will never be the same”, highlighting the importance of (6) “Support and understanding” and triggers for (7) “Re-grief”. Conclusions: Parental bereavement has significant emotional and physical consequences, but can also lead to personal growth. Talking therapies were rarely accessed, often due to a lack of awareness or desire to engage, revealing a translational gap between existing support services and uptake. Enabling open conversations about grief and identifying suitable support is a public health priority. This need has been amplified since the start of the COVID-19 pandemic, which may be a trigger for grief empathy and re-grief in those who have already been bereaved.
Collapse
|
13
|
Ozkok H, Tatar BH, Ayyıldız TN, Eskin M, Erdem G, Turan B. To Blame or Not to Blame: the Role of Belief in Free Will in Substance Use and Suicide Stigma. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00755-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
14
|
Jang J, Park SY, Kim YY, Kim EJ, Lee G, Seo J, Na EJ, Park JY, Jeon HJ. Risks of suicide among family members of suicide victims: A nationwide sample of South Korea. Front Psychiatry 2022; 13:995834. [PMID: 36311502 PMCID: PMC9614235 DOI: 10.3389/fpsyt.2022.995834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Identifying the risks of completed suicide in suicide survivors is essential for policies supporting family members of suicide victims. We aimed to determine the suicide risk of suicide survivors and identify the number of suicides per 100,000 population of suicide survivors, bereaved families of traffic accident victims, and bereaved families with non-suicide deaths. METHODS This was a nationwide population-based cohort study in South Korea. The data were taken from the Korean National Health Insurance and Korea National Statistical Office between January 2008 and December 2017. The relationship between the decedent and the bereaved family was identified using the family database of the National Health Insurance Data. Age and gender were randomly matched 1:1 among 133,386 suicide deaths and non-suicide deaths. A proportional hazard model regression analysis was conducted after confirming the cumulative hazard using Kaplan-Meier curves to obtain the hazard ratio (HR) of completed suicide in suicide survivors. RESULTS Using 423,331 bereaved families of suicide victims and 420,978 bereaved families of non-suicide deaths as the control group, HR of completed suicide in suicidal survivors was found to be 2.755 [95% confidence limit (CL): 2.550-2.977]. HR for wives committing suicide after husbands' suicide was 5.096 (95% CL: 3.982-6.522), which was the highest HR among all relationships with suicide decedents. The average duration from suicide death to suicide of family members was 25.4 months. Among suicide survivors, the number of suicides per 100,000 people was 586, thrice that of people in bereaved families of traffic accident victims and in bereaved families of non-suicide deaths. CONCLUSION The risk of completed suicide was three times higher in suicide survivors than in bereaved families with non-suicide deaths, and it was highest in wives of suicide decedents. Thus, socio-environmental interventions for suicidal survivors must be expanded.
Collapse
Affiliation(s)
- Jihoon Jang
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Korea Psychological Autopsy Center, Seoul, South Korea.,Department of Psychiatry, Keyo Hospital, Uiwang, South Korea
| | - Seong Yong Park
- Department of Big Data Management, National Health Insurance Service, Wonju, South Korea.,Department of Health Administration, Yonsei University Graduate School, Wonju, South Korea
| | - Yeon Yong Kim
- Department of Big Data Management, National Health Insurance Service, Wonju, South Korea
| | - Eun Ji Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Korea Psychological Autopsy Center, Seoul, South Korea
| | - Gusang Lee
- Korea Psychological Autopsy Center, Seoul, South Korea
| | - Jihye Seo
- Korea Psychological Autopsy Center, Seoul, South Korea
| | - Eun Jin Na
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Korea Psychological Autopsy Center, Seoul, South Korea.,Department of Psychiatry, Seoul Medical Center, Seoul, South Korea
| | | | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Korea Psychological Autopsy Center, Seoul, South Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea.,Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea.,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
| |
Collapse
|
15
|
Kaur H, Singh A. Six Thinking Dupatta Skills for Problem Solving: Case Study of Suicide Prevention of Wives in Grief. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2021. [DOI: 10.1080/15401383.2021.2000910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
16
|
del Carpio L, Paul S, Paterson A, Rasmussen S. A systematic review of controlled studies of suicidal and self-harming behaviours in adolescents following bereavement by suicide. PLoS One 2021; 16:e0254203. [PMID: 34242305 PMCID: PMC8270178 DOI: 10.1371/journal.pone.0254203] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/23/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Research suggests that being exposed to the suicide of others increases risk of subsequent suicidal or self-harming thoughts or behaviours. What is less clear is whether this applies to adolescents, and if the risk exceeds that following other causes of death, which has implications on suicide prevention approaches. This study aimed to systematically review the evidence on adolescent bereavement experiences by different causes to address this gap. METHODS A comprehensive literature search using four databases (MEDLINE, PsycInfo, Web of Science, and Embase) identified 21 studies which measured suicidal or self-harm outcomes among bereaved adolescents aged between 12 to 18 years old. The literature was screened, data was extracted using pre-piloted forms, and risk of bias was assessed using versions of the Newcastle-Ottawa Scale; a proportion of papers were double extracted and assessed for bias. The review has been registered with PROSPERO (CRD42016051125). RESULTS A narrative synthesis of the literature demonstrated divergent findings depending on the outcome being measured. Suicide bereavement appears to be strongly associated with suicide mortality among parentally bereaved youth, while self-harm or non-fatal suicide attempts (either presenting to hospital or self-reported) showed mixed evidence. Suicidal ideation was not uniquely associated with suicide bereavement. An exploration of circumstances surrounding the death, characteristics of the person who died, and characteristics of the young person across each outcome measure suggested that earlier experiences of loss, shorter timeframes following the death, and maternal death are associated with particularly elevated risk of suicidal outcomes. CONCLUSIONS Findings suggest that suicide loss is associated with subsequent suicide, and may be associated with non-fatal self-harm. A detailed account of the risk and protective factors surrounding suicide bereavement among young people is crucial to understand the pathways through which suicidal behaviours develop. Researchers, policy makers and practitioners with an interest in suicide prevention will benefit from clarity around the needs of young bereaved individuals.
