The impact of suicidal behaviour on family members in Ireland: a mixed methods study

Background: Suicidal behaviour is a complex and multifaceted problem encompassing individual, social and environmental components. There is a plethora of studies examining the adverse psychological health effects of suicide bereavement, but high quality research in this area is still limited. However, the physical health consequences of both suicide and self-harm on family members is lacking. There is also a paucity of research exploring the specific support needs of people bereaved by suicide and people experiencing a family member’s self-harm, regardless of severity, both in the short and long-term. Methods: This doctoral work adopted a mixed methods approach and comprised four studies. Study 1 was a systematic review of the physical and psychosomatic health outcomes of family members bereaved by suicide. Study 2 (Inc. a published protocol) was a mixed methods examination of the physical and psychological health outcomes of family members bereaved by suicide that was conducted using qualitative interviews and quantitative scaled data. Study 3 was a qualitative study exploring how suicide-bereaved family members experienced the inquest process. Study 4 was a qualitative examination of individuals’ experiences of a family member’s high-risk self-harm. Results: The systematic review found tentative evidence that suicide-bereaved family members have an increased risk of a number of adverse physical health outcomes, including cardiovascular disease, diabetes and hypertension, compared to people bereaved by non-suicide deaths. The qualitative component of the mixed methods study indicated that intense grief reactions, including guilt, blame, anger and shame manifested in exacerbating and prolonging physical, psychological and psychosomatic difficulties. The quantitative component of the mixed methods study demonstrated that suicide-bereaved family members have elevated depression, anxiety and stress levels. The qualitative study exploring the impact of the inquest process identified a number of distressing and challenging aspects for family members, including the timing and setting of the inquest and hearing graphic evidence about their own family member and that of other people who died by suicide. Finally, the qualitative study exploring experiences after a family member’s high-risk self-harm indicated that the health impacts of experiencing multiple high-risk self-harm acts is particularly marked compared to experiencing a single self-harm act. Conclusion: The doctoral work presented in this thesis is innovative in examining the impact of a family member’s fatal or non-fatal suicidal behaviour from multiple research methods. The health impact of family members experiencing fatal or non-fatal suicidal behaviour are broadly similar and require proactive facilitation of support by clinicians. The inquest process was often viewed as distressing by suicide-bereaved family members. The support needs of people experiencing a family member’s suicide or high-risk self-harm are similar and both groups would benefit from a model of proactive facilitation of support by clinicians and other health professionals