“Doctor, please don’t say he died by suicide”: exploring the burden of suicide survivorship in a developing country

Abstract

Abstract Background Annually, 800, 000 die from suicide worldwide. However, suicide is believed to be rare in our environment. Suicide causes significant life disruptions in people bereaved by it. These disruptions result from associated complicated grieving pattern characterised by stigma, feeling of shame, responsibility, guilt, etc. People therefore usually want to be certain that their relation indeed died from suicide. Being certain can in part help survivors achieve closure. A pathologist is often called upon to diagnose the actual cause of death in suspected suicide. The aim of this paper is to highlight the perception and attitude of survivors to suicide in our environment. Methods This is a prospective study carried out in Enugu State University Teaching Hospital, Enugu, Nigeria. Data was obtained by audio-recording and transcription of face-to-face interviews of 8 groups of relatives who had presented to the pathologist for autopsy of their relation suspected to have committed suicide. Transcribed data was double checked for accuracy and analysed. Informed consent was obtained from participants. Ethical clearance was obtained from the Ethical Committee of the hospital. Results There were 8 cases of suspected suicide over a 7-year period accounting for 0.6% of all violent deaths in the period. The central attitude of survivors in all the cases was denial of the event. At all the meetings survivors desired the pathologist to report cause of death differently than suicide. Also, in all cases, the extended family felt affected by the event. The following six themes in descending order of importance were identified to underlie survivors’ attitude to suicide: fear of stigma and its consequent isolation, fear of economic repercussions, a conflict of choice of cause of death stemming from religious beliefs about the afterlife, feeling of shame and anger against the deceased and fear that acknowledging the event may bring a repeat in the family. Conclusion There is profound fear of stigma and associative concerns which leads to outright suicide-denial. There is a need to educate the society about the reality and dynamics of suicide. This will make a bereaved person open to receiving requisite care.

Keywords

• Suicide
• Suicide survivor
• Perception
• Attitude
• Complicated grieving
• Stigma