Collapse
Affiliation(s)
- Laura del Carpio
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Sally Paul
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, United Kingdom
| | - Abigail Paterson
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Susan Rasmussen
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| |
Collapse
|
17
|
Hvidkjaer KL, Ranning A, Madsen T, Fleischer E, Eckardt JP, Hjorthøj C, Cerel J, Nordentoft M, Erlangsen A. People exposed to suicide attempts: Frequency, impact, and the support received. Suicide Life Threat Behav 2021; 51:467-477. [PMID: 33258173 DOI: 10.1111/sltb.12720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/24/2020] [Accepted: 08/18/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Little is known about people who have been exposed to a suicide attempt by someone they know. The purpose of this study was to examine how many people have been exposed to a suicide attempt by someone they knew and whether the exposure was associated with general well-being and suicidal ideation. METHOD A population-based online survey was conducted during 2019 in Denmark (n = 6,191). The associations between exposures to suicide attempt and general well-being (WHO-5) and suicidal ideation (Suicidal Ideation Attributes Scale) were examined using linear regression analyses. RESULTS Overall, 24.6% reported having experienced a suicide attempt by someone they knew. Of those, 46.5% had experienced a suicide attempt of a close relation and this group reported having been more affected by the event. Those exposed scored lower on general well-being (b: -3.0; 95% CI: -4.2 to -1.8; p > 0.001) and higher on suicidal ideation (b: 1.6; 95% CI: 1.3 - 1.9; p = 0.001) than those not exposed. Half of the exposed reported not having received sufficient support after the event. CONCLUSION Suicide attempt affects a substantial share of the population, and it might be relevant to ensure that support is available for those exposed perceived to be in need of support.
Collapse
Affiliation(s)
| | - Anne Ranning
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.,Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital
| | - Trine Madsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.,Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital
| | - Elene Fleischer
- Network for the Affected by Suicidal Behavior (NEFOS, Odense, Denmark
| | - Jens Peter Eckardt
- Research Unit at Bedre Psykiatri (Better Psychiatry, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Julie Cerel
- College of Social Work, University of Kentucky, Lexington, KY, USA
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.,Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.,Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| |
Collapse
|
18
|
Williams J, Shorter GW, Howlett N, Zakrzewski-Fruer J, Chater AM. Can Physical Activity Support Grief Outcomes in Individuals Who Have Been Bereaved? A Systematic Review. SPORTS MEDICINE-OPEN 2021; 7:26. [PMID: 33830368 PMCID: PMC8028581 DOI: 10.1186/s40798-021-00311-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 03/04/2021] [Indexed: 11/11/2022]
Abstract
Background In 2018, there were 616,014 registered deaths in the United Kingdom (UK). Grief is a natural consequence. Many mental health concerns, which can be identified as grief outcomes (e.g. anxiety and depression) in those who have experienced a bereavement, can be improved through physical activity. The objective of this review was to identify from the existing literature if physical activity can benefit grief outcomes in individuals who have been bereaved. Methods A systematic review of nine databases was performed. Included studies (qualitative and quantitative) explored physical activity to help individuals (of any age) who had experienced a human bereavement (excluding national loss). Results From 1299 studies screened, 25 met the inclusion criteria, detailing eight types of bereavement (parental (n = 5), spousal (n = 6), patient (n = 4), pre-natal (n = 3), later life (n = 1), caregiver (n = 1), multiple (n = 4) and non-defined (n = 1). Activities including yoga, running, walking and martial arts were noted as beneficial. Physical activity allowed a sense of freedom, to express emotions, provided a distraction and an escape from grief, whilst enhancing social support. Conclusion There is some evidence that physical activity may provide benefit for the physical health and psychological wellbeing of those who have been bereaved, including when the loss has happened at a young age. This review is timely, given the wide-scale national loss of life due to COVID-19 and extends knowledge in this area. More research is needed to explore the benefits of physical activity for those who have been bereaved. In particular, there is a need for well-designed interventions which are tailored to specific activities, populations and grief outcomes.
Collapse
Affiliation(s)
- Jane Williams
- Institute for Sport and Physical Activity Research, Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, MK41 9EA, UK
| | - Gillian W Shorter
- Centre for Improving Health Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, BT9 7NN, UK
| | - Neil Howlett
- Department of Psychology and Sport Sciences, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | - Julia Zakrzewski-Fruer
- Institute for Sport and Physical Activity Research, Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, MK41 9EA, UK
| | - Angel M Chater
- Institute for Sport and Physical Activity Research, Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, MK41 9EA, UK.
| |
Collapse
|
19
|
Tan J, Andriessen K. The Experiences of Grief and Personal Growth in University Students: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1899. [PMID: 33669340 PMCID: PMC7920249 DOI: 10.3390/ijerph18041899] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Experiencing the death of a close person, especially in emerging adults and students, can have profound effects on the bereaved individual's life. As most research in this field has focused on negative effects of a loss, little is known about potential positive effects experienced by bereaved university students. This study investigated the experience of grief and personal growth in a sample of students from The University of Melbourne, Australia. METHODS Semi-structured interviews via Zoom/telephone with bereaved students (n = 14), who were invited to reflect on their loss and any personal growth potentially experienced. Thematic analysis of the data was based on a deductive and inductive approach. RESULTS The analysis identified four themes: (i) sharing of grief as a coping mechanism, (ii) balance between grief reactions and moving forward in life, (iii) lessons learned and personal growth, and (iv) adopting values from the deceased person and continuing bonds. CONCLUSIONS Participants emphasized personal growth regarding self-perception and philosophical views on life. Following the loss, they preferred peer support, and used formal services only when they had a specific need. The findings indicate the importance of social support for bereaved students, and the complimentary role of peer and professional support. Hence, academic institutions should offer supportive services tailored to both students and professionals to help bereaved students.
Collapse
Affiliation(s)
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| |
Collapse
|
20
|
Leaune E, Lestienne L, Grandgenèvre P, Morgiève M, Vaiva G, Vieux M, Chalancon B, Laplace N, Haesebaert J, Poulet E. Development of an Online Resource for People Bereaved by Suicide: A Mixed-Method User-Centered Study Protocol. Front Psychiatry 2021; 12:770154. [PMID: 34992555 PMCID: PMC8724422 DOI: 10.3389/fpsyt.2021.770154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/22/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction: Suicide bereavement is known to be highly distressing and is frequently associated with mental health problems. Despite high-level of need regarding mental and physical health, people bereaved by suicide display low level of help-seeking and perceived support in the aftermath of the loss. The lack of accessibility and reliability of face-to-face counseling resources is notably reported by suicide survivors. Online resources can enhance early access to help and support for people bereaved by suicide. The primary objective of the study is to design and implement an innovative and adaptive online resource for people bereaved by suicide according to their needs and expectation regarding online solutions dedicated to suicide bereavement. Methods: The ESPOIR2S study is a mixed-method user-centered study. ESPOIR2S seeks to build the resource from the perspectives and needs of both people bereaved by suicide and professionals or volunteers working in the field of postvention. The Information System Research (ISR) Framework is used to guide the design of the study through a 3-step research cycle. The structure of the ESPOIR2S study relies on a simultaneous collection of qualitative and quantitative data which will be collected and analyzed during (a) the Relevance cycle through an online questionnaire and focus groups; (b) the Design cycle through focus groups; and (c) and the Rigor cycle through an online questionnaire and semi-structured interviews. The user-centeredness will be ensured by the active participation of people bereaved by suicide, members of associations for bereaved people and professionals of postvention. Discussion: The mixed-method and user-centered design of the ESPOIR2S study will offer an in-depth collection of the needs and expectation of suicide survivors regarding online resources. Through the implementation of an adaptive online solution, we aim to enhance the access to help and support for suicide survivors which are highly correlated with well-being and recovery.
