Death Studies, 39: 323–331, 2015 Copyright # Taylor & Francis Group, LLC ISSN: 0748-1187 print=1091-7683 online DOI: 10.1080/07481187.2014.946624
Suicide-Bereaved Siblings’ Perception of Health Services Rossana Pettersen and Pernilla Omerov Stockholm Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, and Division of Clinical Cancer Epidemiology, Department of Oncology–Pathology, Karolinska Institute, Stockholm, Sweden
Gunnar Steineck Division of Clinical Cancer Epidemiology, Department of Oncology–Pathology, Karolinska Institute, Stockholm, Sweden and Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
Atle Dyregrov Center for Crisis Psychology, Bergen, Norway
David Titelman National Center for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institute, Stockholm, Sweden
Kari Dyregrov Center for Crisis Psychology, Bergen, Norway and Norwegian Institute of Public Health, Division of Mental Health, Oslo, Norway
Ullakarin Nyberg Stockholm Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, and Division of Clinical Cancer Epidemiology, Department of Oncology–Pathology, Karolinska Institute, Stockholm, Sweden
The authors investigated suicide-bereaved siblings’ reported reasons for seeking or not seeking professional support, their reported satisfaction when receiving it, and their recommendations to health services when meeting suicide-bereaved siblings. Using qualitative content analysis of 18 interviews with suicide-bereaved siblings, the authors found that the perception of health services as being helpful was influenced by both the participants’ and by the deceased siblings’ experiences with health services. They conclude that the bereaved sibling’s and the deceased sibling’s unmet needs may generate negative attitudes toward health services, which reduces the likelihood of seeking professional help as well as medication acceptance in some cases.
Received 15 June 2013; accepted 2 July 2014. Address correspondence to Rossana Pettersen, Division of Clinical Cancer Epidemiology, Karolinska University, Hospital Z5:U1, 171 76 Stockholm, Sweden. E-mail: [email protected]
The loss of a sibling to suicide is a devastating experience that significantly increases the risk of complicated grief reactions and psychiatric morbidity such as depression, anxiety, and symptoms of posttraumatic stress disorder in the bereaved siblings (de Groot, de Keijser, & Neeleman, 2006; Mitchell, Kim, Prigerson,
324
R. PETTERSEN ET AL.
& Mortimer-Stephens, 2004). Common aspects of grief in those bereaved by a sibling’s suicide are persistent guilt feelings (Dyregrov & Dyregrov, 2005), insomnia, social dysfunction (Sethi & Bhargava, 2003), and physical problems (Mitchell et al., 2004). In addition, suicide-bereaved parents and siblings are themselves at an increased risk of suicide independently of socioeconomic, demographic, and psychiatric background (Qin, Agerbo, & Mortensen, 2002), and younger cohorts are at risk of premature overall mortality (Rostila, Saarela, & Kawachi, 2012). Despite their needs, suicide-bereaved siblings have been described as ‘‘forgotten bereaved’’ (Dyregrov & Dyregrov, 2005). They are often overlooked by professionals and sometimes also by their parents, who may be occupied with their own grief. Among Swedish parents who lost a child to suicide between 2004 and 2007, many acknowledged that they had been unable to provide sufficient emotional support to their remaining children due to their own grief reactions (Omerov et al., 2013). On the other hand, not all persons exposed to a potentially traumatic loss need professional support (Bonanno, 2004). Among 164 relatives and friends of suicide victims, 56% of first-degree relatives reported great or significant need of professional help, whereas 8% of them reported no such need (Wilson & Marshall, 2010). Nevertheless, only a small percentage of suicide-bereaved relatives receive professional help in connection with the loss, and professional help after a suicide seems to be only offered arbitrarily, especially to siblings (Jordan, 2001; Provini, Everett, & Pfeffer, 2000; Wilson & Marshall, 2010). Moreover, many of those who receive professional help are dissatisfied and discontinue treatment prematurely (Andriessen, 2009; Clark, 2001). In Sweden, suicide-bereaved persons can access professional help through public mental health units, telephone and Internet helplines, specialized primary care, psychosocial teams, private mental health professionals, and grief specialists. The Church of Sweden provides emotional support through individual and group meetings, and the Swedish Self-Help Organization for Suicide Survivors (SPES) offers peer support. Because of a scarcity of research, we do not know what factors underlie siblings’ perception of health services (HS) following the suicide of a sibling. To explore the subjective experiences that underlie helpseeking, we chose a qualitative approach in this study, the aim of which was to increase the understanding of (a) suicide-bereaved siblings’ reported reasons for seeking or not seeking professional support, (b) factors determining their reported satisfaction or dissatisfaction with the help received, and (c) suicide-bereaved siblings’ experience-based recommendations to health providers.
