Why do individuals commit suicide?
Despite its prevalence, suicide remains highly stigmatized and survivors of suicide often suffer in silence in fear of being judged and criticized. This paper will first examine the prevalence of suicide, focusing on gender, culture, method, and mental illness. Further, this paper aims to explore the impact suicide has on parents, siblings, children, peers, spouses, attempters, and therapist survivors. A thorough examination of the areas of greatest difficulty each survivor group experiences will be done. Finally, a thorough review of treatment guidelines and efficacy will be explored. With these goals, the hope is to shape the therapist’s understanding of the suicide based upon the relationship to the victim of suicide, and guide treatment based upon the available evidence of treatment efficacy.
Based upon 2004 statistical data (Laughinrichsen-Rohling, Friend, & Powell, 2009) suicide was identified as the third leading cause of death among youth and young adults. Much research in the prevalence of suicide has been aimed at identifying gender, age, and socioeconomic status differences. Research consistently finds men demonstrate higher rates of suicide, while females are consistently more likely to make a suicide attempt (Spicer and Miller, 2000; Grucza, Pryzbeck, & Cloninger, 2005), which is sometimes identified as the gender paradox (Langhinrichsen-Rohling, Friend, and Powell, 2009). In addition, elderly individuals were found to attempt suicide at a lower rate, but due to significant use of lethal means, completed suicide at a high rate. Furthermore, attempters are more likely to be teenagers, young adults, women, and African American (Spicer and Miller, 2000).
Impact on survivors
Parents have been widely studied as suicide survivors. Many studies compare parents who are suicide-bereaved to those who are bereaved from homicides or accidents. Several studies found there was not a significant difference in emotional distress for type of bereavement, but shame seems to be a unique experience of suicide-bereaved parents. This unique factor may account for the difference in the way suicide survivors interact with the public (Murphy et al., 2003; Seguin, Lesage, Kiely, 1995; Demi 1988).
Further research has examined the interaction of suicide-bereaved parents and the social world. In qualitative analyses, parents stated they rarely felt permitted to talk about the deceased, and expressed a desire to share experiences but felt unable to do so publicly. In addition, parents reported regularly monitoring their conversations based upon the comfort of others, leading to isolation which is present more in the suicide-bereaved parents than other forms of loss (Maple, Edwards, & Plummer, 2010).
Parental suicide survivors also are more apt to blame themselves for actions either taken or overlooked and often felt powerless over the situation. Blaming was found to be endemic in the families of suicide, where the child was viewed as an innocent victim in the incident. Furthermore, the parents of suicide victims expressed a need to reconstruct their lives through an extensive period of self-examination and self-exculpation (Tornblom, Werbat, & Ryedelius, 2013; Owens et al., 2008).
For therapists, encouragement to share their experiences may be a way to alleviate the shame and guilt expressed throughout the research. The acknowledgment of significant emotions of guilt, blame, anger, and shame needs to be at the forefront and addressed in the therapeutic relationship. In addition, existential processes aimed at allowing exploration of blame and the self may prove to be a significant factor in a parent’s ability to move on and live a meaningful life after a child’s suicide.
While shame and guilt colored parents’ experiences, the siblings of suicide victims present a different challenge for therapists. It is first important to note there was found to be a seven-time increase in depression in siblings of suicide victims and 43 percent of the depressed siblings showed significant suicidal ideation (Brent et al., 1993). Dyregrov and Dyregrov (2003) and Dyregrov et al. (2015) took a deeper look into the impact of sibling suicide. They found that younger siblings living at home experienced the most difficulties in the aftermath of the suicide. This was hypothesized to be the result of a closer relationship to the then bereaved parents.
In addition, siblings have a great difficulty expressing grief, and may have challenges in communicating knowledge for fear of breaking the confidentiality of the deceased sibling. Furthermore, siblings were found to be overlooked often because of a greater focus on parents, and because parents cut off communication to protect the surviving child from information. However, this severing of communication was found to result in an experience of isolation, and did not protect the siblings from developing psychological symptoms (Dyregrov & Dyregrov, 2005; Dyregrov et al., 2015).
The challenge for therapists in addressing siblings of suicide victims is uncovered in the work of Powell and Matthews (2013) and Dyregrov et al. (2015); they found most siblings reported needing professional help to overcome the grief experienced. However, their perception of health care providers may have been negatively colored by their sibling’s negative experiences.
In addition, siblings often view therapists as incompetent if they do not directly address the suicide, instead focusing on the resulting emotions. Therapists should create an empathetic dialogue allowing venting, grief, and hostility, and should assess for fears for personal risk or for more suicides in the family. In addition, siblings often need immediate and repeated contact despite hesitation to openly seek treatment (Powell & Matthews, 2013).
Transmission of suicidal behavior is noted in the literature as one of the greatest threats to children of suicide victims. In fact, Hung and Rabin (2009) found children of suicide victims were two and a half times more likely to report suicidal ideation, and six and one half times more likely to attempt suicide than control groups.
In addition to increased suicidal behavior, a significant increase in psychological disturbance was found across research including higher levels of depression, increased social maladjustment, and post-traumatic stress disorder (Pfeffer et al., 2000; Ratnarajah & Schofield, 2007; Sethi & Bhargava, 2003). A correlation was identified between mania and parental suicide. In addition, children who found the bodies of the deceased parent were significantly more like to develop post-traumatic stress disorder and major depressive disorder (Hung & Rabin, 2009; Sethi & Bhargava, 2003).
