Bereaved parents' outcomes 4 to 60 months after their children's deaths by accident,suicide, or homicide: a comparative study demonstrating differences

In this article, the authors revisit a controversial issue in the bereavement field: Does one violent cause of death of a child influence parents' outcomes more than another? To address this question, we observed 173 parents prospectively 4, 12, 24, and 60 months after their children's deaths by accident, suicide, or homicide. Quantitative and qualitative research methods were used to examine the influence of three types of a child's violent death and time since death upon 4 parent outcomes (mental distress, post-traumatic stress disorder [PTSD], acceptance of the child's death, and marital satisfaction). The results showed a significant interaction for the bereavement Group x Time effect for acceptance of death, a significant main effect for time for all four outcomes, and a significant main effect for group (homicide) for PTSD. Nearly 70% of the parents reported that it took either 3 or 4 years to put their children's death into perspective and continue with their own lives; however the child's cause of death did not significantly influence parents' sense of timing in this regard. Clinical and research implications of the findings are discussed.     

Chronic Pain,TBI, and PTSD in Military Veterans: A Link to Suicidal Ideation and Violent Impulses?

The polytrauma clinical triad refers to the co-occurrence of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD). Despite research implicating dyadic relationships between these conditions and adverse outcomes, scant research has examined the polytrauma clinical triad's relation to suicide or violence. The present cross-sectional study was designed to examine whether this complex clinical presentation increases risk of suicidal ideation and violent impulses after accounting for other established risk factors. Veterans who served in the military since September 11, 2001 (N?=?667) who reported chronic pain completed an interview and self-report battery. Bivariate analyses showed that suicidal ideation and violent impulses both correlated with PTSD, TBI+PTSD, pain intensity and interference, drug abuse, and major depressive disorder (MDD). Multiple regression analyses showed that: 1) race, chronic pain with PTSD, alcohol abuse, and MDD significantly predicted suicidal ideation, 2) pain interference, chronic pain with TBI, chronic pain with PTSD, chronic pain with TBI+PTSD, drug abuse, and MDD significantly predicted violent impulses, and 3) pain interference was a more critical predictor of suicidal and violent ideation than pain intensity. Implications for risk assessment and treatment are discussed.

Suicidal Ideation and Distress in Family Members Bereaved by Suicide in Portugal

The present study assessed the impact of suicide and distress on suicidal ideation in a sample of 93 Portuguese family members bereaved by suicide. A control community sample of 102 adults also participated. After controlling for educational level, those bereaved by the suicide of a family member were found to have higher levels of suicidal ideation. Forty-two percent of family members had Suicide Ideation Questionnaire scores at or above the cutoff point. General distress, depression, anxiety, and hostility related to suicidal ideation, whereas time since suicide also interacted with general distress and depression in predicting suicidal ideation.     

Posttraumatic stress disorder, depression, and suicide in veterans

Suicidal behavior is a critical problem in war veterans. Combat veterans are not only more likely to have suicidal ideation, often associated with posttraumatic stress disorder (PTSD) and depression, but they are more likely to act on a suicidal plan. Especially since veterans may be less likely to seek help from a mental health professional, non-mental-health physicians are in a key position to screen for PTSD, depression, and suicidal ideation in these patients. The authors discuss the association of PTSD, depression, and suicide in veterans, keys to assessment of suicide risk, and interventions.     

Complicated grief after suicide bereavement and other causes of death

The authors compared baseline demographic characteristics, clinical features, and grief-related thoughts, feelings, and behaviors of individuals bereaved by suicide, accident/homicide and natural causes participating in a complicated grief (CG) treatment clinical trial. Severity of CG and depression and current depression diagnosis did not vary by loss type. After adjusting for baseline demographic features, time since death and relationship to the deceased, those with CG after suicide had the highest rates of lifetime depression, preloss passive suicidal ideation, self-blaming thoughts, and impaired work and social adjustment. Even among this treatment-seeking sample of research participants with CG, suicide survivors may face unique challenges.     

