grief reactions among suicide survivors: an exploratory comparison of relationships

This article was downloaded by: [McMaster University]On: 20 December 2014, At: 06:06Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

Death StudiesPublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/udst20

Grief reactions among suicidesurvivors: An exploratorycomparison of relationshipsJohn L. McIntosh a & Adina Wrobleski ba Indiana University at South Bendb Minneapolis, MinnesotaPublished online: 14 Aug 2007.

To cite this article: John L. McIntosh & Adina Wrobleski (1988) Grief reactions amongsuicide survivors: An exploratory comparison of relationships, Death Studies, 12:1,21-39, DOI: 10.1080/07481188808252217

To link to this article: http://dx.doi.org/10.1080/07481188808252217

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all theinformation (the “Content”) contained in the publications on our platform.However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness,or suitability for any purpose of the Content. Any opinions and viewsexpressed in this publication are the opinions and views of the authors, andare not the views of or endorsed by Taylor & Francis. The accuracy of theContent should not be relied upon and should be independently verified withprimary sources of information. Taylor and Francis shall not be liable for anylosses, actions, claims, proceedings, demands, costs, expenses, damages,and other liabilities whatsoever or howsoever caused arising directly orindirectly in connection with, in relation to or arising out of the use of theContent.

http://www.tandfonline.com/loi/udst20

http://www.tandfonline.com/action/showCitFormats?doi=10.1080/07481188808252217

http://dx.doi.org/10.1080/07481188808252217

This article may be used for research, teaching, and private study purposes.Any substantial or systematic reproduction, redistribution, reselling, loan,sub-licensing, systematic supply, or distribution in any form to anyone isexpressly forbidden. Terms & Conditions of access and use can be found athttp://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014

http://www.tandfonline.com/page/terms-and-conditions

m m w m m m m m w m m m m w m m m m w w m m m m w m m m w m m m m m m m m m m m m m m m m

GRIEF REACTIONS AMONG SUICIDE SURVIVORS: AN EXPLORATORY COMPARISON

OF RELATIONSHIPS m w w m m m m w m m m m m w m m m m w m m m m w m m m m m m m m m m m m m m m m m m w m m

JOHN L. McINTOSH

Indiana University at South Bend

ADINA WROBLESKI

Minneapolis, Minnesota

, Little research has focused upon those who survive the suicide death of a family member. Among the existing research, survivors representing only one interpersonal relationship class to the deceased (e.g., widows OT parents) are usually studied or no differentiation is made with respect to this factor. The purpose of this exploratory study was to investigate some o f the assumptions frequently made regarding differences among suicide survivors as a result of their kinship relation to the deceased. Questionnaires were sent to a convenience sample o f survivors who had contacted the Minneapolis Suicide Survivors Grief Group. Responses from 141 individuals who survived the suicide death o f a child (N = 56), spouse (N - 24), parent (N = 24), OT sibling (N = 37) were studied. Few kinshz) group differences were observed for feelings ofguilt or anger, the severity of seeing the death scene in one i mind, personal symptoms following the suicide, or aspects o f social stigma or shame. When kinship group differences were observed they were often contrary to assumptions made, particularly regarding parents as survivors of oflspring suicides. It is concluded, however, that, with f e w exceptions, suicide survivors variously related to the deceased have similar grief experiences, and patholou is not characteristic among any kinship group, and that most expectations of differences are not supported.

The authors wish to thank Michon Spees, a graduate student at the University of Notre Dame, for her assistance with the computer input of the data.

Death Studies, 12:21-39, 1988 21 Copyright @ 1988 by Hemisphere Publishing Corporation

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014

22 J . L. Mclntosh and A . Wrobleski

Grief Reactions among Suicide Survivors: An Exploratory Comparison of Relationships

Little empirical research has been conducted with the individuals who survive the suicide death of a family member of friend. The number of suicide survivors is estimated to be in the millions in the U.S. alone (1) with at least 180,000 added to their rolls annually (2, p. 22). Although little is known about the exact nature of suicide survivor’s grief reactions (for a comprehensive bibliography see 3 or 4; for reviews of the literature see 5-8), even less is known about the potential differences experienced by those with various family (i.e. , kinship) or interpersonal relationships to the deceased.

A recent literature review of survivor family relationships (9) reveals the paucity of literature and research on each relationship category. It also emerges that qualitative and perhaps even quanti- tative differences are assumed in the experiences of those who were related to the deceased in different ways. The following are exam- ples of these opinions. Seiden (10, p. 25) stated that “Possibly suicides of the young are even more shameful and embarrassing to survivors than are adult suicides,” and therefore parents may be particularly affected by the suicide death of their child. Calhoun, Selby, and Selby (5, p. 410) omitted the literature on the impact of parental suicide on children from their literature review “since that may represent a unique set of circurnstance~.’~ Virtually nothing is known about sibling survivors and they have been labeled the “for- gotten mourners” (1 1) who “often assume the responsibility for taking care of things, postponing their own needs” (12, p. 77). Finally, the life change, stress, and the need for adaptation associated with the loss of the spouse has been designated the greatest of any of life events by pioneers in research on stress (13). It is certainly conceivable that loss of the spouse through suicide may be an additional compounding factor.

It is uncertain after all these suggestions, however, whether the grief experiences of these groups are more similar or dissimilar following the suicide death of a loved one. Virtually no research that directly compares the kinship groups has been conducted. The present investigation is a preliminary attempt to provide some information in this regard by directly comparing survivors of four major kinship relations to the deceased (i.e., parent, child, sibling,

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014

Suicide Survivors Relationships 23

spouse). The respondents were drawn from the same sample of survivors and were administered the same questionnaires.

