Essay 4

Kayla Audet                                                                                                                                        Audet  5/6/2017
Professor Holly Pappas
English 101
Essay 4

Increased Risk for Suicidal Behavior in Offspring of a Parent who Committed Suicide:
Caused by Genetic Predisposition or Effects in the Aftermath.

 

Suicide can be defined as the intentional taking of one’s own life. It is a highly controversial issue as it is not seen as a respected way to die. However, suicide is documented as the third leading cause of death in the world. I know from personal experience that children exposed to suicide of a parent often think about their future and if they will end up the same way. Do children of a parental suicide have a higher risk of attempting or succeeding in suicide themselves and if so what causes this? I believe that it is a mixture of predisposition to mental illness and/or mood disorders and the changes and effects of the aftermath this type of death leaves behind. In fact, if we can figure out what causes this higher risk for these children than maybe we can prevent attempts or suicide from happening in their future.

The act of suicide affects millions worldwide and leaves a devastating impact on the family members left behind. A study that was performed in Sweden (Kuramoto, et al.) took 71,595 offspring of parents who committed suicide of which 27,997 were younger than 25 years of age. They believed that these children lost a caregiver not only in a devastating way but at a critical developmental period in their life. The research group reported that among the children younger than 25 years who lost a parent to suicide risk for hospitalization for an attempt varied based upon what developmental period the death occurred. Those children who lost a parent to suicide before the age 13 were at particularly higher risk. The researchers excluded 1,901 participants that did not meet the criteria to take part in the research study and they began their research on the 26,096 that did. They broke the participants into groups based on the timing that the parental suicide occurred. These groups were 3534 early childhood from 0-5 years of age, 7,147 later childhood from 6-2 years of age 6,401 adolescence from 13-17 years of age and lastly 9,014 young adulthood from 18-24 years of age. To complete this study these researchers followed-up with these children for 30 years after the death occurred.

The study reported the early and later childhood group’s risk increased after 5 years of the death and did not level-off until 20 years after the death. This was compared to adolescent and young adulthood participants whose risk increased after just 2 years and decreased gradually over time. If the death occurred during childhood they showed higher anger and depressive symptoms. It suggested that parents who died suddenly earlier in their children’s lives were more likely to have severe mental illness. In turn that research suggested that losing a parent during childhood may be a marker of higher familial and environmental vulnerability to suicidal behavior or psychiatric disorder. They also found that a suicide may have a different meaning or consequences to children at different developmental periods. They study proposes that this may have a long-term impact on the mental well-being of the child. Findings implicated for parents and clinicians to monitor risk for suicide attempts that may vary depending on when the death occurred in the child’s life. They place emphasis on more immediate support for adolescent and young adult offspring who have lost a parent to suicide and more proactive long-term support for these individuals.

In agreeance with the transmission of familial mood disorders and mental illness another research group prepared a study on the familial pathways to early-onset suicidal behavior (Brent, David A. et al). The study followed-up with 701 offspring ages 10-50 off parental suicide, in which the parent had a history of a mood disorder or mental illness. They focused on possible mediators of familial transmission which included impulsive aggression, mood disorder, and childhood maltreatment. They used interviews and self-questionnaires such as to target known contributors to suicidal risk. These interviews and questionnaires included commonly used psychiatric and medical test such as the Columbia history of suicide form, The Brown-Goodwin lifetime history of aggression, the DSM-IV, the Becks hopelessness scale or children’s hopelessness scale and the Becks depression inventory or children’s depression inventory. Although the transmission of attempts occurs independently of the transmission of mood disorder, the transmission of mood disorders was also a significant pathway to early onset suicidal behavior. Impulsive aggression was an important precursor of mood disorders in offspring which resulted in increased risk.

The clinical implications these researchers focused on regarding their results included the importance of assessment and early intervention in offspring of parents with mood disorders and history of suicide attempts. They believed that early prevention may attenuate the transmission of suicidal behavior. They suggested helping the youth with prominent irritability and impulsive aggression would achieve better emotion regulation. This in turn could reduce suicidal risk by reducing the risk for mood disorders and acting on suicidal impulses. I see a strong agreeance between these two different research groups on the prevention of the transmission of mood disorders and other mental illness. Maybe if we can give more support and prevention methods to these offspring who have lost a parent to suicide we can reduce the risk for suicidal behavior from manifesting.