Posttraumatic Cognitions and Suicidal Ideation Among Veterans Receiving PTSD Treatment

With approximately 20 veteran suicide deaths per day, suicidal ideation (SI) among veterans is an important concern. Posttraumatic stress disorder (PTSD) is associated with SI among veterans, yet mechanisms of this relationship remain unclear. Negative posttraumatic cognitions contribute to the development and maintenance of PTSD, yet no studies have prospectively examined the relationship between posttraumatic cognitions and SI. Veterans (N?=?177; 66% Male) participating in a 3-week intensive outpatient program for PTSD completed assessments of PTSD severity, depressive symptoms, SI, and posttraumatic cognitions. Negative posttraumatic cognitions about the self significantly predicted SI at posttreatment, controlling for pretreatment levels of SI, depression, and PTSD symptom severity. Self-blame and negative posttraumatic cognitions about others/world did not predict SI prospectively. Negative posttraumatic cognitions about the self appear to be an important factor in the manifestation of SI among veterans with PTSD and should be monitored as a potential indicator of suicide risk.     

Challenging the Myths About Parents' Adjustment After the Sudden, Violent Death of a Child

Purpose: To examine three commonly held myths: (a) a child's death by suicide results in the worst parental outcomes compared with other causes of violent death, (b) divorce is not only more common among bereaved than nonbereaved married couples, it might be inevitable, and (c) 'letting go and moving on' is an essential bereavement task needed for a satisfactory adjustment following the violent death of a child.
Design and Methods: Review of empirical evidence and critical reviews, review of Internet resources available to the general public, and the inclusion of original data obtained from a longitudinal, prospective study conducted by the authors.
Findings: Conclusive evidence was found to dispel two of the three myths, but sufficient evidence was not found to draw conclusions about the third myth regarding parents' adjustment to a child's suicidal death.
Conclusions: Myths in regard to parental bereavement are resistant to disconfirming evidence and they appear to persist among professional practitioners and the general public despite contrary empirical evidence.     

开放病房抑郁症自杀行为分析与对策

目的：探讨开放心理病房抑郁症自杀行为的对策。方法：对2006年10月8日至2008年4月30日收住的195例抑郁症患者进行回顾性分析。结果：经治疗和干预后自杀意念明显下降,而自杀未遂在治疗好转时有所增加,治疗4周时自杀意念和自杀未遂明显下降：入院前与第一周比较自杀意念没有统计学差异,而自杀未遂则有统计学差异,和第二周及第四周比较自杀意念、自杀未遂有统计学差异。结论：开放式心理病房采取综合的治疗和护理措施可有效地预防抑郁症患者的自杀行为。     

Evaluation and treatment of patients with suicidal ideation

Suicidal ideation is more common than completed suicide. Most persons who commit suicide have a psychiatric disorder at the time of death. Because many patients with psychiatric disorders are seen by family physicians and other primary care practitioners rather than by psychiatrists, it is important that these practitioners recognize the signs and symptoms of the psychiatric disorders (particularly alcohol abuse and major depression) that are associated with suicide. Although most patients with suicidal ideation do not ultimately commit suicide, the extent of suicidal ideation must be determined, including the presence of a suicide plan and the patient's means to commit suicide.     

A CHILD'S DEATH AND DIVORCE: DISPELLING THE MYTH

In view of the commonly held assumption about a high divorce rate among bereaved parents, a thorough review of literature was conducted to determine what evidence exists. Evidence was found to indicate that a child's death can strain marital relationships, which may lead to separation and/or divorce in some cases; however, there is no conclusive evidence that bereaved parents are likely to divorce as a result of a child's death. On the contrary, it appears that the majority of marital relationships survive the strain brought about by a child's death and may even be strengthened in the long run. The time it takes for bereaved parents to restore their relationship to the level it was before the child's illness and /or death varies depending on the couple and the circumstances involved. The ultimate effects of a child's death on marriage may not be known until after several years have passed. The quality of marital relationship prior to the child's death, cause of death, and circumstances surrounding the death may produce differential outcomes for the marital relationship. In the process of conducting a literature review, a number of questionable or erroneous citations that professionals made were discovered. In addition to those mistakes, confusion between marital distress and divorce appears to be partially responsible for perpetuating the myth of a high divorce rate among bereaved parents. It is time for professionals to dispel the myth. Recommendations for future research are provided.     

Living in a world without closure: reality for parents who have experienced the death of a child

The death of a child has been described as being for parents one of the most traumatic of losses. Nevertheless, information about how parents experience transition through the death trajectory is lacking. This phenomenological study explored parents' lived experienced of transitioning through the death of a child. Twenty-eight bereaved parents (17 mothers, 11 fathers) took part in retrospective, open-ended interviews. Findings showed that, regardless of the time, parents continued to live in a world without closure and, more importantly, did not want to experience closure in their transitioning. To parents, "closure" meant an end to their child in every sense of the word. Their experience of living in a world without closure was supported by four themes: "keeping the memories alive", "being a good parent", "being there at my child's death", and "being there for me after my child dies". Findings yield new insights into how parents live with the death of a child.     

