Silence after suicide: A phenomenological study of young men's experience of losing a close male friend

<p>Losing a close friend to suicide can significantly increase the risk of dysfunction, depression and suicide in young people. Previous studies of suicide bereavement have focused on parents, parentally-bereaved children, young adolescents’ experiences of peer suicide and female college-students. A paucity of qualitative research exists that examines young men’s experiences of suicide bereavement. This lack of research has meant that their grief may go unnoticed, be minimized, or even misunderstood. The purpose of this research was to explore the experiences of eight young New Zealand men (aged 17-25 years) who lost a close male friend to suicide. Repeated in-depth phenomenological interviews were used to gain new insights into the conceptualisation of this event in the young men’s lives through an exploration of their experiences. Interviews were audio recorded and transcribed for analysis. The inductive, descriptive approach of the phenomenological method was used to explore and describe the essence of their lived experience and led to seven themes: Being gutted, stoicism, grieving in silence, being silenced, breaking the silence, being in silence and analytic silence. The overarching essence of their experience and the phenomenon was silence. The silence the men experienced after suicide was ubiquitous. The findings suggest losing a close male friend to suicide implicates men to suffer, grieve, live through and transform in silence. Participants experienced four types of silence: personal, private, public and analytic silence. The men were gutted and personally unable to talk about their experience. They chose to keep quiet, be stoical, suppress their emotions and keep their grief private. They grieved in silence and were silenced by others. They broke their silence with people they could trust and who provided presence support and care. They sought quiet spaces where they could reconnect, reflect on their experience. Their navigation of silence fostered new values, priorities and identities, acceptance of their loss and helped them move on with their lives. This study has brought new understandings of men’s experiences of suicide bereavement and silence. Their experience suggests that health professionals, families/whānau and friends need to learn to see, listen to and interpret the silence of men in order to better understand their experience and needs for care and support. Recommendations are made for intervention, health care practice and future research.</p>

Leaving Home for Marital and Non-Marital Reasons in the Netherlands, 1850-1940 – The Impact of Parental Death and Parental Remarriage

Previous research shows that parentally bereaved children in north-western Europe in the past left home earlier than children who lived together with both biological parents. This article analyses the mechanisms behind this phenomenon with a special focus on the routes out of the parental household and the entry of step-parents and step-siblings. The Historical Sample of the Netherlands (HSN) is exploited which contains detailed infor-mation about household composition and life courses of more than 22,000 female and male adolescent and young adult children born between 1850 and 1922. Event-history analysis is applied and two exclusive routes out of the parental household, for marital and non-marital reasons, are studied in a competing risk design. The results show that parental loss does not increase the risk of early marriage before age 23, but strongly en-hances the chances for leaving home for non-marital reasons, which are mainly work-related. This is especially true in case of maternal loss. No support is found for the hy-pothesis that the entry of a step-parent and step-siblings increases the risk of leaving home compared to living with a single widowed parent. Tensions with step-parents therefore do not suffice to explain why parentally bereaved children left earlier for non-marital reasons. Instead, we argue that children’s exit was in the interest of both the single widowed parent and the bereaved child.

Bereavement

The phenomena and trajectory of mourning as a normal adaptive process are differentiated from clinical depression, avoidant and complicated grief, post-traumatic distress disorder, and other forms of pathological grief. Anticipatory grief can be a particular challenge during palliative care. The family is recognized as the major source of social support and the environment in which grief is shared with others. Key risk factors for pathological bereavement outcomes can be identified on admission to palliative care, permitting preventive models of psychological care to be used through palliative care into bereavement. Models of therapy include supportive-expressive, interpersonal, cognitive behavioural, family focused, and specific therapy for complicated grief. Pharmacotherapy can judiciously accompany psychotherapy. Life-cycle issues include bereaved children, siblings, parents, and grief for the very elderly. Grief can be stigmatized and ambiguous in special circumstances, yet positive growth is a desirable outcome from any loss.

Direct and indirect effects of bereaved caregivers’ self-compassion on their complicated grief and their child’s mental health

Self-compassion, which involves mindfulness, self-kindness, and common humanity, has been found to be related to individuals’ mental health. Few studies have examined caregivers’ self-compassion in relation to parenting behaviors or child adjustment in addition to its relation their own mental health. Objectives: In the current study we examined caregivers’ self-compassion as a protective factor related to parentally bereaved children’s internalizing and externalizing problems. We further tested whether the relations were mediated by caregivers’ parenting practices or complicated grief (i.e., persistent severe grief reactions that impair normal functioning). Methods: The sample consists of caregivers who participated in an intervention study for bereaved families and reported high levels of complicated grief. At T1 (baseline) and T2 (20 weeks later), caregivers completed surveys on demographic information, self-compassion, complicated grief, parental warmth and consistent discipline, as well as child internalizing and externalizing problems. Results: Findings supported that caregivers’ self-compassion was prospectively related to decreased internalizing and externalizing problems in bereaved children. The effect of self-compassion on externalizing problems was mediated by parental warmth and consistent discipline. Self-compassion was also prospectively associated with decreased complicated grief and psychological distress, although complicated grief and psychological distress were not related to child outcomes. Conclusions: These findings add to the knowledge on the psychological benefits of self-compassion for both bereaved children and their caregivers.