Method

Respondents and Decedents

A total of 158 individuals aged 9 to 75 years ( M = 40.3) responded to a mail questionnaire regarding a suicide victim to whom they had been close. The names of these individuals were derived from lists of people who had contacted (but not necessarily attended) any of four suicide survivors support groups in the Minneapolis-St. Paul, Minnesota area. A total of 250 letters were sent to households, with completed questionnaires returned from 1 1 1 households (a return rate of 44.4 percent). Two questionnaires were sent to each household and their completion by at least two individuals close to the deceased was requested. In 39 cases there were at least two questionnaires returned regarding the same death. Of these 39, there were three instances of 3 respondents, two with 4 respondents, and one with 5. Responses regarding a total of 112 suicide deaths were received. One individual completed separate questionnaires for the suicide deaths of two spouses. The time since the death had occurred varied between 1 and 500 months with an average of 40.4 months (3.4 years; 66.7 percent of the deaths had occurred within 3 years or less, while 80 percent had been within 4 years). The respondents were predominantly family members of the deceased ( N = 138; 87.3 percent). There were 36 male respondents and 122 females. Although all households had contacted the suicide survivors groups, only 119 individuals had actually attended a meeting, while 38 said they had not. The mean education of the respondents was 14.2 years.

The 112 decedents ranged from 16 to 77 years of age with a mean of 32.9 (66.7 percent were aged 33 and below, with 83.6 percent below 50). Most of the suicides ( N = 85; 75.9 percent) were males (females: N = 27; 24.1 percent). As for the nation as a whole, most suicides resulted from the use of firearms ( N = 89; 56 percent), while hanging ( N = 27; 17 percent), carbon monoxide poisoning ( N = 23; 15 percent), and drugs and poisons ( N = 10;

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014

24 J. L. Mclntosh and A . Wrobleski

6 percent), and still other methods (N = 19; 12 percent) trailed far behind.

The relationship of the deceased to the respondents shows the male predominance noted above, 39 (24.5 percent) of the suicides were sons, 28 (17.6 percent) brothers, 19 (11.9 percent) fathers, 18 (11.3 percent) husbands, 13 (8.2 percent) daughters, 9 (5.7 percent sisters, 5 (3.1 percent) mothers, 4 (2.5 percent) were wives, and a total of 24 (15.1 percent) were related in some other way to the deceased (fiance, friend, in-law, boyfriend, stepson or step- daughter, ex-husband, grandfather, uncle; with no single category representing more than 4 decedents). The 141 individuals who survived the death of a child ( N = 56), parent (N = 24), sibling (N = 37), and spouse (N = 24) were the focus of this investigation. Included in these totals were those who survived the deaths of ex-spouses ( N = 2) and stepchildren (N = 4). The responses of the remaining survivors (N = 18) in the miscellaneous relationship category above were excluded in these analyses (detailed results for the entire sample of 159 respondents are presented in references 14 and 15).

Questionnaire

The 9-page questionnaire consisted predominantly of “ y e ~ ” I ~ ~ n o ’ ~ and open-ended items regarding background information about the deceased, the circumstances of death and emotional state prior to death, as well as the feelings and experiences of the responding survivor regarding the death. In some cases the degree to which an affective response was felt or to which a change had occurred was also indicated. This exploratory questionnaire was constructed based on the experience of the second author as a suicide survivor and facilitator of survivors groups.

Of the many questions asked, some were more quantifiable than others and will be the focus of the presentation here. These factors include the amount of guilt and anger felt by the survivors after the death (“none” scored as 0, “mild” as 1, “moderate” as 2, and “very guilty/angry” as 3), the severity with which the survivors saw the death scene in their mind (0 = “didn’t see,” 1 = “mild,” 2 = “moderate,” 3 = “severe”), the symptoms of physical and/or psychological difficulties displayed by the survivors

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014


following the deaths, and socially stigmatizing aspects experienced following the suicide. To determine specifically the personal symptoms or responses since the death, respondents were asked whether they had (u) felt guilt or ( b ) anger; (c) experienced problems seeing the death scene in their minds following the death; (6) thought about their own suicide; ( e ) worried that someone else might die, or v> become mentally ill; (g) experienced any panic attacks; (h ) ever momentarily forgot that the person was dead; ( 2 3 thought even just for a moment that they had seen the deceased; 0’) dreamed about the deceased; (k) experienced difficulty in concentrating or (0 sleeping; (m) experienced headaches, (n) stomach aches, or (0) back pain; and @I) how they would rate their physical health. For symptoms a-j a response was counted as indicating the presence of a personal symptom associated with the death, whereas for k-o any response except “not at all” was so counted. Self-rating of health, symptom p , was included if the person said “moderate” or “p00r” (compared to “good” or “excellent”). The total number of these personal symptoms was tallied for each subject.

Reflecting the shame and stigma associated with suicide and experienced by these survivors, eight questions were asked to determine ( u ) how much discussion of the death occurred in the family; ( b ) whether immediately after the death the survivor told people that the death was a suicide; (c) if the survivor felt guilty, or ( d ) was blamed by anyone for the suicide; (e ) whether people avoided the survivor, cf> avoided talking about the deceased to them, (g) acted as though the death had not occurred, or ( h ) taunted, ridiculed, or made fun of them after the death. Responses of “very little” or “absolutely none” were scored as indicating that shame and/or stigma were experienced and present for item a. For questions c-h a “yes” response reflected shame or stigma elements whereas a “no” response for question b was so counted. The total number of stigmatizing aspects was computed for each subject.

