title: Support for Relatives Bereaved by Psychiatric Patient Suicide: National Confidential Inquiry Into Suicide and Homicide Findings.
abstract: OBJECTIVE
  International suicide prevention strategies recommend providing support to families bereaved by suicide. The study objectives were to measure the proportion of cases in which psychiatric professionals contact next of kin after a patient's suicide and to investigate whether specific, potentially stigmatizing patient characteristics influence whether the family is contacted.
  
  
  METHODS
  Annual survey data from England and Wales (2003-2012) were used to identify 11,572 suicide cases among psychiatric patients. Multivariate regression analysis was used to describe the association between specific covariates (chosen on the basis of clinical judgment and the published literature) and the probability that psychiatric staff would contact bereaved relatives of the deceased.
  
  
  RESULTS
  Relatives were not contacted after the death in 33% of cases. Contrary to the hypothesis, a violent method of suicide was independently associated with greater likelihood of contact with relatives (adjusted odds ratio=1.67). Four patient factors (forensic history, unemployment, and primary diagnosis of alcohol or drug dependence or misuse) were independently associated with less likelihood of contact with relatives. Patients' race-ethnicity and recent alcohol or drug misuse were not associated with contact with relatives.
  
  
  CONCLUSIONS
  Four stigmatizing patient-related factors reduced the likelihood of contacting next of kin after patient suicide, suggesting inequitable access to support after a potentially traumatic bereavement. Given the association of suicide bereavement with suicide attempt, and the possibility of relatives' shared risk factors for suicide, British psychiatric services should provide more support to relatives after patient suicide.
authors.affiliation: Dr. Pitman is with the University College London (UCL) Division of Psychiatry, UCL, London (e-mail: a.pitman@ucl.ac.uk ). Dr. Hunt, Dr. McDonnell, Prof. Appleby, and Prof. Kapur are with the Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, Manchester, United Kingdom.
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Pitman
authors.affiliation: Dr. Pitman is with the University College London (UCL) Division of Psychiatry, UCL, London (e-mail: a.pitman@ucl.ac.uk ). Dr. Hunt, Dr. McDonnell, Prof. Appleby, and Prof. Kapur are with the Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, Manchester, United Kingdom.
authors.forename: Isabelle M
authors.initials: IM
authors.lastname: Hunt
authors.affiliation: Dr. Pitman is with the University College London (UCL) Division of Psychiatry, UCL, London (e-mail: a.pitman@ucl.ac.uk ). Dr. Hunt, Dr. McDonnell, Prof. Appleby, and Prof. Kapur are with the Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, Manchester, United Kingdom.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: McDonnell
authors.affiliation: Dr. Pitman is with the University College London (UCL) Division of Psychiatry, UCL, London (e-mail: a.pitman@ucl.ac.uk ). Dr. Hunt, Dr. McDonnell, Prof. Appleby, and Prof. Kapur are with the Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, Manchester, United Kingdom.
authors.forename: Louis
authors.initials: L
authors.lastname: Appleby
authors.affiliation: Dr. Pitman is with the University College London (UCL) Division of Psychiatry, UCL, London (e-mail: a.pitman@ucl.ac.uk ). Dr. Hunt, Dr. McDonnell, Prof. Appleby, and Prof. Kapur are with the Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, Manchester, United Kingdom.
authors.forename: Navneet
authors.initials: N
authors.lastname: Kapur
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001601:Bereavement; D004739:England; D005190:Family; D005260:Female; D006708:Homicide; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000453:epidemiology; D013405:Suicide / Q000706:statistics & numerical data*; D014478:Unemployment / Q000706:statistics & numerical data; D014852:Wales; D055815:Young Adult
keywords: Attitudes toward mental illness, Families of the mentally ill, Grief &amp; mourning, Staff relationships/roles, Suicide &amp; self-destructive behavior