Perceived Stigma of Sudden Bereavement as a Risk Factor for Suicidal Thoughts and Suicide Attempt: Analysis of British Cross-Sectional Survey Data on 3387 Young Bereaved Adults
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Measures
- feel like a social outcast?
- feel like no-one cared to listen to you?
- feel that neighbours and friends did not offer enough concern?
- feel avoided by friends?
- think people were gossiping about you or the person?
- think that others didn’t want you to talk about the death?
- feel somehow stigmatised by the death?
- feel like people were probably wondering about what kind of personal problems you and the person had experienced?
- think that people were uncomfortable offering their condolences to you?
- feel like the death somehow reflected negatively on you or your family?
2.3. Statistical Analysis
3. Results
3.1. Participant Characteristics
3.2. Association between High Stigma Scores and Outcomes
3.3. Interactions
3.4. Sensitivity Analysis
4. Discussion
4.1. Main Findings
4.2. Results in the Context of Other Studies
4.3. Strengths and Limitations
4.4. Clinical and Policy Implications
4.5. Future Research
5. Conclusions
Supplementary Materials
Acknowledgments
Author Contributions
Conflicts of Interest
References
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GEQ Stigma Sub-Scale Score | Low Perceived Stigma Score a (n = 1764) | High Perceived Stigma Score a (n = 1623) | Total (n = 3387) | p-Value b |
---|---|---|---|---|
Socio-demographic characteristics | ||||
Gender † | ||||
Female n (%) | 1388 (79) | 1360 (84) | 2748 (81) | <0.001 |
missing n (%) | 0 (0) | 1 (<1) | 1 (<1) | |
Age of participant † | ||||
mean (SD) | 25.0 (6.2) | 25.1 (6.4) | 25.0 (6.3) | 1.000 |
Self-defined ethnicity | ||||
white n (%) | 1598 (91) | 1449 (89) | 3047 (90) | 0.224 |
non-white n (%) | 165 (9) | 172 (11) | 337 (10) | |
missing n (%) | 1 (<1) | 2 (<1) | 3 (<1) | |
Socio-economic status c † | ||||
social classes 1.1 and 1.2 n (%) | 551 (31) | 440 (27) | 991 (29) | <0.001 |
social class 2 n (%) | 586 (33) | 526 (32) | 1112 (33) | |
social class 3 n (%) | 209 (12) | 185 (11) | 394 (12) | |
social class 4 n (%) | 91 (5) | 63 (4) | 154 (5) | |
social classes 5–7 and 9 n (%) | 273 (16) | 359 (22) | 632 (19) | |
missing n (%) | 54 (3) | 50 (3) | 104 (3) | |
Educational status | ||||
attained up to A level equivalent leaving qualification n (%) | 734 (42) | 750 (46) | 1484 (44) | 0.008 |
attained undergraduate degree or above n (%) | 1025 (58) | 871 (54) | 1896 (56) | |
missing n (%) | 5 (<1) | 2 (<1) | 7 (<1) | |
Student status | ||||
student n (%) | 1472 (83) | 1428 (88) | 2900 (86) | 0.001 |
staff n (%) | 238 (13) | 156 (10) | 394 (12) | |
both n (%) | 54 (3) | 38 (2) | 92 (3) | |
missing n (%) | 1 (0) | 1 (<1) | 1 (<1) | |
Characteristics of index bereavement | ||||
Mode of death | ||||
sudden natural causes n (%) | 1184 (67) | 892 (55) | 2076 (61) | <0.001 |
sudden unnatural causes n (%) | 368 (21) | 336 (21) | 704 (21) | |
suicide n (%) | 212 (12) | 395 (24) | 607 (18) | |
missing n (%) | 0 (0) | 0 (0) | 0 (0) | |
Kinship to the deceased † | ||||
blood relative n (%) | 1224 (69) | 1176 (73) | 2400 (71) | 0.050 |
unrelated n (%) | 533 (30) | 441 (27) | 974 (29) | |
missing n (%) | 7 (<1) | 6 (<1) | 13 (<1) | |
Age of the deceased | ||||
median (IQR) | 50 (23–70) | 45 (22–58) | 47 (23–64) | <0.001 |
Gender of the deceased | ||||
Female n (%) | 666 (38) | 583 (36) | 1249 (37) | 0.216 |
missing n (%) | 54 (3) | 41 (3) | 95 (3) | |
Time since bereavement † | ||||
mean (SD) | 4.6 (5) | 5.4 (6) | 5 (5.3) | 1.000 |
Clinical characteristics | ||||
Family history of suicide (excluding index suicide bereavement) † | ||||
Yes n (%) | 109 (6) | 104 (6) | 213 (6) | 0.829 |
missing n (%) | 128 (7) | 106 (7) | 234 (7) | |
Family history of psychiatric problems | ||||
Yes n (%) | 1008 (57) | 1059 (65) | 2067 (61) | <0.001 |
missing n (%) | 124 (7) | 102 (6) | 226 (7) | |
Personality disorder screen positive d | ||||
Yes n (%) | 464 (26) | 712 (44) | 1176 (35) | <0.001 |
missing n (%) | 105 (6) | 84 (5) | 189 (6) | |
Pre-loss depression † | ||||
Yes n (%) | 280 (16) | 353 (22) | 633 (19) | <0.001 |
missing n (%) | 74 (4) | 54 (3) | 128 (4) | |
Pre-loss non-suicidal self-harm and suicide attempt † | ||||
