The most commonly employed methods of suicide are by gunshot, hanging, drug overdose or other poisoning, jumping, asphyxiation, vehicular impact, drowning, exsanguination, and electrocution. There are other indirect methods some attempters may employ, such as behaving recklessly or not taking vitally required medications. Many suicides go unreported, as it can be difficult to identify indirect suicide attempts as suicide, and even some of the more direct methods of suicide may not be clearly identifiable attempts. For example, drug overdoses or vehicular impact attempts are more passive methods, and it may be difficult to determine whether an event was an attempt or accident. Conversely, accidental drug overdoses can often be confused with suicide attempts. If the deceased left behind a note or told someone about their plans or intent to take their own life, this can help those left behind, the suicide survivors, to distinguish between an attempt and an accident, but often no such explanation exists.
Nearly 90% of all suicides are associated with a diagnosable mental health or substance-abuse disorder.3 The underlying vulnerability of suicidal behavior is the subject of intense research scrutiny, and includes biological, social, and psychological underpinnings.4-8 While depression and bipolar disorder are the most common disorders among people who attempt suicide, suicide attempters may also suffer from substance abuse disorders, other psychiatric disorders such as schizophrenia, and may feel that suicide is the only way to end an unbearable pain they may be feeling as the result of their mental illness, trauma, or a significant loss, rejection, or disappointment. Additionally, a past history of suicide attempts is the best predictor for future attempts.9 Common themes among suicide attempters are feelings of hopelessness, despair, and isolation from family and friends. Despite loved ones' and professionals' best efforts to support them in their suffering, suicide attempters are often unable to think clearly and rationally through their pain.
Coping with Suicide in Recovery
Suicide bereaved spouses often struggle because the marriage may be the most intimate relationship an individual ever experiences, and to be left by a self-inflicted death can feel like the ultimate form of rejection.44 Children who lose their parents to suicide are left to feel that the person whom they count on the most for the most basic needs has abandoned them.45,46 Results of one study suggest that children whose parents completed suicide and had an alcohol-use disorder were less likely to feel guilty or abandoned, and suicide bereaved spouses whose partners had an alcohol-use disorder were more likely to react with anger than other suicide bereaved spouses.47
Individuals from that same sample who developed CG were almost 10 times more likely to have reported suicidal ideation 1 month after the death of their loved ones, controlling for depression.30 In another sample of participants with CG, suicide bereaved participants reported twice the rate of recurrent and current depression compared with other bereaved individuals, reported higher rates of suicidal ideation before the death, and were at least as likely to report suicidal ideation since the death as other bereaved participants suffering from complicated grief.58 Finally, Latham and Prigerson found that CG is associated with higher levels of suicidal ideation independent of PTSD and depression.29
Although not specific to suicide bereavement, studies support the use of cognitive behavioral therapy (CBT),79,80 time-limited interpretive group therapy,81,82 and complicated grief therapy83 for the treatment of CG. Complicated grief treatment (CGT) is a modification of interpersonal psychotherapy, adding elements of cognitive behavioral therapy, exposure, gestalt, and motivational interviewing. The basic principle underlying CGT is that acute grief will transition instinctively to integrated grief if the complications of the grief are addressed and the natural mourning process is supported. Each session includes loss-focused grief work as well as restorationfocused attention. The loss-focused grief work aids the bereaved in accepting the loss, talking about the death and surrounding events, starting to take pleasure and comfort in memories of the loved one, and feeling a deep sense of connection with the deceased. It uses imagery and other exercises that resemble exposure techniques coupled with cognitive restructuring. The restorationfocused work helps the person become free to pursue personal goals, engage in meaningful relationships with others, and experience satisfaction and enjoyment. Studies support the robust efficacy of CGT for the treatment of complicated grief, even in situations of great severity, chronicity, and comorbidity.83-85
Death by suicide is always a tragic event. It can trigger a host of complicated and confusing emotions. Whether you are coping with the loss of a loved one or are helping a child or adult navigate such a loss, these tools can help.
