Surviving Loss By Suicide: How To Help Those Left Behind

How Much of a Problem Is Suicide In the U.S.?

According to the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, in the United States (CDC, 2020):

• Suicide is the 10^th leading cause of death
• 48,344 people died from suicide in 2018 (37,991 died from motor vehicle traffic deaths, just to put that into perspective)
• In 2018 there were approximately 1.4 million suicide attempts
• In 2015 suicide deaths and attempts cost $69 billion in work loss and medical costs

From 1999 to 2016, suicide rates rose across the nation (Center for Disease Control):

Who Is At Risk?

According to the American foundation for Suicide Prevention:

• 90% of those dying by suicide had a diagnosable mental health condition
• The suicide rate was 1.5 times higher for Veterans than for non-Veteran adults over age 18
• Men died by suicide 3.6 times more frequently than women
• Suicide is the 2^nd leading cause of death for ages 10-34 and the 4^th leading cause of death for ages 35-54

In Nevada (Nevada Coalition for Suicide Prevention, 2020):

• One person died by suicide every 13 hours, making it 8^th in the nation for deaths by suicide
• Suicide is the leading cause of death for those 11-19 years of age
• Suicide is the 2^nd leading cause of death for those 20-49 years of age
• The rate of suicide by elders is the 2^nd highest in the nation
• Suicide is the 3^rd leading cause of death for Native American males
• Veterans comprise approximately 20% of suicides
• More people die from suicide that homicide and Motor Vehicle Accident Deaths combined

According to Cherylyn Rahr-Wood, Nevada Office of Suicide Prevention, Zero Suicide Project Coordinator, there are multiple factors involved in a person deciding to suicide. The data shows risk factors according to age, sex, culture, and mental illness. Yet there is another risk factor that many people do not know about. According to MS Rahr-Wood, when a friend or relative dies from suicide, that exposure puts survivors of the loss at risk for suicide themselves. What is more, the research backs up this premise (Pitman et al., 2016; Molina et al., 2019). One systematic review of the literature that researched suicidal ideation after bereavement due to a variety of causes of death found nine studies that studied bereavement by suicide. The review concluded that families bereaved by suicide had higher rates of both suicide and suicidal ideation than families bereaved by other causes of death (Molina et al., 2019).

Experiences of Those Bereaved By Suicide

One qualitative study to gain a deeper understanding of the experiences and subsequent need of those bereaved by suicide found that participants described a wide variety of feelings and experiences (Ross et al, 2019). Researchers identified four themes among the participants of their focus groups:

• Changing support needs – survivors’ needs changed over time, requiring different support structures at different stages of bereavement. While some survivors experienced a great deal of support initially, others felt that responders did not have the information needed to refer them and the survivors were too numb to ask for help or did not know where to seek it. Support should be flexible in both timeliness and approaches.
• Difficulty navigating services – Some loss survivors were struggling with grief that prevented them from navigating available services on their own. They found that they needed help negotiating the funeral arrangements, insurance process, legal systems, and financial institutions. Many times they did not know where to start and needed guidance or prompts. Others found locating general practitioners and counsellors with suicide bereavement skills very difficult, which caused them to experience increased stress and difficulty due to having to explain their situation to strangers repeatedly.
• Stigma and isolation – Many participants experienced shame, guilt, and self-blame. Hurt and anger were common. The inability or unwillingness of friends and family to talk about the suicide resulted in feelings of rejection, loneliness, and isolations. Some experienced insensitivity or avoidance from co-workers or supervisors.
• Connecting with others – While participants had mixed opinions on the usefulness of support groups, most found face-to-face groups to be a positive experience. Most of them experienced understanding and some made new friends. Others expressed the need for professional guidelines for facilitating support groups to avoid blurring of boundaries between facilitators who shared too much and too often and those more recently bereaved.