Parental Attachment Style and Young Persons’ Adjustment to Bereavement

Background Previous clinical and theoretical work supports the idea that parental attachment style and complicated grief affect young persons’ mental health, but empirical research investigating their impact on young person’s adjustment to bereavement is lacking. Objective This study investigated the impact of parental attachment style and complicated grief on young person’s adjustment to bereavement. It was hypothesised that a) parental attachment anxiety, avoidance, and complicated grief would moderate the link between bereavement experience and psychological distress in young persons and b) parental attachment style would moderate the link between parental complicated grief and psychological distress experienced by bereaved young persons. Method This was a questionnaire-based case control study, involving two participant groups: 133 parents of young persons who had experienced the loss of the loved one and 101 parents of young persons with no bereavement experience. Results Bereaved young persons experienced greater externalising and internalising problems than the non-bereaved only when they were raised by an anxiously attached parent, but when parental attachment anxiety was low, bereaved children had fewer problems than the non-bereaved. When parental attachment avoidance was low, bereaved children also had fewer externalising problems than the non-bereaved. Among the bereaved, high levels of parental attachment anxiety and attachment avoidance amplified the link between parental complicated grief and child post-traumatic stress, while in the presence of low parental anxiety, complicated grief was negatively associated with an immediate distressing response and numbing-dissociative symptomatology. Conclusions Psychological vulnerability in bereaved young persons was associated with an insecure parental attachment style.

Parental death in childhood and pathways to increased mortality across the life course in Stockholm, Sweden: A cohort study

Background Previous studies have shown that the experience of parental death during childhood is associated with increased mortality risk. However, few studies have examined potential pathways that may explain these findings. The aim of this study is to examine whether familial and behavioural factors during adolescence and socioeconomic disadvantages in early adulthood mediate the association between loss of a parent at age 0 to 12 and all-cause mortality by the age of 63. Methods and findings A cohort study was conducted using data from the Stockholm Birth Cohort Multigenerational Study for 12,615 children born in 1953, with information covering 1953 to 2016. Familial and behavioural factors at age 13 to 19 included psychiatric and alcohol problems in the surviving parent, receipt of social assistance, and delinquent behaviour in the offspring. Socioeconomic disadvantage in early adulthood included educational attainment, occupational social class, and income at age 27 to 37. We used Cox proportional hazard regression models, combined with a multimediator analysis, to separate direct and indirect effects of parental death on all-cause mortality. Among the 12,582 offspring in the study (men 51%; women 49%), about 3% experienced the death of a parent in childhood. During follow-up from the age of 38 to 63, there were 935 deaths among offspring. Parental death was associated with an elevated risk of mortality after adjusting for demographic and household socioeconomic characteristics at birth (hazard ratio [HR]: 1.52 [95% confidence interval: 1.10 to 2.08, p-value = 0.010]). Delinquent behaviour in adolescence and income during early adulthood were the most influential mediators, and the indirect associations through these variables were HR 1.03 (1.00 to 1.06, 0.029) and HR 1.04 (1.01 to 1.07, 0.029), respectively. After accounting for these indirect paths, the direct path was attenuated to HR 1.35 (0.98 to 1.85, 0.066). The limitations of the study include that the associations may be partly due to genetic, social, and behavioural residual confounding, that statistical power was low in some of the subgroup analyses, and that there might be other relevant paths that were not investigated in the present study. Conclusions Our findings from this cohort study suggest that childhood parental death is associated with increased mortality and that the association was mediated through a chain of disadvantages over the life course including delinquency in adolescence and lower income during early adulthood. Professionals working with bereaved children should take the higher mortality risk in bereaved offspring into account and consider its lifelong consequences. When planning and providing support to bereaved children, it may be particularly important to be aware of their increased susceptibility to delinquency and socioeconomic vulnerability that eventually lead to higher mortality.

Dealing with bereaved children: a case study

<sec id="s1"> Introduction: A personal reflection on managing bereaved children (BC) following unexpected death of a parent. </sec> <sec id="s2"> Questions: What evidence is available to assist ambulance clinicians when supporting BC? </sec> <sec id="s3"> Methods: A literature search on BC in pre-hospital environments was undertaken. </sec> <sec id="s4"> Results: Paucity of literature necessitated search expansion beyond pre-hospital/ambulance focus, and use of supplementary sources of credible information from registered bereavement charities and help groups. </sec> <sec id="s5"> Conclusion: More research is needed to better support this vulnerable, unique demographic. It is hoped that this article will encourage further discussion and research into this topic. </sec>