Suicide risk increased following death of spouse
Surviving spouses are at a high risk of suicide following bereavement, particularly if they are young or middle-aged.
A Swiss study used data from federal mortality statistics to estimate the risk of suicide within 12 months of the death of a spouse.
Over an 18-year period, 453,200 individuals were widowed. During the same period 26,841 people committed suicide, of whom 366 had been widowed during the past year. About 1 in 600 widowers, but only 1 in 2,500 widows, committed suicide within 12 months of their bereavement.
The period of greatest risk was the first week after bereavement, when the standardised mortality ratios (SMR) were approximately 34 for men and 19 for women.
The risk declined rapidly over the first month (SMRs at one month were 7.2 and 3.1 respectively) and then gradually thereafter.
Young and middle-aged people were most at risk. For widowed persons under the age of 60, the SMR during the first week after bereavement was 87, compared with 9.7 for those over 60. Whereas older women had a low risk of suicide, women under 60 were at least as likely to commit suicide as widowed men.
Grief following bereavement is a universal experience. Whereas most people are able to adjust to their loss without professional intervention, some will need supportive counselling and a significant minority will require help from mental health services. The prevalence of major depression 12 months after bereavement has been reported as 12%1 and bereavement is a recognised risk factor for suicide.2
The Gold Standards Framework for palliative care recommends planned bereavement support, for example through a practice bereavement protocol.3 A survey of GPs in North Cumbria, however, found that only 5 out of 127 responders (4%) had such a system in place.4
This study provides strong evidence to support the recommendation that bereavement visits should occur as soon as possible after a patient has died:1 the surviving spouse is at most risk during the first few days. Risk assessment tools may help to identify those most at risk;4 this study suggests that age and gender are relevant.
However, the adoption of bereavement protocols is likely to have only a limited impact on suicide mortality. Although the relative risk is high, the absolute risk would appear to be very low, even allowing for the fact that mortality data tend to underestimate the number of suicides.
Moreover, suicides occurring within the first week of a bereavement are likely to be ‘rash acts' and may, by their nature, be unpredictable.
Ajdacic-Gross V, Ring M, Gadola E et al. Suicide after bereavement: an overlooked problem. Psychol Med 2008;38:673-6Reviewer
Dr Phillip Bland