METHOD Participants We interviewed 18 suicide-bereaved siblings (13 women). At the time of the interview, two participants were between 15–20 years old, seven were between 21–30 years old, and nine were between 31–38 years old. Regarding residence at time of loss, three lived in rural communities (
Suicide-Bereaved Siblings’ Perception of Health Services Rossana Pettersen and Pernilla Omerov Stockholm Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, and Division of Clinical Cancer Epidemiology, Department of Oncology–Pathology, Karolinska Institute, Stockholm, Sweden
Gunnar Steineck Division of Clinical Cancer Epidemiology, Department of Oncology–Pathology, Karolinska Institute, Stockholm, Sweden and Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
Atle Dyregrov Center for Crisis Psychology, Bergen, Norway
David Titelman National Center for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institute, Stockholm, Sweden
Kari Dyregrov Center for Crisis Psychology, Bergen, Norway and Norwegian Institute of Public Health, Division of Mental Health, Oslo, Norway
Ullakarin Nyberg Stockholm Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, and Division of Clinical Cancer Epidemiology, Department of Oncology–Pathology, Karolinska Institute, Stockholm, Sweden
The authors investigated suicide-bereaved siblings’ reported reasons for seeking or not seeking professional support, their reported satisfaction when receiving it, and their recommendations to health services when meeting suicide-bereaved siblings. Using qualitative content analysis of 18 interviews with suicide-bereaved siblings, the authors found that the perception of health services as being helpful was influenced by both the participants’ and by the deceased siblings’ experiences with health services. They conclude that the bereaved sibling’s and the deceased sibling’s unmet needs may generate negative attitudes toward health services, which reduces the likelihood of seeking professional help as well as medication acceptance in some cases.
Received 15 June 2013; accepted 2 July 2014. Address correspondence to Rossana Pettersen, Division of Clinical Cancer Epidemiology, Karolinska University, Hospital Z5:U1, 171 76 Stockholm, Sweden. E-mail: [email protected]
The loss of a sibling to suicide is a devastating experience that significantly increases the risk of complicated grief reactions and psychiatric morbidity such as depression, anxiety, and symptoms of posttraumatic stress disorder in the bereaved siblings (de Groot, de Keijser, & Neeleman, 2006; Mitchell, Kim, Prigerson,
324
R. PETTERSEN ET AL.
& Mortimer-Stephens, 2004). Common aspects of grief in those bereaved by a sibling’s suicide are persistent guilt feelings (Dyregrov & Dyregrov, 2005), insomnia, social dysfunction (Sethi & Bhargava, 2003), and physical problems (Mitchell et al., 2004). In addition, suicide-bereaved parents and siblings are themselves at an increased risk of suicide independently of socioeconomic, demographic, and psychiatric background (Qin, Agerbo, & Mortensen, 2002), and younger cohorts are at risk of premature overall mortality (Rostila, Saarela, & Kawachi, 2012). Despite their needs, suicide-bereaved siblings have been described as ‘‘forgotten bereaved’’ (Dyregrov & Dyregrov, 2005). They are often overlooked by professionals and sometimes also by their parents, who may be occupied with their own grief. Among Swedish parents who lost a child to suicide between 2004 and 2007, many acknowledged that they had been unable to provide sufficient emotional support to their remaining children due to their own grief reactions (Omerov et al., 2013). On the other hand, not all persons exposed to a potentially traumatic loss need professional support (Bonanno, 2004). Among 164 relatives and friends of suicide victims, 56% of first-degree relatives reported great or significant need of professional help, whereas 8% of them reported no such need (Wilson & Marshall, 2010). Nevertheless, only a small percentage of suicide-bereaved relatives receive professional help in connection with the loss, and professional help after a suicide seems to be only offered arbitrarily, especially to siblings (Jordan, 2001; Provini, Everett, & Pfeffer, 2000; Wilson & Marshall, 2010). Moreover, many of those who receive professional help are dissatisfied and discontinue treatment prematurely (Andriessen, 2009; Clark, 2001). In Sweden, suicide-bereaved persons can access professional help through public mental health units, telephone and Internet helplines, specialized primary care, psychosocial teams, private mental health professionals, and grief specialists. The Church of Sweden provides emotional support through individual and group meetings, and the Swedish Self-Help Organization for Suicide Survivors (SPES) offers peer support. Because of a scarcity of research, we do not know what factors underlie siblings’ perception of health services (HS) following the suicide of a sibling. To explore the subjective experiences that underlie helpseeking, we chose a qualitative approach in this study, the aim of which was to increase the understanding of (a) suicide-bereaved siblings’ reported reasons for seeking or not seeking professional support, (b) factors determining their reported satisfaction or dissatisfaction with the help received, and (c) suicide-bereaved siblings’ experience-based recommendations to health providers.
METHOD Participants We interviewed 18 suicide-bereaved siblings (13 women). At the time of the interview, two participants were between 15–20 years old, seven were between 21–30 years old, and nine were between 31–38 years old. Regarding residence at time of loss, three lived in rural communities (
