Functional somatic syndromes

PSYCHOLOGICAL FEATURES OF PATIENTS WITH THERAPEUTIC,

SURGICAL DISEASES. PSYCHOLOGICAL FEATURES OF

PREGNANT WOMEN AND DURING BIRTH GIVING. FEATURES OF

PSYCHOLOGY OF SICK CHILDREN AND OLD PEOPLE.

FUNCTIONAL SOMATIC SYNDROMES

Gastroenterology Irritable Bowel SyndromeFunctional dyspepsia

Cardiology Atypical chest painNeurology Common Headache

Chronic fatigue syndromeRheumatology Fibromyalgia

Complex regional pain syndromesGynaecology Chronic pelvic painOrthopaedics Chronic back pain

SUICIDE IS… 1. A form of behavior designed to deal with and solve a problem. 2. A goal-oriented coping method.3. A way to take control. 4. The ultimate revenge.

WHY DO PEOPLE COMMIT SUICIDE?

I. PRIMARY REASONS A. Hopelessness B. Helplessness

II. PRE-SUICIDAL SITUATIONS A. Sudden loss B. Social isolation C. Deep loneliness D. Illness and pain E. Changes in life style F. Burden to others G. Unfulfilled, unrealistic expectations

SOME COMMON CHARACTERISTICS OF SUICIDAL PEOPLE A. Feelings of helplessness-sees the situation as intolerable and feels helpless to change it. B. Feeling of hopelessness-sees the situation as having no solution therefore is unable to change it. C. The individual experiences ambivalence-feels like dying but likes living at the same time. Ambivalence is the key in the intervention process. You must offer hope and strength to the side that wants to live, but also hear and understand the part seeking relief in the form of death. NEVER deny or ignore the side that wants to die. This will make the individual defensive and he/she will withdraw. D. Suicide is rarely a spontaneous activity. It is usually a long drawn out process of depression and loss of ability to cope with stress, disappointment, etc.

SOME VERBAL AND BEHAVIORAL CLUES TO SUICIDE RISKREMEMBER: Any one clue does not equate suicide BUT a cluster of clues definitely warrants caution and intervention. Suicidal individuals give clues of their intent. These are verbal, blatant or coded, and behavioral messages we can listen for or be aware of.

VERBAL:A. I'm going to kill myself.B. My family would be better off without me.C. I can't go on any longer. D. I'm going on a trip/going to leave. E. Please tell my family good-bye. F. I wish I'd never been born.G. You're going to be sorry when I'm gone. H. I want to go to sleep and never wake up.

BEHAVIORAL: A. Some abrupt behavior change in appearance, socialization, use/non-use of money, lessening of caution in dangerous situations. B. A previous suicide attempt. C. Giving away prized possessions D. Putting business affairs in order. E. Quick, unexpected recovery from deep depression. F. A suicide note (some are written way before the attempt), death-related poems/stories/essays/journal entries.

SUICIDE CLUES SITUATION REFERENCES 1. I can't put my family through all the suffering and expense of these last few months. 2. The doctor says there is no treatment for it. 3. I don't know how I got into this mess, there's no way out. 4. I've tried every drug program available, I've really tried, there's nowhere else to turn. 5. I never thought I'd get caught. I can't face anyone after this. 6. Nothing is going to make it any better. 7. How can I be sure that my cats will be taken care of when I'm not there to do it? 8. How does one leave their body to a medical school? 9. Take care of my children. 10. I've really tried but nothing works for me, nothing makes it right.

SUICIDE CLUES SITUATION REFERENCES 11. I just can't do the things I use to be able to do. 12. I'd like to crawl into a hole and never come out. 13. Sometimes I think I'd be better off dead. 14. I just want out of the whole mess. 15. That's one problem I'll never have to worry about again. 16. I want out. 17. I'm tired of trying. 18. I have nothing to live for. 19. The doctor says it's just a matter of time anyway. 20. Everyone I ever loved is gone. 21. I want you to tell my family good-bye for me.