Psychosomatic symptoms in parents 2 years after the death of a child with cancer

Forty-five mothers and 30 fathers, representing 58 families, completed the Symptom Checklist 90-Revised, a measure of current psychological and somatic symptoms, 24 months after the death of a child with cancer. The mean scores from six symptom dimensions (somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, and hostility) and a global measure of the depth of symptomatology, the Global Severity Index, were contrasted with those of the nonpatient and psychiatric outpatient norms reported by Derogatis (1983). Two years after the child's death parents showed a symptom profile reflecting significantly greater distress than that reported by nonbereaved, nonpatient adults. The results highlight important distinctions between bereaved parents and psychiatric outpatients.     

Psychopathy,Depression, and Anxiety as Predictors of Suicidal Ideation in Offenders

Compared to nonoffenders, offenders are at increased risk for suicidal ideation and psychopathy. However, literature currently lacks sufficient understanding of moderating pathways linking psychopathy to suicidal ideation among offenders. This study investigated anxiety and depressive symptoms as potential moderators using a sample of 162 male offenders in the New Jersey correctional system. Results supported a significant positive correlation between secondary psychopathy and suicidal ideation. In addition, depression and physiological anxiety moderated the association between secondary psychopathy and suicidal ideation. Present findings may assist in determining relevant suicide risk factors (i.e., depression, physiological anxiety, secondary psychopathy) to assess for in offenders.     

Changes in parents' mental distress after the violent death of an adolescent or young adult child: a longitudinal prospective analysis

This study examined changes in bereaved parents' mental distress following the violent deaths of their 12 - to 28 - year - old children . A community - based sample of 171 bereaved mothers and 90 fathers was recruited by a review of medical examiner records . Data were collected 4 , 12 , and 24 months post - death . Repeated measures analysis of variance showed significant reductions in 8 of 10 measures of mental distress among mothers and 4 of 10 for fathers , with the most change for both genders occurring between 4 and 12 months post - death . During the 2nd year of bereavement , mothers' symptoms continued to decline , whereas fathers , who started out with less distress than mothers , reported slight increases in 5 of 10 symptom domains . Nonetheless , 2 years after the deaths , mothers' mental distress scores were to 5 times higher than those of 'typical' U . S . women and fathers' scores were to 4 times higher than 'typical' U . S . men . Of the 7 intervening variables , higher scores on self - esteem and self - efficacy predicted lower distress for mothers and fathers 4 , 12 , and 24 months post - death . Repressive coping was of distress among fathers . It was concluded that violent death bereavement sustained , distressing consequences on parents of children who die as a result of , homicides , and suicide .     

Passive Suicidal Ideations in Older Adults: A Case Report

This case study presents the diagnosis and treatment of an older adult with depression and passive suicide ideation (SI). While treating depressed patients at risk for suicide, family nurse practitioners must stay grounded in patient data related to medications, ideally using the patient’s psychiatric condition (ie, depression with suicidal risk) as the separate and appropriate target of clinical intervention, and discuss the risks and benefits of medications targeting both conditions with the patient. The response and ongoing management of individuals with passive SI depend on determining their risk level.     

Suicidality in parentally bereaved adolescents

The purpose of the study was to examine the effects on suicidality of exposure to suicidal behavior in other people, depression, parent perceptions, and attitudes about life and death in a sample of 25 parentally bereaved teens. Participants participated in face-to-face interviews and completed the Reynolds Adolescent Depression Scale, Suicidal Ideation Questionnaire, Multi-Attitude Suicide Tendency Scale, and the Parent Perception Inventory. These adolescents were not clinically depressed, did not express serious levels of suicidal ideation, and had relatively minor histories of suicidality. However, significant relationships were found between attitudes, exposure, depression, and suicidality in partial support of previous research. Ways in which this study extend our knowledge of bereaved teens and recommendations for future research are discussed.     

Posttraumatic Stress and Suicidality Among Firefighters: The Moderating Role of Distress Tolerance

Firefighters report high rates of suicidality and posttraumatic stress disorder (PTSD). This investigation explored the moderating role of distress tolerance (DT) in the association between PTSD symptomatology and suicidality in firefighters. Covariates included trauma load, depressive symptom severity, gender, race, age, and education. The sample was comprised of 765 (94.0% male; M_age?=?38.8, SD?=?8.6) trauma-exposed firefighters who completed a questionnaire battery. Structural equation modeling was employed. PTSD symptom severity was significantly, positively associated with global suicide risk, suicidal ideation/attempt, frequency of suicidal ideation, lifetime threat of suicide, and perceived likelihood of future suicide attempts. Lower levels of DT were significantly associated with higher frequency of past-year suicidal ideation. Significant interactive effects were noted; firefighters with higher levels of PTSD symptom severity and low levels of DT had the highest levels of global suicide risk and perceived likelihood of future suicide attempt. Clinical and research implications are discussed.     

