Bereavement by suicide as a risk factor for suicide attempt: a cross-sectional national UK-wide study of 3432 young bereaved adults

Abstract

ObjectivesUS and UK suicide prevention strategies suggest that bereavement by the suicide of a relative or friend is a risk factor for suicide. However, evidence is lacking that the risk exceeds that of any sudden bereavement, is specific to suicide, or applies to peer suicide. We conducted the first controlled UK-wide study to test the hypothesis that young adults bereaved by suicide have an increased risk of suicidal ideation and suicide attempt compared with young adults bereaved by other sudden deaths.DesignNational cross-sectional study.SettingStaff and students at 37 UK higher educational institutions in 2010.Participants3432 eligible respondents aged 18–40 exposed to sudden bereavement of a friend or relative after the age of 10.ExposuresBereavement by suicide (n=614), by sudden unnatural causes (n=712) and by sudden natural causes (n=2106).Primary outcome measuresIncident suicidal ideation and suicide attempt.FindingsAdults bereaved by suicide had a higher probability of attempting suicide (adjusted OR (AOR)=1.65; 95% CI 1.12 to 2.42; p=0.012) than those bereaved by sudden natural causes. There was no such increased risk in adults bereaved by sudden unnatural causes. There were no group differences in probability of suicidal ideation. The effect of suicide bereavement was similar whether bereaved participants were blood-related to the deceased or not. The significant association between bereavement by suicide and suicide attempt became non-significant when adding perceived stigma (AOR=1.11; 95% CI 0.74 to 1.67; p=0.610). When compared with adults bereaved by sudden unnatural causes, those bereaved by suicide did not show significant differences in suicide attempt (AOR=1.48; 95% CI 0.94 to 2.33; p=0.089).ConclusionsBereavement by suicide is a specific risk factor for suicide attempt among young bereaved adults, whether related to the deceased or not. Suicide risk assessment of young adults should involve screening for a history of suicide in blood relatives, non-blood relatives and friends.

Support for Relatives Bereaved by Psychiatric Patient Suicide: National Confidential Inquiry Into Suicide and Homicide Findings

“…These and other shared familial and environmental risk factors for mental illness and suicidal behavior (35,36), together with the additional risk conferred by suicide bereavement (4,5), identifies this group of relatives as being at higher risk of suicidal behavior. Their helpseeking behavior is likely to have been conditioned by the stigma associated with their relative's mental illness (37) and further influenced by the stigma of suicide (6-9).…”

“…In the case of these patients, NHS guidelines recommend that clinical teams offer families and carers "prompt and open information" and "appropriate and effective support" and involve them in a routine postsuicide review (16). No previous studies have explored the extent to which relatives are offered such support, despite growing evidence describing the vulnerabilities of persons bereaved by suicide (4,5). Psychiatric services that involve family members in postsuicide multidisciplinary reviews have shown local reductions in suicide rates, suggesting systemic benefits (17).…”

Perceived Stigma of Sudden Bereavement as a Risk Factor for Suicidal Thoughts and Suicide Attempt: Analysis of British Cross-Sectional Survey Data on 3387 Young Bereaved Adults

“…We analysed data from the UCL Bereavement Study [8,9]. This was a UK-wide cross-sectional survey of young adults aged 18–40 working and/or studying at UK higher education institutions (HEIs) who had experienced the sudden bereavement of a close friend or relative.…”

“…This study had focused on young adults due to concerns about their risk of suicide [18] and the difficulties of engaging young suicidal men with services [19]. Full details of sampling for this closed online survey have been described elsewhere, including the survey instrument (see Supplementary Materials) [8,9]. Sampling via institution-wide email lists (to all staff and students) avoided the biases associated with recruiting a help-seeking sample, and was felt to be the most efficient, comprehensive and pragmatic means of recruiting a hard-to-reach population of young adults [20].…”

“…Studies comparing grief reactions after different causes of death reveal that experiences of stigma, shame, and concealing the cause are reported after all modes of bereavement, but particularly after violent deaths [1,7] and specifically suicide [8]. Accounting for high levels of perceived stigma has been found to attenuate the association of suicide bereavement with suicide attempt [9], suggesting its role as a mediator of suicide risk. The implication is that anti-stigma interventions might reduce the risk of suicide attempt in people who experience sudden bereavement, perhaps by reducing distress and/or optimising support.…”