Suicide bereavement and risk for suicide attempt: a national cross-sectional survey of young adults

Abstract

BackgroundProvision of support to people bereaved by suicide has become a key priority for suicide prevention strategies in the UK and many other developed countries. Stigma, social modelling, depression, heritability, and other factors are thought to increase this group's risk of suicidality. Few studies have described the nature or magnitude of the effects of suicide bereavement on family, friends, and other contacts, or assessed the effectiveness of post-bereavement support. We tested the hypothesis that young adults bereaved by the suicide of a close contact have an increased risk of suicidal thoughts and suicide attempts and poorer social functioning than those bereaved by other causes of sudden death. MethodsWe used a sample of 635 000 staff and students on the email distribution lists of 37 UK higher education institutions in 2010. Via mass email, we invited adults who had experienced a sudden bereavement to complete an online survey measuring outcomes relating to suicidal thoughts, suicide attempts, and social functioning. Inclusion criteria were current age 18–40 years, and sudden bereavement of a close contact since the age of 10 years. Multiple regression was used to compare those bereaved by suicide, those bereaved by accidental death, and those bereaved by sudden natural death (the baseline group), adjusting for covariates chosen a priori: age, sex, social class, family history of suicide (excluding an index suicide), past psychological problems, and kinship to the deceased (non-relative vs blood relative). FindingsOf 3685 bereaved adults (from 4631 consenting to participate), 658 had been bereaved by suicide, 761 by sudden accidental death, and 2266 by sudden death due to natural causes. 20% were male. Because the denominator for the population of people exposed to sudden bereavement could not be estimated reliably, calculation of a response rate was not possible. Multiple logistic regression showed a non-significant excess risk of suicidal ideation (odds ratio 1·10, 95% CI 0·87–1·40) and a significant excess risk of suicide attempt (1·63, 1·06–2·50) in the group bereaved by suicide. No statistically significant interactions were found between type of bereavement and kinship to the deceased. InterpretationOur findings suggest that young adults who have been exposed to suicide bereavement might be at increased risk of suicide attempts and poor social functioning compared with young adults bereaved by other causes of sudden death, whether or not they were related to the deceased. Clinically, this finding suggests that inquiring about a history of suicide in unrelated close contacts should be added to family history of suicide within routine psychosocial assessments. From a public health policy perspective the findings confirm that this population of young adults is vulnerable to suicidal behaviour. Further work is needed to identify the nature and effectiveness of the support needed for this group. FundingUK Medical Research Council.