CRISE - IASP 2013 - XÉNIA HALMOV

PO2-19 – xenia halmov

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Psychosocial Needs and Coping

Strategies in Children and

Adolescents Living with a Family

Member with

Suicidal Behaviour

Presented by Xénia Halmov

This research was conducted as part of a Masters Degree programme in Social Work, supervised by Annie Devault, Ph.D,

Professor, Université du Québec en Outaouais, Canada.


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1. BACKGROUND

The research literature indicates an association between the development

of suicidal behaviours of young people and parental suicide behaviours

(Fleming, Merry, Robinson, Denny, & Watson, 2007; Fotti, Katz, Afifi, & Cox, 2006;

Johnson, Cohen, Gould, Kasen, Brown, & Brook 2002); Johnson, Cohen, Gould,

Kasen, Brown, & Brook, 2002); Klimes-Dougan, Free, Ronsaville, Stilwell, Welsh, &

Radke-Yarrow, 1998). A suicide attempt has a great impact on family

functioning, with heightened feelings of anxiety and fear about further suicidal

behaviour and various other emotional responses (Beautrais, 2004). In Quebec,

Canada, several papers in suicidology emphasize the importance of meeting

the needs of family members of a suicidal person as well as to those bereaved

by suicide (Gouvernement du Québec, 1998; 2010). However, we lack empirical

data on what children and adolescents know about their parent’s suicidal

behaviours and how they cope with the stress of living in a family where a

parent has attempted suicide and may be at risk of attempting.


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1. OBJECTIVE

We present the preliminary results of a qualitative exploratory

study on what adolescents know about the suicidality of their

parent, what they thought and felt about it and how they coped

with the situation.

The main objective is to document the real-life experiences and

the psychosocial needs of youth aged 12 - 20 years who live with a

family member who has suicidal behavior. We wanted to know

how these young people perceive their family, the impact the

situation has on them and the way they cope. We also sought to

identify which types of psychosocial support that could best help

them.


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2. METHODS

2.1. Participants

Age Gender Siblings Person

who

made

suicide

attempt

Lives with suicidal

parent

Advantaged or

disadvantaged

environment

Studies Work

1 16 F Only

child

Mother Yes, full time. Sees

father

occasionally.

Advantaged Student

2 16 M Brother

19

Mother Part time (50/50).

Father remarried.

Advantaged Student

3 19 M Brother

16

Mother Part time (50/50).

Father remarried.

Advantaged Student

Part

time

4 20 F Only

child

Mother Yes, full time.

Father absent,

mother has

boyfriend.

Disadvantaged Student

5 14 F Sisters 17

& 19

Father

and

mother

Full time with

mother, father visits

often.


6 17 F Sisters 14

& 19

Father

and

mother

Full time with


often.


7 19 F Sisters 14

& 17

Father

and

mother

Full time with


often.

Disadvantaged Student Part

time


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2.2. Procedure

We conducted semi-structured interviews with seven adolescents and young

adults between 14 and 20 years old living in a family where a parent had

attempted suicide in the past 2 years.

In the initial project, we were intending to interview younger adolescents,

between 12 and 15 years old. However, most of the crisis centres we initially

contacted refused to participate in the study (without explanation), and the

parents of the younger adolescents we contacted also refused to participate,

mainly because they feared that the interview would reveal to the adolescent the

fact that they made a suicide attempt. Finally, we obtained access to a sample of

participants in a longitudinal study of suicide attempters who had expressed an

interest in being solicited for participating in other research projects. That allowed us

to contact adults who had made a suicide attempt. Because, these adults had

older children our sample will be a little bit older that what we had previously

planned. Although the teenagers and young adults aged between 14 and 20 we

interviewed were older than we initially envisioned, the participants had rich

experiences that they were able to verbalize in detail.


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The main themes of the interview were:

(I) The perception of the adolescents of their family situation in general.

(II) The perception of the adolescents of the nature and quality of the

relationships between family members.

(III) The strategies they use to cope with living with a suicidal family

member.

(IV) Their perception of their life in general, their values and beliefs.

(V) Their perception of the social support they receive and their needs

for support.

Each interview was transcribed and rendered anonymous and a content

analyses was undertaken for each interview.


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3. RESULTS

Awareness of the suicide attempt

All but one of the participants, a 15 year old female who was not

certain if the parent had attempted suicide or not, were aware of the

suicide attempt of their parent and talked about it without being directly

asked about suicide.

Family life in General

All of the youth came from families where their parents are divorced,

and none of the divorces were recent. They lived with the parent who had

made a suicide attempt and they generally had poor relationships with

the parent with whom they were not living primarily. All but one felt that

their most difficult experience was their parents’ separation and the tense

relationship between their parents, more so than the suicide attempt itself.


