Patricia Casey: The unique pain that suicide leaves behind
Bereavement brings with it unbearable pain. There is no easy solution. For those who lose a loved one to suicide, the grief is different though. It is estimated that about 800,000 people die by suicide worldwide each year and that up to 500 million experience suicide bereavement.
To date three dimensions that impact on the grief process, in the wake of suicide, have been identified. Firstly, the families themselves may experience self-blame. They wonder if they have missed cues that might have alerted them to the state of mind of their loved one. Sometimes they see themselves as responsible through some word or action they engaged in. "If only" they say. The guilt is intensified if they now feel a degree of relief, especially when the person had a long complex history with multiple suicide attempts.
The social responses, real or imaginary, that accompany suicide may be hugely stigmatising for the family, fearing that they will be blamed and marked out as deficient. They believe that people will avoid them and will not know what to say when they encounter them on the street.
In some instances the family environment may be dysfunctional and this will augment the distress and sadness. It will also cause family members to worry that it was this collective environment which caused the deceased to end their lives. If there is a family history of mental illness, specifically of suicide, they may believe that the family is tainted.
It is clear that the grief process after suicide is more complex than grief in other bereavement situations. Two recent studies, from the National Suicide Research Foundation and the School of Public Health in UCC have expanded our information on the impact of suicide and its attendant grief on physical and mental health. The lead author of both papers is Dr Ailbhe Spillane of UCC and they were recently published in BMC Open and BMJ Open.
The first was a systematic review in which the scientific literature was searched and 24 studies located which met the inclusion criteria for high quality. In this study, those bereaved by suicide were compared to those bereaved in other ways. Seven studies found statistically significant associations between physical health and suicide bereavement. Five of the studies found that suicide-bereaved family members were more likely to experience pain, more physical illnesses and poorer general health. They were also at increased risk of cardiovascular disease, hypertension, diabetes and chronic obstructive pulmonary disease. The study found that those bereaved by suicide had lower rates of physical illness. The remainder found no difference between those bereaved by suicide or by other types of death. This study concluded that the evidence for an increased risk of adverse physical outcomes is growing and needs to be expanded with better quality studies than are currently available.
The second study was very different in design. It consisted of in depth qualitative interviews of 18 family members bereaved by suicide to evaluate its impact. These were the next of kin. They also completed questionnaires. The results indicated that there were initial feelings of guilt, blame, shame and anger that often manifested in physical, psychological and psychosomatic difficulties. The need for support was highlighted and these were both from formal and from informal sources including family and friends. At times these were lacking. The quantitative tests indicated high scores for depression, anxiety and stress symptoms. In addition, other symptoms such as panic attacks, suicidal thoughts, intrusive images and nightmares were described. Those interviewed regarded the informal support as valuable as the more formal type. In relation to reconstructing life after the suicide, some spoke of problems seeing a future, or of ever forming a new relationship, while others were open to this. Some felt they would ever experience a positive thought again.
These studies point to the need for attention to physical and mental health among those bereaved by suicide. They also highlight the importance of support from family and friends, as well as more formal support from professionals trained in suicide bereavement.
There is a danger that when neighbours and friends are bereaved by suicide we will step away from them, not through malice or indifference, but because we don't feel equipped to deal with it. Yet it is likely that just as with anybody bereaved for any other reason, the support and concern of those we know is vitally important when the loss is a result of suicide. One does not have to be a professional to offer solace and consolation to the griefstricken, no matter what the cause.
Health & Living