Procedure. Before being mailed to the survivors on the compiled lists, the questionnaire was read over the phone and verbally responded to by ten survivors. These respondents indicated that they felt all questions were appropriate and none were offensive. After this pretesting, two copies and a cover letter were mailed to each of the 250 households. The cover letter indicated that the recipients

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014

26 J . L. McIntosh and A . Wrobleski

had been chosen because they had made contact with a suicide survivors group. After explaining the purpose of the study, the letter asked that two members of the family complete the questions to give the different perspectives that might exist within families. The respondents were also instructed to return the questionnaire within one month in the enclosed stamped, self-addressed envelope. Re- spondents were assured of the confidentiality and anonymity of their data and thanked for their help.

Results

In general, fewer differences than expected were observed among the survivors of these various relationship categories with respect to guilt, anger, seeing the death scene, and the number of personal symptoms or stigmatizing elements reported. More specifically, no differences in the amount of guilt felt (overall M = 1.96; means for child, parent, sibling, and spouse survivors were 1.63, 2.05, 2.16, and 1.75, respectively) or problems seeing the death scene in their mind (overall M = 1.56; means as above were 1.29, 1.55, 1.41, 2.08, respectively) were found for the groups. A significant effect was found for the amount of anger felt, F(3, 137) = 4.61, p < .005 (overall M = 2.05). More anger was expressed by spouses (M = 2.42), (78) = 2.79, p < .01, and siblings (M = 2.38), t(91) = 2.98, p < .005, than among parents who survived the death of a child (M = 1.64). No other group differences for anger were observed (for children who survived a parental death M = 2.17). The results of all analyses remained the same when each specific kinship group was compared to the remainder of the sample (e.g., parents vs. nonparent survivors, sibling vs. non- sibling survivors, etc.).

Of the 16 total symptoms, the average number reported was 12.1 for the 141 survivors and a significant effect was found for the number of personal symptoms, F(3, 137) = 7.73, p < .OOl. Fewer personal symptoms were indicated by parents who survived the suicide of a child (M = 10.5) than by spouses (M = 13.58), (78) = 4.23, p < .001, siblings (M = 13.22), t(9l) = 4.31, p < .OOl, and children who survived a parental death (M = 12.63), t(78) = 2.44, p < .05. All other group differences were nonsignifi-

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014


cant. As seen in Table I , more than half of the respondents of all four kinship relations indicated that they had experienced the following symptoms (in descending order of frequency for the entire sample): concentration difficulties, sleeping difficulty, guilt, anger, dreaming about the deceased, problems seeing the death scene in their mind, and worrying about someone else dying. Of the other symptoms, more than half of the responding survivors in the child, sibling, and spouse groups reported thinking about their own suicide, having panic attacks, momentarily forgetting that the person was dead, and thinking that they had seen the deceased, In each of these cases, less than half of the parents who survived the death of a child had experienced the symptom. Child and sibling survivors were more likely to worry about someone else becoming mentally ill. The physical symptoms of headaches, stomach aches and back pain were less commonly seen among nearly all groups. Poor health was the least frequently observed symptom for any kinship group, with only 22 total respondents (15.6 percent) indicating that their health was “moderate” and none rating their health as “poor.”

From among the eight questions that assessed the presence of social stigma or shame experienced by the survivors, the overall mean was 2.74. There was an overall main effect for kinship relation, F(3 , 137) = 7.29, p < .01. Parents (M = 2.21) reported significantly fewer of these stigmatizing events than did either siblings (M = 3.32), (91) = 3.54, p < .OOI , or spouses (M = 3.33), t(78) = 2.95, p < .005. There were no other significant group differences (child survivors of parental suicides had a M = 2.46). The number of stigmatizing events was significantly related to all of the major variables of the investigation. Higher numbers of stigmatizing elements were associated with greater amounts of guilt, r = .29, p < .001; anger, r = .19, p < .05; problems seeing the death scene in one’s mind, r = .17, p < .005; changes in guilt feelings over time, r = .16, p < .05, and the number of personal symptoms, r = .40, p < .001. The number of stigmatizing events was negatively related to the age of both the survivor, r = - .27, p < .001, and the decedent r = - .15, p < .05. Younger ages of the survivor and decedent occurred with higher numbers of stigmatizing events.

The distribution of the particular stigmatizing elements pro- vides some feel for the somewhat different experience of the various

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014

N

TA

BL

E 1

. N

umbe

r of

Per

sona

l Sy

mpt

oms

Am

ong

Suic

ide

Surv

ivor

s of

Var

ious

Kin

ship

Rel

atio

ns

0

Kin

ship

rel

atio

n (S

urvi

vor

was

:)

Tot

al

Pare

nt

Chi

ld

Sibl

ing

Spou

se

Sym

ptom

s %

(N

) R

ank

%

(N)

Ran

k %

(N

) R

ank

% (N)

