The grief experiences and needs of bereaved relatives and friends of older people dying through suicide: a descriptive and case-control study.
BACKGROUND
Little is known about grief experiences of individuals bereaved through suicide of older people. Legal procedures may be one source of distress. Studies have suggested that guilt feelings, and a sense of rejection, shame or stigma, are probably more frequent in relatives bereaved through suicide than in those bereaved through other modes of death.


METHODS
We examined (a) problems experienced during legal procedures after death and (b) grief experiences, in 85 relatives and friends bereaved through the suicide of person 60 years old or over. In a case-control study the bereavement reactions in a subgroup of 46 people were compared with those of a control group bereaved by the natural death of an older person. Interviews, carried out 6-21 months after the deaths, included a semi-structured assessment of problems following the death, the Grief Experience Questionnaire (GEQ) and the Montgomery and Asberg Depression Rating Scale (MADRS).


RESULTS
Thirty-six (42.4%) of those bereaved through suicide reported problems in their dealings with the coroner's office, and 33 (38.8%) described distress caused by media reporting of the inquest. Depression scores were similar in the group of individuals bereaved through suicide and those bereaved through natural causes. The former scored higher on subscales of the GEQ measuring stigmatisation, shame, sense of rejection and "unique reactions" compared with those bereaved through natural death.


CONCLUSIONS
The participation rate of potential subjects was somewhat low, especially in the control group. Proportions of different kinships to the deceased differed in the study and control groups.


CONCLUSIONS
Problems in the media reporting of coroners' inquests and in inquest procedures are a frequent source of distress for bereaved relatives. The common themes of stigma, shame, and sense of rejection in bereavement after suicide suggest that these areas should be specifically addressed in the counselling of relatives bereaved in this way.
University of Oxford Department of Psychiatry, Warneford Hospital, OX3 7JX, Oxford, UK.
Daniel
D
Harwood
Keith
K
Hawton
Tony
T
Hope
Robin
R
Jacoby
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D001601:Bereavement; D016022:Case-Control Studies; D003865:Major Depressive Disorder / Q000175:diagnosis; D005190:Family / Q000523:psychology*; D005192:Family Health; D005260:Female; D006117:Grief; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013405:Suicide / Q000523:psychology*; D011795:Surveys and Questionnaires