There were two articles I found that were more geared toward the effects and aftermath of the suicide. The first study was done on child survivors of a parental suicide versus of a death due to terminal illness. The death of a parent is one of the most stressful life events for a child. Few studies have investigated however, the children’s psychological outcomes after the parental death. Researchers reported depressive symptoms to be the most consistent adverse outcome in bereaved children. Children who experience unexpected, sudden or violent forms of parental death have been reported to manifest symptoms of depression, severe anxiety, hyperarousal and intrusive thoughts within the first year of the death. This is compared to children who lost their parent to a terminal illness and who have had time to anticipate and start coping with the parent’s death before it occurs. These children who lose a parent to a terminal illness are shown to have had time to come to terms with the death and say goodbye to the parent as compared with offspring of parental suicide who often are left with just a note and do not get a chance to say goodbye. Clinical observations show that death by suicide disrupts the child’s grieving process and shows to have adverse effects on the child’s life long-term psychological adjustment and may be more problematic than other forms of death.

This research studied prepubescent children and young adults whose parents committed suicide within 1.5 years preceding the research assessment. Families were randomly assigned either to receive intervention or not receive intervention after the death. Both samples completed a twenty-seven item self-report questionnaire called the Children’s Depression Inventory, that focused on children and adolescents. This questionnaire rated the severity of depression symptoms present within the previous two weeks. These results showed scores of behavior problem syndromes such as internalizing and externalizing behaviors, as well as symptoms of withdrawal, somatic complaints, anxiety, depression, social problems, thought and attention problems, delinquent problems, and aggressive behavior. It was also reported that children may be reluctant to acknowledge their own feelings of depression for fear that doing so would upset other family members. Another problem may be that the bereaved parents may be overwhelmed by their grief and mourning that they are not fully aware of the distress their children are sometimes in. They also may not be able to cope with the issues necessary to intervene with their children’s psychologically distressed states.

Worden (1996), found that children’s risk of developing serious emotional or behavioral problems attributed to the experience of parental death doubled between 1 to 2 years after the death. In addition, a parent remarrying and other life changes may also have a devastating impact on how the child may adjust to the death. These life changes may trigger grief responses or depressive disorders in the children as they may be losing something else they are familiar with. Complications in the process of grieving the parent of suicide include possible traumatic thoughts about the suddenness and way the death occurred. If the child has PTSD it is reported that it may prolong the duration of depressive symptoms. This study showed that how a death occurs and the immediate actions afterward can be a major influence on the mental well-being of the child. It also suggests that how the child is told about the death has a major impact as well. This task should not be taken lightly as it could majorly influence the child’s well-being and should be handle delicately and in more a process form then just coming out and saying it.

The other research study done on the aftermath of a parental suicide was titled just that. In this study, the also agreed that predisposition to mental health disorders and mood disorders influenced the risk a child then has for suicidal behavior. However, it focused on the aftermath and changes that occurred as well as the interventions and support that should be provided for not just the children but other family members as well. It is well-established that suicide is associated with grief that is complex. They strongly agree that the child’s adjustment is influenced by the age of the child at the time of the parent’s death. The child’s personal attributes, level of family and social support, social environment, economic and environmental factor and the process of meaning-making(1) of the child. Research reviewed potentially contributing factors present in the family especially those relevant to a child’s coping with the loss of their parent. It examined factors that influence the child’s capacity to comprehend and adjust to the loss. Suicide represents an unexpected, traumatic and often violent death that poses special challenges to the bereaved. These challenges may include shock, withdrawal, guilt, feelings of aloneness, pain and confusion and feelings of rejection and abandonment.

A study conducted by Pfeffer recruited sixteen families with suicide bereaved children aged from 5 to 14. This study found that suicide bereaved children were at a higher risk of specific types of psychosocial dysfunction. It was reported that the younger children were also unlikely to be told of the circumstance surrounding the parent’s death. Many of these children felt excluded and disenfranchised following the suicide of their parent. The study also reported that while some children wanted to see the body of their deceased parent while other expressed concern that people would forget about the deceased parent and they just wanted to preserve the memory of the parent. The grief process should be handle with care no matter how a parent dies as a child’s developmental well-being is the focus. The child should be told about the parent’s death in a way where they can try and comprehend the death in a better way and feel as if it is okay to talk about the deceased parent and what they meant to the child.

It is suggested that there are four major domains of factors influencing adjustment to parental suicide. The first is the age and developmental stage of the child at the time of the parent’s death as well as the way it occurred. This means as stated above it should be handled with care and caress as it will have a significant impact on the child’s life. Children under the age of 2 years have little understanding of death. Feelings of separation and abandonment are those primarily experienced as the concept of death is unclear and fragmented. As the children develop they gradually come to realize that death is final and everyone including themselves will eventually die. A mature and realistic comprehension of the finality of death is not achieved until 8 to 11 years of age. Communication patterns within the bereaved family also play a critical role in the adjustment after the death and should be handled like stated before in the form of a process and not just a quick conversation. The second and third factors are family characteristics including the quality of family relationships and the social-environmental factors and economic factors. Heikes (1997) suggested that the quality of support available to the bereaved child from the family and social environment may determine their adjustment to the loss. It is important that the surviving parent be available to support the bereaved child This is because children express their distress following the suicide by “acting out” and showing signs and symptoms of behavioral problems as a way of expressing inexpressible feelings. If the child has a stable relationship with the surviving parent they are said to cope more effectively.