Collapse
Affiliation(s)
- Edouard Leaune
- Centre Hospitalier Le Vinatier, Bron, France.,INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response - PSYR2 Team, Lyon, France.,Groupement d'étude et de prévention du suicide, Saint-Benoît, France
| | | | - Pierre Grandgenèvre
- Groupement d'étude et de prévention du suicide, Saint-Benoît, France.,Univ. Lille, INSERM, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Margot Morgiève
- Groupement d'étude et de prévention du suicide, Saint-Benoît, France.,Centre de Recherche Médecine, Sciences, Santé, Santé Mentale, Société (Cermes3), UMR CNRS 8211, Unité INSERM 988-EHESS-Université Paris Descartes, Paris, France
| | - Guillaume Vaiva
- Groupement d'étude et de prévention du suicide, Saint-Benoît, France.,Univ. Lille, INSERM, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France.,Centre National de Ressources & Résilience pour les Psychotraumatismes (Cn2r Lille Paris), Lille, France
| | | | | | | | - Julie Haesebaert
- EA 7425, HESPER Health Services and Performance Research-Claude Bernard Lyon 1 University, Université de Lyon, Lyon, France
| | - Emmanuel Poulet
- Centre Hospitalier Le Vinatier, Bron, France.,INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response - PSYR2 Team, Lyon, France.,Groupement d'étude et de prévention du suicide, Saint-Benoît, France.,Department of Emergency Psychiatry, University Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
21
|
Pitman AL, King MB, Marston L, Osborn DPJ. The association of loneliness after sudden bereavement with risk of suicide attempt: a nationwide survey of bereaved adults. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1081-1092. [PMID: 32683472 PMCID: PMC7395013 DOI: 10.1007/s00127-020-01921-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 07/08/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE We aimed to test the hypothesis that among people who experience sudden bereavement, loneliness is associated with post-bereavement suicide attempt and post-bereavement suicidal ideation, even when adjusting for network size. METHODS We analysed cross-sectional data collected in the 2010 UCL Bereavement Study, to identify 3193 respondents who had experienced sudden bereavement. We used multivariable logistic regression to test for an association between loneliness (using a newly-developed eight-item loneliness measure) and post-bereavement suicide attempt and suicidal ideation, adjusting for socio-demographic factors, pre-bereavement depression and self-harm, and network size. RESULTS Among bereaved adults, loneliness was significantly associated with probability of post-bereavement suicide attempt (AOR 1.19; 95% CI 1.14-1.25) and of post-bereavement suicidal ideation (AOR 1.24; 95% CI 1.20-1.28), with estimates unchanged by adding perceived stigma of the bereavement to adjusted models. There was no association between suicide bereavement and loneliness (adjusted coefficient 0.22; 95% CI - 0.12 to 0.45; p = 0.063). The association of loneliness and suicide attempt risk was similar whether participants were bereaved by suicide or not. CONCLUSIONS People who report feeling lonely after sudden bereavement are more likely to make a suicide attempt after their loss, even when taking into account their network size and the perceived stigma of the sudden bereavement. There is no evidence that the effects of loneliness on suicidality are specific to suicide bereavement. This work identifies loneliness as a potential target for suicide prevention interventions among bereaved people. It also fuels interest in longitudinal research investigating loneliness as a putative mediator of suicide risk.
Collapse
Affiliation(s)
- Alexandra L Pitman
- UCL Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London, NW1 0PE, UK.
| | - Michael B King
- UCL Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Louise Marston
- UCL Research Department of Primary Care and Population Health, University College London, Gower St, London, WC1E 6BT, UK
| | - David P J Osborn
- UCL Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London, NW1 0PE, UK
| |
Collapse
|
22
|
Hybholt L, Berring LL, Erlangsen A, Fleischer E, Toftegaard J, Kristensen E, Toftegaard V, Havn J, Buus N. Older Adults' Conduct of Everyday Life After Bereavement by Suicide: A Qualitative Study. Front Psychol 2020; 11:1131. [PMID: 32636776 PMCID: PMC7316951 DOI: 10.3389/fpsyg.2020.01131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/04/2020] [Indexed: 11/23/2022] Open
Abstract
Background The loss of a loved one to suicide can be a devastating experience that can have negative long-term effects on the social life and physical and mental health of the bereaved person. Worldwide, an estimated 237 million older adults have experienced suicide bereavement. As assumed in critical psychology, “the conduct of everyday life” reflects the social self-understanding by which people actively organize their lives based on their personal concerns, negotiation with co-participants in various action contexts, and their life interests. Bereaved people may change their social self-understanding as they adjust to their new roles and relationships in everyday life. The aim of this study was to investigate how older adults bereaved by suicide conducted their everyday life during the first 5 years after the loss of a loved one. Methods This was a semi-structured qualitative interview study carried out by a research team consisting of co-researchers (older adults aged ≥60 years and bereaved by suicide), professionals, and researchers. The team conducted 15 semi-structured interviews with 20 older adults bereaved by suicide. The interviews were audio-recorded and verbatim transcribed. The participants’ mean age was 67.6 (range 61–79) years at the time of the loss. Data were thematically analyzed through a “conduct of everyday life” theoretical perspective. Results We constructed a central theme, “the broken notion of late-life living” in that late-life would no longer be as the participants had imagined. They struggled with their understanding of themselves and other people in social communities when they pursued their concerns adjusting to their broken notions of late-life living. We construed three primary concerns: (1) seeking meaning in the suicide, (2) keeping the memory of the deceased alive, and (3) regaining life despite the loss. Conclusion The participants’ bereavement process was influenced by their stage in life. They perceived themselves as having reduced possibilities to restore their life project and limited time to re-orient their life. Age-related factors influenced their possibilities to pursue their concerns in order to adjust to their new life conditions.
