The impact of sudden or unexpected bereavement: a research study of the impact of sudden bereavement on the everyday life of young adults.
The UCL Bereavement Study was funded by a Medical Research Council Population Health Scientist Fellowship to Dr Alexandra Pitman. Its aim was to investigate the impact of sudden bereavement on the emotional health and social functioning of young adults.
Why we decided to do this study
We felt that there was insufficient research describing the impact of sudden bereavement. Even though grief is a normal response to loss, we were aware of clinical concerns that the unanticipated death of a loved one can be a particularly difficult adjustment for some people. A 2007 Lancet review had suggested that sudden deaths left the bereaved more vulnerable to mental health problems, but that more research was required to confirm this. We noticed that NICE guidelines addressed bereavement only in the context of anticipated deaths (ie. end-of-life care), and that Department of Health guidelines on developing bereavement services in the NHS lacked information on how to respond to sudden deaths. There was clearly a need to improve our understanding of the needs of people who experience sudden loss, with which to inform policies to address identified needs.
Our systematic review, published in the Lancet Psychiatry in 2014, summarised research findings from 57 studies comparing groups of people bereaved by sudden natural deaths, sudden unnatural deaths, suicide, and anticipated natural deaths. The study found that experiences of shame and feeling stigmatised by the death were common to all these groups, but that this was particularly characteristic of those bereaved by unnatural or violent causes. We also noted that people bereaved by suicide had an increased probability of psychiatric admission and of depression, and that there were many similarities in the mental health problems experienced after bereavement by sudden unnatural causes and by suicide. We highlighted evidence showing an increased probability of suicide in mothers bereaved by a child's suicide and partners bereaved by a spouse or cohabitee's suicide. However, we felt that there was a lack of studies making specific comparisons between people bereaved by different causes of sudden death. This is why we chose to conduct a national UK-wide study of people bereaved by sudden natural causes, sudden unnatural causes, and suicide, to describe the specific problems they might face in terms of mental well-being and everyday functioning.
The UCL Bereavement Study involved email sampling and an internet-based survey to collect quantitative and qualitative data from people bereaved by sudden deaths by natural causes (for example a cardiac arrest) and unnatural causes (for example a road crash, manslaughter, or suicide). In 2009-10 the questionnaire was piloted in bereaved people of all ages via national organisations providing bereavement support: Cruse Bereavement Care, Samaritans, Survivors of Bereavement by Suicide, and Widowed by Suicide. The revised questionnaire was then sent out to over 635,000 staff and students at 37 British universities and colleges, inviting participation from people aged 18-40 who had experienced a sudden bereavement. The age group chosen does not imply that that bereavement has a lesser impact in other age-groups, but allowed us to focus on a specific sub-group which has tended to be under-represented in work of this kind.
The on-line questionnaire collected information on each respondent's relationship with the deceased, the length of time since their death, and measures of the effect of the bereavement on their social relationships, education or employment, and emotional well-being. In the second half of the questionnaire we collected free-text responses to specific questions about issues such as stigma, attitudes to death, and support accessed, to allow qualitative analysis of important themes.
We also conducted qualitative interviews with a sub-sample of 27 participants to allow further in-depth qualitative analysis of the issues of stigma and support.
Read our article describing the strengths and limitations of internet-based survey methods in mental health research.
Our survey went out by individual email to 659,572 staff and students at 37 colleges and universities across England, Northern Ireland, Wales and Scotland in 2010. As there are no national estimates of the number of people affected by sudden bereavement it was not possible to forecast how many would be eligible. However we had an overwhelming response, with 5,085 people opening the online questionnaire and 4,630 consenting to participate. We collected quantitative (fixed choice) data from over 3,400 people and qualitative (free text) data from over 2,700 people.