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The one exception was a girl who did not mention the separation but the

intense impact of her mother’s suicide attempt. The positive experiences

they described were often family outings and happy times spent with their

mother.

Warning signs

None of the participants reported that their parent made an overt

suicide threat before they attempted. However, they noticed behavioural

changes, such as withdrawal, apathy, emotional changes and increased

conflicts between divorced parents. These behaviours resulted in the

adolescents feeling vague concerns. In one case the mother told her

daughter that she must not stop her if she attempts suicide. When the

daughter returned from school every day she wondered if she would find

her mother dead. She always checked each room to make sure her

mother had not hanged herself there.


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Impact of the suicide attempt on the adolescent

All of the adolescents reported experiencing great stress, and

fear that the parent would attempt again. They all watched their

parent closely to look for signs of another attempt. For example,

three sisters read the text messages their father sent to his ex-wife

to see if he threatened suicide. Another asked her mother every

day when she returned from school how she was feeling, and she

worried whenever her mother was angry or sad. For the participant

who was not sure if her mother had made a suicide attempt or

not, when one of her mother’s friends committed suicide the

adolescent desperately sought her mother to check if she was still

alive. Long after the attempts, even when things were going well

for their parent, the youths were less worried but continued to fear

that their parent would attempt again if things got worse.


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Coping strategies and social Support

Friends: All participants reported that friends were their primary source of

support. They all either had a best friend (6/7) or a boyfriend-girlfriend (4/7)

whom they confided in. They also had friends with whom they did things to

distract themselves (5/7), in order to stop thinking about the situation with the

parent, but with whom they did not want to talk about the situation and their

feelings.

Parents: Only one of the adolescents confided in the parent who had

attempted suicide, a female who confided in her mother. One male confided

in his father concerning his mother’s attempt. Overall, participants confided

about other matters more with their mother than their father.

Other family members: Although 5 of the 7 mentioned other family

members as sources of support, none of them discussed the suicide attempt

with them.

Formal support: Only one adolescent sought help from a school counsellor

and another one was offered help at school but refused it. 6 out of 7 had no

one offer to talk to them about the suicide attempt of their parent.


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Social-recreational support: The adolescents said that the following

activities helped them get through difficult times: sports (6/7), television (3/7),

surfing the internet (3/7), playing video games (2/7), listening to music (2/7),

writing (2/7), attending school (2/7) and being at work for the 2 participants

who had a job. Three mentioned that having a pet was an important source of

comfort.

Other coping strategies: 3 of the 7 said that checking up on the parent

who had attempted suicide by calling or visiting them was helpful. 6 of the 7

said that they avoided conflicts or ‘opening old wounds’ when in contact with

the parent after the attempt.

Helping others as a coping strategy: 5 of the 7 said that they helped their

friends with their problems by listening and consoling them, and this increased

their sense of self-worth, allowing them to think about other things and others

rather than themselves.

Strengths, values, beliefs and suicidal ideation: The adolescents felt that

their strengths are their ability to listen, to not judge others, to be patient and

persevering, to want to help others in a gentle way, through valuing the family


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and friends. What they all wanted most was to have a good relationship with

their family.

All of the participants but one said that they had no suicidal ideation. The

youth that had reported considering suicide said that thoughts were several

years before the parent’s attempt and she had follow-up afterwards with a

therapist.

Perceived needs: Above all, every participant wanted their divorced

parents to have a better relationship. Two participants wanted to know why

their parent attempted suicide. One wanted to be able to be with someone

his age who understood what he was experiencing, someone who has

experienced the same situation, but not recently, not necessarily to talk about

it. One wanted to meet an adult or a professional to discuss the situation and

talk about it. One wanted someone to talk to confidentially.

IMPACT OF THE INTERVIEW: 6 of the 7 participants said at the end of the

interview that they felt good and that the interview helped lessen the burden

they felt.


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4. DISCUSSION

Friends are the main source of support for these adolescents whose parent

attempted suicide, although most of them also confided in adults as well. Only one

participant received professional help when she actively sought it out. Only one

person received an offer of help, which was refused. However, a number of

recreational activities were useful in coping with the situation according to the

participants, often with peers. Although 5 of the participants had siblings, no one

mentioned a sibling as a source of support. One mentioned not wanting to make

things worse by bringing up the subject with his brother. One sister was very

protective of the other two younger sisters. None of the youngsters mentioned

receiving any information from adults. Several participants said that if an adult had

offered to talk about the situation they would have accepted the offer. Overall,

they lacked information as well as the opportunity to discuss the situation with an

adult in a safe context. Contrary to our expectations, none of the participants

reported any false beliefs or information about suicide. We wonder about the

benefits of the tendency of the adolescents to be kind and helpful to others. While

this may be a source of feeling valued, it could also lead to them neglecting their

own needs by focusing on others.


