Suicide is a sensitive and complicated topic to talk about—but it's essential to do so. Suicide is never the answer, and we should look at the lack of familial and community connections and societal systems that allow someone to think suicide is the best and only way out of their difficult situation. Suicide should not be ignored or hidden from the world.

We have to talk about it.

Losing someone to suicide is extremely painful and is compounded by many factors, with thoughts around prevention and blame often taking center stage. The complex grief held by those left behind often feels impossible. These complex emotional responses can take longer to get through.

What is Suicide?

Suicide is an act of intentionally taking one's own life. It should never be viewed as a sign of weakness or a character flaw but rather as a severe public health issue that impacts people of all ages, genders, races, and backgrounds. According to AFSP (American Foundation for Suicide Prevention), it is the 11th leading cause of death in the US (1). In 2021, 48,183 Americans died by suicide, with an estimated 1.70M suicide attempts (1). On average, this amounts to around 132 suicides per day. Suicide rates have increased over 30% since 2000.

Who is most impacted by Suicide?

Suicide often results from falling through the many healthcare cracks and not receiving the proper mental health support, oversight, and other much-needed social and financial supports. The term ‘Social Determinants of Health’ comes into play here in a big way, as those who lack access to resources are also the ones most impacted by suicide. Suicide is higher in certain communities, what we call a health disparity. Chronic issues such as experiencing trauma, having limited to no income, one’s lived racial identity, cultural experiences, acculturation, transphobia, and homophobia, being excluded from one’s family of origin, lack of meaningful connections that feel safe, and other issues too many people face, increases ones risk to complete suicide. It is no surprise that there is such a high rate of suicide within the communities we serve (3). Those with the highest numbers of suicide are:

• Veterans: Veterans have an adjusted suicide rate 57.3% greater than the non-veteran U.S. adult population.

• People who live in rural areas: Suicide rates increase as population density decreases and areas become more rural.

• Middle-aged adults: Adults aged 35–64 account for 46.8% of all suicides in the United States, and suicide is the 8th leading cause of death for this age group.

• Sexual and gender minorities: LGBT adults are three to six times more likely than heterosexual adults to report suicidal thoughts, plans, and attempts (7). LGBTQ youth are more than four times as likely to attempt suicide than their peers (5). 45% of LGBTQ youth seriously considered suicide in the past year, and an attempt is made every 45 seconds (6).

• Black Americans: Suicide was the second leading cause of death among Black people ages 15 to 24 in 2019. Suicide is also the second leading cause of death for Black youths ages 10 to 19 (4). Black transgender and nonbinary youth report disproportionate rates of suicide risk — with 59% seriously considering suicide and more than 1 in 4 (26%) attempting suicide in the past year (6).

• Indigenous populations: Suicide is the 9th leading cause of death among AI/AN people. Native/Indigenous youth who are Two-Spirit are 2.5 times more likely to report a suicide attempt in the past year (33%) (6).

What are the Causes of Suicide?

As one can read here, there is no single cause of suicide. Below are some risk factors that can increase one’s risk of suicide.

• Mental health conditions: PTSD, Depression, anxiety, bipolar disorder, schizophrenia, and other mental health conditions can increase the risk of suicide.

• Substance abuse: Substance abuse and addiction can contribute to suicidal behavior by increasing impulsiveness and reducing the ability to think clearly.

• Traumatic life events: Experiencing racism or homophobia and transphobia, losing a loved one, a relationship breakup, financial difficulties, or health problems can increase the risk of suicide.

• Physical health problems: Chronic pain, terminal illness, or other physical health problems can increase the risk of suicide, especially if accompanied by depression or anxiety.

• Access to firearms: Access to firearms compounded with a desire for suicide significantly increases the risk of suicide.

• Family history: A family history of suicide or mental health problems can increase the risk of suicide.

It's important to note that suicide is not the answer to challenging life events, and help is available for struggling people. If you or someone you know is experiencing thoughts of suicide, it's essential to reach out for help as soon as possible.

When we lose a loved one to suicide, our hearts shatter into a million pieces.

Grief is a part of life. We all experience. When it comes, it often feels like the most challenging part of being human. It's also important to remember that grief doesn't last forever; eventually, things will improve if you allow yourself enough time to heal from your loss. You may want to talk about how you feel with friends or family members who understand what you're going through because they've experienced similar losses themselves or know someone who has died by suicide or another means other than natural causes (e.g., murder). You may not want to talk to anyone about it. Whatever you feel is OK.

While suicide and suicide attempts are severe public health issues that can be prevented by seeking help and support, the survivors of suicide are an entirely different aspect that deserves equal attention and support. The complicated grief after a suicide that the survivors feel is even worse and may last longer. These survivors are at a higher risk of developing mental health issues such as depression, PTSD, and possibly suicidal behavior (3).

You can start by allowing your grief to be there, which can be one of the most complex steps to take, as it means letting yourself feel the pain of losing someone you love. It is never easy and can be too painful to do alone. If you feel alone or isolated because of this loss, finding a support group to join with other people who have been through the same thing can be helpful.

What are the Stages You Go through with Suicide Grief?

Grief is not linear and can feel like the waves of the ocean coming again and again. However, there are some common themes to grief, which can include, in no particular order:

• Shock and disbelief: For someone who goes through losing someone to suicide, feelings of shock and disbelief are unavoidable. It is something unexpected, and there is no preparation. Tragically, more often than not, those who die by suicide do not usually show signs of taking their own life. There's this feeling of numbness and detachment from your feelings because it is too intense to deal with.

