Suicide Survivors

Survivor of suicide does not refer to individuals who have made a nonfatal attempt on their life. Rather, a survivor of suicide is a loved one or other individual who has experienced the death by suicide of someone close to them. The less ambiguous wording “bereaved of suicide” is used in Australia. The term survivor of suicide, therefore, is appropriate in the context of the aftermath of a suicide death. The sequelae of suicide may include a difficult and complicated bereavement experience. Edwin Shneidman, founder of the American Association of Suicidology, expressed his belief that the greatest mental health toll associated with suicide occurs among the survivors of suicide. Despite this contention, the topic of suicide survivors remains one of the most neglected areas in suicidology.

Although relatively little research exists regarding suicide survivorship, available evidence provides initial insights of suicide survivorship. Virtually no epidemiological data have been gathered regarding how many individuals are survivors or their characteristics. It is usually suggested (though not based on epidemiological investigation) that there are at least six survivors for every suicide. If true, the 32,000-plus annual U.S. suicides produce more than 190,000 survivors each year. As one measure of the cumulative effect, the more than 750,000 suicides in the last 25 years would be associated with over 4.5 million survivors, or at least 1 of every 65 Americans (1.5#x0025;). One small-scale study implied 5.5#x0025; were survivors. Even using conservative estimates, the number of surviving family members and friends is substantial.

The impact of suicide on survivors' grief and bereavement has yet to be adequately studied. Personal accounts and research have provided delineation of some characteristic aspects of suicide bereavement. While potentially unique features may result from experiencing the suicide of a loved one, it is important before considering these to understand that suicide survivors share aspects of grief common to essentially all bereaved individuals. For instance, as with other deaths, the suicide grief process is unique and individual, it follows no time frame or specific duration, and its movement is not always in a forward direction.

Many specific characteristics of grief following death by suicide have been described in the past 35 years. University of Michigan professor Albert Cain produced one of the earliest considerations of the topic in the 1972 edited book, Survivors of[Page 920]Suicide. Cain's book provided a portrayal of the reactions and features of suicide bereavement largely from clinical case descriptions. Many of these reactions would later be observed in studies and survivors' accounts of their personal journeys following suicide loss. Cain's volume noted the bereavement reactions of guilt, rage, search for meaning associated with the death, identification with the person who died by suicide, incomplete mourning, as well as depression and self-destructive behaviors among the bereaved. Additionally, anniversary reactions, feelings of shame, stigma, abandonment, and preoccupation with the topic of suicide and suicide prevention efforts were listed. Although these published descriptions were available, a 1982 review by Lawrence Calhoun and his colleagues from North Carolina revealed a number of published studies of survivors, but also a particularly problematic issue. Specifically, among several methodological difficulties, not a single investigation had included a group of survivors of other modes of death to which suicide survivors of the study could be compared. Therefore, any attempt to specify unique grief features or differences among suicide survivors was impossible. As a result, Calhoun and colleagues were willing to venture only “cautious generalizations” derived from the sheer consistency of the themes could be offered. Perhaps three commonalities for suicide bereaved as compared to other bereaved individuals can be derived from this work. They suggested that suicide grief may differ from other causes in the prominence of feelings of guilt, a search by suicide survivors to understand their loved one's death, and lower amounts of social support following the death.

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