Abstract
ObjectiveTo test the hypothesis that perceived stigma scores in young adults bereaved by suicide are significantly higher than in young adults bereaved by other sudden deaths, whether blood-related to the deceased or not. MethodsWe conducted a cross-sectional study of all staff and students aged 18–40 at 37 UK higher educational institutions in 2010, and identified 3432 respondents who had experienced a sudden bereavement of a close contact since reaching the age of 10, either due to sudden natural causes, sudden unnatural causes, or suicide. We used multivariable regression to compare scores on the stigma, shame, responsibility and guilt subscales of the Grief Experience Questionnaire, adjusting for socio-demographic factors and pre-bereavement psychopathology. ResultsPeople bereaved by suicide (n=614) had higher stigma scores than people bereaved by sudden natural death (n=2106; adjusted coefficient=2.52; 95% CI=2.13–2.90; p=<0.001) and people bereaved by sudden unnatural death (n=712; adjusted coefficient=1.69; 95% CI=1.25–2.13; p=<0.001). Shame, responsibility and guilt scores were also significantly higher in people bereaved by suicide, whether compared with bereavement by sudden natural death or sudden unnatural death. Associations were not modified by whether the bereaved was blood-related to the deceased or not. ConclusionsStigma was perceived more acutely by the relatives and friends of those who died by suicide than those bereaved by other causes of sudden natural or sudden unnatural death. Their high levels of perceived stigma, shame, responsibility and guilt require qualitative investigation to identify whether these grief dimensions limit social functioning, help-seeking behaviour and/or support offered.
Highlights
Supporting people bereaved by suicide is a key objective of many international suicide prevention strategies [1,2], and this group are known to have an increased risk of suicide, depression, and psychiatric admission compared with people bereaved by other mortality causes [3]
To begin to understand the role of stigma after sudden death, we need to start by confirming whether the degree of stigma associated with suicide bereavement exceeds that associated with other losses [3]
In the largest study measuring stigma after sudden loss, people bereaved by suicide had the highest levels of perceived stigma, shame, responsibility and guilt, whether compared with people bereaved by sudden unnatural death or those bereaved by sudden natural death
Summary
Supporting people bereaved by suicide is a key objective of many international suicide prevention strategies [1,2], and this group are known to have an increased risk of suicide, depression, and psychiatric admission compared with people bereaved by other mortality causes [3]. UK evidence shows that the risk of suicide attempt applies whether blood-related to the deceased or not [4], indicating that explanations for these adverse outcomes lie beyond familial factors. Identifying explanatory factors is a key step in designing suicide prevention interventions targeted at people bereaved by suicide, but as yet our understanding of these mechanisms remains theoretical. There is tentative evidence for its contribution to explaining adverse outcomes in people bereaved by suicide [4]. Stigmatising attitudes are not unique to suicide, and may be directed at people bereaved by accidental deaths [7] or preventable natural causes [8] for their links with someone judged to have exhibited risky health behaviour. To begin to understand the role of stigma after sudden death, we need to start by confirming whether the degree of stigma associated with suicide bereavement exceeds that associated with other losses [3]
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