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Loss of spouse or partner to suicide linked to physical, mental disorders

March 22, 2017

People who lose a partner to suicide are at increased risk for a number of mental and physical disorders, including cancer, depression, herniated discs and mood disorders than those in the general population, new Johns Hopkins Bloomberg School of Public Health research suggests.

The study, believed to be the first large-scale examination of the broader impact of losing a partner to suicide, underscores the need for support systems for bereaved partners and others who've lost loved ones to suicide, since interventions addressing complicated grief could help mitigate some of the effects. More than 800,000 people around the world die by suicide each year, and the suicide rate in many countries, including the United States, is on the rise.

The study, published online March 22 in JAMA Psychiatry, followed 4,814 Danish men and 10,793 Danish women bereaved by partner suicide for up to 35 years, from 1980 to 2014, and compared them to the general population of Denmark.

"It is an exceedingly devastating experience when someone you love dearly dies suddenly by suicide," says study leader Annette Erlangsen, PhD, an adjunct professor in the Bloomberg School's Department of Mental Health. "We were able to show that being exposed to such a stressful life event as the suicide of your partner holds higher risks for physical and mental disorders and is different from losing a partner from other causes of death, such as illness or sudden accident."

Using Denmark's Cause of Death Registry, the researchers identified everyone in the country age 18 or older who died by suicide since 1970. Using national records on the entire population, the team then identified surviving partners, including spouses, registered partners or those with whom the deceased cohabitated and studied these over the years after the loss.

The researchers compared this data to two groups: Denmark's general population age 18 or older living in the country between 1980 and 2014 and people in the general population who were bereaved by partner death due to causes other than suicide.

Those who lost partners to suicide were at increased risk of cancer, cirrhosis of the liver and spinal disc herniation than the general population. After long-term follow-up, there was an increased risk of sleep disorders and, for women only, chronic respiratory disease. Like earlier research, the study found that the risk was particularly elevated during the first five years after the loss. The study found that suicide bereaved had an increased risk for mood disorders, PTSD, anxiety disorders, alcohol use disorder as well as self-harm compared to the general population.

"The suicide rate in the United States is increasing which makes this research even more relevant," says another study author, Holly C. Wilcox, PhD, associate professor in the Bloomberg School's Department of Mental Health and the Johns Hopkins University School of Medicine's Department of Psychiatry. "Health care providers, friends and neighbors often do not know how best to support those bereaved by suicide."

While the researchers were not surprised by the thrust of the findings, there were some things that were unexpected, such as the finding of an increased risk for a herniated disc. Also, they found that partners who had lost a loved one to suicide and who remarried had a lower chance of divorcing than the general population. At approximately 44 percent, the divorce rate in Denmark is comparable to other developed countries, including the United States. "Maybe people who have experienced such a traumatic loss might be more selective when they choose a new partner and as such are less likely to experience a divorce," Erlangsen says.

The research highlights the need for both personal and professional interventions for people whose lives have been impacted by the suicide of their spouse or partner.

"This is a population in need of support and outreach," Wilcox says. "Surviving a family member's suicide is often a very isolating experience. Often friends and family of the bereaved are afraid of saying the wrong thing so they don't say anything at all. The stigma associated with suicide can lead survivors to suffer in silence alone."

The researchers say they chose Denmark because it has such a rich data set. Sweden has comparably rich databases for large-scale studies. The U.S. does not. The findings, the researchers say, are applicable to other countries.
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"A longitudinal and nationwide register-based study of the association between spousal suicide and mental, physical, and social health outcomes" was written by Annette Erlangsen, PhD; Bo Runeson, MD, PhD; James M. Bolton, MD; Holly C. Wilcox, PhD; Julie L. Forman, PhD; Jesper Krogh, DMSc; M. Katherine Shear, MD; Merete Nordentoft, DMSc; and Yeates Conwell, MD.

The research was funded by the American Foundation for Suicide Prevention and the Danish Health Insurance Foundation.

Johns Hopkins University Bloomberg School of Public Health

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