title: Bereavement by suicide as a risk factor for suicide attempt: a cross-sectional national UK-wide study of 3432 young bereaved adults.
abstract: OBJECTIVE
  US and UK suicide prevention strategies suggest that bereavement by the suicide of a relative or friend is a risk factor for suicide. However, evidence is lacking that the risk exceeds that of any sudden bereavement, is specific to suicide, or applies to peer suicide. We conducted the first controlled UK-wide study to test the hypothesis that young adults bereaved by suicide have an increased risk of suicidal ideation and suicide attempt compared with young adults bereaved by other sudden deaths.
  
  
  METHODS
  National cross-sectional study.
  
  
  METHODS
  Staff and students at 37 UK higher educational institutions in 2010.
  
  
  METHODS
  3432 eligible respondents aged 18-40 exposed to sudden bereavement of a friend or relative after the age of 10.
  
  
  METHODS
  Bereavement by suicide (n=614), by sudden unnatural causes (n=712) and by sudden natural causes (n=2106).
  
  
  METHODS
  Incident suicidal ideation and suicide attempt.
  
  
  RESULTS
  Adults bereaved by suicide had a higher probability of attempting suicide (adjusted OR (AOR)=1.65; 95% CI 1.12 to 2.42; p=0.012) than those bereaved by sudden natural causes. There was no such increased risk in adults bereaved by sudden unnatural causes. There were no group differences in probability of suicidal ideation. The effect of suicide bereavement was similar whether bereaved participants were blood-related to the deceased or not. The significant association between bereavement by suicide and suicide attempt became non-significant when adding perceived stigma (AOR=1.11; 95% CI 0.74 to 1.67; p=0.610). When compared with adults bereaved by sudden unnatural causes, those bereaved by suicide did not show significant differences in suicide attempt (AOR=1.48; 95% CI 0.94 to 2.33; p=0.089).
  
  
  CONCLUSIONS
  Bereavement by suicide is a specific risk factor for suicide attempt among young bereaved adults, whether related to the deceased or not. Suicide risk assessment of young adults should involve screening for a history of suicide in blood relatives, non-blood relatives and friends.
authors.affiliation: Division of Psychiatry, University College London, London, UK Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK.
authors.forename: Alexandra L
authors.identifier: http://orcid.org/0000-0002-9742-1359
authors.initials: AL
authors.lastname: Pitman
authors.affiliation: Division of Psychiatry, University College London, London, UK Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK.
authors.forename: David P J
authors.initials: DP
authors.lastname: Osborn
authors.affiliation: Institute of Neurology, University College London, London, UK.
authors.forename: Khadija
authors.initials: K
authors.lastname: Rantell
authors.affiliation: Division of Psychiatry, University College London, London, UK Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK.
authors.forename: Michael B
authors.initials: MB
authors.lastname: King
mesh_terms: D000293:Adolescent; D000328:Adult; D001601:Bereavement; D003430:Cross-Sectional Studies; D003645:Death, Sudden; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D057545:Social Stigma; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology*; D013406:Suicide, Attempted / Q000523:psychology*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: EPIDEMIOLOGY; bereavement; stigma; suicide attempt; unnatural causes
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