Suicide in the family : towards improved care of bereaved parents and siblings

Sammanfattning: Background Losing a child to suicide is an overwhelming experience, which increases the risk for negative health outcomes in the bereaved parents and siblings, such as long-term psychiatric morbidity and increased risk of premature mortality, including suicide. Despite their needs and the increased risk for bereavement related difficulties, there is limited evidence coming from population-based studies for the efficacious care of the suicide-bereaved. The main aim of our studies is to contribute with knowledge in order to improve the professional care of suicide-bereaved parents and siblings by exploring some areas of interest that can be seen as first steps towards this aim. Methods We refined our working hypotheses, created a study-specific questionnaire, validated and tested it, including the data collection procedures (study I). Also, we interviewed 18 suicidebereaved siblings and qualitatively analyzed the data concerning their perception of health services (study II). Then, using our study-specific questionnaire, we investigated the prevalence and variables associated with lack of trust in the healthcare system in a population of 666 suicide-bereaved parents and 326 non-bereaved-parents (study III), and we also investigated the psychological impact of confronting the body of the deceased child at the site of death in the suicide-bereaved parents (study IV). Results Of the 46 suicide-bereaved parents that answered the questionnaire in our preliminary study, 45 asserted that they found the survey valuable, 24 that they had been positively affected by answering the questionnaire, and 3 that they had been negatively affected. A majority stated that they were grateful for the opportunity to tell about their experience surrounding their child’s death (study I). We also found that most suicide-bereaved siblings wanted professional help but not all of them sought it due to lack of trust in the helpfulness of health services or because they experienced overwhelming grief. A minority did not feel the need of professional help. Moreover, the deceased sibling’s experience with health services became a point of reference that influenced the bereaved siblings’ perception of the helpfulness of health services (study II). Furthermore, we found that lack of trust in the healthcare system was more prevalent in the suicide-bereaved parents (47%) than in the non-bereaved parents (18%), resulting in a Relative Risk (RR) of 2.5 (95% CI 2.0 – 3.3). Considering only the bereaved parents, the variables associated to lack of trust in the healthcare system were having high scores of depression, as measured by the Patient Health Questionnaire (PHQ-9), living in big cities (>200,000 inhabitants) and being single (study III). In study IV, we found that confronting the body of the dead child was not associated with a statistically significant higher risk of reliving the child’s death through nightmares (RR 0.95, 95% CI 0.67 – 1.35), intrusive memories (RR 0.97, 95% CI 0.84 – 1.12), avoidance of thoughts (RR 0.97, 95% CI 0.74 – 1.27), avoidance of places or things (RR 0.91, 95% CI 0.66 – 1.25), anxiety (RR 0.93, 95% CI 0.64 – 1.34) or depression (RR 0.94, 95% CI 0.63 – 1.42) when comparing parents who confronted the body of their child with parents who did not. Conclusions Suicide-bereaved parents may participate in research studies including sensitive questions, as long as the research process follows robust ethical and methodological procedures (study I). The suicide-bereaved siblings’ perception that the care provided to their deceased sibling was deficient, may produce negative attitudes towards health services and also low expectations regarding the helpfulness of health services (study II). The prevalence of lack of trust in the healthcare system was larger in the suicide-bereaved parents than in the non-bereaved parents. Their lack of trust was found to be associated with having high scores of depression, living in big cities and being single (study III). Regarding the psychological impact of confronting the body of the child at the scene of death, we found no significant statistical differences between parents who confronted the body of the deceased child and parents who did not (study IV).