Skip to main content

Grief Reactions in the Suicide Bereaved

  • Chapter
  • First Online:
Clinical Handbook of Bereavement and Grief Reactions

Part of the book series: Current Clinical Psychiatry ((CCPSY))

Abstract

Suicide bereavement is common, can be life-altering, and has both societal and intergenerational implications and effects. Despite the fact that every bereaved person’s grief is unique, grieving the loss of a loved one to suicide adds layers of complexity to what can be an already profoundly painful experience. Suicide bereavement often is characterized by prominent symptoms of overwhelming guilt, confusion, shame, rejection, and anger. The experience of suicide bereavement is also often steeped in the context of stigma. Many aspects of suicide bereavement add to its complexity and set it apart from bereavement in general. This chapter will focus on these factors, delineating the unique context, qualitative features, sequelae, and treatment considerations for suicide bereavement.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. American Foundation for Suicide Prevention. Suicide statistics. https://afsp.org/about-suicide/suicide-statistics/. 2017. Accessed 29 Mar 2017.

  2. Crosby AE, Sacks JJ. Exposure to suicide: incidence and association with suicidal ideation and behavior: United States, 1994. Suicide Life Threat Behav. 2002;32(3):321–8.

    Article  PubMed  Google Scholar 

  3. Berman AL. Estimating the population of survivors of suicide: seeking an evidence base. Suicide Life Threat Behav. 2011;41(1):110–6. https://doi.org/10.1111/j.1943-278X.2010.00009.x.

    Article  PubMed  Google Scholar 

  4. Pitman A, Osborn D, King M, Erlangsen A. Effects of suicide bereavement on mental health and suicide risk. Lancet Psychiatry. 2014;1(1):86–94. https://doi.org/10.1016/s2215-0366(14)70224-x.

    Article  PubMed  Google Scholar 

  5. Shear MK, Zisook S. Suicide-related bereavement and grief. In: Koslow SH, Ruiz P, Nemeroff CB, editors. A concise guide to understanding suicide: epidemiology, pathophysiology and prevention. Cambridge: Cambridge University Press; 2014. p. 66–73.

    Chapter  Google Scholar 

  6. Feigelman W, Gorman BS, Jordan JR. Stigmatization and suicide bereavement. Death Stud. 2009;33(7):591–608. https://doi.org/10.1080/07481180902979973.

    Article  PubMed  Google Scholar 

  7. Obama B. Statement by the President on Change of Condolence Letter Policy. https://obamawhitehouse.archives.gov/the-press-office/2011/07/06/statement-president-change-condolence-letter-policy. 2011. Accessed 29 Mar 2017.

  8. Sudak H, Maxim K, Carpenter M. Suicide and stigma: a review of the literature and personal reflections. Acad Psychiatry. 2008;32(2):136–42. https://doi.org/10.1176/appi.ap.32.2.136.

    Article  PubMed  Google Scholar 

  9. Zisook S, Shear K. Grief and bereavement: what psychiatrists need to know. World Psychiatry. 2009;8(2):67–74.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Jordan JR. Bereavement after Suicide. Psychiatr Ann. 2008;38(10):679–85.

    Article  Google Scholar 

  11. Dyregrov K, Nordanger D, Dyregrov A. Predictors of psychosocial distress after suicide, SIDS and accidents. Death Stud. 2003;27(2):143–65. https://doi.org/10.1080/07481180302892.

    Article  PubMed  Google Scholar 

  12. Sveen CA, Walby FA. Suicide survivors’ mental health and grief reactions: a systematic review of controlled studies. Suicide Life Threat Behav. 2008;38(1):13–29. https://doi.org/10.1521/suli.2008.38.1.13.

    Article  PubMed  Google Scholar 

  13. Cvinar JG. Do suicide survivors suffer social stigma: a review of the literature. Perspect Psychiatr Care. 2005;41(1):14–21.

    Article  PubMed  Google Scholar 

  14. Jordan JR. Is suicide bereavement different? A reassessment of the literature. Suicide Life Threat Behav. 2001;31(1):91–102.

    Article  CAS  PubMed  Google Scholar 

  15. Tal Young I, Iglewicz A, Glorioso D, Lanouette N, Seay K, Ilapakurti M, et al. Suicide bereavement and complicated grief. Dialogues Clin Neurosci. 2012;14(2):177–86.

