International Journal of Environmental Research & Public Health
Victoria Ross, Kairi Kõlves *, Lisa Kunde and Diego De Leo
Abstract: The death of a child by suicide is a severe trauma, placing parents at greater risk of psychological morbidity and physical health problems compared to other causes of death. However, few studies have examined the aftermath and bereavement experience for parents following the death of a child to suicide, limiting the ability to guide effective postvention services through empirical research. The current study, which was part of a larger longitudinal investigation of suicide bereavement in Queensland, Australia, examined the individual experiences of both mothers and
fathers bereaved by suicide over time, specifically at the six month and 12 month time points after their loss. Bereaved parents who had provided written consent to be contacted for research purposes were identified through the Queensland Suicide Register, and took part in individual, semi-structured interviews. Generic qualitative analysis identified three key themes: searching for answers and sense-making, coping strategies and support, and finding meaning and purpose. Some participants showed indications of meaning-making and post-traumatic growth at 12 months after the suicide.
According to the dual process model of bereavement, it is likely that participants were still oscillating between sense-making and meaning making, indicating that adapting to bereavement is a dynamic and fluctuating process.
Keywords: suicide-bereavement; parents; sense-making; meaning-making; coping; qualitative
Three key themes were identified from the analysis: searching for answers and sense-making, coping strategies and support, and finding meaning and purpose.
3.1. Searching for Answers and Sense-Making
All participants (male and female) described their struggles to make sense of their loss, and their search for answers for reasons for their child’s suicide. This contemplative and reflective process was dominant across all interviews at both six months and 12 months. Parents spoke of their often traumatic experiences leading up the suicide, such as their child’s mental health problems, incidents of self-harm and suicide attempts; and in turn, questioned what could have been done differently. Where there had been no previous indications that the suicide would occur, parents described their feelings of shock and bewilderment, and reflected on their many unanswered questions about the
motivations for the suicide. Some parents described their frustrations at trying to obtain information from coroners, psychologists and doctors in order to gain some understanding of the reasons for the suicide. For some, the process of searching for answers resulted in anger and blaming others (e.g., their child’s friends who were perceived to be a bad influence, doctors and the health system that were not
able to help).
“You question so much all the time. Because you’re going to naturally question whether
it’s you, whether he’s in trouble at uni, money trouble . . . Maybe he was depressed. I don’t know. We didn’t see any signs… It would’ve been nice to have someone who would’ve had the answers, to tell you the thought processes that could go on. But no one’s really had any idea. Just the questions behind why—give us some ideas why he would’ve done it.” (Father:6 months).
“There are times when you start to think and you think, why? I mean we had no idea that he’d ever do anything like this, we didn’t think he would. He even said that he would never ever do anything like this, and then to turn around and do it.” (Mother: 6 months).
I don’t think they did the right thing for her. They were treating her and checking her out of hospital five days later into the same environment where she came from. Is this the right way to treat these sorts of people? I suppose I’ll always question why the medical system had to let her down. I’m looking for somebody to blame, somebody’s ass to kick. How did this happen? What could you do to prevent it? (Father: 12 months).
Despite their search for answers and struggles to make sense of their loss, several mothers at both the six and 12 month period, indicated that they were beginning to accept the finality of the death of their child and were resigned to the fact that the situation could not be changed.
“My answers probably would have been different six months ago, but now I’m, like I’m
resigned to the fact that she’s not coming back obviously. It’s just, as time passes the pain
doesn’t go away but it gets easier.” (Mother: 6 months).
“We’ve gone through a year and you still have moments of why and if, and all the rest of it, but I suppose in my head and in my heart I know that it doesn’t matter what I do now,
she can’t ever re-arrive. It’s not like in the beginning when you think ‘oh it’s like as if she’s gone away and she’s still alive’, but you realize after a while that doesn’t happen . . . but it leaves a massive void. There’s a deep spot there and we know that place in your head and heart will become less painful, but that spot still just remains.” (Mother: 12 months).
3.2. Coping Strategies and Support
Parents revealed a variety of coping styles—both adaptive and maladaptive, although there were no obvious differences between mothers and fathers in the types of strategies applied. A number of parents mentioned avoidance of the topic (i.e., refusing to discuss the loss of their child with their partner/families or others), with some individuals describing how they did not like to talk about the suicide to their partner, and others recounting how it was their partner who refused to discuss their loss.
