Skip to main content
Springer Nature Link
Log in

“The psychological skeleton in the closet”: mortality after a sibling’s suicide

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

To study the association between loss of an adult sibling due to suicide and mortality from various causes up to 18 years after bereavement.

Methods

We conducted a follow-up study between 1981 and 2002, based on register data representing the total population of Swedes aged 25–64 years (n = 1,748,069).

Results

An elevated mortality rate from all causes was found among men (RR 1.26; 95 % CI: 1.14–1.40) and women (1.27; 1.11–1.45) who had experienced a sibling’s suicide. The standardized rate ratio of suicide of bereaved to non-bereaved persons was 2.46 (1.86–3.24) among men and 3.25 (2.28–4.65) among women. We also found some indications of an interrelation between sibling suicide and subsequent deaths from external causes other than suicide in men (1.77; 1.34–2.34) and deaths from cardiovascular disease in women (1.37; 0.99–1.91). An elevated all-cause mortality rate was found after the first year of bereavement in men, while bereaved women experienced higher mortality rates during the first 2 years and after 5 years of bereavement.

Conclusions

Our study provides support for adverse health effects among survivors associated with sibling loss due to suicide. Sibling suicides were primarily associated with suicide in bereaved survivors, although there was an increased mortality rate from discordant causes, which strengthens the possibility that the observed associations might not be entirely due to shared genetic causes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Shneidman E (1972) Foreword. In: Cain AC (ed) Survivors of suicide. Charles C. Thomas, Springfield

    Google Scholar 

  2. Dyregrov K, Dyregrov A (2005) Siblings after suicide—“The forgotten bereaved”. Suicide Life Threat Behav 35:714–724

    Article  PubMed  Google Scholar 

  3. Clark S, Goldney RD (1995) Grief reactions and recovery in a support group for people bereaved by suicide. Crisis 16:27–33

    CAS  PubMed  Google Scholar 

  4. Kneiper A (1999) The suicide survivor’s grief and recovery. Suicide Life Threat Behav 29:353–364

    Google Scholar 

  5. Range L (1998) When a loss is due to suicide: unique aspects of bereavement. In: Harvey JH (ed) Perspectives on loss: a sourcebook. Brunner/Mazel, Philadelphia

    Google Scholar 

  6. Barrett TW, Scott TB (1990) Suicide bereavement and recovery patterns compared with non-suicide bereavement patterns. Suicide Life Threat Behav 20:1–15

    CAS  PubMed  Google Scholar 

  7. Amick-McMullan A, Kilpatrick DG, Resnick HS (1991) Homicide as a risk factor for PTSD among surviving family members. Behav Modif 15:545–559

    Article  CAS  PubMed  Google Scholar 

  8. Murphy SA, Johnson LC, Wu L, Fan JJ, Lohan J (2003) Bereaved parents’ outcomes 4 to 60 months after their children’s deaths by accidents, suicide or homicide: a comparative study demonstrating differences. Death Stud 27:39–61

    Article  PubMed  Google Scholar 

  9. Brent D, Melhem N, Donohoe MB, Walker M (2009) The incidence and course of depression in bereaved youth 21 months after the loss of a parent to suicide, accident, or sudden natural death. Am J Psychiatry 166:786–794

    Article  PubMed Central  PubMed  Google Scholar 

  10. Dyregrov K, Nordanger D, Dyregrov A (2003) Predictors of psychosocial distress after suicide, SIDS and accidents. Death Stud 27:143–165

    Article  PubMed  Google Scholar 

  11. Van der Wal J (1989–1990) The aftermath of suicide: a review of empirical evidence. Omega 20:149–171

    Google Scholar 

  12. Cleiren M, Diekstra R (1995) After the loss: bereavement after suicide and other types of death. In: Mishara B (ed) The impact of suicide. Springer, New York, pp 7–39

    Google Scholar 

  13. Stroebe M, Schut H, Stroebe W (2007) Health outcomes of bereavement. Lancet 370:1960–1973

    Article  PubMed  Google Scholar 

  14. Cicirelli VG (1995) Sibling relationships across the life span. Plenum Press, New York

    Book  Google Scholar 

  15. Segal NL, Wilson SM, Bouchard TJ et al (1995) Comparative grief experiences of bereaved twins and other bereaved relatives. Person Individ Diff 18:511–524

    Article  Google Scholar 

  16. Robinson L, Mahon MM (1997) Sibling bereavement: a concept analysis. Death Stud 21:477–499

    Article  CAS  PubMed  Google Scholar 

  17. Calhoun LG, Selby JW, Abernathy CB (1986) The rules of bereavement: are suicidal deaths different? J Commun Psychol 14:213–218

    Article  Google Scholar 

  18. Jordan JR (2001) Is suicide bereavement different? A reassessment of the literature. Suicide Life Threat Behav 31:91–102

    Article  CAS  PubMed  Google Scholar 

  19. Eshtehardi P, Koestner SC, Adorjan P, Windecker S, Meier B, Hess OM, Wahl A, Cook S (2009) Transient apical ballooning syndrome—clinical characteristics, ballooning pattern, and long-term follow-up in a Swiss population. Int J Cardiol 135:370–375

    Article  PubMed  Google Scholar 

  20. Movahed M-R, Donohue D (2007) Review: transient left ventricular apical ballooning, broken heart syndrome, ampulla cardiomyopathy, atypical apical ballooning or Tako-Tsubo cardiomyopathy. Cardiovasc Revasc Med 8:289–292

    Article  PubMed  Google Scholar 

  21. Wittstein IS (2007) The broken heart syndrome. Cleve Clin J Med 74(suppl):17–22

    Article  Google Scholar 

  22. Li J, Precht DH, Mortensen PB, Olsen J (2003) Mortality in parents after death of a child in Denmark: a nationwide follow-up study. Lancet 361:363–367

    Article  PubMed  Google Scholar 

  23. McEwen BS (1998) Protective and damaging effects of the stress mediators. N Engl J Medicine 338:171–179

    Article  CAS  Google Scholar 

  24. Martikainen P, Valkonen T (1996) Mortality after the death of a spouse: rates and causes of death in a large Finnish cohort. Am J Public Health 86:1087–1093

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Thompson DG, Futterman A, Farberow N, Thompson LW, Peterson J (1993) The impact of spousal bereavement on older widows and widowers. In: Stroebe MS, Stroebe W, Hansson RO (eds) Handbook of bereavement: theory, research, and intervention. Cambridge University Press, New York, pp 227–239

    Chapter  Google Scholar 

  26. Moscicki EK (1995) Epidemiology of suicidal behavior. Suicide Life Threat Behav 25:22–35

    CAS  PubMed  Google Scholar 

  27. Rostila M, Saarela J, Kawachi I (2012) The forgotten griever: a nationwide follow-up study of mortality subsequent to the death of a sibling. Am J Epidemiol 176:338–346

    Article  PubMed  Google Scholar 

  28. Grad O, Zavasnik A (1996) Similarities and differences in the process of bereavement after suicide and after traffic fatalities in Slovenia. Omega 33:243–251

    Google Scholar 

  29. Cleiren M (1993) Bereavement and adaptation: a comparative study of the aftermath of death. Hemisphere, Washington DC

    Google Scholar 

  30. Bailley SE, Kral MJ, Dunham K (1999) Survivors of suicide do grieve differently: empirical evidence for a common sense proposition. Suicide Life Threat Behav 29:256–271

    CAS  PubMed  Google Scholar 

  31. Umberson D, Meichu C, House J, Hopkins K, Slaten E (1996) The effect of social relationships on psychological well-being: are men and women really so different? Am Sociol Rev 61:837–857

    Article  Google Scholar 

  32. Qin P, Agerbo E, Mortensen P (2003) Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997. Am J Psychiatry 160:765–772

    Article  PubMed  Google Scholar 

  33. Kapusta ND, Tran US, Rockett IRH, De Leo D, Naylor CPE, Niederkrotenhaler T, Voracek M, Etzersdorfer E, Sonneck G (2011) Declining autopsy rates and suicide misclassification: a cross-national analysis of 35 countries. Arch Gen Psychiatry 68:1050–1057

    Article  PubMed  Google Scholar 

  34. World Health Organization (WHO) (2012) http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/. Accessed 15 Oct 2012

  35. Christakis NA (2004) Social networks and collateral health effects. BMJ 24:184–185

    Article  Google Scholar 

Download references

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sveavägen 160, 106 91, Stockholm, Sweden

    Mikael Rostila

  2. Åbo Akademi University, PO Box 311, 65101, Vaasa, Finland

    Jan Saarela

  3. Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115-6096, USA

    Ichiro Kawachi

  4. University of Helsinki, Helsinki, Finland

    Jan Saarela

Authors
  1. Mikael Rostila
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Jan Saarela
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Ichiro Kawachi
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Mikael Rostila.

Appendix

Appendix

See Table 4.

Table 4 Association between sibling’s suicide and all-cause mortality in index persons stratified by age category, socioeconomic status, marital status, number of children, and number of siblings
Full size table

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rostila, M., Saarela, J. & Kawachi, I. “The psychological skeleton in the closet”: mortality after a sibling’s suicide. Soc Psychiatry Psychiatr Epidemiol 49, 919–927 (2014). https://doi.org/10.1007/s00127-013-0780-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-013-0780-1

Keywords