    PubMed  PubMed Central  Google Scholar 

  16. Maple M, Edwards H, Plummer D, Minichiello V. Silenced voices: hearing the stories of parents bereaved through the suicide death of a young adult child. Health Soc Care Community. 2010;18(3):241–8. https://doi.org/10.1111/j.1365-2524.2009.00886.x.

    PubMed  Google Scholar 

  17. Middleton W, Raphael B, Burnett P, Martinek N. A longitudinal study comparing bereavement phenomena in recently bereaved spouses, adult children and parents. Aust N Z J Psychiatry. 1998;32(2):235–41. https://doi.org/10.3109/00048679809062734.

    Article  CAS  PubMed  Google Scholar 

  18. Hung NC, Rabin LA. Comprehending childhood bereavement by parental suicide: a critical review of research on outcomes, grief processes, and interventions. Death Stud. 2009;33(9):781–814. https://doi.org/10.1080/07481180903142357.

    Article  PubMed  Google Scholar 

  19. Kuramoto JS, Brent DA, Wilcox HC. The impact of parental suicide on child and adolescent offspring. Suicide Life Threat Behav. 2009;39(2):137–51. https://doi.org/10.1521/suli.2009.39.2.137.

    Article  Google Scholar 

  20. Tall K, Kolves K, Sisask M, Varnik A. Do survivors respond differently when alcohol abuse complicates suicide? Findings from the psychological autopsy study in Estonia. Drug Alcohol Depend. 2008;95(1–2):129–33. https://doi.org/10.1016/j.drugalcdep.2007.12.015.

    Article  PubMed  Google Scholar 

  21. de Groot MH, de Keijser J, Neeleman J. Grief shortly after suicide and natural death: a comparative study among spouses and first-degree relatives. Suicide Life Threat Behav. 2006;36(4):418–31. https://doi.org/10.1521/suli.2006.36.4.418.

    Article  PubMed  Google Scholar 

  22. Cerel J, Jordan JR, Duberstein PR. The impact of suicide on the family. Crisis. 2008;29(1):38–44. https://doi.org/10.1027/0227-5910.29.1.38.

    Article  PubMed  Google Scholar 

  23. Callahan J. Predictors and correlates of bereavement in suicide support group participants. Suicide Life Threat Behav. 2000;30(2):104–24.

    CAS  PubMed  Google Scholar 

  24. Mitchell AM, Terhorst L. PTSD symptoms in survivors bereaved by the suicide of a significant other. J Am Psychiatr Nurses Assoc. 2017;23(1):61–5. https://doi.org/10.1177/1078390316673716.

    Article  PubMed  Google Scholar 

  25. Zisook S, Chentsova-Dutton Y, Shuchter SR. PTSD following bereavement. Ann Clin Psychiatry. 1998;10(4):157–63.

    Article  CAS  PubMed  Google Scholar 

  26. Hibberd R, Elwood LS, Galovski TE. Risk and protective factors for posttraumatic stress disorder, prolonged grief, and depression in survivors of the violent death of a loved one. J Loss Trauma. 2010;15(5):426–47. https://doi.org/10.1080/15325024.2010.507660.

    Article  Google Scholar 

  27. Jordan JR, McIntosh JL. Grief after suicide: understanding the consequences and caring for the survivors. New York: Routledge; 2011.

    Google Scholar 

  28. Tal I, Mauro C, Reynolds CF III, Shear MK, Simon N, Lebowitz B, et al. Complicated grief after suicide bereavement and other causes of death. Death Stud. 2016:1–9. Doi:https://doi.org/10.1080/07481187.2016.1265028.

  29. Segal NL. Suicidal behaviors in surviving monozygotic and dizygotic co-twins: is the nature of the co-twin's cause of death a factor? Suicide Life Threat Behav. 2009;39(6):569–75. https://doi.org/10.1521/suli.2009.39.6.569.

    Article  PubMed  Google Scholar 

  30. Tidemalm D, Runeson B, Waern M, Frisell T, Carlstrom E, Lichtenstein P, et al. Familial clustering of suicide risk: a total population study of 11.4 million individuals. Psychol Med. 2011;41(12):2527–34. https://doi.org/10.1017/s0033291711000833.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Krysinska KE. Loss by suicide. A risk factor for suicidal behavior. J Psychosoc Nurs Ment Health Serv. 2003;41(7):34–41.