Optimism Reduces Suicidal Ideation and Weakens the Effect of Hopelessness Among Military Personnel

Suicide risk is an issue of increasing concern among military personnel. To date, most studies have focused on identifying risk factors for suicide in military personnel, but have by and large overlooked possible protective factors that reduce suicide risk, such as optimism. In a clinical sample of 97 treatment-seeking active duty Air Force personnel, the protective effects of optimism on suicidal ideation was investigated by considering the direct effect of optimism on suicidal ideation as well as the possible moderating effects of optimism on several suicide risk factors: depression, posttraumatic stress, and hopelessness. When adjusting for demographic and clinical covariates, results of multiple regression indicated that optimism was significantly associated with less severe depression, hopelessness, and suicidal ideation, but not posttraumatic stress symptoms. The interaction of optimism with hopelessness was also significant, and indicated that severe hopelessness contributed to more severe suicidal ideation only among participants with low levels of optimism. Results suggest that optimism is associated with less severe suicidal ideation, and buffer the effects of hopelessness among military patients.     

A Prospective Investigation of the Impact of Distinct Posttraumatic (PTSD) Symptom Clusters on Suicidal Ideation

Inconsistent findings have been reported by previous cross-sectional studies regarding the association between specific posttraumatic stress disorder (PTSD) symptom clusters and suicidality. To advance the understanding of the role of specific PTSD symptoms in the development of suicidality, the primary aim of this study was to investigate the predictive effects of the three specific PTSD symptom clusters on suicidal ideation prospectively. Fifty-six individuals diagnosed with PTSD completed a two-stage research design, at baseline and 13–15 months follow-up. The clinician administered PTSD scale (CAPS) was used to assess the severity of the PTSD symptom clusters and validated self-report measures were used to assess suicidal ideation, severity of depressive symptoms and perceptions of defeat entrapment. The results showed that only the hyperarousal symptom cluster significantly predicted suicidal ideation at follow-up after controlling for baseline suicidal ideation, severity of depressive symptoms and perceptions of defeat and entrapment. These findings suggest that both disorder-specific and transdiagnostic factors are implicated in the development of suicidal ideation in PTSD. Important clinical implications are discussed in terms of predicting and treating suicidality in those with PTSD.     

Suicidal ideation in outpatients with chronic musculoskeletal pain: an exploratory study of the role of sleep onset insomnia and pain intensity

OBJECTIVES: Sleep disturbance, depression, and heightened risk of suicide are among the most clinically significant sequelae of chronic pain. While sleep disturbance is associated with suicidality in patients with major depression and is a significant independent predictor of completed suicide in psychiatric patients, it is not known whether sleep disturbance is associated with suicidal behavior in chronic pain. This exploratory study evaluates the importance of insomnia in discriminating suicidal ideation in chronic pain relative to depression severity and other pain-related factors. METHODS: Fifty-one outpatients with non-cancer chronic pain were recruited. Subjects completed a pain and sleep survey, the Pittsburgh Sleep Quality Index, the Beck Depression Inventory, and the Multidimensional Pain Inventory. Subjects were classified as "suicidal ideators" or "non-ideators" based on their responses to BDI-Item 9 (Suicide). Bivariate analyses and multivariate discriminant function analyses were conducted. RESULTS: Twenty-four percent reported suicidal ideation (without intent). Suicidal ideators endorsed higher levels of: sleep onset insomnia, pain intensity, medication usage, pain-related interference, affective distress, and depressive symptoms (P < 0.03). These 6 variables were entered into stepwise discriminant function analyses. Two variables predicted group membership: Sleep Onset Insomnia Severity and Pain Intensity, respectively. The discriminant function correctly classified 84.3% of the cases (P < 0.0001). DISCUSSION: Chronic pain patients who self-reported severe and frequent initial insomnia with concomitant daytime dysfunction and high pain intensity were more likely to report passive suicidal ideation, independent from the effects of depression severity. Future research aimed at determining whether sleep disturbance is a modifiable risk factor for suicidal ideation in chronic pain is warranted.