Special Focus: Child Survivors
Child survivors are a special population that has received very little specific attention in the suicide survivor research literature. Just as the loss of a child to suicide is thought to be particularly difficult for parents, it is also thought that the loss of a parent through suicide is a unique psychological phenomenon that warrants more investigation (Cain, 2002).
In one study, children whose parents died from suicide were compared to those whose parents died from cancer. In this particular study, none of the children had seen the body of the suicide victim, but all of the children in the study had attended the funerals of the parent. The results of the study indicated that the children who were survivors of a parent's suicide had significantly more depressive symptoms, negative mood, interpersonal problems, ineffectiveness, and anhedonia than did the children who were survivors of a parent's death from cancer (Pfeffer, Karus, Siegel, & Jiang, 2000). Other studies also have shown the deleterious effects on the mental health of children caused by parental suicide. Increased risk for major depressive disorder, posttraumatic disorder, and impaired social adjustments have all been linked in children to a parent's suicide (Sethi & Bhargava, 2003). These results indicate how powerfully a parent's suicide affects a child, with both immediately significant and long-lasting effects.
One question that has been asked about child survivors concerns whether or not they should be told of the nature of their parent's death. Cain (2002) reminds us that being told and knowing about the suicide can be two separate things. He cites examples of children who were not explicitly told about their parent's suicide but who knew a great deal about them and, conversely, children who were directly told about their parent's death who refused to believe or could not comprehend the communicated information. Some clinicians and researchers believe that it is best to openly communicate the nature of the parent's death to the child to prevent the child from experiencing anxiety about not knowing or denial on the part of the surviving parent. The question of whether or not to tell children has not been answered by any empirical research, and we cannot say from a research perspective how telling the child would affect grieving or outcomes. Parents and clinicians, it would seem, have to make an informed choice after considering many situational individual factors, such as the age or maturity of the child, the child's ability to comprehend the finality of death, the child's witnessing of events related to the suicide, and the child's relationship with the dead parent. The danger, of course, is that without a full understanding of the death, children could possibly blame themselves for causing this unspeakable horror to occur. Therefore, any decisions to withhold information should be very carefully thought through. However, it does not seem at this point that anyone can give a definitive answer to the question of how best to discuss the circumstances surrounding the death with the child.
An area that is even less understood is the effects of a sibling's suicide. We know that suicide increases risk for other family members, and the effects of the death of a sibling are poorly understood. There is some evidence that within three years following the death, children who experience a sibling's suicide are seven times more likely to develop major depression, posttraumatic stress disorder, or suicidal behavior (Brent, Moritz, Bridge, Perper, & Canobbio, 1996). Any clinician who has ever worked with families after suicide knows all too well the risk these children face. Although we know little about these children, we do know that they need help working through the crisis. There is some very promising research that demonstrates that children who survive a sibling's suicide benefit from therapeutic intervention. In one study, changes in anxiety and depressive symptoms were significantly greater among children who received a group counseling intervention for suicide survivors than in those who did not (Pfeffer, Jiang, Kakuma, Hawng, & Mersch, 2002). Clearly, more research on assisting children (and families) to cope with the grieving process is essential.
Another area of concern for suicide-surviving children and adolescents is the attempt or completion of a suicide by a peer. Adolescent peer survivors might be at significant risk for psychological disorders and suicidal behaviors. Close friends of suicide attempters or completers are at particular risk, and approximately 25% of friends in one study in Hong Kong required psychiatric treatment, and 15-21% indicated their own suicidal behaviors (Ro, Leung, Hung, Lee, & Tang, 2000). Suicide contagion is always a serious subject, and adequate postvention interventions should be carried out with adolescent survivors.
Although little is known about the effects of suicide on children, there are some resources to help. For example, a book entitled After a Suicide: A Workbook for Grieving Kids, produced by the Dougy Center for Grieving Children (www.dougy.org) can be a useful therapeutic tool to help children through the grief process.
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