Collapse
Affiliation(s)
- Lisbeth Hybholt
- Center for Relationships and De-escalation, Psychiatry Region Zealand, Slagelse, Denmark
| | - Lene Lauge Berring
- Center for Relationships and De-escalation, Psychiatry Region Zealand, Slagelse, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen, Denmark.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Elene Fleischer
- NEFOS, Network for People Affected by Suicidal Behaviour, Odense, Denmark
| | - Jørn Toftegaard
- NEFOS, Network for People Affected by Suicidal Behaviour, Odense, Denmark
| | - Elin Kristensen
- NEFOS, Network for People Affected by Suicidal Behaviour, Odense, Denmark
| | - Vibeke Toftegaard
- NEFOS, Network for People Affected by Suicidal Behaviour, Odense, Denmark
| | - Jenny Havn
- NEFOS, Network for People Affected by Suicidal Behaviour, Odense, Denmark
| | - Niels Buus
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,St. Vincent's Hospital, Sydney, NSW, Australia.,St. Vincent's Private Hospital, Sydney, NSW, Australia
| |
Collapse
|
23
|
Kennedy AJ, Brumby SA, Versace VL, Brumby-Rendell T. The ripple effect: a digital intervention to reduce suicide stigma among farming men. BMC Public Health 2020; 20:813. [PMID: 32471501 PMCID: PMC7260777 DOI: 10.1186/s12889-020-08954-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 05/19/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Compared with the general population, Australian farmers-particularly men-have been identified as at greater risk of suicide. A complex range of factors are thought to contribute to this risk, including the experience of Stigma. stigma also impacts those who have attempted suicide, their carers, and those bereaved by suicide-manifesting as shame, guilt, social isolation, concealment of death, reduced help seeking and ongoing risk of suicide. This paper evaluates the effectiveness of an intervention, tailored for the farming context, designed to reduce stigma among farming men with a lived experience of suicide. METHODS The digital intervention used an adult learning model providing opportunity to share insights, reflect, learn and apply new knowledge among people with shared farming interests, suicide experience and cultural context. A range of content-tailored to the gender, farming type and suicide experience of participants-included video stories, postcard messages, education and personal goal setting. Pre- and post- assessment of suicide stigma and literacy was complemented by qualitative data collection during the intervention and participant feedback surveys. RESULTS The intervention was successful in reaching members of the target group from across Australia's rural communities-with diverse geographic locations and farming industries represented. One hundred and sixty-nine participants from the target group (farming males aged 30-64 years) were recruited. While the Stigma of Suicide Scale failed to identify a reduction in self- or perceived-stigma, qualitative data and participant feedback identified behavioural indicators of stigma reduction. Four subthemes-'growth', 'new realisations', 'hope' and 'encouragement'-highlighted attitudinal and behaviour change indicative of reduced stigma associated with mental health and suicide. Participants' baseline suicide literacy (Literacy of Suicide Scale) was high when compared with previous community samples and total literacy scores did not demonstrate significant improvement over time, although literacy about the link between suicide and alcoholism did significantly improve. CONCLUSIONS These results highlight opportunities in groups with high suicide literacy for targeted stigma reduction and suicide prevention efforts for both the target group and other populations within Australia and internationally. Results also highlight the need to reassess how stigma change is understood and evaluated across a wider range of population groups. TRIAL REGISTRATION This research project was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12616000289415) on 7th March, 2016.
Collapse
Affiliation(s)
- Alison J. Kennedy
- Deakin University/National Centre for Farmer Health, 75 Pigdons Road, Waurn Ponds, VIC 3216 Australia
| | - Susan A. Brumby
- Deakin University/National Centre for Farmer Health, 75 Pigdons Road, Waurn Ponds, VIC 3216 Australia
- Deakin Rural Health, Deakin University, 75 Pigdons Road, Waurn Ponds, VIC 3216 Australia
| | - Vincent Lawrence Versace
- National Centre for Farmer Health, Western District Health Service, PO Box 283, Hamilton, VIC 3300 Australia
| | - Tristan Brumby-Rendell
- Deakin Rural Health, Deakin University, 75 Pigdons Road, Waurn Ponds, VIC 3216 Australia
| |
Collapse
|
24
|
Evans A, Abrahamson K. The Influence of Stigma on Suicide Bereavement: A Systematic Review. J Psychosoc Nurs Ment Health Serv 2020; 58:21-27. [PMID: 32065654 DOI: 10.3928/02793695-20200127-02] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/19/2019] [Indexed: 11/20/2022]
Abstract
Suicide loss affects a significant proportion of the population, and despite its prevalence there remains a stigma surrounding death by suicide. It is important for health professionals to understand the effects of suicide stigma on surviving friends and family members so that they can respond appropriately and provide effective support. A systematic review of the literature was conducted to evaluate the impact of public stigma on bereavement of suicide survivors. A total of 11 qualitative and quantitative studies were reviewed. Suicide survivors reported feeling shamed, blamed, and judged. They perceived a general discomfort and awkwardness surrounding the suicide, which contributed to avoidance and secrecy. Higher perceived stigma levels were associated with global psychological distress, depression, self-harm, and suicidality. Despite the recognized negative impact of suicide stigma on the bereaved, studies on grief interventions for suicide survivors are scarce. There is a critical need for research and evidence-based recommendations on how to best to support this vulnerable population. [Journal of Psychosocial Nursing and Mental Health Services, 58(4), 21-27.].
Collapse
|
25
|
Finlayson-Short L, Hetrick S, Krysinska K, Harris M, Salom C, Stefanac N, Bailey E, Robinson J. Community Based Support for People at Risk for Suicide and Those Who Care for them - Areas for Improvement. Arch Suicide Res 2020; 24:125-157. [PMID: 31159666 DOI: 10.1080/13811118.2019.1619113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To systematically review the quality of evidence regarding the effectiveness of supports for people affected by suicide. EMBASE, MEDLINE, and PsychINFO were searched for evaluations of community-based supports for people affected by suicide. Outcomes included suicide-related behavior, depression, grief, quality of life, caring ability, and qualitative experiences. Fifteen studies evaluated 15 supports of various modalities. Study quality was generally poor; most studies examined bereaved individuals with mixed findings. Few reduced suicide-related behavior, half improved depression, and grief, while studies of caring ability, quality of life, or qualitative experiences reported positive effects. Supports associated with better outcomes connected peers with similar experiences, were provided over a period of months, and involved veteran rather than novice facilitators. Supports for people affected by suicide may be effective for improving suicide-related behavior, psychological adjustment, quality of life and caregiving, but require further evaluation.
