title: "The psychological skeleton in the closet": mortality after a sibling's suicide.
abstract: OBJECTIVE
  To study the association between loss of an adult sibling due to suicide and mortality from various causes up to 18 years after bereavement.
  
  
  METHODS
  We conducted a follow-up study between 1981 and 2002, based on register data representing the total population of Swedes aged 25-64 years (n = 1,748,069).
  
  
  RESULTS
  An elevated mortality rate from all causes was found among men (RR 1.26; 95 % CI: 1.14-1.40) and women (1.27; 1.11-1.45) who had experienced a sibling's suicide. The standardized rate ratio of suicide of bereaved to non-bereaved persons was 2.46 (1.86-3.24) among men and 3.25 (2.28-4.65) among women. We also found some indications of an interrelation between sibling suicide and subsequent deaths from external causes other than suicide in men (1.77; 1.34-2.34) and deaths from cardiovascular disease in women (1.37; 0.99-1.91). An elevated all-cause mortality rate was found after the first year of bereavement in men, while bereaved women experienced higher mortality rates during the first 2 years and after 5 years of bereavement.
  
  
  CONCLUSIONS
  Our study provides support for adverse health effects among survivors associated with sibling loss due to suicide. Sibling suicides were primarily associated with suicide in bereaved survivors, although there was an increased mortality rate from discordant causes, which strengthens the possibility that the observed associations might not be entirely due to shared genetic causes.
authors.affiliation: Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sveavägen 160, 106 91, Stockholm, Sweden, mikael.rostila@chess.su.se.
authors.forename: Mikael
authors.initials: M
authors.lastname: Rostila
authors.forename: Jan
authors.initials: J
authors.lastname: Saarela
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006117:Grief; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012737:Sex Factors; D035781:Siblings / Q000523:psychology*; D013405:Suicide / Q000523:psychology*; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data*; D013997:Time Factors