“It’s a Living Experience”: Bereavement by Suicide in Later Life
2. Materials and Methods
3.1. Moral Injury and Trauma
“Because it was suicide, I could instantly tell by the person’s reaction whether to go on with the conversation. A lot of them, kind of, just back away and wouldn’t even respond. I remember walking down the town that I used to live in, this lady that I knew really well was walking towards me, she crossed over when she saw me. I’ll never forget that.”(female, 69, parent).
“… it’s the guilt that this person… could do something so awful to themselves. To be so desperate that they’d take their own life. You know,… I think, the guilt just gets to you, just… and you feel that everybody’s sort of, not judging you, but they must think, gosh, you know, what’s happened in this family, that this person could do this to themselves? Why did he not come to you and talk to you?”(female, 64 years, parent).
“… I felt I should have been able to do something to have spotted what was going on… done something to change the course of events.”(male, 72 years, partner).
“he’d been threatening with suicide and that day they had the mental health team out, a crisis team and he told them he was wanting to die and they dismissed it, basically and left him in the community. They had convinced me and my daughter that, oh, we were overreacting… it was only a few hours later he killed himself.”(female, 62 years, grandparent).
3.1.1. The Rippling Effect on Relationships and Wider Social Networks
“I can honestly say it was the most devastating thing that’s ever, ever happened to me. I had been bereaved, I’d lost both my parents, I’d lost my friends, I had a miscarriage, I’ve been divorced. I had gone through major life affecting events but honestly this was… I just can’t tell just how devastating it was.”(female, 72 years, parent).
“she was diagnosed with Alzheimer’s in February and I truly believe, it was bought on by the shock of my brother’s death.…she went down so quickly, it was shocking”(female, 62 years, sibling).
“There was one friend actually who I thought was a good friend and she sent flowers and sent a card and then I didn’t hear anything from her at all for nine months… I was absolutely furious, I thought she has not been in touch with me since he died, not once to say are you okay, is there anything I can do, do you want to talk?… and then nine months later when it’s my birthday she just gets in touch and asked me if I wanted to go out for lunch. No mention of [name], no mention of how are you feeling… And I just said I don’t want you to contact me ever again …… she didn’t even come to the funeral, she didn’t ask when it was, she didn’t come, and I was so livid that after 20 years I just cut off all connection with her.”(female, 62 years, grandparent).
“The practical things my daughter is absolutely amazing. She took over everything. I mean, I’m absolute… I’m at the stage in life, I’m nearly 70, I just couldn’t deal with anything anyway, but she is so good …she thinks of everything, actually. And she still does.”(female, 62 years, grandparent).
“She needs me …… and what I did was, I became the… I, kind of, absorbed everyone’s pain. My mum, my niece, my nephew, my sister, so I didn’t actually have time to process me. And my aunt actually rang me and said, [name] what about you?”(female, 62 years, sibling).
“So, the first few weeks really was me being there for them and cooking and cleaning and doing all the things that she couldn’t do. I had to be there and I had to be strong and look after my granddaughter because her mother wasn’t capable of doing it at the time, she was in such grief that she couldn’t do anything. My daughter couldn’t go to work, she was in very, very, deep depression… ”(female, 68, grandparent).
3.1.2. Transition and Adaptation to Ageing through a Living Experience
“… I’m 74 and she was my only child… she was the future and how things are going to be is something very, very important at the moment. I’m giving sort of a lot of thought to it and it’s causing me a lot of sadness. So, it’s something that, yeah that I need to really… that I’ve been thinking of. At one point years ago, in terms of a Will, in terms of what I do with my property and my precious possessions and things, is something that is huge”(female, 74 years, parent).
“I think that’s the older a person is, when the bereavement happens, the more age does have an impact from isolation point of view, or lack of grand-children, or lack of somebody coming in to do your washing for you, or whatever it might be. The older you are, the less time you’ve got to sort of get your life back together again in some way or other”(female, 73 years, parent).
