Presentation Transcript

1. Who is Exposed, Affected & Bereaved Following Suicide?

   Julie Cerel, PhD University of Kentucky September 10, 2013 Suicide Prevention in New Zealand
2. How is it after a suicide loss, some people end up hopeful? The love of my life took her life in March 2006 when she was six months pregnant. I thought my life was over; what more did I have to live for given what we had to look forward to? But how wrong was I. As I write this toward the end of 2010, I am in a new relationship and am about to become a father again. The horror of my tragic loss has been replaced with pure joy, hope, and a future; all things that I believed were taken from me on March 5, 2006. I always have been an optimist, but I never imagined this to happen. I’m writing my story about losing a life partner to suicide in the hope that others who have lost a partner can see that there is hope, and there can be joy in your life again. -Mark Wilson, New Zealand
3. Suicide Bereavement Often the statistic of 6 survivors per suicide is used. This approximation is based on an estimate created by Dr. Edwin Shneidman in the 1970s meant to be comparable to the number of extended family members who were eligible to receive compensation following either an incident in which bodies were double-buried in a cemetery (Linn-Gust, 2004) or an airline disaster Not Empirically based!
4. Estimates of “Survivors” Most people believe this is very low as many more than 6 people experience life changing effects when a person with whom they are connected ends their life
5. A new nomenclature for “survivors” (Cerel, McIntosh, Neimeyer, Marshall & Maple, in submission)
6. Potential Moderators of reaction: kinship relationship proximity to the decedent perceived emotional closeness, bond or attachment to the decedent previous experience with suicide (acquired capacity) exposure to the trauma of the death demographics (age, sex, etc.) perceived responsibility hostile social environment protective such as resources, support systems, and coping skills
7. Potential types of individuals in each category

8. What do we know about who is exposed to suicide?

9. Random Digit Dial studies Call a randomly selected sample of the general public To answer the questions What percentage of people know someone who has died by suicide? What variables influence outcome for people exposed to suicide? Two studies we’ve completed
10. Kentucky Population= 4.380 million (NZ=4.405 million) Veterans= 323,823 Land area in square km 104,659(NZ= 268,680) Persons per square km 68.9 (NZ=26.3) Suicide rate (24thin US) 631 people rate=14.5/100,000 population (NZ= 11.5)
11. Kentucky Awareness of Suicide Survey (KASS) 300 people per year for 3 years 64% knew at least one person who had attempted or died by suicide 40% knew at least 1 person who had died by suicide (Cerel, J, Maple, M., Aldrich, R., Van de Venne, J. (2013) Exposure to suicide and identification as survivor: Results from a random-digit dial survey. Crisis: The Journal of Crisis Intervention and Suicide Prevention)
12. Who is more likely to be exposed to suicide? No differences between people who had no exposure to suicide (n=107) compared to people who knew someone who had died by suicide (n=123) sex, race, rural/urban status, educational level, or income level

13. Of people exposed to suicide, who is a survivor?

14. Who is a survivor? Drawing from the individuals in the sample who knew someone who had died by suicide (n=123) , they were asked, “do you consider yourself a survivor of suicide. That is, someone whose life has been personally affected by a suicide?” 19.9% (n=61) of the complete sample reported being survivors
15. What makes someone “personally affected” following a suicide? No differences between survivors and non-survivors in terms of the following variables: age, sex of respondent, race, rural/urban status, education, age of the person who died, number of people they knew who had died by suicide
16. What about actual relationship?27 different relationships The top 11 most-common categories 5 non-familial categories (friend, friend’s family, acquaintance, co-worker, and ex) 6 familial categories (cousin, family other, uncle, brother-in-law, and nephew) But not reliable Someone lost a father and did not identify as a survivor Half of people who lost a friend identified as survivor Relationships does not distinguish between survivor or non-survivor status