Collapse
|
26
|
Zhao J, Chi Y, Ju Y, Liu X, Wang J, Liu X, Lew B, Siau CS, Jia C. Shame and Suicidal Ideation among Undergraduates in China: The Mediating Effect of Thwarted Belongingness and Perceived Burdensomeness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072360. [PMID: 32244371 PMCID: PMC7178018 DOI: 10.3390/ijerph17072360] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/27/2020] [Indexed: 01/26/2023]
Abstract
Undergraduate students with shame are more likely to experience suicidal ideation, but there remains a lack of research investigating the factors underlying this relationship. The interpersonal theory of suicide posits that suicidal ideation is influenced by the simultaneous presence of thwarted belongingness and perceived burdensomeness. We examined the prevalence of suicidal ideation among undergraduate students in China and examined the association between shame and suicidal ideation mediated by perceived burdensomeness and thwarted belongingness. A survey was conducted in July 2018 involving 2320 undergraduate students, and the twelve-month prevalence of suicidal ideation was 8.95%. Shame played a crucial role in predicting suicidal ideation, and the mediating effects of perceived burdensomeness and thwarted belongingness between shame and suicidal ideation were significant. Suicidal ideation is common among undergraduate students in China and merits greater attention. Shame, perceived burdensomeness, and thwarted belongingness may be important factors to assess among undergraduate students in suicide risk assessment and psychological intervention.
Collapse
Affiliation(s)
- Jingjing Zhao
- School of Marxism, Shandong University, Jinan 250012, China
| | - Yanna Chi
- School of Public Health, Shandong University, Jinan 250012, China
| | - Yanli Ju
- School of Public Health, Shandong University, Jinan 250012, China
| | - Xiyao Liu
- School of Public Health, Shandong University, Jinan 250012, China
| | - Jingjing Wang
- School of Public Health, Shandong University, Jinan 250012, China
| | - Xinglai Liu
- School of Public Health, Shandong University, Jinan 250012, China
| | - Bob Lew
- Department of Social Psychology, Putra University of Malaysia, Serdang 43400, Selangor Malaysia
| | - Ching Sin Siau
- Faculty of Social Sciences and Liberal Arts, UCSI University, Kuala Lumpur 56000, Malaysia
| | - Cunxian Jia
- School of Public Health, Shandong University, Jinan 250012, China
- Correspondence: ; Tel.: +86-0531-8838-2141-8803
| |
Collapse
|
27
|
Drabwell L, Eng J, Stevenson F, King M, Osborn D, Pitman A. Perceptions of the Use of Alcohol and Drugs after Sudden Bereavement by Unnatural Causes: Analysis of Online Qualitative Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030677. [PMID: 31972984 PMCID: PMC7037803 DOI: 10.3390/ijerph17030677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 12/03/2022]
Abstract
Bereavement is associated with an increased risk of psychiatric morbidity and all-cause mortality, particularly in younger people and after unnatural deaths. Substance misuse is implicated but little research has investigated patterns of drug or alcohol use after bereavement. We used a national online survey to collect qualitative data describing whether and how substance use changes after sudden bereavement. We conducted thematic analysis of free-text responses to a question probing use of alcohol and drugs after the sudden unnatural (non-suicide) death of a family member or a close friend. We analysed data from 243 adults in British Higher Education Institutions aged 18–40, identifying two main themes describing post-bereavement alcohol or drug use: (1) sense of control over use of drugs or alcohol (loss of control versus self-discipline), (2) harnessing the specific effects of drugs or alcohol. Across themes we identified age patterning in relation to substance misuse as a form of rebellion among those bereaved in childhood, and gender patterning in relation to men using alcohol to help express their emotions. The limitations of our sampling mean that these findings may not be generalizable from highly-educated settings to young people in the general population. Our findings describe how some young bereaved adults use drugs and alcohol to help them cope with traumatic loss, and suggest how clinicians might respond to any difficulties controlling substance use.
Collapse
Affiliation(s)
- Lauren Drabwell
- UCL Centre for Behaviour Change, Research Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK;
| | - Jessica Eng
- UCL Division of Psychology and Language Sciences, 26 Bedford Way, London WC1H 0AP, UK;
| | - Fiona Stevenson
- UCL Research Department of Primary Care & Population Health, Rowland Hill St, London NW3 2PF, UK;
| | - Michael King
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK; (D.O.); (M.K.)
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London NW1 0PE, UK
| | - David Osborn
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK; (D.O.); (M.K.)
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London NW1 0PE, UK
| | - Alexandra Pitman
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK; (D.O.); (M.K.)
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London NW1 0PE, UK
- Correspondence: ; Tel.: +44-20-7679-9467
| |
Collapse
|
28
|
Spillane A, Matvienko-Sikar K, Larkin C, Corcoran P, Arensman E. How suicide-bereaved family members experience the inquest process: a qualitative study using thematic analysis. Int J Qual Stud Health Well-being 2019; 14:1563430. [PMID: 30693845 PMCID: PMC6352946 DOI: 10.1080/17482631.2018.1563430] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2018] [Indexed: 12/04/2022] Open
Abstract
PURPOSE Suicide bereavement confers unique risk and distress. In several countries, bereaved family members are called on to attend an inquest, an official public inquiry into deaths caused by external factors. The current study aimed to explore how suicide-bereaved family members (n = 18) experienced the inquest process, through qualitative semi-structured interviews. METHOD Participants were identified via coroner's records and had previously taken part in a case-control study. RESULTS Qualitative findings indicated four overall themes with respect to family members' experiences of the inquest process: "inquest as fearfully unknown", "structural processes of the inquest", "enduring public and private pain to obtain answers" and "gaining answers and making sense". Most family members experienced distress and fear as a result of several elements of the inquest process. Some participants had positive experiences but these did not outweigh the distress experienced by the majority of family members regarding their overall experience of the inquest process. CONCLUSIONS Key recommendations include informing family members of the main aspects and purpose of the inquest process beforehand, adapting the process to maximise the privacy and comfort of the bereaved relatives, and restricting graphic evidence being heard, where possible, to minimise distress experienced by family members.