RELATIONSHIP REFERENCES1. He/she will be better off without me. 2. Nobody cares. 3. He/she will be sorry when they find me. 4. He/she will be sorry when they find out what I did. 5. I can't wait to see his/her face when they find me dead. 6. My mother is so angry with me because I won't have anything to do with her now. She thinks she has done something wrong but it just makes it easier this way. 7. He deserves what I'm going to do to him. 8. I've never been good enough for him it'll be better this way. 9. Everything will be all right when my husband finds me. 10. I'm going to make him suffer like I have. 11. My children don't need me anymore-they'll be O.K.

TIME REFERENCES 1. It won't matter after today. 2. That doesn't matter now. 3. I just can't go on like this anymore. 4. I just called to say goodbye. 5. You're the last person that will hear from me. 6. That is one problem I am taking care of right now. 7. I just want to sleep forever. 8. I won't be around much longer anyway. 9. I'm leaving. 10. I've decided now…(pause)…it's time to do it.

TIME REFERENCES 11. I can't take this any longer. 12. Tomorrow…there won't be a tomorrow. 13. That was a problem, a big problem, but it can't bother me now. 14. I talked to all my family last night so everything is taken care of. 15. About three months ago I went through a rough time and took an overdose, but I couldn't even pull that off. 16. You can't help me now, nobody can. 17. My sister killed herself a year ago today. 18. I won't have any problems tomorrow. 19. I don't have to worry about that anymore. 20. You won't be hearing form me again. 21. I can't live this way another day.

MYTHS ABOUT SUICIDESuicide happens without warning.Suicide people wish to die.Once someone becomes suicidal, the person is always suicidal.Once a persons depression has lifted, the danger of suicide is over.Suicide is inherited and runs in families.Suicidal people are mentally ill.If someone is despondent, mentioning suicide will give the person suicide ideas.

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MYTHS VERSUS FACTSABOUT SUICIDE

MYTHS VERSUS FACTSMYTH:

People who talk about suicide don't complete suicide.

FACT: Many people who die by suicide have given

definite warnings to family and friends of their intentions. Always take any comment about suicide seriously.

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Suicide happens without warning.

FACT: Most suicidal people give clues and signs

regarding their suicidal intentions.

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Suicidal people are fully intent on dying.

FACT: Most suicidal people are undecided about

living or dying, which is called “suicidal ambivalence.” A part of them wants to live; however, death seems like the only way out of their pain and suffering. They may allow themselves to "gamble with death," leaving it up to others to save them.

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Men are more likely to be suicidal.

FACT: Men are four times more likely to kill

themselves than women. Women attempt suicide three times more often than men do.

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Asking a depressed person about suicide will push him/her to complete suicide.

FACT: Studies have shown that patients with

depression have these ideas and talking about them does not increase the risk of them taking their own life.

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Improvement following a suicide attempt or crisis means that the risk is over.

FACT: Most suicides occur within days or weeks of

"improvement," when the individual has the energy and motivation to actually follow through with his/her suicidal thoughts. The highest suicide rates are immediately after a hospitalization for a suicide attempt.

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Once a person attempts suicide, the pain and shame they experience afterward will keep them from trying again.

FACT: The most common psychiatric illness that

ends in suicide is Major Depression, a recurring illness. Every time a patient gets depressed, the risk of suicide returns.

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Suicide occurs in great numbers around holidays in November and December.

FACT: Highest rates of suicide are in May or June, while the lowest rates are in December.

