The families of suicide victims who seek solace in a self-help group are often worse off than if they had not contacted fellow-sufferers. This type of contact can complicate the grief process and leave people feeling dispirited and suicidal themselves. Healthcare professionals (GPs, mental health services) often recommend self-help groups as contact with fellow-sufferers is assumed to have a positive impact on dealing with grief. But this is not always the case. Researchers Marieke de Groot and Boudewijn Kollen from the University Medical Center Groningen reached this surprising conclusion after a long-term study of grief among the bereaved relatives of suicide victims. They conducted their research in the General Practice Department and their findings are published in this week’s edition of the leading British Medical Journal.
Research has shown that in general, people who consider or commit suicide respond emotionally to setbacks and display a certain tendency to suicidal behaviour. The signs are often recognized after a suicide, even if the act itself comes as a complete surprise. Important signs that may indicate a suicidal character are despondency and impulsive behaviour, an inability to resolve problems and a tendency to think in extremes. Research also shows that a higher than average proportion of bereaved relatives of suicide victims have these risk factors too. Findings also indicate that people with this tendency have a higher than average risk of someone close to them committing suicide.
Grief is a process of adjustment and finding new meaning. This can be particularly difficult after a suicide. Roughly speaking, there are two sides to grief: on the one hand, feeling and experiencing the pain of the loss, and on the other hand, getting on with life. Grief after a suicide is no different, but relatives are often also plagued by the questions ‘why?’ and ‘what did I do wrong?’ Guilt and shame can also play a role. Bereaved relatives do not always experience support from those around them. Differences of opinion on the subject make it more difficult to discuss the loss within the family and family members are often unable to help each other. This makes the grief process even more difficult for the relatives of people who commit suicide, and encourages them to seek out fellow-sufferers who have at least been through the same experience and will sympathize with their feelings.
Complicated grief occurs when the normal and common symptoms of grief do not lessen with the passage of time. In their study, De Groot and Kollen give a possible explanation for the increased risk of complicated grief in people who join self-help groups after a loved one has committed suicide. ‘Reliving’ the feelings associated with the loss can prevent people from getting on with their life without the deceased. Too much emphasis on feelings may also have an adverse effect. Another explanation they put forward is that the adjustment process can be hampered by the higher than average chance that the deceased’s relative is experiencing suicidal feelings of his or her own. After all, people who doubt whether life is worth living are probably less able to put what has happened into perspective. This represents a challenge for researchers: do people become suicidal because of complicated grief, or does grief become complicated because people are suicidal?
Some 1,700 people die every year after committing suicide. This is two-and-a-half times the number that die in road traffic accidents. The number of attempted suicides is even more horrifying: 94,000 per year (including people who make multiple attempts). One person in ten will think about suicide at some time in their life. This comes to an estimated 400,000 people per year, most of whom soon drop the idea.
Every year, 15,000 people require hospital treatment after attempting suicide. Approximately 45 percent of people who commit suicide are being treated by a mental health service at the time of their death, and 75 percent have at some time received some kind of healthcare. This makes suicide and attempted suicide an expensive problem. But treating people with suicidal tendencies also comes at a ‘cost’ to the professionals who treat them. Nursing and caring for a patient who has attempted suicide is often an intensive process, and puts a particular strain on those caring for patients who make repeated suicide attempts.
Research shows that training healthcare professionals to recognize suicidal tendencies and persuade people to talk about suicidal thoughts can help them to deal with this type of patient behaviour more effectively. In turn, this can reduce the number of suicides. It is important that policy-makers understand that most self-help groups are run by volunteers without any form of subsidy, who try to help mentally unstable people.
Other forms of help, such as help from the local mental health service or the GP, have no impact on the mental welfare of bereaved relatives. The only thing that can heal psychological problems is time, but in most cases, the impact of suicide can still be felt in a family eight to ten years later. Relatives of people who commit suicide have a higher than average tendency to emotional destabilization and suicidal behaviour. This group is most likely to seek out fellow-sufferers, and is also most likely to suffer the adverse effects of this contact.
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