Course of bereavement over 8-10 years in first degree relatives and spouses of people who committed suicide: longitudinal community based cohort studyBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5519 (Published 02 October 2013) Cite this as: BMJ 2013;347:f5519
- Marieke de Groot, senior researcher123,
- Boudewijn J Kollen, senior researcher department of general practice medicine1
- 1University of Groningen/University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands
- 2VU University, Van der Boechorststraat 1, 1081 BT Amsterdam, Netherlands
- 3EMGO+ Institute for Heath and Care Research, Amsterdam, Netherlands
- Correspondence to: M de Groot, University of Groningen/University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands
- Accepted 20 August 2013
Objective To identify factors predicting the long term course of complicated grief, depression, and suicide ideation in a community based sample of relatives bereaved through suicide.
Design Longitudinal cohort study. Included in the multilevel regression models were sociodemographic and personality features, mental health history, records of received help, long term complicated grief, depression, and suicide ideation.
Setting Community based sample located in the northern part of the Netherlands.
Participants 153 first degree relatives and spouses of 74 people who had committed suicide.
Main outcome measures Complicated grief, depression, and suicide ideation assessed at 2.5 months, 13 months and 96-120 months (8-10 years) by means of self report questionnaires.
Results Complicated grief, depression, and suicide ideation were mutually associated in relatives and spouses of people who had committed suicide. A history of attempted suicide was associated with long term suicide ideation (odds ratio 5.5, 95% confidence interval 1.8 to 16.7; P=0.003). Depression was more likely to be predicted by female sex and low mastery, whereas complicated grief was more likely to be predicted by the trauma of losing a child. The risk of both complicated grief and depression decreased over time; for complicated grief the change corresponded with a Cohen’s d effect size of 0.36 at 13 months and 0.89 at 96-120 months; for depression these figures were 0.28 at 13 months and 0.94 at 96-120 months. The long term course of bereavement was not affected by family based cognitive behavioural therapy, support from a general practitioner, and/or mental healthcare. Mutual support was associated with an increased risk of complicated grief: B regression coefficient=6.4 (95% confidence interval 1.8 to 11.0; P=0.006). Throughout this long term study, selection bias might have affected some outcomes.
Conclusion In relatives bereaved by suicide, suicide ideation is associated with an increased risk of long term complicated grief and depression. The risk of complicated grief and depression decreases over time. Although mutual support is associated with an increased risk of complicated grief, we could not draw conclusions about a causal relation.
We thank Janyte Holwerda and Alberta ten Klooster for their assistance with data collection, and M Y Berger and J Neeleman for their overall support.
Contributors: MdG designed the study, obtained funding, collected data, was responsible for data management and interpretation, wrote the draft, assisted in data analyses, and is guarantor. BJK designed and performed the data analyses, wrote the analyses section, and approved the final draft.
Funding: This study was funded by ZONMW (Netherlands Organisation for Health Research and Development) No 60-60100-98-052.
Competing interest: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: The study was approved by the medical ethical committee of the University Medical Center Groningen (METc 2009/052). All participants provided informed consent.
Data sharing: The dataset and additional data are available from the corresponding author. Consent for data sharing was not obtained but the presented data are anonymous and risk of identification is low.
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