Ran

k %

(N

) R

ank

Con

cent

ratio

n di

ffic

ulty

Sl

eepi

ng d

iffi

culty

G

uilt

afte

r th

e de

ath

Ang

er a

fter

the

dea

th

Dre

amed

abo

ut t

he d

ecea

sed

Wor

ried

som

eone

els

e m

ight

die

T

roub

le s

eein

g th

e de

ath

scen

e in

one

’s m

ind

Wor

ried

som

eone

els

e m

ight

bec

ome

men

tally

ill

Mom

enta

rily

for

got t

he p

erso

n ha

d di

ed

Tho

ught

for

a m

omen

t th

ey h

ad s

een

the

dece

ased

H

ad p

anic

atta

cks

Had

hea

dach

es

Tho

ught

s of

ow

n su

icid

e H

ad s

tom

ach

ache

s H

ad b

ack

pain

Se

lf-r

ated

hea

lth a

s m

oder

ate

or

poor

*

89.3

(12

6)

86.5

(12

2)

85.1

(12

0)

83.7

(11

8)

80.1

(11

3)

68.8

(9

7)

66.0

(9

3)

57.4

(8

1)

57.4

(8

1)

56.7

(8

0)

54.6

(7

7)

46.8

(6

6)

46.1

(6

5)

38.3

(5

4)

34.8

(4

9)

15.6

(2

2)

1 84

.0 (

47)

2 84

.0 (

47)

3 85

.7 (

48)

4 71

.4 (

40)

5 66

.1 (

37)

6 64

.3 (

36)

7 67

.9 (

38)

8 48

.2

(27)

8

42.9

(24

) 10

48

.2 (

27)

11

44.6

(2

5)

13

28.6

(1

6)

14

26.7

(1

5)

15

26.7

(1

5)

16

16.1

(9

)

12’

33.9

(19

)

2 87

.5 (

21)

1 2

83.3

(20

) 3

1 70

.8 (

17)

6 4

87.5

(21

) 1

6 79

.2

(19)

5

7 70

.8 (

17)

6 5

54.2

(13

) 10

8

83.3

(20

) 3

11

50.0

(12

) 12

8

54.2

(13

) 10

10

62

.5 (

15)

8 12

45

.8 (

11)

14

13

58.3

(14

) 9

14

50.0

(12

) 12

14

37

.5

(9)

15

16

12.5

(3

) 16

94.6

(3

5)

94.6

(35

) 89

.2

(33)

81.1

(30

) 56

.8 (

21)

67.6

(25

) 70

.3 (

26)

67.6

(25

) 62

.2 (

23)

62.2

(23

) 56

.8 (

21)

37.8

(14

) 32

.4 (

12)

13.5

(5

)

91.9

(34

)

91.9

(34

)

1 3 1 5 3 6 12 8 7 8 10

10

12

14

15

16

95.8

(23

) 2

87.5

(21

) 4

83.3

(20

) 6

100.

0 (2

4)

1 95

.8 (

23)

2 58

.3 (

14)

9 87

.5 (

21)

4 37

.5

(9)

15

79.2

(1

9)

7 62

.5 (

15)

8 58

.3 (

14)

9 54

.2 (

13)

12

58.3

(14

) 9

54.2

(13

) 12

54

.2 (

13)

12

20.8

(5

) 16

Tot

al n

o. o

f re

spon

dent

s:

141

56

24

37

24

Mea

n no

. of

sym

ptom

s:

12.1

10

.5

12.6

13

.2

13.6

~

~ ~

-

~~~

~

*No

resp

onde

nts

rate

d th

eir

heal

th a

s “p

oor.”

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014

Suicide Suruiuors Relationships 29

kinship groups (Table 2). Being taunted, ridiculed, or made fun of was infrequent among all groups, while guilt feelings and the avoid- ance of talking about the deceased were high for nearly all groups. People behaving as if the death had not occurred was the only other prominent aspects of stigma among parents surviving the deaths of their child offspring. Parents of adult offspring were the most likely of all groups to express feelings of guilt, even more likely than the parents of young offspring suicides. O n the other hand, parents of adult offspring least often reported that they felt blamed by others. One might argue that even though their children did not live with them, these parents of adult offspring might have felt that perhaps they could have done something (“what if’ guilt) if only they had been with the children.

Although it was not a prevalent occurrence, little or no family discussion of the suicide death was more common for children who survived parental suicides, for siblings, and spouses. In the case of siblings and children, this may reflect a desire on the part of adults to shield or protect the young from the death. The most common stigma related elements noted by sibling survivors, however, were people avoiding them, avoiding talking about the deceased, and acting as if the death had not occurred. These elements are perhaps among the most clearly related to social aspects of stigma and, in a slightly different configuration, are also almost prominent for spouse survivors. Spouses commonly reported being blamed, avoided, and having people avoid talking about the deceased. In the case of being blamed, this may reflect, as the literature suggests (9, pp. 82-83), being held responsible by the spouse’s (usually the husband’s) family as well as the community.

There was a significant difference in the groups with respect to the time since the death, F(3, 137) = 6.00, p < .001. As would be expected, the time since the death was greatest for the offspring who survived a parental suicide (M = 88.21 months; vs. parents, (78) = 2.94, p < . O l ; vs. siblings, t(59) = 2.90, p < .01; vs. spouses, t(46) = 2.12, p < .05, but comparisons were not significantly different among parents who survived a child’s suicide ( M = 35.39), siblings ( M = 28.59), and spouse survivors (M = 34.54). A negative relation was observed between the number of months since the death and the number of symptoms noted,

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014

TA

BL

E 2

. St

igm

a-R

elat

ed E

xper

ienc

es A

mon

g Su

icid

e Su

rviv

ors

of V

ario

us K

insh

ip R

elat

ions

~ St

igm

a-re

late

d el

emen

ts’

Kin

ship

rel

atio

n (S

urvi

vor

was

:)

Pare

nt o

f of

fspr

ing’

*

Tot

al

Tot

al

You

ng

Adu

lt

Chi

ld

Sibl

ing

Spou

se

.%

%

%

%

%

%

%

Did

you

fee

l gui

lty a

fter

the

dea

th?

85.1

85

.7

76.7

96

.2

70.8

94

.6

83.3

D

id p

eopl

e av

oid

talk

ing

to y

ou a

bout

the

dec

ease

d?

63.8

55

.4

63.3

46

.2

66.7

73

.0

66.7

D

o yo

u fe

el p

eopl

e av

oide

d yo

u af

ter

the

deat

h?

36.2

21

.4

30.0

11

.5

29.2

51

.4

54.2

D

id p

eopl

e ac

t as

tho

ugh

the

deat

h ha

d no

t oc

curr

ed?

34.8

30

.4

43.3

15

.4

29.2

54

.1

20.8

W

ere

you

blam

ed b

y an

yone

for

the

dea

th?

19.9

12

.5

20.0

3.

8 8.

3 13

.5

58.3

Im

med

iate

ly a

fter

the

dea

th d

id y

ou t

ell

peop

le i

t w

as a

sui

cide

? 14

.9

8.9

3.3

15.4

16

.7

18.9

20

.8

Wha

t am

ount

of

fam

ily d

iscu

ssio

n of

the

dea

th o

ccur

red?

14

.9

7.1

6.7

7.7

20.8

18

.9

20.8

D

id a

nyon

e ta

unt,

rid

icul

e, o

r m

ake

fun

of y

ou a

fter

the

dea

th?

4.3

0.0

0.0

0.0

4.2

8.1

8.3

Tot

al n

o. o

f re

spon

dent

s 14

1 56

30

26

24

37

24

Mea

n no

. of

ele

men

ts:

2.74

2.

21

2.43

1.

96

2.46

3.

32

3.33

*A re

spon

se o

f “N

o” w

as s

core

d as

ind

icat

ing

sham

e or

sti

gma

for i

tem

f (t

ell p

eopl

e it

was

a s

uici

de);

“ve

ry l

ittl

e” o

r “a

bsol

utel

y no

ne”

are

repr

esen

ted

for

item

**Y

oung

offs

prin

g re

fers

to t

hose

age

d be

low

25

year

s; a

dult

off

spri

ng w

ere

25 y

ears

of

age

and

olde

r. g

(am

ount

of

fam

ily d

iscu

ssio

n) a

s in

dica

tions

of

stig

ma;

res

pons

es o

f “Y

es”

for

all

othe

r qu

esti

ons

wer

e sc

ored

as

stig

ma

resp

onse

s.

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014


r = - .34, p < . O O l , such that longer periods of time since the death were observed in association with fewer symptoms.

Among the 141 respondents, the vast majority ( N = 120; 85.1 percent) indicated that they had felt guilty after the person’s death. When asked how much guilt they had felt 15.6 percent ( N = 22) replied none or did not respond while 12.1 percent ( N = 17) expressed mild guilt, 33.3 percent ( N = 47) indicated moderate levels, and 39.0 percent ( N = 55) said they felt very guilty. Scoring no guilt as zero (0) and very guilty as 3, the mean guilt was 1.96, or essentially moderate levels of guilt. As stated above, no significant kinship group differences were observed. No significant correla- tions were found between the actual age of the deceased or respondents and the guilt felt after the death.

For nearly all survivors the guilt had lessened since the death ( N = 80, 56.7 percent) or had remained the same ( N = 34, 24.1 percent), while only 2 (1.4 percent) indicated greater feelings of guilt. No significant kinship differences in the change in guilt feelings were noted (0 = no guilt, 1 = less, 2 = same, 3 = more, overall M = 1.09; parent survivors = 1.23; child = 0.88; siblings = 1.16; spouses = 0.88). A significant correlation was observed between the months since the death had occurred and the level of guilt, compared to level of guilt immediately after the death, r = - .24, p < .01. That is, declines in guilt were associated with increases in the number of months since the death. In addition, the amount of guilt felt immediately after the death was significantly related to current levels of guilt, r = .58, p < .001. In other words, those with greater amounts of guilt just after the death were less likely to report declines in guilt or likely to report lesser declines, whereas those with lesser amounts initially were more likely to indicate lower levels currently. Although they were in the minority, the most.guilty seem to feel guiltier currently as well.

