Bereavement after a suicide
Grief after someone has taken their own life. It carries what most grief carries and often more: the question of why, guilt about missed signs, anger at the person, and a silence or stigma from others that leaves the bereaved alone with it.
What drives it
The death leaves a question the person who died can no longer answer, so the mind keeps asking it. Useful for identification because people bereaved by suicide are themselves at raised risk, and naming this kind of loss makes it easier to notice when grief starts to carry thoughts of one’s own death.
How it shows
Work
Telling colleagues the death was ‘sudden’ and leaving it there. Going back to work within days and then being unable to open an email about a mental health awareness week.
Relationships
Family members holding different stories of why, and never comparing them. Friends who stop calling because they don’t know what to say, and a person who feels judged in every room.
Self
Notice the hours spent on why: rereading the last messages, searching for a sign that was missed. Notice too whether thoughts of not wanting to be here have come in with the grief.
What tells it apart
Traumatic grief after a sudden or violent death: Traumatic grief covers any sudden or violent death and centers on shock and the images of how it happened. Suicide bereavement may carry those too, and more likely adds the question of why, a sense of rejection and stigma.
Bereavement guilt and regret (Li and Stroebe): Guilt scores run higher after suicide than after long illness (Li and colleagues, 2017). When the guilt is about missed signs it may be both, and hindsight may make the signs look clearer than they were.
Warning signs of suicide risk and self-harm: Suicide bereavement is grief for someone else. If the bereaved person starts talking about wanting to die, feeling a burden or making plans, that is more likely a warning sign about them, and the warning signs entry applies.
A test
Ask whether the grief keeps circling the question of why and who could have known. If it does, and people around the person have gone quiet, the manner of the death may be shaping the grief as much as the loss itself.
Questions to carry
- Which question about their death do I keep going back to?
- Who have I stopped telling how I really am since they died?
Go deeper
- Read: The Other Side of Sadness, George A. Bonanno, 2009, revised 2019. Written for readers by a psychologist who has followed bereaved people for years. He questions the idea that grief moves through set stages and argues that most people come through a loss with more resilience than expected. Much of it rests on his own group's studies.
How strong the research is
moderate. A review of 56 studies (Pitman, Osborn, King and Erlangsen, Lancet Psychiatry, 2014) found a higher risk of suicide in partners after a partner’s suicide and in mothers after an adult child’s suicide, compared with people bereaved by other causes, and more admissions for depression in children after a parent’s suicide. Many other comparisons showed no difference, and many studies were small or unadjusted. In 3,432 bereaved young adults in the UK (Pitman and colleagues, BMJ Open, 2016), those bereaved by suicide were more likely to have made a suicide attempt than those bereaved by sudden natural death (adjusted odds ratio 1.65), whether or not they were related to the person. The difference with sudden unnatural death was not significant, and the link lost significance once perceived stigma was added. A telephone survey of 1,736 adults (Cerel and colleagues, 2019) estimated that 135 people knew each person who died by suicide.
Where it comes from
Edwin Shneidman, 1972 (postvention, the support that follows a suicide). Alexandra Pitman, David Osborn, Michael King and Annette Erlangsen, 2014. Julie Cerel and colleagues, How many people are exposed to suicide? Not six, 2019