Collapse
Affiliation(s)
- Ailbhe Spillane
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | | | - Celine Larkin
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Paul Corcoran
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - Ella Arensman
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| |
Collapse
|
29
|
Adapting Digital Social Prescribing for Suicide Bereavement Support: The Findings of a Consultation Exercise to Explore the Acceptability of Implementing Digital Social Prescribing within an Existing Postvention Service. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224561. [PMID: 31752170 PMCID: PMC6888585 DOI: 10.3390/ijerph16224561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 11/21/2022]
Abstract
This paper describes a consultation exercise to explore the acceptability of adapting digital social prescribing (DSP) for suicide bereavement support. Bereavement by suicide increases the risk of suicide and mental health issues. Social prescribing improves connectedness and empowerment and can provide digital outcomes-based reporting to improve the capacity for measuring the effectiveness of interventions. Our aim was to consult on the acceptability and potential value of DSP for addressing the complexities of suicide bereavement support. Our approach was underpinned by implementation science and a co-design ethos. We reviewed the literature and delivered DSP demonstrations as part of our engagement process with commissioners and service providers (marrying evidence and context) and identified key roles for stakeholders (facilitation). Stakeholders contributed to a co-designed workshop to establish consensus on the challenges of providing postvention support. We present findings on eight priority challenges, as well as roles and outcomes for testing the feasibility of DSP for support after suicide. There was a consensus that DSP could potentially improve access, reach, and monitoring of care and support. Stakeholders also recognised the potential for DSP to contribute substantially to the evidence base for postvention support. In conclusion, the consultation exercise identified challenges to facilitating DSP for support after suicide and parameters for feasibility testing to progress to the evaluation of this innovative approach to postvention.
Collapse
|
30
|
Andriessen K, Krysinska K, Castelli Dransart DA, Dargis L, Mishara BL. Grief After Euthanasia and Physician-Assisted Suicide. CRISIS 2019; 41:255-272. [PMID: 31657640 DOI: 10.1027/0227-5910/a000630] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Several countries have regulated euthanasia and physician-assisted suicide (PAS). Research has looked at the experiences of patients, family, and professionals. However, little is known of the effects on bereaved individuals. Aims: We aimed to assess (a) what is known about the grief and mental health of people bereaved by euthanasia or PAS and (b) the quality of the research. Method: Systematic review according to PRISMA guidelines with searches in Cinahl, Embase, PsycINFO, Pubmed, and Scopus. Results: The searches identified 10 articles (eight studies), and the study quality was fair. People bereaved by euthanasia/PAS generally had similar or lower scores on measures of disordered grief, mental health, and posttraumatic stress compared with those who died naturally. Lack of social support and secrecy may compound their grief. Being involved in the decision-making process and having the feeling of honoring the deceased's will may facilitate their grief. Limitations: Studies used self-reports from non-random self-selected participants, were retrospective, and were conducted in only three countries. Conclusion: There is little evidence of increased risk of adverse grief or mental health outcomes in people bereaved by euthanasia/PAS. As more countries legalize assisted dying, high-quality studies of the factors that may hinder or facilitate the grief process are needed.
Collapse
Affiliation(s)
- Karl Andriessen
- Centre for Mental Health, School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Karolina Krysinska
- Centre for Mental Health, School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Luc Dargis
- Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices (CRISE), Montréal, Canada
| | - Brian L Mishara
- Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices (CRISE), Montréal, Canada.,Psychology Department, Université du Québec á Montréal, Canada
| |
Collapse
|
31
|
The Perceived Impact of Suicide Bereavement on Specific Interpersonal Relationships: A Qualitative Study of Survey Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101801. [PMID: 31117207 PMCID: PMC6572476 DOI: 10.3390/ijerph16101801] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/08/2019] [Accepted: 05/18/2019] [Indexed: 11/17/2022]
Abstract
People bereaved by suicide have an increased risk of suicide and suicide attempt, yet report receiving less support than people bereaved by other sudden deaths. Reductions in support may contribute to suicide risk, yet their nature is unclear. We explored the impact of suicide bereavement on the interpersonal relationships of young adults in the UK using an online survey to collect qualitative data. We conducted thematic analysis of free-text responses from 499 adults to questions capturing the impact of bereavement on relationships with partners, close friends, close family, extended family, and other contacts. We identified four main themes describing the changes in relationships following the suicide: (1) Social discomfort over the death (stigma and taboo; painfulness for self or others to discuss; socially prescribed grief reactions); (2) social withdrawal (loss of social confidence; withdrawal as a coping mechanism); (3) shared bereavement experience creating closeness and avoidance; (4) attachments influenced by fear of further losses (overprotectiveness towards others; avoiding attachments as protective). These findings contribute to understanding deficits in support and pathways to suicidality after suicide bereavement. Such disrupted attachments add to the burden of grief and could be addressed by public education on how to support those bereaved by suicide.
Collapse
|
32
|
Molina N, Viola M, Rogers M, Ouyang D, Gang J, Derry H, Prigerson HG. Suicidal Ideation in Bereavement: A Systematic Review. Behav Sci (Basel) 2019; 9:E53. [PMID: 31091772 PMCID: PMC6562884 DOI: 10.3390/bs9050053] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/18/2019] [Accepted: 05/06/2019] [Indexed: 02/05/2023] Open
Abstract
Background: Bereavement is associated with impaired mental health, increases in adverse health behaviors, and heightened risk of suicidal ideation, attempts, and death by suicide. The purpose of this literature review was to explore associations between cause of death and suicidal thoughts among bereaved individuals. Our aim was to compare incidence of suicidal ideation by cause of death and identify gaps in this literature to guide future research and clinical intervention. Methods: PRISMA-P guidelines were used to structure an electronic literature search in the PsycINFO, MEDLINE, and Web of Science databases. The search focused on English language studies that were published before February 2019 and sought to compare rates of suicidal ideation among bereaved people who lost a loved one to suicide, accidental overdose, cancer, dementia, cardiovascular disease, and HIV/AIDs. Results: Ten articles were identified with suicide as cause of death, zero articles for accidental overdose, zero articles for cardiovascular disease, eight articles for cancer, one article for dementia, and one article for HIV/AIDs. Given the limited number of articles generated by our search, a formal meta-analysis was not appropriate. However, a comparison of results did suggest that suicide bereavement was associated with the highest rates of suicide ideation (14.1% to 49%). Stigma, isolation, avoidance behaviors, and psychological distress were associated with suicidal thoughts among bereaved individuals, regardless of the deceased's cause of death. Conclusions: Findings of this literature search revealed significant gaps in the literature, especially regarding thoughts of suicide in bereaved survivors of accidental overdose and cardiovascular disease. Results suggest that multiple causes of death are associated with suicidal ideation in bereavement, but that suicide bereavement may be the cause of death associated with the highest risk of suicidal ideation. More research is needed to understand the ways in which cause of death influences prevalence, risk, and protective factors associated with suicidal thoughts among bereaved individuals.