Yes n (%) | 325 (18) | 380 (23) | 705 (21) | <0.001 |
missing n (%) | 127 (7) | 104 (6) | 231 (7) | |
Help sought after suicide attempt post-bereavement | ||||
Yes n (%) | 15 (1) | 54 (3) | 69 (2) | <0.001 |
No n (%) | 36 (2) | 101 (6) | 137 (4) | |
No suicide attempt post-bereavement n (%) | 1713 (97) | 1468 (91) | 3181 (94) |
GEQ Stigma sub-Scale Score | Low Perceived Stigma Score a (n = 1764) | High Perceived Stigma Score a (n = 1623) | Total (n = 3387) | p-Value b |
---|---|---|---|---|
Primary outcomes | ||||
Post-loss suicidal thoughts | ||||
Yes n (%) | 582 (33) | 929 (57) | 1511 (45) | <0.001 |
missing n (%) | 121 (7) | 100 (6) | 221 (7) | |
Post-loss suicide attempt | ||||
Yes n (%) | 51 (3) | 155 (10) | 206 (6) | <0.001 |
missing n (%) | 126 (7) | 100 (6) | 226 (7) | |
Secondary outcomes | ||||
Secondary mental health outcomes | ||||
Post-loss non-suicidal self-harm | ||||
Yes n (%) | 260 (15) | 473 (29) | 733 (22) | <0.001 |
missing n (%) | 125 (15) | 102 (6) | 227 (7) | |
Post-loss non-suicidal self-harm and suicide attempt | ||||
Yes n (%) | 280 (16) | 519 (32) | 799 (24) | <0.001 |
missing n (%) | 121 (7) | 98 (6) | 219 (7) | |
Post-loss depression | ||||
Yes n (%) | 361 (21) | 699 (43) | 1060 (4) | <0.001 |
missing n (%) | 74 (4) | 54 (3) | 128 (4) | |
Support measures | ||||
Measure of social support c | ||||
no lack of perceived social support n (%) | 1228 (70) | 739 (46) | 1967 (58) | <0.001 |
moderate lack of perceived social support n (%) | 406 (23) | 499 (31) | 905 (27) | |
severe lack of perceived social support n (%) | 130 (7) | 384 (24) | 514 (15) | |
missing n (%) | 0 (0) | 1 (<1) | 1 (<1) | |
Receipt of formal support after index bereavement | ||||
Yes n (%) | 553 (31) | 704 (43) | 1257 (37) | <0.001 |
No n (%) | 1135 (64) | 861 (53) | 1996 (59) | |
missing n (%) | 76 (4) | 58 (4) | 134 (4) | |
Receipt of informal support after index bereavement | ||||
Yes n (%) | 1277 (72) | 907 (56) | 2184 (65) | <0.001 |
No n (%) | 411 (23) | 658 (41) | 1069 (32) | |
missing n (%) | 76 (4) | 58 (4) | 134 (4) |
GEQ Stigma Sub-Scale Score | Low Perceived Stigma Score a (n = 1764) | High Perceived Stigma Score a (n = 1623) | |||
---|---|---|---|---|---|
Primary Outcomes | Odds Ratio (reference) | Unadjusted Odds Ratio (95% CI) | p Value b | Adjusted c Odds Ratio (95% CI) | p Value b |
post-bereavement suicidal ideation | 1 | 3.45 (2.47–4.81) | <0.001 | 2.74 (1.93–3.89) | <0.001 |
post-bereavement suicide attempt | 1 | 2.84 (2.45–3.89) | <0.001 | 2.73 (2.33–3.18) | <0.001 |
Secondary Measures | |||||
post-bereavement non-suicidal self-harm | 1 | 2.40 (2.01–2.86) | <0.001 | 2.16 (1.76–2.64) | <0.001 |
post-bereavement suicidal and non-suicidal self-harm | 1 | 2.50 (2.11–2.96) | <0.001 | 2.25 (1.85–2.74) | <0.001 |
post-bereavement depression | 1 | 2.91 (2.48–3.41) | <0.001 | 3.84 (3.21–4.59) | <0.001 |
low perceived social support | 1 | 2.84 (2.45–3.28) | <0.001 | 2.86 (2.44–3.34) | <0.001 |
use of formal bereavement support | 1 | 1.76 (1.52–2.04) | <0.001 | 1.87 (1.60–2.19) | <0.001 |
use of informal bereavement support | 1 | 0.44 (0.37–0.51) | <0.001 | 0.48 (0.41–0.57) | <0.001 |
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Pitman, A.; Rantell, K.; Marston, L.; King, M.; Osborn, D. Perceived Stigma of Sudden Bereavement as a Risk Factor for Suicidal Thoughts and Suicide Attempt: Analysis of British Cross-Sectional Survey Data on 3387 Young Bereaved Adults. Int. J. Environ. Res. Public Health 2017, 14, 286. https://doi.org/10.3390/ijerph14030286
Pitman A, Rantell K, Marston L, King M, Osborn D. Perceived Stigma of Sudden Bereavement as a Risk Factor for Suicidal Thoughts and Suicide Attempt: Analysis of British Cross-Sectional Survey Data on 3387 Young Bereaved Adults. International Journal of Environmental Research and Public Health. 2017; 14(3):286. https://doi.org/10.3390/ijerph14030286
Chicago/Turabian StylePitman, Alexandra, Khadija Rantell, Louise Marston, Michael King, and David Osborn. 2017. "Perceived Stigma of Sudden Bereavement as a Risk Factor for Suicidal Thoughts and Suicide Attempt: Analysis of British Cross-Sectional Survey Data on 3387 Young Bereaved Adults" International Journal of Environmental Research and Public Health 14, no. 3: 286. https://doi.org/10.3390/ijerph14030286