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Cited by 241Suicide and Self-Harm StudiesGrief, Bereavement, and Mental HealthDeath, Funerary Practices, and Mourning

Bereavement by suicide as a risk factor for suicide attempt: A cross-sectional national UK-wide study of 3432 young bereaved adults

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Pitman, Alexandra L, Osborn, David P J, Rantell, Khadija, King, Michael B·2016·BMJ Open
DOI 10.1136/bmjopen-2015-009948PMC PMC4735143
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Abstract

OBJECTIVES: US and UK suicide prevention strategies suggest that bereavement by the suicide of a relative or friend is a risk factor for suicide. However, evidence is lacking that the risk exceeds that of any sudden bereavement, is specific to suicide, or applies to peer suicide. We conducted the first controlled UK-wide study to test the hypothesis that young adults bereaved by suicide have an increased risk of suicidal ideation and suicide attempt compared with young adults bereaved by other sudden deaths. DESIGN: National cross-sectional study. SETTING: Staff and students at 37 UK higher educational institutions in 2010. PARTICIPANTS: 3432 eligible respondents aged 18-40 exposed to sudden bereavement of a friend or relative after the age of 10. EXPOSURES: Bereavement by suicide (n=614), by sudden unnatural causes (n=712) and by sudden natural causes (n=2106). PRIMARY OUTCOME MEASURES: Incident suicidal ideation and suicide attempt. FINDINGS: Adults bereaved by suicide had a higher probability of attempting suicide (adjusted OR (AOR)=1.65; 95% CI 1.12 to 2.42; p=0.012) than those bereaved by sudden natural causes. There was no such increased risk in adults bereaved by sudden unnatural causes. There were no group differences in probability of suicidal ideation. The effect of suicide bereavement was similar whether bereaved participants were blood-related to the deceased or not. The significant association between bereavement by suicide and suicide attempt became non-significant when adding perceived stigma (AOR=1.11; 95% CI 0.74 to 1.67; p=0.610). When compared with adults bereaved by sudden unnatural causes, those bereaved by suicide did not show significant differences in suicide attempt (AOR=1.48; 95% CI 0.94 to 2.33; p=0.089). CONCLUSIONS: Bereavement by suicide is a specific risk factor for suicide attempt among young bereaved adults, whether related to the deceased or not. Suicide risk assessment of young adults should involve screening for a history of suicide in blood relatives, non-blood relatives and friends.

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  • People bereaved by suicide are at increased risk of adverse mental health outcomes, including depression, complicated/prolonged grief reactions, and suicidal behavior, compared with other bereaved groups.

    “Evidence synthesis indicates that people bereaved by suicide are at increased risk of adverse mental health outcomes, including depression, complicated/prolonged grief reactions, and suicidal behavior, compared with other bereaved groups (A. Pitman et al., 2014;A. L. Pitman et al., 2016).”

    From Relational and Institutional Disenfranchisement in Suicide Bereavement: A Qualitative Meta-Synthesis of Family Members' Experiences (2026) · cites this paper as A. L. Pitman et al., 2016

    The Findings report more suicide attempts among young adults bereaved by suicide than among those bereaved by sudden natural causes, but no significant difference from those bereaved by sudden unnatural causes. The Discussion reports no association with depression or suicidal ideation, and the passages do not establish an increased risk of complicated or prolonged grief. Thus this source supports only the narrower suicide-attempt part of the claim. (LLM, conf=0.91)

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  • Postvention is not only compassionate aftercare but a preventive intervention, with potential to mitigate prolonged grief trajectories, moral injury, and suicide risk among bereaved family members.

    “In this sense, postvention is not only compassionate aftercare but a preventive intervention, with potential to mitigate prolonged grief trajectories, moral injury, and suicide risk among bereaved family members (Bellini et al., 2018;A. Pitman et al., 2014;A. L. Pitman et al., 2016).”

