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      The stigma associated with bereavement by suicide and other sudden deaths: A qualitative interview study

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          Abstract

          Quantitative studies have found that suicide bereavement is associated with suicide attempt, and is perceived as the most stigmatising of sudden losses. Their findings also suggest that perceived stigma may explain the excess suicidality. There is a need to understand the nature of this stigma and address suicide risk in this group. We aimed to describe and compare the nature of the experiences of stigma reported by people bereaved by suicide, sudden unnatural death, and sudden natural death, and identify any commonalities and unique experiences. We conducted a population-based cross-sectional survey of 659,572 staff and students at 37 British higher educational institutions in 2010, inviting those aged 18–40 who had experienced sudden bereavement of a close contact since the age of 10 to take part in an on-line survey and to volunteer for an interview to discuss their experiences. We used maximum variation sampling from 1398 volunteer interviewees to capture a range of experiences, and conducted individual face-to-face semi-structured interviews to explore perceptions of stigma and support. We continued sampling until no new themes were forthcoming, reaching saturation at n = 27 interviews (11 participants bereaved by suicide). We employed thematic analysis to identify any distinct dimensions of reported stigma, and any commonalities across the three groups. We identified two key themes: specific negative attitudes of others, and social awkwardness. Both themes were common to interviewees bereaved by suicide, sudden unnatural death, and sudden natural death. All interviewees reported the experience of stigmatising social awkwardness, but this may have been experienced more acutely by those bereaved by suicide due to self-stigma. This study provides evidence of a persistent death taboo in relation to sudden deaths. There is potential for anti-stigma interventions to reduce the isolation and social awkwardness perceived by people bereaved suddenly, particularly after suicide loss.

          Highlights

          • Explores stigma after suicide, unnatural deaths and sudden natural deaths.
          • First qualitative study internally comparing these three groups' experiences.
          • All three groups described stigmatising social awkwardness.
          • The death taboo in relation to sudden deaths is particularly marked after suicide.

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          Most cited references 16

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          A method of analysing interview transcripts in qualitative research.

           P Burnard (1991)
          A method of analysing qualitative interview data is outlined as a stage-by-stage process. Some of the problems associated with the method are identified. The researcher in the field of qualitative work is urged to be systematic and open to the difficulties of the task of understanding other people's perceptions.
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            Stigma, shame, and blame experienced by patients with lung cancer: qualitative study.

            To draw on narrative interviews with patients with lung cancer and to explore their perceptions and experience of stigma. Qualitative study. United Kingdom. 45 patients with lung cancer recruited through several sources. Participants experienced stigma commonly felt by patients with other types of cancer, but, whether they smoked or not, they felt particularly stigmatised because the disease is so strongly associated with smoking. Interaction with family, friends, and doctors was often affected as a result, and many patients, particularly those who had stopped smoking years ago or had never smoked, felt unjustly blamed for their illness. Those who resisted victim blaming maintained that the real culprits were tobacco companies with unscrupulous policies. Some patients concealed their illness, which sometimes had adverse financial consequences or made it hard for them to gain support from other people. Some indicated that newspaper and television reports may have added to the stigma: television advertisements aim to put young people off tobacco, but they usually portray a dreadful death, which may exacerbate fear and anxiety. A few patients were worried that diagnosis, access to care, and research into lung cancer might be adversely affected by the stigma attached to the disease and those who smoke. Patients with lung cancer report stigmatisation with far reaching consequences. Efforts to help people to quit smoking are important, but clinical and educational interventions should be presented with care so as not to add to the stigma experienced by patients with lung cancer and other smoking related diseases.
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              • Article: not found

              Explaining non-help-seeking amongst young adults with mental distress: a dynamic interpretive model of illness behaviour.

              Mental disorder is common amongst young adults and is associated with many adverse outcomes. Data, however, indicate that young adults are particularly unlikely to seek help for such distress. This paper describes a qualitative study of 23 young adults (aged 16 to 24 years) with mental distress. Interviewing was used to obtain detailed narratives of illness behaviour and to explore reasons for non-help-seeking. Help-seekers and non-help-seekers were interviewed. The findings allowed development of an explanatory model - the cycle of avoidance (COA) - which contributes towards attempts to provide a dynamic understanding of help-seeking behaviour. Dominant approaches tend to be deterministic and static and to account for non-help-seeking in terms of 'barriers' to care, which although easily translated into targets for policy intervention, are superficial representations of complex issues. The COA conceptualises help-seeking as a circular process and offers a model of 'non-help-seeking' in which lay conceptions of mental distress, the social meanings attached to 'help-seeking' and treatment, and the purposeful action of individuals, assume central importance. Although derived in the context of young adulthood and mental distress, this model may have wider applicability as a theoretical template for explaining non-help-seeking in other age groups and conditions, and other illness behaviours.
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                Author and article information

                Contributors
                Journal
                Soc Sci Med
                Soc Sci Med
                Social Science & Medicine (1982)
                Pergamon
                0277-9536
                1873-5347
                1 February 2018
                February 2018
                : 198
                : 121-129
                Affiliations
                [a ]UCL Division of Psychiatry, 6th floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom
                [b ]Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom
                [c ]UCL Research Department of Primary Care & Population Health, UCL Medical School, Royal Free Campus, Rowland Hill St, London NW3 2PF, United Kingdom
                Author notes
                []Corresponding author. UCL Division of Psychiatry, 6th floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, United Kingdom.UCL Division of Psychiatry6th floor, Maple House149 Tottenham Court RoadLondonW1T 7NFUnited Kingdom a.pitman@ 123456ucl.ac.uk
                Article
                S0277-9536(17)30779-7
                10.1016/j.socscimed.2017.12.035
                5884304
                29316512
                © 2018 The Authors

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                Categories
                Article

                Health & Social care

                united kingdom, taboo, social support, grief, bereavement, suicide, stigma

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