“Well, the first one is, I find sometimes that something’s bothering me or upsetting me, or I’m feeling down, I think well is this [Name] or is just getting old?… am I attributing all of this to the bereavement, when in actual fact, I’d be feeling like this anyway?… I don’t think you can rush grief. But, at the same time, I’m conscious of the fact that if I don’t try and at least twin track, I’m not going to finish grieving before I die.”(female, 73 years, parent).
“I had a foot operation, nothing serious, about a year and a half ago and that made me really realise that there’s not going to be [name] around to come and be my next of kin. It really struck home that sort of feeling that as you approach old age and all the rest of it, you’re not going to have your nearest and dearest around. It’s something that I’ve got to manage very much on my own.”(female, 74 years, parent).
“We struggle with that somebody has gone, and they’re actually gone forever. And again, I put it down in part, to a sort of an arrogance that we feel we’re impregnable and immortal, yet we know we’re not, and I know now, that as I age more and more”(Participant 15, male, 72 years. partner).
“Well, I sometimes feel that I’ve not got the energy for it anymore.… I feel as if one leg of the table’s missing, if you know what I mean. That sounds a bit weird, but there’s still a limp if you know what I mean. That’s what I’m trying to say, I think. I feel at times kind of broken, yes.”(female, 78 years, parent).
“You feel it, and you’ll recognise this I’m sure, [name] yourself. It’s mornings and evenings, those early hours, those moments when you put yourself into bed, and there is this, almost deafening silence”.(male, 72 years, partner).
“It feels as if my chest is being torn up”.(female, 63 years, parent).
“She gave me permission to fall. And I fell hard. I became scared of everything, I didn’t like the dark, I became paranoid, I thought people were talking about me. It was the most frightening time of my life. There was no energy, I just slept all day and all night. So, one or two weeks since… I had to go back to the doctor to renew my prescription and he said, what can I do to help, would you like counselling? And I said, yes please. So, that was my turning point. But those few weeks were the darkest period of my life… I’m really lucky that I was able to meet with this counsellor, who was my saviour.”(female, 74 years, parent).
“You’ve got a very simply choice, you either carry on or you don’t. And I did have moments, I think they were, what I would call, poetic moments… I remember going through a period, I can’t remember quite when it was, when [name] had gone, and realising that both my daughters are married, they’ve both had two children, my mother was still alive, she only died, it’s coming up to two years now.. and I remember feeling, nobody needs me anymore. Nobody needs me. My kids don’t really need me. They’ve got their own lives, I’m potentially a complication.”(male, 72 years, partner).
“I sometimes feel I can drive my car into a wall. I just get fed up with it, I can’t take anymore. Aye, I think of suicide a lot. I don’t think I’d do it, but I sometimes wish I wasn’t here”.(female, 68 years, parent).
“I think what I worry about is that, that when I do get older, and I get, I mean, I kind of, if I do realise, if I get to that chance to realise my mortality, and you know, I’m reaching the end of my existence. That I’ll start to become more mentally challenged… Because my belief is that if you suppress it, it doesn’t go away, it just goes deep, and when you get older, it then begins to come out, in all sorts of ways”(female, 73 years, partner).
“I couldn’t put people through what we’ve all been through basically. Although there have been times and certainly even in lockdown last year, although I do feel most of the time I feel incredibly together, but things… you do think oh this is a battle. Which is why I think it is a living experience, I don’t think it’s a lived experience”.(female, 73 years old, parent).
“I’m really pleased that this is… you know, somebody’s doing things that are about suicide, especially at our age, because when you get older, you’re not important, in general”.(female, 68 years, parent).
“I have to say it’s been a real privilege to meet some of the people who’ve lost somebody and to realise how… and everybody does it their own way and it’s just… but it is unbelievably painful. I wish I wasn’t doing any of this because I wish I didn’t know about it, but in some way it’s given me some meaning in life. You’re not alone. They’re not alone. It’s not just feeling… we know what it’s like”.(female, 73 years, parent).
“I was around in London when there was AIDS, and we belonged to a group way back then, and I said, if there’s anything I can do? And in fact, I’ve sort of become, I don’t know what I am really… I think I’ll step down. And they keep saying, no, no. And I think I’m just a wise old woman”.(female, 73 years, parent).
