Health outcomes following suicide bereavement

A systematic review published today in BMC Public Health finds that those bereaved by suicide may closely resemble people bereaved by other causes of death. Author Ailbhe Spillane looks at why it is important to examine health outcomes following a suicide and discusses the study findings.

Bereavement is something that most people will experience at some point in their lives. Grief responses to bereavement include shock, sadness, despair, disbelief, guilt and longing for the deceased. These grief reactions are often coupled with adverse physical, psychosomatic and mental health outcomes, including headaches, pain and dizziness.

Individuals bereaved by suicide can experience any or all of these grief reactions but may also experience reactions that are unique to suicide bereavement. Reactions to suicide bereavement include feelings of abandonment and anger towards the deceased. They may also experience trauma as a result of finding the body of their loved one. If grieving is prolonged and is not processed adequately by an individual, this may lead to complicated grief which is characterized by intense suffering.

Due to the potential for suicide bereavement to be a unique experience, it is important to examine possible psychosomatic and physical health outcomes following a suicide. We conducted the first systematic review to synthesise 24 quantitative published research articles that compared physical or psychosomatic health outcomes in individuals who experienced suicide bereavement to outcomes in those bereaved by other causes of death.

Five articles found that family members bereaved by suicide had a higher risk of adverse health outcomes, including cardiovascular disease, chronic obstructive pulmonary disease, hypertension and diabetes. They also had poorer general health, and they experienced more physical pain and physical illnesses than those bereaved by a non-suicide death.

Interestingly, two further studies found that suicide bereavement was associated with lower risk of a number of health concerns. People bereaved by suicide had a lower risk of cancers, diabetes, cardiovascular and chronic lower respiratory tract disorders compared to those bereaved by other causes of death. Suicide-bereaved children also didn’t go to a GP as often as non-suicide bereaved children.

So, are those who experience suicide bereavement different to those bereaved by other causes of death? The answer is both yes and no. No study found a significant association for an increase in psychosomatic health outcomes following suicide bereavement, which appears to show that the two groups are similar in this respect.

People bereaved by non-suicide deaths often experience similar emotions to those bereaved by suicide but reactions such as shame, stigma, responsibility and guilt are more pronounced in the latter group. Our study provides some evidence to suggest that people bereaved by suicide have worse physical health outcomes compared to those bereaved by non-suicide deaths.

To what extent are these results relevant for clinicians and researchers? We know that shame and stigma often experienced by the suicide-bereaved, negatively impacts on people’s help-seeking ability. It is important then for health professionals and researchers to be aware that reduced help-seeking together with the increased risk of adverse outcomes, makes people bereaved by suicide an additionally vulnerable group.

The study findings also underline the need for a more pro-active approach by health professionals to assess both mental health and physical health symptoms in the aftermath of a death by suicide.

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