As with guilt, most respondents felt anger after the person had died ( N = 118; 83.7 percent responded “yes,” compared to 23 or 16.3 percent who said “no” or made no response). When asked how much anger they had felt, a total of 26 (18.4 percent) survivors failed to respond or said they had experienced no anger; 10 (7.1 percent) noted mild anger; while 35 (24.8 percent) and 70 (49.6 percent) stated that they were moderately or very angry, respectively. A significant negative correlation was observed between an-

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014

32 J. L. Mclntosh and A . Wrobleski

ger after the death and the respondents’ actual ages, r = - .33, p < .001, such that higher levels of anger were associated with younger ages of the survivors.

The persons toward whom anger was felt were most typically the deceased or the deceased and others (50.3 percent, N - 71). Less than 10 percent were angry at any other group including other family members, mental health or medical professionals, friends, or police. The feelings of anger that were felt were in most cases less than they had been earlier ( N = 74, 52.5 percent) or at the same levels (N = 29, 20.6 percent), with only 10 (7.1 percent) people indicating greater feelings of anger. Current anger compared to that immediately after the death was significantly related to the age of the deceased, r = .18, p < .05, with less change in anger being associated with younger decedents. It should be noted that the amount of anger felt after the death was significantly related to how much guilt was felt, r = .19, p < .05. That is, greater anger was associated with greater feelings of guilt.

A third response to the death had to do with whether survivors have or had problems seeing the death scene in their minds and how severely they saw it. Most (N = 93, 66.0 percent) said they did have such trouble compared to only 43 (30.5 percent) who said they had not. Among those who said they had trouble seeing the death scene, slightly less than half (N = 43) had a severe or moderate (N = 40) problem, and a small number had mild (N = 11) problems. The mean severity for the entire sample was 1.60, or roughly between mild and moderate. There were moderate relations observed between severity of seeing the death scene and months since death, r = - . l a , p < .05, and guilt after the death, r = .14, p < .05. The longer the time since the death, the less the severity of seeing the death scene in one’s mind, while higher levels of guilt were seen in association with greater severity of seeing the scene. As with both anger and guilt, nearly all respondents reported that seeing the death scene in their minds had decreased (N = 63) or stayed the same ( N = 26) while only 3 said it had increased.

Parents Suruiuors of Young uersus Older Offspring

Possible differences in grief experiences among surviving parents of offspring who committed suicide when they were young versus

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014


parents of adult offspring were also investigated as well as compared to other kinship groups. A total of 30 parents survived the death of a child under the age of 25 (range = 16-24, M age of child = 20.0) while the other 26 were survivors of offspring who were 25 and above at the time of their suicide (range =

25-38, M = 28.6 years old). The analyses described above were affected in some cases by the further breakdown of the group of parent survivors, but no significant differences for any of the measures were observed between the two groups of parents who survived young and adult offspring’s suicides. More specifically, as before, no group differences in the amount of guilt or problems seeing the death scene were found. Once again, main effects for kinship relation were noted for both the amount of anger felt, F(4, 136) = 4.17, p < .005, the number of personal symptoms experienced, F ( 4 , 136) = 6.55, p < .OOl, and the time since the death in months, F(4, 136) = 4.47, p < ,005. For the latter, there was little difference in the time since the death for the two parent groups (M = 34.5 for those surviving young suicides, M = 36.4 for older offspring suicides), and both were significantly shorter periods of time than for the children who survived parental suicides (M = 88.2 months).

In the case of the amount of anger felt by the survivors, the parents who survived the suicides of adult offspring (M = 1.38) expressed less anger than the child survivors of parental suicides ( M = 2.17), t(48) = 2.23, p < .05; siblings ( M = 2.38), (48) = 3.46, p < .001; and spouses (M = 2.42), (48) = 3.44, p < .001, but not significantly less than among parents who survived child offspring suicides (M = 1.87). Parents of child offspring suicides were not significantly different from any of the other kinship groups in the anger they felt.

With only one exception, both parental groups were different from the other three kinship groups with respect to the number of personal symptoms displayed. Parents of young (M = 11.17) and parents of adult offspring suicides ( M = 9.73), respectively, exhibited fewer personal symptoms than did sibling ( M = 13.22; t(65) = 2.81, p < .01, t(6l) = 4.77, p < .OOl) or spouse survivors (M = 13.58; t(52) = 2.96, p < .005, t(48) = 4.79, p < .OOl). However, only parents of adult offspring suicides had signifi-

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014

34 J. L. McIntosh and A . Wrobleski

cantly fewer symptoms than did the children who survived parental suicides (M = 12.63; t(48) = 2.70, p < .Ol).

As seen above, the main effect observed for socially stigmatizing elements was produced by differences between parents who survived the suicide of an offspring compared to siblings and spouses of suicides. When breaking down parents into survivors of child ( M = 2.43) and adult offspring suicides (A4 = 1.96), both experienced fewer stigmatizing events than did siblings (M = 3.32), t(65) = 2.33, p < .05, and t(61) = 3.69, p < .001, respectively. However, only parents who survived the suicide of adult offspring displayed fewer of the socially stigmatizing elements than did spouses (M = 3.33), t(48) = 3.11, p < .005. No other significant group differences were observed, including between the two parental groups.

Discussion

As seen in other studies, the 141 suicide survivors in this exploratory investigation also were observed to have experienced feelings of guilt and anger following the suicide death as well as other reactions such as sleep and concentration difficulty, dreaming about the deceased, seeing the death scene in their mind, and worrying that someone else in their family might die. Several other aspects were also present that probably complicated the grief process compared to that for other modes of death. The specific kinship relation of the survivor to the deceased had less of an effect on the reactions of these survivors than the literature and clinical opinion would indicate. This particularly stands in contrast to the popular notion that the suicides of the young are more tragic, devastating or difficult to deal with.

