Research Questions/Hypothesis
For those who have been distressed by grief in losing a loved one to the act of suicide many may face an array of emotions; quilt, anger, longing, trauma, shame and furthermore they may acquire major depression disorders. To state further; the effects of suicide may cause a person to be at a higher risk of developing; behavioral issues, effects of post traumatic disorder and depression linked to their own thoughts of suicide. Family and companions of those left behind often take on the responsibility of trying to find clarity of the loss and through their findings may adapt the sadness of person’s grief and their own. Suicide and the loss of a loved one can attribute to those in morning to experience significant grief, furthering the effects of loss and heightened effects depression enhancing personal thoughts of suicide. The following Literature Reviews attempt to establish a basis and support the stated hypothesis.
Research Question: Would enhanced depression such as Complicated Grief and Trauma lead to those suffering from the loss of a loved one be more prone to committing suicide as well?
Hypothesis: It is hypothesized that the link between suicide of those left behind would have increased depressive symptoms that would cause suicidal behaviors or the act of suicide, in response to those suffering from loss
Literature Review
Complicated Grief and Emotional Risk Factors
Due to the amount of suicides reported; upwards of 121 suicides per day, and with suicide being the 10th leading cause of death, there many suffering from the grief and loss after suicide from a loved one. The research provided by Linde K, Treml J, Steinig J, Nagl M, Kersting A (2017) stated that the following interchangeable terms are used to describe the emotions of those effected by suicide; pathological grief, persistent, traumatic, prolonged grief, and complicated grief are all expressions used to describe those who are living with the aftermath from a loved one committing suicide and the bereaved are not able to accept the confirmation of death and the grieving process is slowed or never completed.
With Complicated Grief being one of the more frequently used terms to describe what a person is feeling after the loss of a loved one, this area of the review will focus on the research of Complicated Grief.
Complicated Grief is explained by Tal Young, I., Iglewicz, A., Glorioso, D., Lanouette, N., Seay, K., Ilapakurti, M., & Zisook, S (2012) In the research is it stated how the reaction of the grief is prolonged and that causes the distress and interfering with coping skills and functioning, and that survivors of suicide are at a higher risk for developing complicated grief. Stated in the study Latham, A. E., & Prigerson, H. G. (2004) Complicated Grief, has been known to show in studies of indicators of separation distress; including missing the departed and traumatic suffering from the loss of a loved one. It is hypothesized in this study that the survivors of suicide loss are at higher risk of developing major depression, post-traumatic stress disorder, support the hypothesis that the loss of loved one would enhance one’s own depression, possibly causing suicide in the grieving party.
Roles of Guilt and Stigma in the Bereaved
Several studies show that the Stigma attached to the death of someone from suicide is a main cause of furthering complicated grief and a contributing factor to furthering depression in a person and halting the process of healing; in the studies from; Stroebe M, Stroebe W, van de Schoot R, Schut H, Abakoumkin G, Li J (2014) and Hanschmidt F, Lehnig F, Riedel-Heller SG, Kersting A (2016) it’s discusses that the stigma and self-blame of suicide is higher than those dealing with more natural deaths of other occurrences. The factors of shame and guilt often silence those inconsolable and may enhance loneliness and isolation that form difficulties in grief and psychological deficiencies.
Suicide Influencing Suicide
In the research by Pompili (2013) results were stated that the emotional state of suicide survivors and the turmoil they feel, may last for years and even end in a person’s own suicide. The research goes on to discuss how guilt and shame are a common theme of emotion for survivors, often intensifying even more emotions that could cause a person to adapt to suicide thoughts of their own.
Additional research stated in Zhang (2005) research stated that loved ones of the departed experience difficultly in bereavement and the trauma that follows with unanswered questions, the effects can become more intensified by responses from the suicide form other people causing stigma and lack of expressing feelings to others. It stated that “Bereavement after the death of a loved one usually has great impact on the survivors’ life to follow” (Zhang, J., Tong, H. Q., & Zhou, L. 2005, 217–227), It goes on to discus in the article that survivors are often viewed more harshly than any other types of survivors due to blaming, guilt and blaming, this as a part of reaction to the loss the grieving present with characteristics of Major Depressive Disorder, lastly stated in the article, that people effected by suicide should be a high risk population of suicide and carefully monitored. The results in this study supported the hypotheses that links between suicide of those left behind and increased depressive symptoms in the people suffering can heighten suicidal thoughts and ideations.
Sampling
In the research that was studied for these findings, a variety of sampling methods were used to produce the information needed and to identify the results of the study. For instance, in the studies conducted by; Strobe (2014), Latham (2004), and Guldin (2017) each study conducted a sampling frame based on a variety of sources that were accessible to the public such as Local Registers Offices, AARP, Newspapers, Obituaries and the Registry of Death in their areas. Research from Pomplini (2013), Linde (2017) and Hanschmidt (2016) produced there sampling from PUBMED, Web of Science, PsychInfo and Psychiatric studies.
While; Zhang (2005) and Spillane (2017) conducted in person interviews in rural counties in their countries. Young (2012) and Nakajima (2012) conducted their research using samples from other studies published and gathered. All forms of research used in the studies had prior knowledge that the persons being studied were effected by suicide of a loved one; supporting Stratified Random Sampling where information about the population is known prior to the sampling.
Going further into the research Availability Sampling was used among the participants, the research of Zhang (2005) and Spillane (2017) relied on the ability and availability of those willing to talk and discuss their emotions and their lack or ability to cope with their loss.
