Pitman Alexandra, Stevenson Fiona, King Michael, Osborn David
UCL Division of Psychiatry, University College London, London, United Kingdom.
Camden and Islington National Health Service (NHS) Foundation Trust, London, United Kingdom.
Front Psychol. 2020 May 20;11:1024. doi: 10.3389/fpsyg.2020.01024. eCollection 2020.
Bereavement, particularly by suicide, is associated with an excess risk of mortality and of physical and psychological morbidity. Use of alcohol as a coping mechanism is suggested as a contributing factor. However, studies describing substance use after bereavement rely on diagnostic data, lacking a more fine-grained understanding of patterns of substance use when grieving. We aimed to use mixed methods to compare patterns of substance use after bereavement by suicide and other sudden deaths among young adults in the UK.
Using an online survey throughout 37 UK higher education institutions we collected free text responses from 1,854 young adults who had experienced sudden bereavement. We conducted content analysis of free text responses to an open question about patterns of alcohol and drug use following the bereavement, measuring frequencies of coded categories. Collapsing these categories into binary outcomes reflecting increased use of alcohol or drugs, we used multivariable logistic regression to quantify the associations between mode of bereavement and increased post-bereavement substance use.
Of 1,854 eligible respondents, 353 reported bereavement by suicide, 395 by accidental death, and 1,106 by sudden natural causes. The majority of the sample reported no increase in their use of alcohol (58%) or unprescribed drugs (85%) after the bereavement. Overall 33% had increased their alcohol use at some point after the bereavement, whilst 12% had increased their use of drugs. People bereaved by suicide were significantly more likely to describe an increase in substance use (adjusted OR = 1.29; 95% CI = 1.00-1.66; = 0.049) than people bereaved by sudden natural causes, as were people bereaved by non-suicide unnatural deaths (adjusted OR = 1.32; 95% CI = 1.03-1.68; = 0.026).
Just under half of young UK adults who experience sudden bereavement increase their alcohol use afterwards, and very few increase their use of drugs. People bereaved by suicide or non-suicide unnatural deaths may be more likely than people bereaved by sudden natural causes to use substances as part of the grieving process, and may have a greater need for monitoring of potential harms. Understanding the reasons for substance use will help primary care and bereavement practitioners screen and address needs appropriately.
丧亲之痛，尤其是因自杀导致的丧亲，与死亡风险以及身体和心理疾病的风险增加有关。有人认为，将饮酒作为一种应对机制是一个促成因素。然而，描述丧亲后物质使用情况的研究依赖于诊断数据，缺乏对悲伤时物质使用模式更细致的了解。我们旨在采用混合方法，比较英国年轻人中因自杀和其他突然死亡导致丧亲后物质使用模式。
通过对英国37所高等教育机构进行在线调查，我们收集了1854名经历过突然丧亲的年轻人的自由文本回复。我们对一个关于丧亲后酒精和药物使用模式的开放性问题的自由文本回复进行了内容分析，测量编码类别的频率。将这些类别合并为反映酒精或药物使用增加的二元结果，我们使用多变量逻辑回归来量化丧亲方式与丧亲后物质使用增加之间的关联。
在1854名符合条件的受访者中，353人报告因自杀丧亲，395人因意外死亡丧亲，1106人因突发自然原因丧亲。大多数样本报告丧亲后酒精使用（58%）或非处方药物使用（85%）没有增加。总体而言，33%的人在丧亲后的某个时候增加了酒精使用，而12%的人增加了药物使用。与因突发自然原因丧亲的人相比，因自杀丧亲的人更有可能描述物质使用增加（调整后的比值比 = 1.29；95%置信区间 = 1.00 - 1.66；P = 0.049），因非自杀性非自然死亡丧亲的人也是如此（调整后的比值比 = 1.3,2；95%置信区间 = 1.03 - 1.68；P = 0.026）。
在经历突然丧亲的英国年轻人中略少于一半的人在丧亲后增加了酒精使用，很少有人增加药物使用。与因突发自然原因丧亲的人相比，因自杀或非自杀性非自然死亡丧亲的人在悲伤过程中可能更有可能使用物质，并且可能更需要监测潜在危害。了解物质使用原因将有助于初级保健和丧亲事务从业者进行筛查并适当满足需求。
