Needs for grief support persist long after bereavement by suicide, as is apparent at key milestones

There is a tendency to assume that people who are grieving a death, even a traumatic loss such as suicide, will need support for just a few weeks or months after the death and that after that they will ‘move on’. Bereavement support organisations challenge this, explaining that grief is a long process, taking some people many years to adapt to loss. They warn that people around the bereaved person can forget what they have been through and assume that grief can be ‘fixed’. Meanwhile, many people bereaved by suicide and other unnatural causes of death learn to hide their grief due to these social expectations to recover quickly.  As one research participant in a UCL research study on sudden bereavement commented “You just learn to shut it down, put a smile on.” 

New evidence from our team at UCL, collaborating with the University of Kentucky and the Danish Research Institute for Suicide Prevention (DRISP), and funded by the American Foundation for Suicide Prevention (AFSP), demonstrates starkly that people bereaved by a parent’s suicide need support for many years after the death, particularly when they reach the age at which their parent died by suicide.

We analysed routine anonymised data from the whole population of Denmark, identifying a sample of people who had lost a parent to suicide and later made a suicide attempt (whether fatal or non-fatal) many years after the loss. We found that the risk of suicide attempt was increased in the two years centred on reaching the age of a parent’s suicide. The same pattern was not seen in a comparison sample bereaved by a parent’s death due to other causes, suggesting that this phenomenon was specific to suicide loss. This finding, that risk of suicide may increase at points occurring decades after parental suicide loss, is concerning but we would like to highlight that it only applied to a small subset (less than 188 people) of the wider sample of 18,339 people bereaved by parental suicide over the study period. Indeed it is estimated that the absolute risk of suicide in the offspring of parents who died by suicide is around 0.5%.

Our findings suggest that reaching the age of a parent’s age at death, also referred to as age correspondence, may be an emotionally significant milestone for some people who have lost a parent to suicide. It can represent a time at which intense grief resurges, sometimes accompanied by intense questioning about why they chose to die and a yearning for reunion. Angela Samata, Ambassador for Survivors of Bereavement by Suicide (SoBS) and Patron of the Support After Suicide Partnership, wrote about this topic in 2022 for the Lancet Psychiatry, commenting that studies describing the intergenerational transmission of suicidal behaviour in families give rise to “a fear experienced by most parents caring for children bereaved by suicide”. As a parent caring for children bereaved by parental suicide, she warned that “losing a parent to suicide does not mean that it is the child’s destiny to repeat the same act”. She also noted that it was essential to consider the wider context, including other potential contributory factors to suicide risk such as disrupted family environment, experiences of abuse or bullying, access to harmful material online, and substance use.

Angela has also commented on our team’s recent findings, noting that: “I welcome this study as a vital part of the growing evidence base addressing specific points in time associated with heightened risk of suicide. However, this research should be contextualised within the huge amount of work being carried out looking at how we can mitigate risk and support people bereaved by suicide during times at which distress may be heightened”.

Many people bereaved by suicide may not, however, be aware of the support sources available. Michelle Stebbings, Executive Lead of the Support After Suicide Partnership (SASP), has also commented on the findings of our study, pointing out that, “There is support available for everyone bereaved by suicide, at all stages after the loss, whether through a telephone helpline or a peer support group. Some people bereaved by suicide may start to have suicidal thoughts and it is important for them to know that there are many organisations that will be able to help and support you”.

For some who lose a parent to suicide, reaching the age of their death can be a prompt to resolve questions that have troubled them for years. In his 2015 BBC Panorama documentary about his father, BBC journalist Simon Jack explained that reaching the age of 44 (the same age at which his father had died by suicide) had prompted him to try and understand the problem of male suicide. In his interviews with men who have overcome suicidal thoughts, including professional sportsmen, he encountered men who were trying to help others do the same. The television producer Delilah Jeary also described a desire to understand her mother’s suicide on reaching the age at which her mother had ended her life. She explained in a 2011 Guardian interview that she had no memories of her mother, who had died when she was only two years old. However, on reaching her 20s and becoming the age at which her mother had died, she became determined to find out more about her mother’s life rather than just seeing her in the context of her death: "You can see someone as this tragic, sad person, and it was important to me to give her back her story, to let her be a person rather than this sad suicide victim. That was one act of her life but not her whole life.”

One in five people will lose a friend or relative to suicide over the course of their lives. They need support not only in the years immediately after the death but also at key milestones. These new research findings have changed my practice when assessing psychiatric patients; I now ask patients who have lost a parent to suicide about the anniversary of their death and which points in the year they find more difficult. If they feel comfortable talking about this, I gain a sense of how they feel about reaching the age at which their parent died. This demonstrates to the patient an awareness of how grief can fluctuate throughout the year and at key milestones and is an opportunity to discuss what support they might need at difficult times. 

Advice on the Support After Suicide Partnership website highlights the beneficial effects of having rituals to mark key anniversaries and making time to celebrate that person’s life. A guide on coping with special occasions provided by The Compassionate Friends suggests ways to honour the person who died around key milestones. There is also a guide designed for the friends and family supporting someone bereaved by suicide, Finding The Words, which summarises the advice provided by young bereaved people. It notes that certain times of the year, such as birthdays, public holidays and anniversaries, can be difficult after bereavement and advises setting a reminder to reach out to them at these times to let them know support is still there for them. The same applies on reaching the age at which a parent died.

Primary paper:

Logeswaran Y, McDonald K, Cerel J, Lewis G, Erlangsen A, Pitman A (2024) Risk of self-harm and suicide on reaching the age at which a parent died by suicide or other causes: a Danish, population-based self-controlled case series study. Suicide Life Threat Behav.00:1–14 DOI: 10.1111/sltb.13135 https://onlinelibrary.wiley.com/doi/full/10.1111/sltb.13135 (Open Access)

Useful links and sources of support

• UCL Division of Psychiatry
• Danish Research Institute for Suicide Prevention (DRISP)
• Support After Suicide Partnership
• Survivors of Bereavement By Suicide (SoBS)
• American Foundation for Suicide Prevention (AFSP)
• Samaritans
• UCL information on sources of support for people at risk of self-harm