Suicide following the death of a sibling: a nationwide follow-up study from Sweden

Objectives The death of a sibling can trigger grief and depression. Sibling deaths from external causes may be particularly detrimental, since they are often sudden. We aimed to examine the association between the death of an adult sibling from external causes and the risk of suicide among surviving siblings up to 18 years after bereavement. We adjusted for intrafamily correlation in death risks, which might occur because of shared genetics and shared early-life experiences of siblings in the same family. Design A follow-up study between 1981 and 2002 based on the total population. Setting Sweden. Participants Swedes aged 25–64 years (n=1 748 069). Primary and secondary outcome measures Suicide from the Swedish cause of death register. Results An increased risk of mortality from suicide was found among persons who had experienced the death of a sibling. In women, the suicide risk was 1.55 times that of non-bereaved persons (95% CI 0.99 to 2.44), and in men it was 1.28 times higher (95% CI 0.93 to 1.77). If one sibling committed suicide, the risk of the remaining sibling also committing suicide was 3.19 (95% CI 1.23 to 8.25) among women and 2.44 (95% CI 1.34 to 4.45) among men. Associations with other main causes of death—such as external other than suicide, cardiovascular diseases or cancer—were generally much smaller and statistically not significant in either sex. We found no clear support for a specific time pattern according to time since a sibling's death. Conclusions Our study provided evidence for suicide risk associated with the death of a sibling at adult age, revealing that bereaved persons’ risk of suicide is higher when siblings die from suicide, even when adjusting for intrafamily correlation in death risks.

[1]  I. Kawachi,et al.  The forgotten griever: a nationwide follow-up study of mortality subsequent to the death of a sibling. , 2012, American journal of epidemiology.

[2]  Satomi Nakajima,et al.  Complicated grief in those bereaved by violent death: the effects of post-traumatic stress disorder on complicated grief , 2012, Dialogues in clinical neuroscience.

[3]  J. Saarela,et al.  Time Does Not Heal All Wounds: Mortality Following the Death of a Parent , 2011 .

[4]  A. Mesoudi.  The Cultural Dynamics of Copycat Suicide , 2009, PloS one.

[5]  N. Melhem,et al.  The incidence and course of depression in bereaved youth 21 months after the loss of a parent to suicide, accident, or sudden natural death. , 2009, The American journal of psychiatry.

[6]  K. Hendrickson.  Morbidity, mortality, and parental grief: A review of the literature on the relationship between the death of a child and the subsequent health of parents , 2009, Palliative and Supportive Care.

[7]  J. Vaupel,et al.  Loss of partner and suicide risks among oldest old: a population-based register study. , 2004, Age and ageing.

[8]  K. van Heeringen,et al.  Perceptions, needs and mourning reactions of bereaved relatives confronted with a sudden unexpected death. , 2004, Resuscitation.

[9]  P. Mortensen,et al.  The impact of parental status on the risk of completed suicide. , 2003, Archives of general psychiatry.

[10]  K. Dyregrov,et al.  PREDICTORS OF PSYCHOSOCIAL DISTRESS AFTER SUICIDE, SIDS AND ACCIDENTS , 2003, Death studies.

[11]  P. Mortensen,et al.  Mortality in parents after death of a child in Denmark: a nationwide follow-up study , 2003, The Lancet.

[12]  Lang Wu,et al.  BEREAVED PARENTS' OUTCOMES 4 TO 60 MONTHS AFTER THEIR CHILDREN'S DEATHS BY ACCIDENT, SUICIDE, OR HOMICIDE: A COMPARATIVE STUDY DEMONSTRATING DIFFERENCES , 2003, Death studies.

[13]  J. Jordan.  The American Association of Suicidology Is Suicide Bereavement Different ? A Reassessment of the Literature , 2012 .

[14]  F. Vaida,et al.  Proportional hazards model with random effects. , 2000, Statistics in medicine.

[15]  P. J. Schroder.  Adversity, Stress, and Psychopathology , 1999 .

[16]  S. Jacobs.  Traumatic Grief : Diagnosis, Treatment, and Prevention , 1999 .

[17]  J. Lönnqvist,et al.  Suicide attempts preceding completed suicide , 1998, British Journal of Psychiatry.

[18]  D. Mazza.  Bereavement in adult life , 1998, BMJ.

[19]  M. Mahon,et al.  Sibling bereavement: a concept analysis. , 1997, Death studies.

[20]  O. Grad,et al.  Similarities and Differences in the Process of Bereavement after Suicide and after Traffic Fatalities in Slovenia , 1996 .

[21]  P. Martikainen,et al.  Mortality after the death of a spouse: rates and causes of death in a large Finnish cohort. , 1996, American journal of public health.

[22]  T. Bouchard,et al.  Comparative Grief experiences of bereaved twins and other bereaved relatives , 1995 .

[23]  E. Mościcki.  Epidemiology of suicidal behavior. , 1995, Suicide & life-threatening behavior.

[24]  J. Overholser,et al.  Bereavement from Suicide as Compared to other Forms of Bereavement , 1995 .

[25]  J. Lönnqvist,et al.  Life events and social support in suicide. , 1993, Suicide & life-threatening behavior.

[26]  M. Gilewski,et al.  The role of social supports in the bereavement process of surviving spouses of suicide and natural deaths. , 1992, Suicide & life-threatening behavior.

[27]  H. Resnick,et al.  Homicide as a Risk Factor for PTSD Among Surviving Family Members , 1991, Behavior modification.

[28]  J. Wal,et al.  The Aftermath of Suicide: A Review of Empirical Evidence , 1990 .

[29]  Thomas B. Scott,et al.  Suicide bereavement and recovery patterns compared with nonsuicide bereavement patterns. , 1990, Suicide & life-threatening behavior.

[30]  J. Kaprio,et al.  Mortality after bereavement: a prospective study of 95,647 widowed persons. , 1987, American journal of public health.

[31]  L. Calhoun,et al.  The rules of bereavement: Are suicidal deaths different? , 1986 .

[32]  A. Demi.  Social adjustment of widows after a sudden death: Suicide and non-suicide survivors compared , 1984 .

[33]  J. Bunch.  Recent bereavement in relation to suicide. , 1972, Journal of psychosomatic research.

[34]  B. Dohrenwend,et al.  Adversity, stress, and psychopathology , 1998 .

[35]  J. House,et al.  The effect of social relationships on psychological well-being: Are men and women really so different? , 1996 .

[36]  A. Bowling.  Mortality after bereavement: a review of the literature on survival periods and factors affecting survival. , 1987, Social science & medicine.