Article Text

Bereavement by suicide as a risk factor for suicide attempt: a cross-sectional national UK-wide study of 3432 young bereaved adults
  1. Alexandra L Pitman1,2,
  2. David P J Osborn1,2,
  3. Khadija Rantell3,
  4. Michael B King1,2
  1. 1Division of Psychiatry, University College London, London, UK
  2. 2Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
  3. 3Institute of Neurology, University College London, London, UK
  1. Correspondence to Dr Alexandra L Pitman; a.pitman{at}


Objectives US 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.

Design National cross-sectional study.

Setting Staff and students at 37 UK higher educational institutions in 2010.

Participants 3432 eligible respondents aged 18–40 exposed to sudden bereavement of a friend or relative after the age of 10.

Exposures Bereavement by suicide (n=614), by sudden unnatural causes (n=712) and by sudden natural causes (n=2106).

Primary outcome measures Incident suicidal ideation and suicide attempt.

Findings Adults 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).

Conclusions Bereavement 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.

  • bereavement
  • suicide attempt
  • unnatural causes
  • stigma

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

View Full Text

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.