۱- Introduction

۲- Suicide diffusion

۳- Understanding meaning

۴- Methods

۵- Results

۶- Discussion

References

Abstract

Current research indicates that exposure to suicide is a risk factor for suicidality; however, we know little about the mechanisms through which exposure confers this risk. In this study, we address this gap by examining the role of meaning-making after a suicide death in moderating individual’s vulnerability to suicide. We draw on interview data with suicide bereaved individuals in the USA (N = ۴۸), the majority of whom engaged in intense meaning-making processes after their loss. Many reported an increased awareness of suicide as a ‘something that actually happens,’ a realization that impacted their lives and relationships with others (N = ۳۷). For 7 participants, all women, their loss appeared to trigger increased suicidality, as they not only felt overwhelmed by grief, but also came to see suicide as something they, too, could do. However, for 19 participants, witnessing the profound impact of suicide on others made them feel that suicide was something they could never do. Thus, in our data, how exposure impacted vulnerability was tied to how individuals made sense of and experienced their loss. For some, suicide was re-framed as more of an option, while for others it was re-framed as not just the killing-of-oneself, but as the harming-of-others through grief and trauma, which in turn diminished their view of suicide’s acceptability. Collectively, our findings suggest that exposure to suicide itself is not inherently risky, though it may be inherently distressing; instead, whether it results in increased vulnerability depends on the meaning an individual makes of the experience and likely the context surrounding the death. We discuss the implications of our findings for theories of suicide contagion, suicide itself, and suicide prevention.

Introduction

Over the past 15 years, in the United States, the suicide rate has been steadily climbing across demographic groups (Stone et al., 2018). While this trend has generated considerable efforts to improve suicide prevention, there is concomitant increasing concern about how to support individuals who have lost someone to suicide. This concern is warranted as a plethora of studies indicate that exposure to suicide can lead to a variety of negative sequelae among both kin and non-kin, including depression and anxiety, as well as increased risk of suicide ideation, attempts, and even—in case of family members—death (see Abrutyn and Mueller, 2014; Pitman et al., 2014; Bottomley et al., 2018; Maple et al., 2017). The increased vulnerability to suicide after exposure to suicide is a particularly concerning phenomenon, sometimes referred to as ‘suicide suggestion’ (Phillips, 1974; Bjarnason, 1994), ‘suicide contagion’ (Velting and Gould, 1997; Abrutyn and Mueller, 2014), or ‘suicide diffusion’ (Baller and Richardson, 2009). It has also resulted in efforts at ‘postvention’—essentially, suicide prevention focused on loss survivors—and the notion of “Postvention as Prevention” (Norton, 2015). One of the major limitations in developing effective postvention strategies, and in understanding vulnerability to suicide more generally, is a lack of research investigating the mechanisms undergirding the association between exposure to suicide and vulnerability to suicide. Instead, much of the research effort to date has focused on adjudicating whether the increased risk of suicidality observed in numerous studies represents a ‘real’ effect or whether it is just a consequence of other factors, such as depression that follows a sudden death (e.g. Brent et al. 1989; Wong et al., 2005), or preexisting risk factors shared between the person experiencing bereavement and the person they lost to suicide (Joiner, 1999, 2003). Very little work has examined what mechanisms may be responsible for the change in risk.