The loss of a person to suicide touches friends, family, and other loved ones who must grapple with a host of emotions in the wake of tragic loss. The pain of suicide bereavement can ripple through personal relationships and affect the emotional health of the community of the individual who was lost. Levi-Belz and colleagues reviewed studies showing that every suicide affects an average of five family members and up to 135 community members. Understanding the impact on those left in the wake of suicide highlights the importance for all behavioral health professionals to develop sound policies and procedures to care for individuals who are at risk for suicide.
National Studies of Bereavement From Suicide
A large body of data has found that compared to other bereaved individuals and the general population, suicide-loss survivors are at greater risk for many severe mental health problems. In a large national survey in the United Kingdom, McDonnell and colleagues reported that 77% of survey participants reported a significant impact on their lives. High rates of mental health issues (37%) and physical health problems (22%) were reported, including anxiety, depression, and posttraumatic stress. Suicidal ideation was reported by 38%, and 8% attempted suicide following the loss of a loved one to suicide. Over one-third of the survey participants experienced adverse life events such as financial difficulties and the dissolution of family and other relationships and financial difficulties. A significant number of survey participants engaged in high-risk behaviors such as substance misuse and impulsive financial or sexual behaviors during and after their bereavement.
Suicide Bereavement and Complicated Grief
Research has also shown that bereavement from suicide loss can lead to complicated grief. Complicated grief is a prolonged and intense form of grief that can hinder the mourning process and impair an individual’s functioning and quality of life. In a review titled Suicide Bereavement and Complicated Grief, Young et al. explored the unique challenges faced by individuals who have lost loved ones to suicide, emphasizing the higher risk of developing complicated grief (CG) compared to other types of bereavement. They noted that survivors can experience overwhelming feelings of guilt, confusion, rejection, shame, anger, and trauma. Survivors can face societal stigma, inhibiting their ability to openly discuss their loss, which can impede healing.
Mental Health Effects of Suicide Bereavement
In The Relationship Between Guilt, Depression, Prolonged Grief, and Posttraumatic Stress Symptoms After Suicide Bereavement, Wagner et al. investigated how guilt interacts with symptoms of depression, prolonged grief, and posttraumatic anxiety in people who have experienced suicide bereavement. Their study used cross-sectional data from 154 participants in Germany, examining the moderating role of guilt in relation to the time since the loss. Key findings were that guilt related to bereavement from suicide loss significantly correlated with depression, prolonged grief, and posttraumatic anxiety.
Physical Effects From Suicide Bereavement
There is a large body of literature showing that relative to other bereaved individuals and the general population, suicide-loss survivors are at increased risk for medical health problems. In a study conducted in Ireland, Spillane et al. explored the physical effects of suicide bereavement on family members using a mixed-methods approach. Participants reported physical symptoms such as nausea, chest pain, and insomnia, while nearly one-quarter endorsed symptoms of depression, 18% endorsed anxiety, and 27% posttraumatic stress. They noted that psychological stress can impact the immune system, contributing to gastrointestinal symptoms, headaches, and sometimes heart disease.
Family Dynamics
Other studies have focused on family dynamics in the context of suicide bereavement. Creuze and colleagues investigated the impact of suicide bereavement within families with a focus on emotional, relational, and communication dynamics following the loss of a family member to suicide. Sixteen family members who lost a close relative to suicide were interviewed. These interviews highlighted the family trauma associated with the loss. Families reported logistical and financial challenges, stress from police investigations around the death of their loved one, and societal stigma. The study indicated that fear of further suicides within the family and difficulty forming new relationships outside the family were prevalent. Pre-existing family dynamics – both positive and negative – were often amplified.
In Experiences of Parental Suicide-Bereavement: A Longitudinal Qualitative Analysis Over Two Years, Entilli and colleagues conducted interviews over a two-year period of parents who lost a child to suicide. They found that parents often shifted their focus from intense anger to blame and more reflecting reasoning. Some parents moved toward acceptance, while others struggled with depression and rumination over the loss. Some families exhibited maladaptive coping, such as avoidance and excessive working, while some engaged in more adaptive strategies, such as self-care and routine memorialization of their child. While some continued to face challenges in making sense of the loss in their recovery, some began to find meaning and purpose in the loss of their child, showing resilience and personal growth. Patterns of gender differences were noted, with fathers leaning toward restoration-oriented activity (activity-oriented) while mothers exhibited a loss-oriented approach and expressed grief more openly. Some parents in this study were able to reframe their experience as an opportunity for growth, adopting positive lifestyle changes, while others highlighted the variable trajectory of grief.
