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.
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References
American Foundation for Suicide Prevention. Suicide statistics. https://afsp.org/about-suicide/suicide-statistics/. 2017. Accessed 29 Mar 2017.
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.
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.
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.
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.
Feigelman W, Gorman BS, Jordan JR. Stigmatization and suicide bereavement. Death Stud. 2009;33(7):591–608. https://doi.org/10.1080/07481180902979973.
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.
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.
Zisook S, Shear K. Grief and bereavement: what psychiatrists need to know. World Psychiatry. 2009;8(2):67–74.
Jordan JR. Bereavement after Suicide. Psychiatr Ann. 2008;38(10):679–85.
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.
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.
Cvinar JG. Do suicide survivors suffer social stigma: a review of the literature. Perspect Psychiatr Care. 2005;41(1):14–21.
Jordan JR. Is suicide bereavement different? A reassessment of the literature. Suicide Life Threat Behav. 2001;31(1):91–102.
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.
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.
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.
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.
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.
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.
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.
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.
Callahan J. Predictors and correlates of bereavement in suicide support group participants. Suicide Life Threat Behav. 2000;30(2):104–24.
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.
Zisook S, Chentsova-Dutton Y, Shuchter SR. PTSD following bereavement. Ann Clin Psychiatry. 1998;10(4):157–63.
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.
Jordan JR, McIntosh JL. Grief after suicide: understanding the consequences and caring for the survivors. New York: Routledge; 2011.
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.
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.
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.
Krysinska KE. Loss by suicide. A risk factor for suicidal behavior. J Psychosoc Nurs Ment Health Serv. 2003;41(7):34–41.
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.
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.
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.
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.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). Arlington: American Psychiatric Pub; 2013.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Feigelman W, Jordan JR, Gorman BS. How they died, time since loss, and bereavement outcomes. Omega (Westport). 2008;58(4):251–73.
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.
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.
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.
Sakinofsky I. The aftermath of suicide: managing survivors' bereavement. Can J Psychiatr. 2007;52(6 Suppl 1):129S–36S.
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.
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.
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.
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.
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.
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.
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.
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.
American Psychiatric Association. American Psychiatric Association Practice Guidelines. http://psychiatryonline.org/guidelines. 2010. Accessed 29 Mar 2017.
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.
Shear K, Frank E, Houck PR, Reynolds CF. Treatment of complicated grief: a randomized controlled trial. JAMA. 2005;293(21):2601–8.
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.
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.
Shear MK. Clinical practice. Complicated grief. N Engl J Med. 2015;372(2):153–60. https://doi.org/10.1056/NEJMcp1315618.
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.
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.
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.
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.
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.
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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
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