Insight: Hong Kong's hidden suicide survivors
Do suicides increase during the holidays? In spite of the popular belief in the holiday "blues", statistics show that suicide numbers actually fall during the Christmas period. Perhaps the celebrations and the rituals keep people from slipping deeper into depression. But suicide rates often go up after a holiday.
Suicide can be the result of stress or a traumatic life event. But it is more often due to a mental health problem. Some research suggests that, in 90 per cent of suicides, there is an underlying issue of mental health, most often depression.
Hong Kong's suicide rate of 14.6 per 100,000 is in the highest 25 per cent globally. But it is a long way behind South Korea's 31.2 per 100,000. The US has 12 suicides per 100,000. The rate has been falling here over the past few years.
But these are just numbers. Those left behind after a suicide suffer a special kind of grief. They may be a hidden group. Doctors and researchers have generally concentrated almost exclusively on people who have taken their own lives, or on prevention measures.
Suicide survivors (those bereaved by suicide) are isolated from one another. Little is known about their circumstances, and they may receive little help in coming to terms with their loss. Leading researchers in this field, like Keith Hawton at the University of Oxford, found that when survivors were able to talk about their grief, it helped lessen their feelings of guilt and made their acceptance of death easier.
When research in this field began more than 30 years ago, it became clear that the friends and relatives of suicide victims experience major problems. It has been suggested that for each suicide, at least six people may suffer from intense, perhaps traumatic, grief.
Many others are seriously affected. Suicide is a personal act, but it has a profound impact on society. As well as close family and friends, it can affect the doctor who was treating the deceased, the reporter sent to cover the inquest, the people who found the body, work colleagues, and friends. A Samaritan's survey in Britain found that as many as one in five people had someone close to them who committed suicide.
Some of these may be "secondary" survivors of a suicide death. Without support, they are at risk of developing severe depression, anxiety, panic attacks or symptoms of post-traumatic stress disorder. Physical illness can also occur or be aggravated in the aftermath of suicide.
We are all different, of course. Those left behind after a suicide will not all react in the same way. But shock, disbelief, shame, denial, rejection, anger and the need to know why are common reactions. How an individual copes will depend on family dynamics and communication, whether the loss was expected, the age and relationship to the deceased - and the availability of support. People bereaved by suicide may also be more at risk of suicide themselves.
Support is vital. Survivors report isolation and stigmatisation and may be reluctant to ask for help. Some find support from family and friends, but coping with the outside world can still be a problem. Their friends and family may not know how to react and may offer clichés such as: "I know how you feel" (they don't); "You still have other children"; "Time heals all wounds"; and "Get on with your life".
Reactions to grief are part of the healing process. These reactions can be helped by talking to other survivors. Survivor groups can play a big role in the resolution of grief and pain. Providing a gentle, "just being there" approach is best, as it gives the survivors a chance to grieve, heal and recover in their own time.
Hong Kong held its first "Suicide Survivors Day" conference last month, sponsored by the Samaritans, as part of a series of events in more than 20 countries.
The Samaritans Multilingual Suicide Prevention Service holds "People Bereaved by Suicide" meetings in English at 8pm on the first Wednesday of each month in Tsim Sha Tsui. e-mail: firstname.lastname@example.org; tel: 2896 0000
Samaritans Befrienders also holds regular meetings in Cantonese for those bereaved by suicide. Tel: 2389 2222