The fourth is that these factors combine and are handle appropriately to the situation and child themselves. This will help the child in the future with making meaning of the death and hopefully reduce the feeling of rejection and abandonment. If the child does not have a good support system whether it be family or other people from the community they may become more isolated and withdrawn and manifest the symptoms that could lead to increased suicidal behaviors. This study once fully completed showed that of the children in the intervention group, efficacy was indicated by lower anxiety although PTSD symptoms persisted. The children in the non-intervention group showed increased anxiety continued having depressive symptoms.  The aim is to decrease risk factors and encourage those factors which strengthen and protect. Also, it is important to identify the type of support that would nurture and strengthen the family. The most important aspect of any post-intervention support is that is available and accessible to the family whenever any of the predictable feelings of being alone and overwhelmed arise.

I myself was a child who lost a parent to suicide at the age of 17. I have two siblings that were ages 7 and 12 at the time of my mother’s death. My mother did have a history of eating disorders that had resolved and depression. Although she was also very sick at the time of her death the way she died still came as a shock. No one in my entire extended family had any idea that she would take her own life especially not us, her children. The reason I have chosen this topic for my research and argumentized paper is since not only am I consider a survivor of parental suicide I was one of smaller odds who came home to find her. I agree with the above articles in that transmission of mood disorders and mental illness is a key factor. The reason I agree is because after my mother’s death I started to manifest symptoms of depression which is prolonged due to my PTSD. I also strongly agree that what happens afterwards is also a major influence on how the child adjust to the death. My father was not around and my mother was my best friend and although I know my mother wasn’t trying to abandon me or would ever want me to feel that way it is exactly how I felt. As a child, I was compassionate and fun always talking and singing everywhere I went to anyone that would, listen. I loved to be the center of attention and doing things that were unexpected and spontaneous. After my mother’s death, I became withdraw and quiet, depressed, I felt abandoned and rejected by the one person I thought truly loved me. I thought every night as I cried myself to sleep that no one wanted me and that no one ever would. I had changed I was not that some enthusiastic little girl I had once been.

It wasn’t until four years later that I sought help and went to speak with a therapist. I can honestly say it helped me so much. I would encourage other parental suicide victims to seek help early on. I may be a little biased in the situation but I believe it is important for these children to have the support immediately rather than give them time to develop this mental illness, mood disorders and other feelings they can prevent. This help doesn’t have to be with a therapist but at least talk to supportive family members, friends or other people in their community that the trust and love. If we can help these children get the support and interventions they need earlier than maybe just maybe we can reduce the risk of and attempts made by this child left behind. I believe we need to look at the picture with both being aware of predispositions to mental health issues and post-interventions for those left behind and we could make a difference.

 

 

 

 

 

 

 

 

 

 

 

Notes

1. In regards to this essay meaning-making is the process in which a child makes meaning of their parents death or some other traumatic or devastating process.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Works Cited

Kuramoto, S. Janet et al Time to Hospitalization for Suicide Attempt by the Timing of Parental Suicide During Offspring Early Development. JAMA Psychiatry, 2013.

Brent, David A. et al Familial Pathways to Early-Onset Suicide Attempt: A 5.6-Year Prospective Study. JAMA Psychiatry, 2015

Pfeffer, Cynthia R. et al Child Survivors of Parental Death from Cancer or Suicide: Depressive and Behavioral Outcomes. Psycho-Oncology 9: 1-10(2000)

Ratnarajah, Dorothy and Schofield, Margot J. Parental Suicide and its Aftermath: A review. Journal of Family Studies. (2007)

Posner, K. et al Columbia Classification Algorithm of Suicide Assessment.

Beck AT, et al An Inventory for Measuring Depression Arch Gen Psychiatry (1961)

Kovacs M. The Children’s Depression Inventory(CDI) Psychopharmacology Bulletin.(1985)

Beck AT, et al The Measurement of Pessimism: The Hopelessness Scale. J Consult Clinical Psychology. (1974)

Pfeffer, C.R, et al Child survivors of Suicide: Psychosocial Characteristics. (1997)

Worden, J.W. Children and Grief: When a Parent Dies. Guilford Press Inc., New York (1996)

Heikes, K. Parental Suicide: A System Perspective. bulletin of the Menninger Clinic (1997)