In most cases in which kinship differences were noted, they were due to the indication of greater problems in the responses of siblings and spouses rather than among parents of child suicides. When parents who survived the suicide of a young offspring were compared to parents whose adult offspring committed suicide, the adult offspring survivors usually displayed less problematic levels of grief. The responses of child offspring survivors, however, were in no case in the direction of a more problematic grief than other

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014


kinship groups. In fact, among all parent survivors, the survivors of child offspring suicides were most similar to the survivors of parental, sibling, and spouse suicides. Contrary to the literature cited above (16), no evidence was obtained to support the contention of a more intense, difficult, or different grief among parents whose young child died by suicide. This included psychological, physical, and social aspects of the grief experience.

As a partial explanation for the discrepancy of these findings with clinical and popular opinion, it might be suggested that in suicide deaths the circumstances are so severe as to diminish, and in many cases eliminate, major differences between those of various kinship relations that may exist when comparing survivors of other causes of death. Wrobleski (17, p. 178) would argue that no matter the particular relationship, “every suicide is the ‘worst’ for the specific survivors .” The special aspects of suicide grief, therefore, possibly may “level” the bereavement of suicide survivors.

With respect to particular grief reactions or responses, guilt was among the most prevalent responses and was most often felt not for things one actually did or said, but rather regret for what one felt they might have done or said. In general, 40 percent of the respondents felt very guilty. Similarly, anger was a common response, with 50 percent of the respondents feeling very angry. Both anger and guilt were observed to have declined over time for these survivors. More generally, the suicide survivors exhibited a mean of 12 out of 16 symptoms or reactions about which they were asked and 3 out of 8 stigma-related events.

One might expect that a death, whether suicide or from other causes, would result in a number of reactions on the part of the survivors. Guilt is one of those reactions. McIntosh and Milne (18), however, did not find more guilt for suicide survivors than survivors of accidental or natural deaths among the college students they studied. On the other hand, Demi (19) found more guilt among suicide survivor widows than among widows whose spouse died by accidental or natural deaths. Even if more suicide survivors feel guilt immediately following the death, as other research might indicate (5), in the present study the guilt and other symptoms such as anger had decreased for nearly all survivors over time. In addition, no significant kinship group differences were observed in the amount of guilt felt, and the highest proportion of survivors report-

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014

36 J . L. McIntosh and A . Wrobleski

ing guilt was among siblings (94.6 percent) and not among parents (85.7 percent). When considering the age of the child that the parents survived, however, parents of adult offspring who committed suicide almost universally reported guilt feelings (96.2 percent) while parents of children under the age of 25 who died by suicide often, but less frequently, felt guilty (76.7 percent). There is no evidence that any significant proportion of these survivors with any characteristics have experienced great or prolonged physical or mental health problems as a result of their loss. In other words, no evidence of pathology exists on the part of these suicide survivors.

Stigma-related events were reported by survivors of all kinship relations, and while guilt and avoiding talking about the deceased on the part of others seem to be common elements, there were to some degree differences in the stigma experienced. More specifically, siblings and spouses, and to a lesser degree parents whose young children committed suicide, may experience greater amounts of social stigmatizing in their interactions with others.

There are difficulties with the present investigation. The most problematic is its lack of comparison kinship groups representing other modes of death. It is not certain that the levels of symptoms and reactions observed here are different from those experienced by survivors of other causes of death. Certainly there is a need to do such comparative research, and the few such studies that have thus far been conducted (18-25) are not without their methodological problems.

Another possible difficulty with this investigation is its subject selection procedure. The subjects were those who had contacted a suicide survivors support group and returned the mail survey. It is not clear whether these individuals are representative of survivors in general. In some ways they may be at least similar, however, since most of the decedents were males (as seen in suicide generally), and as might be expected most of the survivors were females. The high education levels of these survivors may reflect some degree of selectivity.

Other potentially problematic aspects of the present investigation include the unknown reliability and validity of the instruments. The sensitivity of these questions in assessing guilt, anger, etc. is also uncertain. Finally, longitudinal research designs that measure the reactions of suicide survivors over time may show differences

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014


that were not observed in the current retrospective study. Indeed, in a retrospective design, Barrett and Scott (20) observed no differences in measures of recovery between suicide and other survivors two to four years after the death. It could be that differences in grief and recovery exist at periods closer to the death that are not present later in the recovery process. However, it is not certain that differences exist at any period following the death. Research that looks more closely at the grief reactions and the course of these reactions in a longitudinal fashion is clearly needed for suicide victim survivors compared to survivors of victims of other causes of death (26- 27).

Conclusion