17. So what doesdistinguish survivors from non-survivors of people who are exposed?

18. Comparison of Survivor Identification & Closeness with Decedent Cerel, Maple, Aldrich, Van de Venne, 2013

19. How does exposure to suicide influence mental health symptoms?

20. University of Kentucky Military Suicide Bereavement Study

    Julie Cerel, PhD, Principal Investigator Chris Flaherty, PhD, & Sabrina Walsh, DrPH, Co-Investigators Melinda Moore, PhD & Judy van de Venne, PhD, Research Team Members Myfanwy Maple, PhD, consultant *This work was in part supported by the Military Suicide Research Consortium (MSRC), Department of Defense, and VISN 19 Mental Illness Research, Education, and Clinical Center (MIRECC), but does not necessarily represent the views of the Department of Defense, Department of Veterans Affairs, or the United States Government. Support from the MSRC does not necessarily constitute or imply endorsement, sponsorship, or favoring of the study design, analysis, or recommendations.
21. Random Digit Dial Survey 931 veterans & 805 non-veteran community Both cell phones (20%) & land lines (80%) are being called. Veteran calls average 16 min, community calls average 10 min. All participants completed Patient Health Questionnaire measures about depressive (Phq-Dep9) & anxiety symptoms (Phq-Anx7), demographics Individuals with exposure to suicide report: Closeness to the decedent (1=not close to 5=very close) Prolonged Grief (PG-13) & PTSD symptoms (SSS-PTSD) about the suicide Veterans are also asked about whether they know someone who died suddenly & traumatically in their military career.
22. Design & Methodology: Progress Interview of family members of recent military suicides n=17 Military purposive sample=6
23. About the sample Whole sample (unweighted) 53.6% veteran (n=931) 68.9% male (n=1,196) Age: range 19-101 (x = 57.84+sd=16.32) 90.3% White (n=1,552) 66.5% married (n=1,152) 45.3% non-metro (n=783) Sample weighted -- comparable to residents of Kentucky 11.2% veteran 46.2% male Age: range 19 – 99, (x = 54.10+sd=16.33) 89.8% White 58.5% married 44.8% non-metro
24. Do you know anyone who has ever died by suicide? Does not differ between veterans and community.
25. Exposure is not related to demographics
26. Who They Lost Closeness to Decedent Impact of Suicide Death
27. Suicide Exposure: Relationships 61 unique relationships Most common Friend (28%) Best friend (2.5%), good friend (1.4%) Cousin (8.75%) Work colleague (6.0%) Boss, co-worker, “knew him from work” Military relationship (5.71%) Deployed together, company medic, buddy from training Acquaintance (5.14%) Unique categories Fan of my band AA group member No relationship- I found him
28. Suicide Exposure: Relationships
29. Quotes from people “exposed” His best friend “couldn’t tolerate having people talk about it. Which was sobering for the rest of us because, for me anyway, it turned it from a....I hate to say, fascinating, ....news into a much more personal experience and uh, I think it helped, in a way helped me to understand a little bit, I mean, it really did bring it home. Which made it more difficult but also official(sigh). In a way easier to process because it was somebody real. It wasn’t news. It was, at least somebody that I knew had lost somebody that they loved.” – former lab partner of a high school student who died by suicide
30. Exposure Related to Symptoms of Depression & Anxiety Those exposure to suicide report higher anxiety and depressive symptoms & probable diagnoses
31. Quotes from people “exposed” “being that young it kind of a....makes you realize that life can be short. You know, when you're young like that you never think about dying or anything like that. …And when something like that happens.. you kinda get reminded of mortality… life doesn't last forever. That everybody's gonna die someday. So it’s probably how it changed for me. It jilted me to the fact that, you know, sometimes life can be short. You know that....like I said, you don’t think about death much when you're young. You know, it jilts you into saying, "Hey, everybody's mortal“ Loss of high school friend to suicide
32. Closeness Associated with Mental Health Symptoms amongSuicide Exposed
33. Conclusions Almost half the population has exposure to the suicide of someone they know Demographic variables do not predict exposure Suicide exposure is related to increased depression, PTSD and overall anxiety symptoms and diagnoses. Perceived closeness to the decedent but not age, sex or time since the loss is related to depression, anxiety and prolonged grief symptoms. Future research needs to examine who goes from affected by suicide to bereaved by suicide
34. Future research needs to examine how some people after a suicide end up in a place where they can be hopeful again www.storiesofsuicideloss.com