Support received after bereavement by suicide and other sudden deaths: a cross-sectional UK study of 3432 young bereaved adults

Abstract

ObjectiveTo test the hypothesis that people bereaved by suicide are less likely to receive formal or informal support than people bereaved by other causes of sudden death.DesignNational cross-sectional study.SettingAdults working or studying at any UK higher education institution (HEI) in 2010.ParticipantsA total of 3432 eligible respondents aged 18–40 years bereaved by the sudden death of a close friend or relative, sampled from approximately 659 572 bereaved and non-bereaved staff and students at 37 of 164 UK HEIs invited to participate.ExposuresBereavement by suicide (n=614; 18%), by sudden unnatural causes (n=712; 21%) and by sudden natural causes (n=2106; 61%).Main outcome measuresReceipt of formal and informal support postbereavement; timing of valued support.Results21% (725/3432) of our sample of bereaved adults reported receiving no formal or informal bereavement support, with no evidence for group differences. People bereaved by suicide were less likely to have received informal support than those bereaved by sudden natural causes (adjusted OR (AOR)=0.79; 95% CI 0.64 to 0.98) or unnatural causes (AOR=0.74; 95% CI 0.58 to 0.96) but did not differ from either comparison group on receipt of formal support. People bereaved by suicide were less likely to have received immediate support (AOR=0.73; 95% CI 0.59 to 0.90) and more likely to report delayed receipt of support (AOR=1.33; 95% CI 1.08 to 1.64) than people bereaved by sudden natural causes. Associations were not modified by gender, or age bereaved, but became non-significant when adjusting for stigma.ConclusionsPeople bereaved by suicide are less likely to receive informal support than people bereaved by other causes of sudden death and are more likely to perceive delays in accessing any support. This is concerning given their higher risk of suicide attempt and the recommendations within suicide prevention strategies regarding their need for support.Study registration http://www.ucl.ac.uk/psychiatry/bereavementstudy/

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

“…As this was a cross-sectional study, it was not possible to ascertain the temporal sequence of outcomes, including whether suicidal behaviour following bereavement had preceded the awareness of stigma, or of lack of support. However, quantitative [43] and qualitative [44] studies identify perceptions of a lack of support immediately after a sudden death. …”

Perceptions of the Use of Alcohol and Drugs after Sudden Bereavement by Unnatural Causes: Analysis of Online Qualitative Data

“…Research shows that people bereaved by unnatural causes feel more stigmatised than those bereaved by natural causes [50], and that this stigma is implicated in adverse mental health outcomes [34]. The stigma of sudden bereavement is itself a risk factor for suicide attempt [51], with findings from qualitative [52] and quantitative [26] research suggest that this stigma can limit support from others [50]. By marketing support services to encourage young people bereaved by unnatural causes to access support for substance misuse and other difficulties, this stigma would be challenged whilst also encouraging help-seeking.…”

“…Across all age groups, mental health and mortality are similar in those bereaved by suicide and by accidental deaths [25], suggesting that it is the violence or unnatural nature of the loss that influences outcomes. The stigma associated with violent or unnatural deaths may also limit support available [26].…”

Addressing suicide risk in partners and relatives bereaved by suicide

“…In a British survey, people bereaved by suicide were less likely to report receiving informal support than bereaved controls, or to have received formal or informal support in the immediate aftermath. 8 Differences became non-significant when adjusting for perceived stigma. 8 Danish men bereaved by a partner's suicide were less likely to consult their general practitioner than bereaved controls, despite their greater likelihood of mental illness.…”

“…Despite these vulnerabilities, survey evidence shows that the suicide-bereaved are poorly supported by family and friends and may feel too ashamed or unworthy to ask for support. 8 The influence of stigma on help-seeking and on others' propensity to offer help may also contribute to suicide risk. In a British survey, people bereaved by suicide were less likely to report receiving informal support than bereaved controls, or to have received formal or informal support in the immediate aftermath.…”