title: The stigma perceived by people bereaved by suicide and other sudden deaths: A cross-sectional UK study of 3432 bereaved adults.
abstract: To test the hypothesis that perceived stigma scores in young adults bereaved by suicide are significantly higher than in young adults bereaved by other sudden deaths, whether blood-related to the deceased or not.
  
  
  
  We conducted a cross-sectional study of all staff and students aged 18-40 at 37 UK higher educational institutions in 2010, and identified 3432 respondents who had experienced a sudden bereavement of a close contact since reaching the age of 10, either due to sudden natural causes, sudden unnatural causes, or suicide. We used multivariable regression to compare scores on the stigma, shame, responsibility and guilt subscales of the Grief Experience Questionnaire, adjusting for socio-demographic factors and pre-bereavement psychopathology.
  
  
  
  People bereaved by suicide (n=614) had higher stigma scores than people bereaved by sudden natural death (n=2106; adjusted coefficient=2.52; 95% CI=2.13-2.90; p=<0.001) and people bereaved by sudden unnatural death (n=712; adjusted coefficient=1.69; 95% CI=1.25-2.13; p=<0.001). Shame, responsibility and guilt scores were also significantly higher in people bereaved by suicide, whether compared with bereavement by sudden natural death or sudden unnatural death. Associations were not modified by whether the bereaved was blood-related to the deceased or not.
  
  
  
  Stigma was perceived more acutely by the relatives and friends of those who died by suicide than those bereaved by other causes of sudden natural or sudden unnatural death. Their high levels of perceived stigma, shame, responsibility and guilt require qualitative investigation to identify whether these grief dimensions limit social functioning, help-seeking behaviour and/or support offered.
authors.affiliation: UCL Division of Psychiatry, University College London, Gower St, London WC1E 6BT, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom. Electronic address: a.pitman@ucl.ac.uk.
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Pitman
authors.affiliation: UCL Division of Psychiatry, University College London, Gower St, London WC1E 6BT, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom.
authors.forename: David P J
authors.initials: DP
authors.lastname: Osborn
authors.affiliation: Education Unit, UCL Institute of Neurology, United Kingdom.
authors.forename: Khadija
authors.initials: K
authors.lastname: Rantell
authors.affiliation: UCL Division of Psychiatry, University College London, Gower St, London WC1E 6BT, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom.
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 / Q000453:epidemiology; D005190:Family; D005260:Female; D006117:Grief; D006167:Guilt; D006801:Humans; D008297:Male; D010465:Perception; D057545:Social Stigma; D013405:Suicide / Q000523:psychology*; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Bereavement; Guilt; Responsibility; Shame; Stigma; Suicide