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5. LIMITATIONS

Since the sample size is small one cannot generalize these findings to

the general population. What is reported is a portrait of how some

adolescents react to a suicidal parent, but more extensive research is

needed to determine how typical these reactions are. Since we recruited

participants whose parent had attempted suicide, but survived the

attempt, it is possible that in retrospect the participants may have

minimized the seriousness, knowing that the parent had survived. We did

not have access to the medical records of the parent who attempted

suicide. However, many of these parents suffered from a mental disorder.

Consequently, we cannot tell to what extent the reactions are in

relationship to the suicidal behaviour and to what extent they may be

shared by anyone living with a parent who has a mental disorder.


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6. IMPLICATIONS FOR PRACTICE

The lack of support offered suggests that support should be

systematically and proactively offered to children and adolescents

when their parent has suicidal behaviours in order to help them find

effective strategies to cope with the stress associated with living with

a suicidal parent. They may also benefit from more information

about their parent’s mental disorder (if diagnosed), and information

on suicide in general once it is known in the family that the person is

suicidal. However, the concerns they expressed suggest that it

would be very important to address the problem carefully in order to

not dramatize the situation and to make sure that the children and

adolescents do not feel that they are responsible for the adult’s

safety.

It seems that when their parent told them that they did not want

to commit suicide anymore, this helped a lot to relieve the stress. A

family meeting with a professional after the attempt could be an


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opportunity to help the children involved. When professionals and

volunteers working in suicide prevention are aware of the suicidal

thoughts of a person even before an attempt is made, it could be

useful if they would systematically verify if there are children involved

and see that these children get support, especially proper

information, access to a helpline 24/7, and emotional support. These

children may also benefit from the help of an adult member of the

family in whom they could confide and express their worries.

Training programs in suicide prevention and intervention should

always include a section on how to support the families of suicidal

individuals, including the children. Children with suicidal parents

need information, help and support to help them cope with a

suicidal parent and we suggest that this help should be offered

proactively.


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7. IMPLICATIONS FOR FUTURE RESEARCH

This is a small exploratory study. It would be interesting to

interview more adolescents and children to obtain further

data on the impact of the suicidal behavior of their parent,

their coping strategies and their needs. We could not

interview younger children, so a future study is needed on

what younger children know and do not know about their

parent’s suicidality, and what they do when they know

and everyone around them thinks they do not know.


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REFERENCES

Beautrais, A. L. (2004). Support for Families, Whanau and Significant Others After a Suicide Attempt. A literature review and

Synthesis of Evidence. Christchurch, Canterbury Suicide Project, Christchurch School of Medicine & Health Sciences, 51 p.

Fleming T., Merry S., Robinson E., Denny, S. & Watson, P. (2007). Self-Reported Suicide Attempts and Associated Risk and

Protective Factors Among Secondary School Students in New Zealand. Australian and New Zealand Journal of Psychiatry.

41(3), p. 213-21.

Fotti, Katz, Afifi, & Cox (2006). The Associations Between Peer and Parental Relationships and Suicidal Behaviors in Early

Adolescents.Canadian Journal of Psychiatry, 51(11), p. 698-703.

Gouvernement du Québec (Ministère de la Santé et des Services sociaux) (1998). Stratégie québécoise d’action face au

suicide : S’entraider pour la vie.Québec : Publications du Québec, 94 p.

Gouvernement du Québec (Santé et services sociaux) (2010). Prévention du suicide. Guide de bonnes pratiques à

l’intention des intervenants des centres de santéet de services sociaux. Québec : Publications du Québec, 83 p.

Johnson, J. G., Cohen, P., Gould, M., Kasen, S., Brown, J. & Brook, J. S. (2002). Childhood Adversities, Interpersonal

Difficulties, and Risk for Suicide Attempts during Late Adolescence and Early Childhood. Arch Gen Psychiatry, 59,

p. 741-749.

Klimes-Dougan B., Free, K., Ronsaville, D., Stilwell, J., Welsh, J., & Radke-Yarrow, M. (1998). Suicidal Ideation and Attempts:

A Longitudinal Investigation of Children of Depressed and Well Mothers. Journal of the American Academy of Child and

Adolescent Psychiatry, 38(6), p. 651-659.

Xénia Halmov, student, Master’s Degree programme in Social Work

Supervision: Annie Devault, Ph.D, Professor, Université du Québec en Outaouais.

CRISE - IASP 2013 - XÉNIA HALMOV

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