    PubMed  Google Scholar 

  32. Pitman AL, Osborn DP, Rantell K, King MB. Bereavement by suicide as a risk factor for suicide attempt: a cross-sectional national UK-wide study of 3432 young bereaved adults. BMJ Open. 2016;6(1):e009948. https://doi.org/10.1136/bmjopen-2015-009948.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Runeson B, Asberg M. Family history of suicide among suicide victims. Am J Psychiatry. 2003;160(8):1525–6. https://doi.org/10.1176/appi.ajp.160.8.1525.

    Article  PubMed  Google Scholar 

  34. Bolton JM, Gunnell D, Turecki G. Suicide risk assessment and intervention in people with mental illness. BMJ. 2015;351:h4978. https://doi.org/10.1136/bmj.h4978.

    Article  PubMed  Google Scholar 

  35. Prigerson HG, Horowitz MJ, Jacobs SC, Parkes CM, Aslan M, Goodkin K, et al. Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Med. 2009;6(8):e1000121. https://doi.org/10.1371/journal.pmed.1000121.

    Article  PubMed  PubMed Central  Google Scholar 

  36. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). Arlington: American Psychiatric Pub; 2013.

    Book  Google Scholar 

  37. Lichtenthal WG, Cruess DG, Prigerson HG. A case for establishing complicated grief as a distinct mental disorder in DSM-V. Clin Psychol Rev. 2004;24(6):637–62. https://doi.org/10.1016/j.cpr.2004.07.002.

    Article  PubMed  Google Scholar 

  38. Stroebe M, Boelen PA, van den Hout M, Stroebe W, Salemink E, van den Bout J. Ruminative coping as avoidance: a reinterpretation of its function in adjustment to bereavement. Eur Arch Psychiatry Clin Neurosci. 2007;257(8):462–72. https://doi.org/10.1007/s00406-007-0746-y.

    Article  PubMed  Google Scholar 

  39. Dell’osso L, Carmassi C, Rucci P, Ciapparelli A, Conversano C, Marazziti D. Complicated grief and suicidality: the impact of subthreshold mood symptoms. CNS Spectr. 2011;16(1):1–6. https://doi.org/10.1017/s1092852912000090.

  40. Latham AE, Prigerson HG. Suicidality and bereavement: complicated grief as psychiatric disorder presenting greatest risk for suicidality. Suicide Life Threat Behav. 2004;34(4):350–62. https://doi.org/10.1521/suli.34.4.350.53737.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Mitchell AM, Kim Y, Prigerson HG, Mortimer MK. Complicated grief and suicidal ideation in adult survivors of suicide. Suicide Life Threat Behav. 2005;35(5):498–506. https://doi.org/10.1521/suli.2005.35.5.498.

    Article  PubMed  Google Scholar 

  42. Prigerson HG, Bridge J, Maciejewski PK, Beery LC, Rosenheck RA, Jacobs SC, et al. Influence of traumatic grief on suicidal ideation among young adults. Am J Psychiatry. 1999;156(12):1994–5. https://doi.org/10.1176/ajp.156.12.1994.

    CAS  PubMed  Google Scholar 

  43. Szanto K, Prigerson H, Houck P, Ehrenpreis L, Reynolds CF 3rd. Suicidal ideation in elderly bereaved: the role of complicated grief. Suicide Life Threat Behav. 1997;27(2):194–207.

    CAS  PubMed  Google Scholar 

  44. Szanto K, Shear MK, Houck PR, Reynolds CF 3rd, Frank E, Caroff K, et al. Indirect self-destructive behavior and overt suicidality in patients with complicated grief. J Clin Psychiatry. 2006;67(2):233–9.

    Article  PubMed  Google Scholar 

  45. de Groot M, Kollen BJ. Course of bereavement over 8-10 years in first degree relatives and spouses of people who committed suicide: longitudinal community based cohort study. BMJ. 2013;347:f5519. https://doi.org/10.1136/bmj.f5519.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Kristensen P, Weisaeth L, Heir T. Bereavement and mental health after sudden and violent losses: a review. Psychiatry. 2012;75(1):76–97. https://doi.org/10.1521/psyc.2012.75.1.76.