These examples were seen across both genders. Another example of avoidance was shown in fathers who reported working excessively in order to avoid the pain of thinking about their loss. Several parents also mentioned that they were drinking excessively, and for some this problem appeared to be increasing. Others spoke of their difficulties sleeping and their subsequent use of alcohol and/or marijuana in order to help them sleep at night. One mother described how she was only just coping, and described her pain as something that she simply had to endure.
“But we don’t really talk about it—if you mean the incident or what happened.” (Father:
“It’s the weekly, every day drinking in the week that’s definitely increased. Whereas before, we’d try not drink for three days . . . but now it’s definitely, at least one bottle to myself, every night.” (Father: 6 months).
“Like I said, you know, you either collapse under the pile, or you scrabble up with it, dig in your toes, and your fingernails, and even your teeth if you have to, to just rise above it . . . ” (Mother: 6 months).
There were also numerous examples of adaptive coping strategies implemented by bereaved parents. Parents described positive coping strategies that ranged from simple approaches such as trying to maintain a positive attitude and looking after their physical and mental health, to more complex strategies such as keeping memories alive and rituals that helped ensure a continuing bond with their child. Several fathers told of how they found it helpful to keep a journal where they wrote letters to their child. Some parents described the importance of celebrating their child’s birthdays (which was generally thought to be far more positive and preferable to marking the day of their loss). Others maintained a connection with their child through visits to their loved one’s grave-site or resting place. Some parents (both male and female) described how their faith/religion and attending church had helped them cope. Keeping occupied and maintaining a routine through work and other interests were also cited as coping strategies.
“If I was to say there were two things that have helped a lot in me just processing what’s
going on in life and where I’m at and reflect on myself—going for walks and thinking and a little bit of talking out loud . . . But also, writing a kind of journal, which is typically just like a brain dump of where I’m at, what I’m thinking. On occasions, I’ve done a letter to Edward and they’ve been good ways for me to step back and evaluate where I’m at.” (Father:12 months).
“I go (to the cemetery) every week. I pick up the flowers on a Friday because I’ve got a
standing order at the florist.” (Mother: 12 months).
“My sister made this amazing cake which somehow she managed to put a vibrant pink heart through the centre. So again, the family came together in little dribs and drabs to celebrate.” (Mother: 6 months).
Some parents (both mothers and fathers) described how attending individual counselling and suicide bereavement support groups had been critical to their ongoing coping and recovery. When discussing support groups, participants spoke of their sense of relief at being able to talk to others who understood and had suffered the same loss. In addition, one mother recounted how her workplace had been greatly supportive of her loss (e.g., helping her to access counselling, and showing empathy and consideration regarding her need to take time off), which she felt helped with her ability to cope.
“We found it very useful . . . everyone tells their story and you can open up and they tell
you things. You stop feeling like you are the only unlucky people in the world. That it does happen to other people as well, even if it’s a small number. You’re not the only ones, which is comforting to know that there’s other people (in the same position).” (Father: 6 months).
“I see him (psychiatrist) about once a month and I just sort of, I suppose, put all the questions into my head that I think need to be answered and of course he doesn’t answer them, I answer them, but it’s something to discuss together.” (Mother: 12 months).
There was considerable variation in levels of support received by bereaved parents, with some participants describing strong support from their partner/spouse, family and friends, and others with very little support. Several individuals said they felt fortunate to be able to speak openly and share feelings with their partners and family members, and described how this helped with their ability to cope. One father spoke of the importance of friendships and having a sense of connectedness to others. However, a number of others reported feeling less patient and uncomfortable with family and
friends, resulting in their withdrawal from social interactions; indicating reduced opportunities to receive social support.
“I’ve got a good supportive family group. I think I have a good enough family and
friendships to be able to share thoughts and feelings . . . and I can talk openly with.” (Father:12 months).
“Even if I go to my friends’ houses and I see their family together it upsets me a little
bit . . . and then someone says ‘how many kids have you got?’ and I’ve got to say
‘four now’(referring to the loss of her son).” (Mother: 12 months).
