Hanschmidt Franz, Lehnig Franziska, Riedel-Heller Steffi G, Kersting Anette
Department of Psychosomatic Medicine, University of Leipzig, Leipzig, Germany.
Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
PLoS One. 2016 Sep 22;11(9):e0162688. doi: 10.1371/journal.pone.0162688. eCollection 2016.
considerable proportion of the population experiences major life disruptions after losing a loved one to suicide. Social stigma attached to suicide survivors adds to complications occurring in the course of suicide bereavement. Despite its known risks, stigma related to suicide survivors has been sparsely investigated.
We conducted a systematic literature search in PubMed, Web of Science, PsycInfo and PsyArticles, of studies indexed up through August 2015. Articles were eligible for inclusion if they addressed experiences of stigma in suicide survivors, compared them to other bereavement populations, or investigated stigmatizing attitudes within the public. The search was restricted to English-language studies.
25 records matched inclusion criteria. Study designs were heterogeneous, making comparisons difficult. Results demonstrated that suicide survivors experience stigma in the form of shame, blame, and avoidance. Suicide survivors showed higher levels of stigma than natural death survivors. Stigma was linked to concealment of the death, social withdrawal, reduced psychological and somatic functioning, and grief difficulties. Only one study investigated stigmatizing attitudes towards suicide survivors among the general population.
Internal and external validity of the studies was restricted by a lack of valid measures and selection bias.
More methodologically sound research is needed to understand the impact of stigma on suicide survivors' grief trajectories and to separate it from other grief aspects. Clinicians and grief-counselors as well as the public should be educated about the persistent stigma experienced by suicide survivors.
相当一部分人在因自杀失去亲人后经历了重大的生活困扰。与自杀幸存者相关的社会污名加剧了自杀丧亲过程中出现的并发症。尽管已知存在风险,但与自杀幸存者相关的污名却很少得到研究。
我们在PubMed、科学网、PsycInfo和PsyArticles中对截至2015年8月索引的研究进行了系统的文献检索。如果文章涉及自杀幸存者的污名经历、将他们与其他丧亲人群进行比较或调查公众中的污名化态度,则符合纳入标准。检索仅限于英语研究。
25条记录符合纳入标准。研究设计各不相同,难以进行比较。结果表明,自杀幸存者会经历羞耻、指责和回避等形式的污名。自杀幸存者的污名程度高于自然死亡幸存者。污名与隐瞒死亡、社交退缩、心理和躯体功能下降以及悲伤困难有关。只有一项研究调查了普通人群对自杀幸存者的污名化态度。
研究的内部和外部有效性受到缺乏有效测量方法和选择偏倚的限制。
需要更具方法学严谨性的研究来了解污名对自杀幸存者悲伤轨迹的影响,并将其与其他悲伤方面区分开来。应该对临床医生、悲伤顾问以及公众进行教育,使其了解自杀幸存者所经历的持续污名。