Reading through the sampling methods that was used in the research there was a large sampling amounts gathered used purposive sampling methods that were effective in identifying targets individuals for the study where firsthand accounts of information was gathered in which it was much easier to focus on the one issue at hand; identify increased depressive symptoms that would cause suicidal behaviors in those left behind.
However, there was a high representation of family members that were studied, but there was a low rate among friends of the departed or those in a relationship of the deceased. The Sampling in almost all of studies except for Young (2012) and Nakajima (2012); did not have an age limit or any issues of race representation within the studies. The samples at times appeared limited such as in the studies of Zhang (2005) and Spillane (2017), those were conducted in small rural areas that used the assistance of locals to identify samples for the study. Another concern that would need to be stated that the studies appeared homogeneous based on the number of female participants in the studies, at times were almost ¾ of the studies participants in certain studies.
Measurement
Research from Zhang (2005) conducted his findings by comparing subjects on the Depression scale from Center for Epidemiologic Studies- Depression Scale or CES-D and the NEO Five- Factor Inventory; his findings were demonstrated by Construct Validity as he was trying to measure the variety or the concepts into the researches theory. Much like most of the research conducted they were gauged by using scales of measurement to come to any conclusions/finding. Latham (2004) used the Yale Evaluation of Suicidality (YES) to measure current suicidal thoughts and actions and attempts, including follow ups with the bereaved after 10 months from the first questioning at the 6-month post loss. Spillane (2017) used a mixed methods approach combining interviews and questionnaires concluding with COREQ checklist to measure their recording of qualitative research in their interviews.
Using the tools such as the YES, COREQ, and CES-D researchers are able to track a person’s progress of coping or lack thereof. In using tools there are less errors that could account to Leading Questions with in person interviews. While the studies were based on longitudinal finding, such as, Pompili (2013) that took research gathered for over 18 years and Guldin (2017) that continued to follow up with their population of study for 19 years, there was ongoing findings that continued to support the basis of the link of depression of survivors from suicide. However, Linde (2017) reported issues of follow up with subjects and that a majority of their subjects were female creating a generalizability of homogeneous responses in what they did have to report. In the research by Hanschmidt (2016) that more research was needed and that internal and external validity were restricted by a lack of valid measurements and selection bias.
The studies gained information by measuring those who have been effected by loss of suicide and are bereaved by conducting questionnaires, interviews, and using tools to measure the results as well. The tools used are verified in their findings, such as YES and using the PRISMA guidelines. Throughout the time working with the individuals and using ongoing measurements with the tools, the researchers were able to validate their findings in most areas that concluded that those who are affected by the loss due take on complicated grief, stigma issues and isolation that can attribute to them taking their own lives.
Design
The research question being sought; “Would enhanced depression such as Complicated Grief and Trauma lead to those suffering from the loss of a loved one be more prone to committing suicide as well?”. Throughout the literature review the question was answer numerous times that, yes it was possible that enhanced depression could lead to heightened thoughts of suicide. From the research conducted by the following authors there is a consensus that support the question and answer it.
The testing that took place for the research in these articles were a mixed approach; Nakajima (2017) and Young (2012) relied heavily on other studies to form their hypothesis and conclusion, that could highlight the issue of bias in their research as they were only taking into an account what would benefit their research.
In the research from other studies that completed in person interviews and follow ups such as Latham (2017) Pompili (2013) and Guldin (2017) that completed interviewing subjects over the period of years to support their study and to find a conclusion that would benefit the bareheaded, however, as previously stated there are issues with the follow up process that could take place as in Linde (2017) study where the subject were not able to reach after a period of time and the fact that they reported a large female population in their study, that was also an issue for the Latham (2017) study was well, having a homogeneous responses for the female population.
A concern for the studies was a under populated male voice present, but an even more under represented population was teenagers that have suffered the loss of a friend or loved one through suicide. Most studies reviewed had a median age of mid-thirties or older. There appears to be a lack of research composed about the younger population from 13-25 effected by suicide.
At the end of the research by the stated, there was a consensus in the conclusion that Complicated Grief and other emotions following suicide from a loved one substantially heightens the risk of suicide and Major Depressive Disorders in those that are bereaved.
Conclusion
The studies examined above have been able to discuss openly and accurately their research stated and the validity of its findings that after the loss of a loved one that there is a risk of a person developing complicated grief that could enhance a person’s isolation and feelings causing the bereaved to turn to suicide as an option. The studies stated were able to find a consensus that there is a noticeable trend in the bereaved in emotion uprising and thoughts of suicide heightened, thankfully in their research it was never stated that a person took their own life through the course of the studies, only that the participants acknowledged thoughts or attempts.
There are of course issues within the research, there are under developed populations that were not interviewed such as men and younger participants. In the research by Hanschmidt (2016) that more research was needed to understand the stigma of the bereaved, that was also supported by Pompili (2013) that stated that further research was needed to evaluate the efficacy of professional treatment and support groups of those that need it. As well as Linde (2017) that reported that more research is necessary so that an effective tool can be adapted to evaluate the bereaved.
In my personal research, I would adapt a mixed methods approach, I feel that using the tools such as the Epidemiologic Studies- Depression Scale and the Yale Evaluation of Suicidality are a good base line to start the forms of research for the bereaved. Furthering upon my own research I would rely upon in person interviews with shorter follow ups between sessions. Such as; within the first three months questionnaire, 6-month mark in person interview, 9-month mark interview, and the year anniversary of the departed interview and following every 3 months with a check in for the first 2 years of the death. While that is intrusive and could cause many to withdrawal from the study, it would be a way to measure the influx and flux of emotion over the critical grieving time, giving way for intervention if needed.