For therapists, these findings can guide treatment and direction by providing knowledge of what the child is likely to be experiencing, as children often have difficulty in identifying their current emotional experiences. In addition, based upon the research demonstrating the impact of the surviving parent on future adjustment, gauging the family interaction and functioning pre-suicide, and the parental involvement following the suicide becomes an important part of treatment. The potential for family sessions focusing on parent interaction skills and emphasizing the need for emotional support and being available to reduce secondary loss may be a significant factor in minimizing future maladjustment.
Buus, N., Caspersen, J., Hansen, R., Stenager, E., & Fleischer, E. (2014). Experiences of parents whose sons or daughters have (had) attempted suicide. Journal of Advanced Nursing, 70(4), 823–832.. http://doi.org/10.1111/jan.12243
Dane, B. O. (1991). Counselling bereaved middle aged children: Parental suicide survivors. Clinical Social Work Journal, 19(1), 35–48. http://doi.org/10.1007/BF00759115
Dyregrov, K., & Dyregrov, A. (2005). Siblings after suicide — “the forgotten bereaved.” Suicide & Life-Threatening Behavior, 35(6), 714–724. http://doi.org/10.1521/suli.2005.35.6.714.
Grucza, R. A., Przybeck, T. R., & Cloninger, C. R. (2005). Personality as a mediator of demographic risk factors for suicide attempts in a community sample. Comprehensive Psychiatry, 46(3), 214–222. http://doi.org/10.1016/j.comppsych.2004.08.006
Hung, N. C., & Rabin, L. A. (2009). Comprehending childhood bereavement by parental suicide: a critical review of research on outcomes, grief processes, and interventions. Death Studies (Vol. 33). http://doi.org/10.1080/07481180903142357
Langhinrichsen-Rohling, J., Friend, J., & Powell, A. (2009). Adolescent suicide, gender, and culture: A rate and risk factor analysis. Aggression and Violent Behavior, 14(5), 402–414. http://doi.org/10.1016/j.avb.2009.06.010
Maple, M., Edwards, H., Plummer, D., & Minichiello, V. (2010). Silenced voices: Hearing the stories of parents bereaved through the suicide death of a young adult child. Health and Social Care in the Community, 18(3), 241–248. http://doi.org/10.1111/j.1365-2524.2009.00886.x
Murphy, S. A., Clark Johnson, L., Wu, L., Fan, J. J., & Lohan, J. (2003). Bereaved Parents’ Outcomes 4 To 60 Months After Their Children’s Deaths By Accident, Suicide, or Homicide: a Comparative Study Demonstrating Differences. Death Studies, 27(1), 39–61. http://doi.org/10.1080/07481180302871
Owens, C., Lambert, H., Lloyd, K., & Donovan, J. (2008). Tales of biographical disintegration: How parents make sense of their sons’ suicides. Sociology of Health and Illness, 30(2), 237–254. http://doi.org/10.1111/j.1467-9566.2007.01034.x
Pfeffer, C. R., Karus, D., Siegel, K., & Jiang, H. (2000). Child survivors of parental death from cancer or suicide: Depressive and behavioral outcomes. Psycho-Oncology, 9(1), 1–10. http://doi.org/10.1002/(SICI)1099-1611(200001/02)9:1<1::AID-PON430>3.0.CO;2-5
Powell, K. A., & Matthys, A. (2013). Effects of Suicide on Siblings: Uncertainty and the Grief Process. Journal of Family Communication, 13(4), 321–339. http://doi.org/10.1080/15267431.2013.823431
Ratnarajah, D., & Schofield, M. J. (2008). Survivors’ Narratives of the Impact of Parental Suicide. Suicide & Life – Threatening Behavior, 38(5), 618–630. Retrieved from http://ezproxy.library.nyu.edu:2048/login?url=http://search.proquest.com/docview/224867106?accountid=12768 http://getit.library.nyu.edu/resolve?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&genre=article&sid=ProQ:ProQ:criminaljusticeperio
Ratnarajah, D., & Schofield, M. J. (2007). Parental suicide and its aftermath: A review. Journal of Family Studies, 13(1), 78–93. http://doi.org/http://dx.doi.org.erl.lib.byu.edu/10.5172/jfs.3220.127.116.11
Séguin, M., Lesage, A., & Kiely, M. C. (1995). Parental Bereavement After Suicide and Accident: A Comparative Study. Suicide and Life-Threatening Behavior, 25(4), 489–498. http://doi.org/10.1111/j.1943-278X.1995.tb00241.x
Sethi, S., & Bhargava, S. C. (2003). Child and adolescent survivors of suicide. Crisis, 24(1), 4–6. http://doi.org/10.1027//0227-5910.24.1.4
Spicer, R. S., & Miller, T. R. (2000). Suicide acts in 8 states: Incidence and case fatality rates by demographics and method. American Journal of Public Health, 90(12), 1885–1891. http://doi.org/10.2105/AJPH.90.12.1885
Törnblom, A. W., Werbart, A., & Rydelius, P.-A. (2013). Shame behind the masks: the parents’ perspective on their sons’ suicide. Archives of Suicide Research : Official Journal of the International Academy for Suicide Research, 17(3), 242–61. http://doi.org/10.1080/13811118.2013.805644