What People Can Do

While all losses impact people’s lives, not all losses result in the unique feelings and experiences that those bereaved by suicide often undergo, so it is very important for those surrounding someone who has experienced this type of loss to know what to look for. Ms Rahr-Wood suggests that what are usually called “warning signs” might better be called “invitations” because they are ways someone might be “inviting us in” or at least “inviting” us to ask. Some of those invitations might be withdrawing from friends and family, increased alcohol or drug us, anxiety, trouble sleeping, or feeling hopeless. A complete list can be found on the Nevada Coalition for Suicide Prevention website. Another useful tool is the phrase “IS PATH WARM”:

• Ideation
• Substance Abuse
• Purposelessness
• Anxiety
• Trapped
• Hopelessness
• Withdrawal
• Anger
• Recklessness
• Mood Change

Most importantly, when someone you know of any age experiences a bereavement by suicide, the most important things you can do are to show you care, ask about suicide, and get help. Many resources are listed below and in the CASAT OnDemand Resources & Downloads page. Catalyst blog posts on suicide:

• • 13.2018: Suicide Contagion: Unintended Consequences of Celebrity Suicide
  • 27.2018: Suicide in Nevada: Are We Making Progress?
  • 04.2018: Suicide and The Crisis Text Line
  • 24.2018: Zero Suicide – Can we get there?
  • 28.2019: What Behavioral Health Providers In Nevada Need To Know About Veterans And Suicide
  • 05.2019: Suicide Update for September 2019
  • 01.2020: Seniors and Suicide: Nevada Programs for Helping Seniors to Stay Healthy
  • 29.2020: Important Facts About Native American Heritage Month

The American Foundation for Suicide Prevention International Survivors of Suicide Loss Day is Saturday November 20, 2021.  This is an event in which survivors of suicide loss come together to find connection, understanding, and hope through their shared experience. This year, International Survivors of Suicide Loss Day is Saturday, November 20, 2021. You can find a current list of registrations here. If you have questions please contact your local AFSP chapter or email survivorday@afsp.org.

References

Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2018 on CDC WONDER Online Database, released in 2020. Data are from the Multiple Cause of Death Files, 1999-2018, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Nov 12, 2020 12:28:04 PM

Molina, N., Viola, M., Rogers, M., Ouyang, D., Gang, J., Derry, H., & Prigerson, H. G. (2019). Suicidal Ideation in Bereavement: A Systematic Review. Behavioral Sciences, 9(5), 53. MDPI AG. Retrieved from http://dx.doi.org/10.3390/bs9050053

Pitman, A. L., Osborn, D. P. J., Rantell, K., & King, M. B. (2016). Bereavement by suicide as a risk factor for suicide attempt: A cross-sectional national UK-wide study of 3432 young bereaved adults. BMJ Open, 6(1), e009948-e009948. doi:10.1136/bmjopen-2015-009948

Ross, V., Kõlves, K., & De Leo, D. (2019). Exploring the Support Needs of People Bereaved by Suicide: A Qualitative Study. OMEGA – Journal of Death and Dying. https://doi.org/10.1177/0030222819825775

Stone DM, Simon TR, Fowler KA, et al. Vital Signs: Trends in State Suicide Rates — United States, 1999–2016 and Circumstances Contributing to Suicide — 27 States, 2015. MMWR Morb Mortal Wkly Rep 2018;67:617–624. DOI: http://dx.doi.org/10.15585/mmwr.mm6722a1external icon

Suicide Resources

American Foundation for Suicide Prevention  – a voluntary health organization with a mission to “same lives and bring hope to those affected by suicide.”

International Survivors of Suicide Loss Day – An event in which survivors of suicide loss come together to find connection, understanding, and hope through their shared experience. This year, International Survivors of Suicide Loss Day is Saturday, November 21, 2020.

American Association of Suicidology:

• Resources for Suicide Loss Survivors
• SOS A Handbook for Survivors of Suicide
• SOS Manual en Español

The Solace Tree – Home of the good grief project

Nevada Coalition for Suicide Prevention

Office of Suicide Prevention – mission is to reduce the rates of suicide and suicidal acts in Nevada with one state plan.

PACT Coalition seeks to empower Southern Nevada with the resources to prevent substance abuse for all ages and promote recover through culturally competent advocacy, education, stigma reduction, support, and outreach.

Care Coalition – To increase public awareness of the effects of drug and alcohol abuse by educating and supporting youth, adults, the community at large and drug prevention agencies in Clark County.

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