“When I go to my outer family . . . if anything I’ve probably shut down a bit more to them. I’ve probably become a bit more insular.” (Mother: 12 months).
3.3. Finding Meaning and Purpose
At the 12 months interviews, a number of parents indicated that they had come to terms with their loss and had started to find meaning and purpose in their lives. For several parents, living through their loss and grief was seen as a learning process which had led to some positive outcomes. Participants spoke of how their experience had made them reflect and re-evaluate their lives, which had in turn enabled them to grow emotionally and spiritually. In addition, many parents described how they felt that they had a greater awareness of others who might be in need of help, and were more aware and open to listening and offering help.
“For me it was cathartic. It helped me have a purpose. As I say I’ve probably readdressed
quite a few things in my life, or we both have. Helping people go forward, to me is a great thing and certainly helping any young person deal with the un-assurances of life.” (Mother:12 months).
“I just attribute this sense of reinvigorated connections with other people, this much more candid and open and openly caring kind of two-way relationships that I’ve got with all these people, including my close family, have really come about because I got this big wake-up call from Edward leaving. It just catapulted me into a different way of living. It’s like it’s just made me do this whole re-prioritising and re-evaluating.” (Father: 12 months).
Others spoke of how they had learnt to change their priorities, placing more value on life and not taking everyday things for granted. Participants described a wide variety of ways in which they were making their lives meaningful again to enable them to move forward. Making a positive contribution through work, helping others through charity work and fundraising, connecting with nature through walks and camping trips, and simply being open to enjoying experiences and friendships were all cited as ways in which parents were beginning to move forward with life. However, it should be noted
that not all parents reported such positive responses, with some still struggling with their grief and unable to move forward at the 12 month time period.
“I’m definitely living life. I feel sorry for other people that are just surviving because I’m
going through everything at the moment, but it’s a privilege. I’ve always been a bit spiritual, but I’m making more decisions now and I’ve grown up. I’ve said to (my wife) this is it; it’s not going to be ‘we’re going to be good to each other today and then tomorrow we’re not’. It’s going to be forever and that’s it. It’s just being happy and living your life. And that’s because of Peter, exactly because of Peter.” (Father: 12 months).
“It doesn’t matter whether you have two or 10 or 20 (years of life left) the lesson that it
teaches you is make the best, look into it and see what’s really good in there and take that
out and go with it. Make sure that the things that you’re doing right have purpose. Don’t
dilly-daddle with the nonsense in life, you know. You know life is very precious and you
have to do the best with the time you’ve got, whatever that time is.” (Mother: 12 months).
“I have good days and bad days. It’s horrible, just horrible. There’s probably not a day goes by that I don’t have a cry … It just doesn’t get any easier.” (Mother: 12 months).
“I tend to think more about being deliberate in how I use my time to enjoy it and to take in new experiences, or revisit experiences I’ve enjoyed that I might have let fall by the wayside over the years. So a drive to the beach, a walk on the beach, trip in the country, just being on the open road, all those are things that I haven’t done much in recent years.” (Father:12 months).
Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, Menzies Health Institute of Queensland, Griffith University, Mt Gravatt Campus, Mount Gravatt, QLD 4122, Australia; email@example.com (V.R.); firstname.lastname@example.org (L.K.);
* Correspondence: email@example.com; Tel.: +61-7-373-53-380
For help in Australia
CAPS – Talk Suicide Support Service – Free telephone and face to face support 1800 008 255
Salvation Army Care Line 1300 36 36 22
Lifeline 13 11 14
Mensline Australia 1300 78 99 78 (24 hour phone counselling and referral)
QLife 1800 184 527 Phone & Chat 3.00 – 12.00 pm everyday
SANE Australia Helpline – Talk to a mental health professional (weekdays, 10am-10pm AEST) 1800 18 72 63
Helpline chat – Chat online with a mental health professional (weekdays 10am-10pm AEST)
Kids Help Line 1800 55 1800 (24 hour phone counselling)
Suicide Call Back Service 1300 659 467 (Professional call back service referral line operates seven days a week)
Veterans Line 1800 011 046 (after hours professional telephone crisis counselling for veterans and their families