    Article  PubMed  Google Scholar 

  47. Lobb EA, Kristjanson LJ, Aoun SM, Monterosso L, Halkett GK, Davies A. Predictors of complicated grief: a systematic review of empirical studies. Death Stud. 2010;34(8):673–98. https://doi.org/10.1080/07481187.2010.496686.

    Article  PubMed  Google Scholar 

  48. Mitchell AM, Kim Y, Prigerson HG, Mortimer-Stephens M. Complicated grief in survivors of suicide. Crisis. 2004;25(1):12–8. https://doi.org/10.1027/0227-5910.25.1.12.

    Article  PubMed  Google Scholar 

  49. Shear MK, Simon N, Wall M, Zisook S, Neimeyer R, Duan N, et al. Complicated grief and related bereavement issues for DSM-5. Depress Anxiety. 2011;28(2):103–17. https://doi.org/10.1002/da.20780.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Kersting A, Brähler E, Glaesmer H, Wagner B. Prevalence of complicated grief in a representative population-based sample. J Affect Disord. 2011;131(1):339–43.

    Article  PubMed  Google Scholar 

  51. Feigelman W, Jordan JR, Gorman BS. How they died, time since loss, and bereavement outcomes. Omega (Westport). 2008;58(4):251–73.

    Article  Google Scholar 

  52. Melhem NM, Day N, Shear MK, Day R, Reynolds CF 3rd, Brent D. Traumatic grief among adolescents exposed to a peer’s suicide. Am J Psychiatry. 2004;161(8):1411–6. https://doi.org/10.1176/appi.ajp.161.8.1411.

    Article  PubMed  Google Scholar 

  53. Shear MK, Reynolds CF 3rd, Simon NM, Zisook S, Wang Y, Mauro C, et al. Optimizing treatment of complicated grief: a randomized clinical trial. JAMA Psychiat. 2016;73(7):685–94. https://doi.org/10.1001/jamapsychiatry.2016.0892.

    Article  Google Scholar 

  54. McDaid C, Trowman R, Golder S, Hawton K, Sowden A. Interventions for people bereaved through suicide: systematic review. Br J Psychiatry. 2008;193(6):438–43. https://doi.org/10.1192/bjp.bp.107.040824.

    Article  PubMed  Google Scholar 

  55. Sakinofsky I. The aftermath of suicide: managing survivors' bereavement. Can J Psychiatr. 2007;52(6 Suppl 1):129S–36S.

    Google Scholar 

  56. McMenamy JM, Jordan JR, Mitchell AM. What do suicide survivors tell us they need? Results of a pilot study. Suicide Life Threat Behav. 2008;38(4):375–89. https://doi.org/10.1521/suli.2008.38.4.375.

    Article  PubMed  Google Scholar 

  57. Cerel J, Padgett JH, Conwell Y, Reed GA. A call for research: the need to better understand the impact of support groups for suicide survivors. Suicide Life Threat Behav. 2009;39(3):269–81. https://doi.org/10.1521/suli.2009.39.3.269.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Zisook S, Pies R, Iglewicz A. Grief, depression, and the DSM-5. J Psychiatr Pract. 2013;19(5):386–96. https://doi.org/10.1097/01.pra.0000435037.91049.2f.

    Article  PubMed  Google Scholar 

  59. Iglewicz A, Seay K, Zetumer SD, Zisook S. The removal of the bereavement exclusion in the DSM-5: exploring the evidence. Curr Psychiatry Rep. 2013;15(11):413. https://doi.org/10.1007/s11920-013-0413-0.

    Article  PubMed  Google Scholar 

  60. Hensley PL, Slonimski CK, Uhlenhuth EH, Clayton PJ. Escitalopram: an open-label study of bereavement-related depression and grief. J Affect Disord. 2009;113(1–2):142–9. https://doi.org/10.1016/j.jad.2008.05.016.