A characterization of the kinship differences observed here would indicate that siblings and spouses experience somewhat more difficult grief and reactions associated with it than do children who survive parental suicides, and especially parents of offspring who commit suicide. Among parents, however, the lowest levels of responses were most often seen for parents whose adult offspring (i.e., aged 25 years and above) died by suicide as compared with parents who survived suicide deaths of offspring under the age of 25. These differences were observed for the number of personal psychological and physical symptoms and the social stigma following the suicide of the loved one, as well as feelings of anger (especially those felt toward the deceased). Although the literature speaks much of guilt as a prominent feature in suicide grief, and although it was observed in high proportions among each of the kinship groups studied here, in no kinship relation group was guilt reported among all respondents. No group displayed significantly greater amounts of guilt, and mean levels were generally moderate for all kinship relations.

Closer scrutiny of possible kinship relation effects in death from the various causes seems warranted. This exploratory study of the problems and reactions of suicide survivors has noted some common responses to a suicide death but has not found the kinship differences that many people may expect. Although some kinship differences were observed here among suicide victim survivors, clear resolution of differences and uniqueness in the grief of survi-

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014

38 J. L. McIntosh and A . Wrobleski

vors of victims of various causes of death and with respect to social relationships remains for future research endeavors.

References

1. Andress, V. R., & Corey, D. M . (1978). Survivor-victims: Who discovers or witnesses suicide? Psychological Reports, 42, 759-764.

2 . Shneidman, E. S. (1972). Foreword. In A. C. Cain (Ed.), Survivors ofsuicide (pp. ix-xi). Springfield, IL: Charles C Thomas.

3. McIntosh, J. L. (1985-86). Survivors of suicide: A comprehensive bibliography. Omega, I S , 355-370.

4. McIntosh, J. L. (1985). Research on suicide: A bibliography. Westport, CT: Greenwood Press.

5. Calhoun, L. G., Selby, J . E., & Selby, L. E. (1982). The psychological aftermath of suicide: An analysis of current evidence. Clinical Psychology Review, 2,

6. Foglia, B. B. (1984). Survivor victims of suicide: Review of the literature. In C . L. Hatton & S. M. Valente (Eds.). Suicide: Assessment and intervention (2nd ed.). (pp. 149-162). Norwalk, CT: Appleton-Century-Crofts.

7. Hauser, M. J . (1987). Special aspects of grief after a suicide. In E. J. Dunne, J. L. McIntosh, & K. Dunne-Maxim (Eds.), Suicide and its aftermath: Under- standing and counseling the survivors (pp. 57-70). New York: W. W. Norton.

8. Henley, S. H . A. (1984). Bereavement following suicide: A review of the literature. Current Psychological Research & Reviews, 3, 53-61.

9. McIntosh, J. L. (1987). Survivor family relationships: Literature review. In E. J. Dunne, J . L. McIntosh, & K. Dunne-Maxim (Eds.), Suicide and its aftermath: Understanding and counselin8 the survivors (pp. 73-84). New York: W. W. Norton.

10. Seiden, R. H. (1969). Suicide among youth: A review of the literature, 1900-1967 (Suppl. to Bulletin of Suicidology) (Public Health Service Publication No. 1971). Washington, D.C.: U.S. Government Printing Office.

11. Morse, S. R. (1984). Survivors of suicide: The siblings tell their story. Disser- tation Abstracts International, 45, 1025B. (University Microfilms No. DA84 14702)

12. Rosenfeld, L., & Prupas, M . (1984). Ldt alive: After a suicide death in the farnib. Springfield, IL: Charles C Thomas.

13. Holmes, T. H. , & Rahe, R. H. (1967). The Social Readjustment Rating Scale. Journal of Psychosomatic Research, 11, 2 13-2 18.

14. Wrobleski, A , , & McIntosh, J . L. (1987). Responses of suicide survivors: An exploratory investigation. In C . A. Corr & R. A. Pacholski (Eds.), Death: Completion and discovery (pp. 123-133). Lakewood, OH: Association for Death Education and Counseling.

15. Wrobleski, A , , & Mclntosh, J . L. (in press). Problems of suicide survivors: An exploratory investigation. Israel Journal of Psychiatry.

409-420.

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014


16. Rando, T. A. (Ed.). (1986). Parental loss of a child. Champaign, IL: Research

17. Wrobleski, A. (1984-1985). The Suicide Survivors Grief Group. Omega, 15,

18. McIntosh, J. L. , & Milne, K. L. (1986, April 4). Survivors’ reactions: Suicide us. other causes. Paper presented at the annual meeting of the American Associa- tion of Suicidology, Atlanta, GA.

19. Demi, A. (1984). Social adjustment of widows after a sudden death: Suicide and non-suicide survivors compared. Death Education, 8(Suppl.), 91-1 11.

20. Barrett, T. W., & Scott, T. B. (1986, May). Suicide us. other bereavement recovery patterns. Paper presented at the joint meeting of the American Association of Suicidology and the International Association for Suicide Prevention, San Francisco, CA.

21. Pennebaker, J . W., & O’Heeron, R . C . (1984). Confiding in others and ill- ness rate among spouses of suicide and accidental-death victims. Journal of Abnormal Psychology, 93, 473-476.

22. Trolley, B. C . (1986). Suicide parents and sudden death parents: The grief process, the nature of help, the role of the professional, and methodological issues. Dissertation Abstracts International, 46, 2449B-2450B. (University Micro- films No. DA8518780)

23. van der Wal, J . , & Diekstra, R. F. W. (1987, May). Griefreactions ofsurvivors of suicide: Results of a sample survey study. Paper presented at the joint meeting of the American Association of Suicidology and the International Association for Suicide Prevention, San Francisco, CA.

24. Vargas, L. A. (1982). Bereavement in thefour modes of death in Whites, Blacks, and Hispanics. Unpublished doctoral dissertation, University of Nebraska.

25. Williams, M. (1986, April). Compariy responses of sudden death survivors. Paper presented at the annual meeting of the American Association of Suicidology, Atlanta, GA.

26. Cain, A. C . (1972). Introduction. In A. C . Cain (Ed.), Survivors ofsuicide (pp. 5-33). Springfield, IL: Charles C Thomas.

27. McIntosh, J. L. (1987). Research, therapy, and education needs. In E. J. Dunne, J. L. McIntosh, & K. Dunne-Maxim (Eds.), Suicide and its ajermath: Understanding and counseling the survivors (pp. 263-277). New York: W. W. Nor- ton.

Press.

173-184.

Received March 21, 1987

Dow

nloa

ded

by [

McM

aste

r U

nive

rsity

] at

06:

06 2

0 D

ecem

ber

2014

grief reactions among suicide survivors: an exploratory comparison of relationships

Documents