Bereavement by suicide as a risk factor for suicide attempt: a cross-sectional national UK-wide study of 3432 young bereaved adults.
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.
['Pitman|Alexandra L|AL|http://orcid.org/0000-0002-9742-1359', 'Osborn|David P J|DP|', 'Rantell|Khadija|K|', 'King|Michael B|MB|']
D000293:Adolescent D000328:Adult D001601:Bereavement D003430:Cross-Sectional Studies D003645:Death, Sudden D005190:Family D005260:Female D006801:Humans D008297:Male D012307:Risk Factors D057545:Social Stigma D059020:Suicidal Ideation D013405:Suicide D013406:Suicide, Attempted D006113:United Kingdom D055815:Young Adult
bereavement suicide attempt unnatural causes stigma EPIDEMIOLOGY