    From Relational and Institutional Disenfranchisement in Suicide Bereavement: A Qualitative Meta-Synthesis of Family Members' Experiences (2026) · cites this paper as A. L. Pitman et al., 2016

    The Discussion proposes psychosocial support after suicide bereavement and calls for trials of interventions to reduce suicide-related outcomes. The Conclusions say the best ways to mitigate suicide-attempt risk remain unclear. Neither passage addresses whether postvention mitigates prolonged grief trajectories or moral injury. (LLM, conf=0.86)

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  • The questionnaire was developed with consultation from young bereaved adults and bereavement counsellors and piloted nationally.

    “We consulted a group of young bereaved adults and bereavement counsellors, who suggested which domains to cover and advised on wording, and we piloted the questionnaire nationally [10].”

    From Support Needs and Experiences of People Bereaved by Suicide: Qualitative Findings from a Cross-Sectional British Study of Bereaved Young Adults (2018) · cites this paper as [10]

    The Methods > Procedures passage says young bereaved adults and bereavement counsellors helped identify domains for the questionnaire, which was piloted with people accessing national bereavement support organisations. It does not say they advised on wording or establish that the pilot itself was conducted nationally. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Suicide bereavement is associated with adverse outcomes including increased risk of suicide attempt, drop-out from college or job, poor social functioning, and high levels of stigma, shame, guilt, and feelings of responsibility.

    “Suicide bereavement is also associated with other adverse outcomes [9], including an increased risk of suicide attempt [10], drop-out from a college course or job [10], poor social functioning [10], and high levels of stigma, shame, guilt, and feelings of responsibility [11].”

    From Support Needs and Experiences of People Bereaved by Suicide: Qualitative Findings from a Cross-Sectional British Study of Bereaved Young Adults (2018) · cites this paper as [10]

  • Bereavement by suicide is associated with an increased probability of suicide attempt in close contacts.

    “Empirical research now supports an association between bereavement by suicide and a range of negative health outcomes, including an increased probability of suicide1 and of suicide attempt in close contacts.2”

    From Support received after bereavement by suicide and other sudden deaths: A cross-sectional UK study of 3432 young bereaved adults (2017) · cites this paper as [2]

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Authors
Pitman, A. L., Osborn, D. P. J., Rantell, K., & King, M. B.
Affiliations
  • St Pancras Hospital (GB)
  • UCL Queen Square Institute of Neurology (GB)
Corresponding author
Pitman, Alexandra L
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2016-01
Volume
6
Issue
1
Pages
e009948
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2015-009948
PMC
PMC4735143
OpenAlex
W2269368194
Cited by
241
References
30
Citations by year
2026: 14 · 2025: 16 · 2024: 30 · 2023: 26 · 2022: 22 · 2021: 47 · 2020: 30 · 2019: 15 · 2018: 19 · 2017: 16 · 2016: 6
FWCI
24.96
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMJ Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • University of Cumbria
  • Bournemouth University
  • University of Dundee
  • Heriot-Watt University
  • Staffordshire University
  • University of Worcester
  • University of Greenwich
  • Queen Margaret University
  • University of Bedfordshire
  • Bishop Grosseteste University
  • University of Chester
  • National Institute for Health and Care Research (ACF-2007-18-010, NF-SI-0611-10210)
  • De Montfort University
  • University of Southampton
  • King's College London
  • University of Oxford
  • University of Leeds
  • Cranfield University
  • Cardiff University
  • Queen's University Belfast
  • University of Westminster
  • Ulster University
  • Cardiff Metropolitan University
  • Queen's University
  • Liverpool John Moores University
  • London Metropolitan University
  • Royal Veterinary College
  • Medical Research Council (G0802441)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
  • Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
Keywords
suicide bereavement, suicide attempts, suicidal ideation, sudden bereavement, young adults, perceived stigma, suicide risk assessment, suicide prevention, peer suicide
MeSH terms
Adolescent, Adult, Bereavement, Cross-Sectional Studies, Death, Sudden, Family, Female, United Kingdom, Humans, Male, Risk Factors, Suicide, Suicide, Attempted, Young Adult, Social Stigma, Suicidal Ideation

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