6. Strengths and Limitations
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Gender of participant||Ethnicity of participant|
|Age of participant||White, English||13|
|60–64 years old||6||White, European||2|
|65–69 years old||4||White, Northern Irish||1|
|70–74 years old||7||White, Scottish||5|
|75–79 years old||3||White, Welsh||1|
|80–84 years old||2||Disability|
|85–89 years old||1||Yes||3|
|90–94 years old||1||No||21|
|Relationship to the deceased||Religion/belief of participant|
|Parent in-law||1||No religion||9|
|Sibling||2||Prefer not to say||1|
|Sexual identity of participant||Location of participant|
|Theme||Description of Theme||Sub-Themes|
|Moral Injury and Trauma||The overall sense of failing responses and trauma to prevent, bearing witness to, or learning about the suicide and how this transgresses deeply held moral beliefs and expectations linked to the sense of negative judgement and stigma from others. Moral injury was strongly associated with feelings of guilt and shame associated with traumatic loss.||Poor engagement and lack of appropriate care from professionals|
|Critical of own failure to prevent/save|
|Feeling helpless and calls for help unrecognised|
|Being left alone to deal with grief|
|Lack of insight from others including avoidance|
|Being given unsolicited advice/careless thoughtless comments from others|
|Lack of physical/practical support|
|Perception of having failed from others/shame/stigma and guilt|
|Grappling with conflicted feelings towards the person who died|
|Use of metaphors to express dramatic experiences and incongruities in situations that emerged|
|Rippling effects||Positive and negative|
The effect on self (beliefs about self), significant others (partners, children, friends, wider family) and wider social networks (acquaintances, work colleagues, neighbours, community) is evident both in the aftermath as well as the longer term impact and consequences.
|Igniting of existing or previous traumas|
|Expositing quality of relationships|
|Lack of care from people close to them|
|Taking up care roles and new responsibilities|
|Invisibility as a mature person|
|Own unmet needs/disappointment|
|Providing substitute care|
|Being unable to assert own needs|
|Impact on physical and mental health of own and others|
|Fear/awareness of suicide in self/others|
|Significance of key people reaching out|
|Making sense of disruption to expected natural order|
|Adaptation and transformation to the living experience in later life||How the bereaved person reflected with time on the impact of suicide on themselves and their lived experiences particularly as they became older. How they learned to adapt following the loss by suicide and connected with peers. This related to the importance of disclosure talking, listening and validation of experiences following loss through suicide and meaning-making about their own lives and life with the person.||Timing of help seeking|
|Quality of responses to help seeking e.g., family doctor|
|Recognising different types of pain|
|Suicidal thoughts and behaviour|
|Radical acceptance of loss|
|Temporal perspectives/time lost vs. time left|
|Marking anniversaries/meaning of significant events|
|Peer support/peer education/activism|
|Role of professionals in recognising bereavement by suicide|
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Hafford-Letchfield, T.; Hanna, J.; Grant, E.; Ryder-Davies, L.; Cogan, N.; Goodman, J.; Rasmussen, S.; Martin, S. “It’s a Living Experience”: Bereavement by Suicide in Later Life. Int. J. Environ. Res. Public Health 2022, 19, 7217. https://doi.org/10.3390/ijerph19127217
Hafford-Letchfield T, Hanna J, Grant E, Ryder-Davies L, Cogan N, Goodman J, Rasmussen S, Martin S. “It’s a Living Experience”: Bereavement by Suicide in Later Life. International Journal of Environmental Research and Public Health. 2022; 19(12):7217. https://doi.org/10.3390/ijerph19127217Chicago/Turabian Style
Hafford-Letchfield, Trish, Jeffrey Hanna, Evan Grant, Lesley Ryder-Davies, Nicola Cogan, Jolie Goodman, Susan Rasmussen, and Sophie Martin. 2022. "“It’s a Living Experience”: Bereavement by Suicide in Later Life" International Journal of Environmental Research and Public Health 19, no. 12: 7217. https://doi.org/10.3390/ijerph19127217