Collapse
Affiliation(s)
- Nicolette Molina
- The American Institute for Cognitive Therapy, New York, NY 10022, USA.
| | - Martin Viola
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY 10065, USA.
| | - Madeline Rogers
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY 10065, USA.
| | - Daniel Ouyang
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY 10065, USA.
| | - James Gang
- Weill Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA.
| | - Heather Derry
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY 10065, USA.
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY 10065, USA.
| |
Collapse
|
33
|
Sales AP, Santana da Silva TP, Sougey EB, Saraiva Câmara Filho JW. Psychopathological and Psychosocial Repercussions of Suicide in the Family. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2019. [DOI: 10.2174/1573400515666190114155014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Although the relationship between the occurrence of suicide and the
presence of psychosocial suffering in bereaved relatives is clear, there are still few studies that deal
with the detail of these repercussions and the therapeutic conduction given to them for the suicide.
Objective:
to carry out an integrative review on the psychopathological and psychosocial
repercussions of suicide in the family, with emphasis on the detail of the main psychopathological
characteristics presented by the individuals and the psychosocial impacts of mourning.
Method:
An integrative review was performed. The guiding question considered Population
Intervention Comparator Outcome Setting and the revision protocol is in agreement with Preferred
Reporting Items for Systematic Reviews and Meta-Analyzes. The search occurred in the bases:
Periodicals CAPES, PsycINFO and PubMed. Original articles were included, without language
restriction that emphasized psychopathological and psychosocial aspects of the mourners after
suicide. We excluded review studies, clinical cases, editorials and retrospectives.
Results:
The process of suicide mourning for family members is a complex event, marked by stigma
and can predispose patients to mental illness and suicidal behavior, especially in the early years of
mourning. In addition, it is necessary to expand the scope of evidence on the effectiveness of
support and intervention with this population.
Conclusion:
Bereaved families need specialized preventive support insofar as the complexity of
bereavement becomes a vulnerability factor for mental illness.
Collapse
Affiliation(s)
- Amanda Patricia Sales
- Doctorate in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Brazil
| | | | - Everton Botelho Sougey
- Doctorate in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Brazil
| | | |
Collapse
|
34
|
Keller S, McNeill V, Honea J, Paulson Miller L. A Look at Culture and Stigma of Suicide: Textual Analysis of Community Theatre Performances. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030352. [PMID: 30691183 PMCID: PMC6388390 DOI: 10.3390/ijerph16030352] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/15/2019] [Accepted: 01/19/2019] [Indexed: 11/16/2022]
Abstract
Stigma against suicidal ideation and help-seeking is a significant barrier to prevention. Little detail is provided on what types of stigma interfere with help-seeking, how stigma is expressed, and how to reduce it. Five groups of two ethnically diverse community theatre programs were formed to analyze differences in Eastern Montana Caucasian and Native American adolescents and young adults’ experiences with stigma about mental illness and mental health treatment that affect help-seeking for suicidal thoughts and experiences. Over a ten-week period, a grassroots theatre project was used to recruit members from the same population as the audience to write and perform a play on suicide and depression (n = 33; 10 males, 23 females; 12 Native American, 21 Caucasian, ages 14–24). Using textual analysis, the community- and campus-based performance scripts were coded for themes related to stigma. Both ethnic groups reported that stigma is a barrier to expressing emotional vulnerability, seeking help, and acknowledging mental illness. We found that Caucasians’ experiences were more individually oriented and Native Americans’ experiences were more collectively oriented. Understanding the cultural bases of experiences with stigma related to mental health treatment for suicide is necessary to create educational programs to reduce stigma for diverse groups of adolescents and young adults.
Collapse
Affiliation(s)
- Sarah Keller
- Department of Communication & Theatre, Montana State University Billings, Billings, MT 59102, USA.
| | - Vanessa McNeill
- Department of Psychology, Montana State University Billings, Billings, MT 59102, USA.
| | - Joy Honea
- Department of Social Sciences & Cultural Studies, Montana State University Billings, Billings, MT 59102, USA.
| | | |
Collapse
|
35
|
Oexle N, Feigelman W, Sheehan L. Perceived suicide stigma, secrecy about suicide loss and mental health outcomes. DEATH STUDIES 2018; 44:248-255. [PMID: 30451645 DOI: 10.1080/07481187.2018.1539052] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/12/2018] [Accepted: 09/20/2018] [Indexed: 05/27/2023]
Abstract
Perceived suicide stigma and consequent secrecy about suicide loss could contribute to impaired mental health among suicide loss survivors. Using online survey data from 195 suicide loss survivors, higher perceived suicide stigma was associated with more grief difficulties, higher suicidality, and less personal growth. Secrecy partly mediated the association between perceived suicide stigma and grief difficulties as well as suicidality and completely mediated the association between perceived suicide stigma and personal growth. Our findings suggest that supporting suicide loss survivors in coping with perceived suicide stigma could reduce secrecy about suicide loss and by this improve their mental health outcomes.
Collapse
Affiliation(s)
- Nathalie Oexle
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
| | | | - Lindsay Sheehan
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| |
Collapse
|
36
|
Hom MA, Stanley IH, Spencer-Thomas S, Joiner TE. Exposure to suicide and suicide bereavement among women firefighters: Associated suicidality and psychiatric symptoms. J Clin Psychol 2018; 74:2219-2237. [PMID: 30022494 DOI: 10.1002/jclp.22674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/18/2018] [Accepted: 06/21/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To examine experiences with suicide exposure and bereavement among women firefighters. METHODS Women firefighters (N = 266, Mage = 37.64y) completed self-report measures assessing their experiences with suicide exposure, history of suicidality, current psychiatric symptoms, and suicide risk. RESULTS Three-fourths (74.4%) of participants reported knowing someone who had died by suicide; of these participants, 31.3% reported losing a fellow firefighter to suicide. Exposure to suicide during one's firefighting career was associated with more severe psychiatric symptoms and suicide risk. Greater impact of a suicide death was significantly associated with more severe current suicide risk, even after controlling for prior suicidality and other psychiatric symptoms. CONCLUSIONS Women firefighters exposed to suicide during their careers may experience more severe psychiatric symptoms and increased suicide risk as compared to their counterparts without this exposure. In particular, women firefighters who are more severely impacted by a suicide loss may be at increased suicide risk.
