Family members of suicidal patients

What do we know about suicidal behaviour?

Suicide is a major public health problem (WHO, 2018), in the last 45 years, suicide rates have increased by 60% globally and today, suicidal behaviour is one of the leading causes of death worldwide (Klonsky, May and Saffer, 2016). The Standardised Mortality Rate (SMR) is 11.4 per 100,000, and every 40 seconds a person commits suicide worldwide. In terms of gender, suicide deaths are three times higher in men than in women and are more frequent in high-income countries. Although it is not possible to speak of a specific age range, 55% of suicides are committed by people under 44 years of age, being the second cause of death worldwide in young people between 15 and 29 years of age, after traffic accidents. However, in Spain, it is considered the leading cause of unnatural death, as suicides currently exceed the number of deaths due to traffic accidents.

Sometimes a person may have the intention to end his or her life, but the suicide is not completed. According to Section III of the DSM 5 (2014), a suicide attempt is a behaviour that a person has carried out with at least some intention to die. It refers to those individuals who have carried out these attempts deliberately, which have not resulted in death, but in whom there was a high suicidal intent so that they wanted to end their life. Regarding the incidence of suicide attempts, according to Spindler et al. (2020), for every suicide, there are up to 20 suicide attempts. Considering the context, it is easy to understand that suicide attempts do not only affect the individual, but also his or her close relations, especially family members, as they may experience high distress at the possibility of repetition of the behaviour, which may significantly impair the overall well-being of the family members.

How does it affect the family?

Suicide attempts are a critical challenge for families living with a patient with this problem. It is not uncommon, after a suicide attempt by a family member, for fear to arise in the family members, and even a certain family atmosphere to become strained. Family members feel guilty, frightened and hopeless about the possibility of another attempt and this increases the risk of medical and psychological problems such as depression and anxiety.

Studies suggest that the needs of family members of people who attempt suicide are not adequately addressed by mental health professionals. However, the still scarce studies on the subject have shown that patients’ recovery improves when the needs of family members for information, clinical guidance and support are met. Therefore, it is necessary to help relatives of suicidal people to reduce the discomfort and burden they bear by providing them with information and skills to improve the relationship with the patients, thus preventing/reducing suicide attempts in the family context. Improving the clinical situation and quality of life of family members of patients with suicidal behaviour implies having evidence-based intervention protocols that focus on family members and for this, it is necessary to test their efficacy and efficiency in research.

Interventions for family members:

It is surprising that in light of such a serious and frequent problem as suicide, there are practically no empirically supported interventions for family members. So far, two interventions for family members of people who have made suicide attempts have been published. In the first intervention, Rajalin’s group (Rajalin et. al, 2009) evaluated the effectiveness of the Family Connections (FC) programme (Hoffman et. al, 2005) in a sample of family members of patients with suicidal behaviour. The sample consisted of 13 family members and the design was a pretreatment, no control group and no follow-up. The results showed a significant reduction in the burden variable and a reduction in anxious-depressive symptomatology. Secondly, Sun et al. (Sun, et al., 2014) tested a two-session psychoeducational intervention. It also had a small N, with no control group and no follow-ups. The results showed significant changes in patients’ caregiving skills and family members’ attitudes towards suicide, but no significant decrease in caregiving-related stress (Sun et al., 2014).

Research Project:

“CARING FOR ALL: Efficacy and effectiveness of an Intervention Programme for relatives of patients with suicidal behaviour.”

– Funding: Proyectos I+D+i de los Programas Estatales Orientada a los Retos de la Sociedad, en el marco del Plan Estatal de Investigación Científica y Técnica y de Innovación 2017-2020.

– Duration: 3 years (06/01/2020 to 06/01/2022)

– Principal Researcher: PhD Verónica Guillén Botella and PhD Heliodoro Marco Salvador.

Based on the results obtained in the study by Rajalin et al. (2009) with relatives of patients with a history of suicide attempts and those of Fruzzetti’s group in a population at high risk of suicide (Hoffman et al., 2005; 2007; Krawitz, et al., 2016; Flynn, et al, 2017), in which it is observed that family members receiving the programme improve in depression, illness burden, hostility and critical attitude towards the patient, on emotional involvement, hope, emotional distress, quality of life and coping strategies it is expected that the Family Connections programme designed for family members of patients with suicidal behaviours, is effective and efficient.

Aim of the project:

The objectives of the study are to adapt and test in Spanish population the modules of the FC intervention protocol, designed to be applied specifically to relatives of patients with suicidal behaviours. On the other hand, to test its efficacy and efficiency in relatives of patients with suicidal behaviour in a randomised controlled study.

Inclusion and Exclusion Criteria:

In the case of relatives, the following inclusion and exclusion criteria are established:

Being a relative of a person who has made a suicide attempt in the last two years.
Signing the informed consent form.
The presence of serious pathology in the family member that prevents the intervention from being carried out (such as major depression, psychosis, schizophrenia, substance dependence, etc.) will be an exclusion criterion.

In the case of patients, the following inclusion and exclusion criteria are established:

Having made a suicide attempt in the last two years.
To express agreement to participate in the study in writing by signing the informed consent form and, in the case of minors, the consent form must be signed by the parents.
The presence of another serious pathology of the patient, such as psychosis, schizophrenia, intellectual disability, etc., will be an exclusion criterion.

Those interested in participating:

Write an email to estbilo@alumni.uv.es

Those interested will be contacted, a brief assessment will be carried out, and if they meet the inclusion criteria, they will be able to receive the Family Connections programme for relatives of people with suicidal behaviour.

Intervention:

This is a free intervention, which is part of this research project. The intervention is group-based and lasts for 3 months and includes 12 sessions that follow a 2-hour group format on a weekly basis. The intervention is led by a therapist and co-therapist who are accredited to deliver FC groups.

*This project is currently active.