Experiences of family members after a suicide

Journal of Family Practice, Oct, 1991 by Carol J. Van Dongen

Survivors of suicide, that is, the relatives and friends of the person who commits suicide, are generally viewed as a vulnerable population at high risk for suffering disturbances in physical and psychological functioning. A recent study by Van Dongen [1] explored the perceived life experiences of 35 adult survivors of suicide 3 to 9 months after the suicide death of a family member. An important, serendipitous finding from that research was that the family physician was repeatedly identified as the key individual to initiate follow-up care for persons bereaved through suicide. Subjects also reported, however, that many physicians failed to understand what the survivors were experiencing and seemed uncertain as to how to help the family members postsuicide.

Methods

Potential subjects were contacted by sending a letter to survivors identified through death certificates, a support organization for survivors of suicide, and through referrals from subjects already in the study. Few difficulties were encountered in obtaining subjects; more survivors volunteered to participate than could be included in the study. Subjects, described in more detail in the recent study, [1] included 25 women and 10 men, ranging in age from 25 to 68 years (mean, 41.7). Nearly half (n = 17) of the subjects were parents of the victim, five were adult children, eight were siblings, and five were spouses of the deceased. Subjects were related to 19 victims of suicide (16 male and 3 female) who ranged in age from 15 to 64 years (mean, 30). Twelve (63%) of the deceased had histories of drug or alcohol abuse, and eight (42%) of the victims had been diagnosed as having severe depression or schizophrenia. All but three of the subjects described their relationship with the deceased as having been close and positive.

Subjects participated in in-depth, audiotaped interviews that averaged 90 minutes in lenght and were conducted an average of 5.8 months postsuicide. All interviews were done with individual subjects, except in two instances when parents requested a joint session. The audiotapes were transcribed and analyzed through systematic methods of qualitative data analysis as described by Glaser and Strauss. [2]

Results

Survivors provided new insight into the nature of postsuicide bereavement, particularly that experienced during the early months after the death, and into what factors may result in variations among survivors' experiences. In addition to discussing how the death was currently affecting the lives of the subject and other family members and how it might continue to affect their lives in the future, a recurrent theme throughout the interviews was the question of why the suicide had occurred.

Emotional Responses

Subjects universally reported experiencing shock on discovering the boyd (n = 10) or being otherwise informed of the death (n = 25). They described being stunned and ovewhelmed with disbelief. Common emotional responses reported included the affective reactions associated with acute grief, such as crying and yearning for the deceased, as well as feelings of irritation, anger, depression, and guilt. Anger was reported by 31 (895) of the subjects and was most often directed toward the deceased, the mental health system, God, and the world in general. Anger may have been part of the questioning process, as survivors searched for a reason why the suicide had occurred, believing that someone or something must be to blame.

Depression was reported by 20 (57%) of the subjects. For 11 (31%) of the family members, the depression became even more severe 3 to 5 months postsuicide. Transient thoughts of suicide were reported by five (14%) subjects, and two (6%) subjects indicated that they had even thought of a suicide plan. When questioned by the researcher, however, these subjects denied current thoughts of suicide and noted that a deterrent to suicidal behavior was the awareness of how devastating another suicide would be for the family.

Twenty-one (60%) subjects described themselves as feeling some guilt related to the suicide. In general, feelings of guilt were evident through subjects questioning as to how they might have inadvertently contributed to the death and what they might have missed in terms of recognizing the victim's intent to die.

Physical Concerns

Nineteen (54%) subjects had been a physician (n = 17) or other health care professional (n = 2) for physical concerns; however, only 7 of the 19 said that the death was discussed during the health care visit. Survivors expected the physician to initiate the discussion, and when that did not occur, they were uncertain as to how to react. Several subjects described the physician as "hurried" and seemingly uninterested in their emotional concerns.

Survivors questioned how the suicide might affect their own future health as well as that of other family members. All subjects reported experiencing some physical symptoms that commonly accompany acute grief. Anorexia, chest discomfort, insomnia, and marked fatigue were the most common complaints. Sleep disturbances were especially troublesome, as survivors repeatedly awoke with thoughts and questions related to the suicide. Eleven (31%) survivors reported exacerbations of preexisting physical illnesses, such as ulcers and other gastrointestinal disorders, arthritis, asthma, cardiovascular conditions, and carcinoma. All subjects attributed their symptoms to stress associated with the suicide.