Signs that a kid is not recovering in a healthy way include sadness and withdrawal from normal activities that last for so long they start to cause problems in their daily life. Their sleeping and eating habits may change. They may feel angry all the time. They may avoid things that remind them of the person who died or have intrusive thoughts about the suicide.
If you are reading this, you may be someone who had to steady yourself for the sudden and unexpected changes to your world that occurred as a result of the suicide of a loved one. You may not know where to start or whether you are experiencing all of the emotions connected to suicide grief. As you navigate these roads, you will find yourself facing different and sometimes intense emotions, punctuated with memories of your loved one and the impact they had on your life.
One of the things I know for sure is that grief happens, whether we are prepared for it or not, and whether there is room in our lives for it. It shows up in both predictable and unpredictable moments, in images and memories that simultaneously can bring joy and pain. Grief is a reflection of the connection we had to who (and what) has been lost. Allowing ourselves to grieve honors that connection. It is no different with suicide grief, and perhaps even more important that we allow our grief to happen.
The grief process is always difficult, but a loss through suicide is like no other, and the grieving can be especially complex and traumatic. People coping with this kind of loss often need more support than others, but may get less. There are various explanations for this. Suicide is a difficult subject to contemplate. Survivors may be reluctant to confide that the death was self-inflicted. And when others know the circumstances of the death, they may feel uncertain about how to offer help. Grief after suicide is different, but there are many resources for survivors, and many ways you can help the bereaved.
The death of a loved one is never easy to experience, whether it comes without warning or after a long struggle with illness. But several circumstances set death by suicide apart and make the grief process more challenging. For example:
A traumatic aftermath. Death by suicide is sudden, sometimes violent, and usually unexpected. Depending on the situation, survivors may need to deal with the police or handle press inquiries. While you are still in shock, you may be asked whether you want to visit the death scene. Sometimes officials will discourage the visit as too upsetting; at other times, you may be told you'll be grateful that you didn't leave it to your imagination. "Either may be the right decision for an individual. But it can add to the trauma if people feel that they don't have a choice," says Jack Jordan, Ph.D., clinical psychologist and co-author of After Suicide Loss: Coping with Your Grief.
Sometimes a person with a disabling or terminal disease chooses suicide as a way of gaining control or hastening the end. When a suicide can be understood that way, survivors may feel relieved of much of their what-if guilt. It doesn't mean someone didn't love their life. The grieving process may be very different than after other suicides.
Suicide survivors are more likely than other bereaved people to seek the help of a mental health professional. Look for a skilled therapist who is experienced in working with grief after suicide. The therapist can support you in many ways, including these:
Knowing what to say or how to help after a death is always difficult, but don't let fear of saying or doing the wrong thing prevent you from reaching out to suicide survivors. Don't hold back. Just as you would after any other death, express your concern, pitch in with practical tasks, and listen to whatever the person wants to tell you. Here are some special considerations:
Remember his or her life. Suicide isn't the most important thing about the person who died. Share memories and stories; use the person's name ("Remember when Brian taught my daughter how to ride a two-wheeler?"). If suicide has come at the end of a long struggle with mental or physical illness, be aware that the family may want to recognize the ongoing illness as the true cause of death.
This resource guides people through the first steps toward recovery and a hopeful future after a suicide attempt. It includes personal stories from survivors, and strategies for recovery, such as re-establishing connections and finding a counselor.
This brochure helps people recovering from a suicide attempt. It discusses how to find healing, hope, and help after emergency room treatment, including how to cope with future thoughts of suicide. The brochure also offers ways to connect with other suicide attempt survivors and lists free apps and other resources to help you move forward.
This brochure is designed to help men deal with child abuse issues that might arise during treatment for substance use disorders. It defines child abuse, lists symptoms of abuse, and describes how counselors can help with coping and healing. 2ff7e9595c
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