Collapse
Affiliation(s)
- Melanie A Hom
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Ian H Stanley
- Department of Psychology, Florida State University, Tallahassee, Florida
| | | | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida
| |
Collapse
|
37
|
Kennedy AJ, Brumby SA, Versace VL, Brumby-Rendell T. Online assessment of suicide stigma, literacy and effect in Australia's rural farming community. BMC Public Health 2018; 18:846. [PMID: 29980237 PMCID: PMC6035410 DOI: 10.1186/s12889-018-5750-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/25/2018] [Indexed: 11/25/2022] Open
Abstract
Background In Australia, farming populations have been identified as having higher rates of suicide, in comparison to metropolitan, rural and regional communities. The reasons for this are unclear although stigma is considered a risk factor. This study was designed to understand the role of suicide stigma and suicide literacy and the relationship between these. Methods A mixed-methods online intervention was developed. This paper reports on baseline quantitative data (suicide stigma, suicide literacy and suicide effect) collected from male and female rural Australian participants (N = 536) with an experience of suicide. Results When compared with previous Australian community samples, our sample demonstrated higher levels of stigma and higher levels of suicide literacy. Males were more likely to have considered suicide than females. Females were more likely than males to report a devastating and ongoing effect of suicide bereavement, but less likely than a previous Australian community sample. Conclusion Results of this study reiterate the need for improved understanding of the risk factors and experience of suicide within the context of life and work in rural Australian farming communities and how ‘best practice’ can be adapted to improve stigma reduction and suicide prevention efforts. Trial registration This research project was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12616000289415) on 7th March, 2016.
Collapse
Affiliation(s)
- Alison J Kennedy
- Deakin University, National Centre for Farmer Health, 75 Pigdons Road, Geelong, VIC, 3216, Australia.
| | - Susan A Brumby
- Deakin University, National Centre for Farmer Health, 75 Pigdons Road, Geelong, VIC, 3216, Australia
| | | | - Tristan Brumby-Rendell
- National Centre for Farmer Health, Western District Health Service, PO Box 283, Hamilton, VIC, 3300, Australia
| |
Collapse
|
38
|
Pitman AL, Stevenson F, Osborn DPJ, King MB. The stigma associated with bereavement by suicide and other sudden deaths: A qualitative interview study. SOCIAL SCIENCE & MEDICINE (1982) 2018. [PMID: 29316512 DOI: 10.1016/j.socscimed.2017.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
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.
Collapse
Affiliation(s)
- Alexandra L Pitman
- UCL Division of Psychiatry, 6th floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom.
| | - Fiona Stevenson
- UCL Research Department of Primary Care & Population Health, UCL Medical School, Royal Free Campus, Rowland Hill St, London NW3 2PF, United Kingdom.
| | - David P J Osborn
- UCL Division of Psychiatry, 6th floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom.
| | - Michael B King
- UCL Division of Psychiatry, 6th floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom.
| |
Collapse
|
39
|
Pitman AL, Stevenson F, Osborn DPJ, King MB. The stigma associated with bereavement by suicide and other sudden deaths: A qualitative interview study. Soc Sci Med 2018; 198:121-129. [PMID: 29316512 PMCID: PMC5884304 DOI: 10.1016/j.socscimed.2017.12.035] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 12/12/2017] [Accepted: 12/28/2017] [Indexed: 12/27/2022]
Abstract
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. Explores stigma after suicide, unnatural deaths and sudden natural deaths. First qualitative study internally comparing these three groups' experiences. All three groups described stigmatising social awkwardness. The death taboo in relation to sudden deaths is particularly marked after suicide.
Collapse
Affiliation(s)
- Alexandra L Pitman
- UCL Division of Psychiatry, 6th floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom.
| | - Fiona Stevenson
- UCL Research Department of Primary Care & Population Health, UCL Medical School, Royal Free Campus, Rowland Hill St, London NW3 2PF, United Kingdom.
| | - David P J Osborn
- UCL Division of Psychiatry, 6th floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom.
| | - Michael B King
- UCL Division of Psychiatry, 6th floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom.
| |
Collapse
|
40
|
Pitman A, Nesse H, Morant N, Azorina V, Stevenson F, King M, Osborn D. Attitudes to suicide following the suicide of a friend or relative: a qualitative study of the views of 429 young bereaved adults in the UK. BMC Psychiatry 2017; 17:400. [PMID: 29237447 PMCID: PMC5729247 DOI: 10.1186/s12888-017-1560-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 11/28/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND People bereaved by suicide are at increased risk of suicide attempt and suicide, but explanations for these associations remain theoretical. It is possible that the experience of suicide bereavement modifies personal attitudes towards suicide, but the nature of these changes remains unexplored. There is a need to understand personal attitudes to suicide following suicide bereavement, as this may inform the development of suicide prevention interventions. Our aim was to explore the attitudes of young adults bereaved by suicide towards their own likelihood of dying by suicide. METHODS We conducted a cross-sectional study of staff and students aged 18-40 at 37 United Kingdom (UK) higher educational institutions in 2010. Ethical approval was granted by the UCL Research Ethics Committee. Qualitative responses to a question probing attitudes to own suicide were provided by 429 respondents who had experienced bereavement by the suicide of a close contact. We identified key themes in this dataset using thematic analysis. RESULTS Analysis identified four main themes: suicide as a more tangible option (whether feared or not); identification with the deceased and awareness of shared vulnerabilities to suicide; personal determination to avoid suicide; and beliefs regarding safeguards against suicide. These themes reflected a broad split in participants' views regarding own likelihood of dying by suicide, influenced by the degree to which own suicide was feared and the extent to which they felt in control of determining a suicide death. Whilst the majority described an aversion to the idea of attempting suicide themselves, largely through an awareness of the impact on others, a minority described their experiences as having normalised suicide as a personal option. CONCLUSIONS The views of a sample of UK-based adults bereaved by suicide suggest that exposure to the suicide of a close friend or relative can influence attitudes to suicide in ways that could influence own risk of suicide attempt. The normalising attitudes to suicide observed in a minority of respondents could contribute to the observed association between suicide bereavement and suicide attempt.
Collapse
Affiliation(s)
- Alexandra Pitman
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK. .,Camden and Islington NHS Foundation Trust, St Pancras Hospital, St Pancras Way, London, NW1 0PE, UK.
| | - Hedvig Nesse
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Nicola Morant
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Valeriya Azorina
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Fiona Stevenson
- 0000000121901201grid.83440.3bUCL Research Department of Primary Care and Population Health, UCL Medical School, Royal Free Campus, Rowland Hill St, London NW3 2PF, UK
| | - Michael King
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK ,grid.439468.4Camden and Islington NHS Foundation Trust, St Pancras Hospital, St Pancras Way, London, NW1 0PE UK
| | - David Osborn
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK ,grid.439468.4Camden and Islington NHS Foundation Trust, St Pancras Hospital, St Pancras Way, London, NW1 0PE UK
| |
Collapse
|