The grief experiences and needs of bereaved relatives and friends of older people dying through suicide: a descriptive and case-control study

Abstract

Background: Little is known about grief experiences of individuals bereaved through suicide of older people. Legal procedures may be one source of distress. Studies have suggested that guilt feelings, and a sense of rejection, shame or stigma, are probably more frequent in relatives bereaved through suicide than in those bereaved through other modes of death. Methods: We examined (a) problems experienced during legal procedures after death and (b) grief experiences, in 85 relatives and friends bereaved through the suicide of person 60 years old or over. In a case-control study the bereavement reactions in a subgroup of 46 people were compared with those of a control group bereaved by the natural death of an older person. Interviews, carried out 6–21 months after the deaths, included a semi-structured assessment of problems following the death, the Grief Experience Questionnaire (GEQ) and the Montgomery and Åsberg Depression Rating Scale (MADRS). Results: Thirty-six (42.4%) of those bereaved through suicide reported problems in their dealings with the coroner’s office, and 33 (38.8%) described distress caused by media reporting of the inquest. Depression scores were similar in the group of individuals bereaved through suicide and those bereaved through natural causes. The former scored higher on subscales of the GEQ measuring stigmatisation, shame, sense of rejection and “unique reactions” compared with those bereaved through natural death. Limitations: The participation rate of potential subjects was somewhat low, especially in the control group. Proportions of different kinships to the deceased differed in the study and control groups. Conclusions: Problems in the media reporting of coroners’ inquests and in inquest procedures are a frequent source of distress for bereaved relatives. The common themes of stigma, shame, and sense of rejection in bereavement after suicide suggest that these areas should be specifically addressed in the counselling of relatives bereaved in this way.

Introduction

Recent studies of post-suicide bereavement using control groups of people bereaved through accidents and natural death have found that the mode of death plays a more modest part in influencing grief reactions than was previously thought. Factors such as the relationship of the bereaved person to the deceased and the characteristics of the relationship are probably more important determinants of bereavement outcome (Barrett and Scott, 1990, Cleiren et al., 1994, Séguin et al., 1995). However, the specific circumstances of suicidal death do have an impact on the bereavement reactions of relatives and friends. First, sudden or unexpected deaths, regardless of cause, are associated with a worse outcome for the bereaved in comparison to expected deaths (Parkes and Weiss, 1983, Parkes, 1998). Second, the legal procedures following deaths due to accident or suicide are an additional source of problems through which those bereaved by a natural death do not have to go (Barraclough and Shepherd, 1976, Barraclough and Shepherd, 1977, Wertheimer, 1991). The nature and frequency of such difficulties have not been evaluated recently in the United Kingdom. Third, although the research findings are not entirely consistent, there is evidence from controlled studies that certain grief symptoms are more prominent after suicide than after other modes of death. These include guilt feelings in bereaved widows and parents (Demi, 1984, Kovarsky, 1989, Miles and Demi, 1991), a sense of having been rejected by the deceased person in bereaved spouses (Barrett and Scott, 1990) and feelings of shame and stigma in spouses, young children, and parents (Barrett and Scott, 1990, Cerel et al., 1999, Séguin et al., 1995).

Relatives or friends of older suicides may have different needs from those bereaved by the suicide of a younger person. A large proportion of older people dying through suicide in the United Kingdom are widowed or living alone (Cattell and Jolley, 1995, Harwood et al., 2000). Children of older people often live far away from their parents. Consequently, the most intimate relationship of an older person dying through suicide might be with a friend or neighbour rather than a close relative. Such friends may be less likely to be identified as being in need of help, and hence may receive less emotional and practical support than spouses or close relatives.

The few studies relating to the needs of survivors of older suicides focused on spouses of suicide victims and found a longer duration of depressive symptoms in those bereaved by suicide than in those bereaved by natural death (Farberow et al., 1987, Farberow et al., 1992).

We have studied a large group of people bereaved through an older person’s suicide to determine the nature and frequency of problems experienced during the legal sequelae of suicide. The subjects were of various different kinships to the deceased. We also studied a control group of people bereaved through a natural death in order to identify aspects of grief specific to post-suicide bereavement.