Adolescents Affected by Suicide Loss
Qualitative studies have shown that a suicide event can be particularly distressing for adolescent peers of the affected individual. Andriessen and colleagues investigated the impact of suicide on adolescents through interviews, exploring how suicide deaths shaped adolescent experiences. They found that bereaved adolescents often experience profound loneliness compared to peers who have not experienced the loss of a friend to suicide. Bereaved adolescents interviewed in the study reported engaging in risky behaviors while their parents struggled to provide sufficient emotional support. The group noted that some adolescents reported personal growth stemming from their process of bereavement, albeit with emotional costs.
Del Carpio and colleagues did a systematic review studying the impact of suicide bereavement in adolescents aged 12 – 18, studying key differences between bereavement by suicide compared to other types of bereavement. They noted that adolescents experiencing suicide bereavement have a higher risk of suicide mortality themselves, especially following the suicide of a parent. They found that maternal suicides presented a particularly elevated risk relative to parental suicides or non-suicide parental deaths. Earlier experiences of loss and shorter timeframes since bereavement were identified as significant factors elevating risk among adolescents.
Older Adults Affected by Suicide Loss
Other suicidologists have studied bereavement by the suicide of older adults later in life. Hafford-Letchfield et al. reported that older individuals bereaved by suicide can also experience intense guilt, shame, and stigma related to traumatic loss. Suicide bereavement among older adults differs from that of younger individuals in that they are more likely to reflect on their own aging and mortality in the context of the loss, expressing concerns about future dependencies and social isolation. Their study highlighted the need for targeted support for this group, including psychosocial interventions and training for professionals to improve their ability to address the unique needs of older bereaved individuals. They also noted that peer support networks play a significant role in the healing of older adults bereaved by suicide.
Spirituality and Religion as a Coping Mechanism
Čepulienė and Skruibis explored the role of spirituality and religion in the process of suicide bereavement. They offered that spirituality serves as an important resource during grief, contributing to the “meaning making” and providing emotional strength during suicide bereavement. Tools such as personal rituals, religious practices, and spiritual beliefs can help individuals process their loss and maintain a connection with the deceased. However, they note that spirituality can also complicate the grieving process, leading to feelings of guilt, stigmatization, or spiritual crisis, raising existential questions and inviting societal judgments around suicide. They emphasize the importance of a tailored approach from religious practitioners who are assisting the bereaved, pointing out the dual role of spirituality, which can offer solace while potentially introducing complications in the bereavement process.
Post-Vention in Suicide Bereavement
There is a significant body of literature on the provision of “post-vention” support for those grieving from a loss to suicide. In a national, cross-sectional survey of young adults in the United Kingdom, Pitman and colleagues interviewed young adults who experienced sudden loss of close contact to suicide. They found that 25% of suicide-bereaved individuals received no formal or informal support, highlighting a gap in care. The stigma surrounding suicide contributed to reduced support, both regarding seeking and receiving help. When bereaved individuals relied on formal support through health services, they often faced delays in accessing help. They suggested the development of national outreach systems to provide immediate, tailored support for individuals bereaved by suicide.
Conclusion
The ripple effect of suicide-affected individuals and their families and friends is a powerful reminder of the imperative for mental health professionals to develop clear plans for how to manage suicide risk in their work with clients – whether they are providing services to individuals in solo practice, as part of a group practice or a larger hospital system or behavioral health agency. All mental health professionals must become facile and comfortable asking questions about suicide risk, recognizing warning size, and connecting those at risk with the appropriate level of mental health services to reduce suicide incidence. And for those who have lost a family member or friend to suicide, sharing their stories can foster a community where seeking help is de-stigmatized, normalized, and welcomed.
The aftermath of suicide touches the lives of everyone who knew the individual affected by the event, far beyond the nuclear family of the deceased. There is no one-size-fits-all in the journey to healing. In addressing the ripple effect of suicide loss, mental health professionals can offer both individual and systems-level support to survivors.
Glen P. Davis, MD, is Chief Medical Officer at Institute for Community Living.
References
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