• Denial: It is a defense mechanism that allows people to temporarily disconnect from the reality of a painful event, such as losing a loved one to suicide. It can manifest in different ways, such as refusing to accept their loved one is gone. They may also avoid thinking about the loss or engage in activities that might trigger painful emotions or create more harm.

• Anger: It is normal and a part of the grieving process. It is common to feel enraged and other intense emotions after losing a loved one as you struggle to understand why it happened. Some people may direct their anger toward themselves, while others may direct it toward others, including friends and family.

• Bargaining: It is a stage of grief that is often characterized by feelings of desperation and a search for a way to reverse or change the situation. Examples of bargaining during the grieving process may include:

  1. Promising to be a better person or to make changes in exchange for the loss being reversed.

  2. Imagining scenarios in which the loss did not occur.

You might hear people make deals with higher powers like," Please let her live; I promise to become a better person ." It's important to remember that bargaining is expected in the grieving process, and everyone experiences it differently. Some people may spend more time in this stage, while others may not experience it at all. The length of time spent in each stage of grief can also vary for each person.

Depression. While not a stage of grief, it is not uncommon for those who struggle with depression and have a history of depression or have other risk factors to develop it following a loss. Depression often follows a period of intense sadness and can be characterized by hopelessness, isolation, and a lack of interest in once-enjoyable activities. It can also manifest as physical symptoms such as a change in appetite or sleep. The feelings of depression associated with a loss through suicide can be particularly intense and long-lasting. Getting help if you struggle with depression is essential, as working with depression in isolation is never a good solution and does not work. Do your best to care for yourself during loss by eating well, exercising, and getting enough rest. Engaging in self-care activities, such as mindfulness practices or spending time in nature, can also help alleviate symptoms of depression.

Acceptance. The question often is asked when or how long it will take before you reach this stage when you lose a loved one to suicide. Acceptance is the final stage of grief and marks a turning point in the grieving process. Sometimes, we may think we’ve reached this stage, only to be thrown back into anger or sadness. These stages come in waves, and there is no endpoint. We will never be okay with what happened. As impossible as it may sound, if we do the work, we will be able to find some peace and acceptance of what is. During this stage, individuals come to terms with their loss and can move forward with their lives, albeit differently. However, it's important to remember that acceptance does not mean forgetting about the person who has died or feeling that the loss is no longer significant. Instead, it is a process of integrating the loss into one's life and finding a new way to carry on.

Losing someone to suicide can complicate the process, as survivors may struggle with guilt, anger, and confusion. Everyone grieves differently.  It may take even longer for some individuals to reach this stage, and it may also come and go, with individuals experiencing moments of acceptance followed by intense grief.

It is also normal to experience various emotions, including anger, sadness, guilt, and bargaining. If you feel overwhelmed by your feelings, seeking support from a mental health professional or a support group may be helpful.

Is Suicide Grief Different?

It is a different kind of grief when suicide is the cause.

Yes. The guilt associated with losing a loved one to suicide differs from other forms of grief and guilt. Survivors of suicide loss may experience intense feelings of guilt and self-blame, wondering if they could have done something to prevent the death or if they missed warning signs. They might not even talk about it with anyone outside the family and go through this grief alone. These feelings can be powerful and persistent, making the grieving process more difficult.

It's important to understand that these feelings of guilt are a normal part of the grieving process. However, they can be harmful if they become excessive and all-consuming, as they can prevent individuals from healing and moving forward.

How do you Cope with Suicide Bereavement?

Here are some ways to cope with suicide bereavement:

• Seek support from family, friends, or a support group

• Talk about your feelings

• Take care of your physical health through exercise and proper nutrition

• Engage in self-care activities

• Seek professional counseling

• Write or journal about your feelings

• Remember the positive memories of your loved one

• Allow yourself to grieve at your own pace

• Consider joining a support group for suicide loss survivors

• Seek out new activities or hobbies to keep yourself occupied.

If you are struggling with guilt after losing a loved one to suicide, seeking support from a mental health professional or a support group may be helpful as you work through your feelings. Talking to someone you trust, such as a friend or family member, can also help you process your emotions.

It's also important to remember that everyone grieves differently, and there is no right or wrong way to feel. What is most important is finding a way to remember your loved one and to honor their memory in a way that is meaningful to you.

Taking care of yourself this time is essential as engaging in self-care activities that bring you comfort and relaxation. Remember that healing is a process, and it may take time to work through your feelings of guilt. However, you can find a way to cope with losing your loved one with support and patience. We are here to support you along the way. Please know you don’t have to do this work alone.

References: 

1. Suicide statistics. AFSP.

2. Facts About Suicide | Suicide. CDC.

3. Disparities in Suicide. CDC.

4. Mental and Behavioral Health. U.S. Department of Health and Human Services Office of Minority Health.

5. Trends in Violence Victimization and Suicide Risk by Sexual Identity Among High School Students. CDC.

6. Facts about Suicide. Trevor Project.

7. Suicidality Among Sexual Minority Adults: Gender, Age, and Race/Ethnicity Differences. American Journal of Preventative Medicine.

8. Suicide bereavement and complicated grief. National Library of Medicine.