    Article  CAS  PubMed  Google Scholar 

  61. Simon NM, Shear MK, Fagiolini A, Frank E, Zalta A, Thompson EH, et al. Impact of concurrent naturalistic pharmacotherapy on psychotherapy of complicated grief. Psychiatry Res. 2008;159(1–2):31–6. https://doi.org/10.1016/j.psychres.2007.05.011.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Simon NM, Thompson EH, Pollack MH, Shear MK. Complicated grief: a case series using escitalopram. Am J Psychiatry. 2007;164(11):1760–1. https://doi.org/10.1176/appi.ajp.2007.07050800.

    Article  PubMed  Google Scholar 

  63. Reynolds CF III, Miller MD, Pasternak RE, Frank E, Perel JM, Cornes C, et al. Treatment of bereavement-related major depressive episodes in later life: a controlled study of acute and continuation treatment with nortriptyline and interpersonal psychotherapy. Am J Psychiatry. 1999;156(2):202–8.

    PubMed  Google Scholar 

  64. American Psychiatric Association. American Psychiatric Association Practice Guidelines. http://psychiatryonline.org/guidelines. 2010. Accessed 29 Mar 2017.

  65. Jordan JR, McMenamy J. Interventions for suicide survivors: a review of the literature. Suicide Life Threat Behav. 2004;34(4):337–49. https://doi.org/10.1521/suli.34.4.337.53742.

    Article  PubMed  Google Scholar 

  66. Shear K, Frank E, Houck PR, Reynolds CF. Treatment of complicated grief: a randomized controlled trial. JAMA. 2005;293(21):2601–8.

    Article  CAS  PubMed  Google Scholar 

  67. Shear MK, Wang Y, Skritskaya N, Duan N, Mauro C, Ghesquiere A. Treatment of complicated grief in elderly persons: a randomized clinical trial. JAMA Psychiat. 2014;71(11):1287–95. https://doi.org/10.1001/jamapsychiatry.2014.1242.

    Article  Google Scholar 

  68. Wittouck C, Van Autreve S, De Jaegere E, Portzky G, van Heeringen K. The prevention and treatment of complicated grief: a meta-analysis. Clin Psychol Rev. 2011;31(1):69–78. https://doi.org/10.1016/j.cpr.2010.09.005.

    Article  PubMed  Google Scholar 

  69. Shear MK. Clinical practice. Complicated grief. N Engl J Med. 2015;372(2):153–60. https://doi.org/10.1056/NEJMcp1315618.

    Article  CAS  PubMed  Google Scholar 

  70. Boelen PA, de Keijser J, van den Hout MA, van den Bout J. Treatment of complicated grief: a comparison between cognitive-behavioral therapy and supportive counseling. J Consult Clin Psychol. 2007;75(2):277–84. https://doi.org/10.1037/0022-006X.75.2.277.

    Article  PubMed  Google Scholar 

  71. Wagner B, Knaevelsrud C, Maercker A. Internet-based cognitive-behavioral therapy for complicated grief: a randomized controlled trial. Death Stud. 2006;30(5):429–53. https://doi.org/10.1080/07481180600614385.

    Article  PubMed  Google Scholar 

  72. Piper WE, McCallum M, Joyce AS, Rosie JS, Ogrodniczuk JS. Patient personality and time-limited group psychotherapy for complicated grief. Int J Group Psychother. 2001;51(4):525–52.

    Article  CAS  PubMed  Google Scholar 

  73. Piper WE, Ogrodniczuk JS, Joyce AS, Weideman R, Rosie JS. Group composition and group therapy for complicated grief. J Consult Clin Psychol. 2007;75(1):116–25. https://doi.org/10.1037/0022-006x.75.1.116.

    Article  PubMed  Google Scholar 

  74. Zisook S, Shuchter SR, Pedrelli P, Sable J, Deaciuc SC. Bupropion sustained release for bereavement: results of an open trial. J Clin Psychiatry. 2001;62(4):227–30.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alana Iglewicz M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Science+Business Media LLC

About this chapter

Cite this chapter

Iglewicz, A., Tal, I., Zisook, S. (2018). Grief Reactions in the Suicide Bereaved. In: Bui, E. (eds) Clinical Handbook of Bereavement and Grief Reactions . Current Clinical Psychiatry. Humana Press, Cham. https://doi.org/10.1007/978-3-319-65241-2_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-65241-2_7

  • Published:

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-65240-5

  • Online ISBN: 978-3-319-65241-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics