Bereavement Leading to Suicide: Statistical Analysis

There is an increased risk of suicidal gestures, completed suicide and death from accidents following the death of a spouse, parent, or a child. The suicide risk for those widowed was first observed over a century ago by Durkheim who found that suicide was higher amongst those widowed compared to those married.

When   compared   to   the   general   population Mergenhagen and colleagues found the mortality ratio for suicide in young widowers (45–64 years of age) was about four and a half times the rate for married men of similar age. Most studies have found a gender bias with younger men being at the greatest risk of suicide, although Heikkinen and coworkers found evidence of an association between widowhood and women aged 60–69 years.

A 12-year follow-up study in Washington, USA of 6266 white married and 3486 white widowed people aged 60 years and older found death rates from suicide to be 28.7 per 100 000 person years for the married and 40.4 for the widowed. There was also a significant effect from gender with the suicide risk for widowed men estimated to be 3.3 times higher than that for married men, while the risk of suicide for widows and married women was found to be similar.

Several longitudinal studies have found that the risk of suicide is greatest for the period immediately following the loss. MacMahon and Pugh compared 320 widowed people who had committed suicide to a matched sample of widows who had died from non-suicide causes. They found that, although the risk of suicide among the widowed population was generally higher in the first 4 years after the death of the spouse, the risk of suicide in the first year was 2.5 times higher, and in the first, second and third years about 1.5 times higher. The risk at 4 years or more was equal to that of the control group. The age-standardized suicide rate was 3.5 times higher for widowed men than married men. Widows had twice the risk compared to those who were married.

Based on MacMahon and Pugh’s findings, Duberstein and colleagues used the psychologic autopsy method as a way of distinguishing those who committed suicide more than 4 years after the death of their spouse compared to those who committed suicide within 4 years. Although using small numbers (n = 21, > 4 years; n = 14, < 4 years), they found those who committed suicide within 4 years had significantly higher rates of psychiatric treatment, earlier loss or separation from one or both parents and a non-significant (P = 0.07) higher rate of substance abuse. Interestingly, loss of a close interpersonal relationship (including bereavement and separation) is a significant predictor of suicide in alcoholics.

While the magnitude of the risk varies with the methodology, there's ample evidence that widows/widowers exhibit what actuaries call "excess mortality." Death rates are highest within six months after bereavement and continue high for about three years. Bereavement produces higher mortality among widowers than widows, and among younger ages than older (although the age differences aren't always significant). Socioeconomic status doesn't seem to matter.

Most experts agree there are three main reasons for this phenomenon, although the statistics don't tell you which is most important:
  • Death-related events affecting both spouses at the same time, such as both being in the same accident. Duh, but you can't overlook the obvious.
  • Common risk environment - for example, both spouses live in the same neighborhood subject to the same environmental factors such as pollution. Similarly, both spouses may engage in common health-related behaviors such as smoking or drinking.
  • Direct dependence, where the death of one spouse changes the other spouse's life, also called "broken-heart" syndrome. This is the kind we're mainly interested in, but it can be tough to distinguish from the first two even if you've got the resources for a case-by-case analysis.
Suicide rates are significantly higher for the recently widowed - this was established by pioneering sociologist Emile Durkheim in a classic 1897 monograph. Suicide is most prevalent during the first week after the death of a spouse. There are also higher rates of death due to heart disease and conditions such as cirrhosis.

The mortality risk is higher for widows/widowers under age 55 when the bereavement was sudden, as from accident. For widows/widowers in the 50-to-65-year range, the highest risk is when the spouse has died of chronic illness. Several studies indicate the risk is lower when the widow/widower has family or other social support and higher when the bereaved is socially isolated.

Why are the bereaved at higher risk? The two broad explanations are grief and stress. Grief can lead to depression and its consequences. Stress can impair the immune system, increasing susceptibility to disease, and trigger dangerous behavioral changes such as higher cigarette and alcohol use. Most data is based on married couples because it's easier to obtain, but there are indications of a similar mortality increase following the death of children, siblings, and parents. Sure, grief is natural and proper, but it's healthier for the survivors to move on.

Sources and Additional Information:
An Atlas of Depression by David S. Baldwin and Jon Birtwistle


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