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RISK FACTORS FOR SUICIDE

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RISK FACTORS

• Psychiatric disorders

• Past suicide attempts

• Symptom risk factors

• Sociodemographic risk factors

• Environmental risk factors

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RISK FACTORSPsychiatric Disorders

Most common psychiatric risk factors resulting in suicide:

• Depression*• Major Depression• Bipolar Depression

• Alcohol abuse and dependence• Drug abuse and dependence• Schizophrenia

*Especially when combined with alcohol and drug abuse

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RISK FACTORSOther psychiatric risk factors with potential to result in suicide (account for significantly fewer suicides than Depression):

• Post Traumatic Stress Disorder (PTSD)• Eating disorders• Borderline personality disorder• Antisocial personality disorder

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RISK FACTORSPast suicide attempt

(See diagram on right)

After a suicide attempt that is seen in the ER about 1% per year take their own life, up to approximately 10% within 10 years.*

More recent research followed attempters for 22 years and saw 7% die by suicide.**

*Jenkins et al, BMJ, 2002**Carter et al, BJP, 2007

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RISK FACTORSSymptom Risk Factors During Depressive Episode:

• Desperation • Hopelessness• Anxiety/psychic anxiety/panic attacks• Aggressive or impulsive personality• Has made preparations for a potentially serious suicide attempt*

or has rehearsed a plan during a previous episode • Recent hospitalization for depression• Psychotic symptoms (especially in hospitalized depression)

*Coryell W, Young et al, J Clin Psych, 2005

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RISK FACTORS

Major physical illness, especially recentChronic physical painHistory of childhood trauma or abuse, or of being bulliedFamily history of death by suicideDrinking/Drug useBeing a smoker

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RISK FACTORSSociodemographic Risk Factors

• Male• Over age 65• White• Separated, widowed or divorced • Living alone• Being unemployed or retired• Occupation: health-related occupations higher (dentists,

doctors, nurses, social workers) • especially high in women physicians

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RISK FACTORSEnvironmental Risk Factors

• Easy access to lethal means

• Local clusters of suicide that have a "contagious influence"

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PROPOSED DSM-V SUICIDE ASSESSMENT DIMENSION

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Level of concern about potential suicidal behavior:

Sum of items coded as present

Suicide risk factor groups:

Lowest concern 0 1. Any history of a suicide attempt

Some concern 1-2 2. Long-standing tendency to lose temper or become aggressive with little provocation

Increased concern 3-4 3. Living alone, chronic severe pain, or recent (within 3 months) significant loss

High Concern 5-7 4. Recent psychiatric admission/discharge or first diagnosis of MDD, bipolar disorder or schizophrenia

5. Recent increase in alcohol abuse or worsening of depressive symptoms

6. Current (within last week) preoccupation with, or plans for, suicide

7. Current psychomotor agitation, marked anxiety or prominent feelings of hopelessness

ORTHODOX PSYCHIATRIC VIEWThe orthodox psychiatric view is that suicide is primarily the result of psychiatric disorder and is therefore predictable and preventable

Major depressive disorder and bipolar disorder are associated with at least 60% of suicides. The lifetime risk of suicide of people with major depression is 3.4%, this is much lower than the commonly cited 15%, but still considerably higher than that of people free of psychiatric disorder. Up to 83% of people who perform suicide have had contact with a physician in the year before their death

Research groups dedicated to the understanding and prevention of suicide conduct “psychological autopsies”, sifting through all the information availa ble regarding the events of the individual’s life prior to suicide. They report evidence of diagnosable mental disorder in almost 90% of those who suicide and argue that the remaining 10% probably suffered a mental disorder which they were unable to detect

THE PREVENTION STRATEGYThe prevention strategy drawn from these observations is for “improved screening of depressed patients by primary care physicians and better treatment of major depression ”Suicide rates peak immediately after admis sion and discharge from psychiatric wards. The prevention strategy drawn from these observations is for “enhanced follow-up”

Schizophrenia is associated with a lifetime risk of completed suicide of 9 -13 and may be more lethal than depression. Other diagnoses, including anxiety, are also associated with greater risk

RISK FACTORSpsychiatric disorder leading to hospitalization was the most prominent risk factor, but unemployment, low income, marital status, and family history of suicide additional important risk factors

ACUTE RISK OF SUICIDESuicide risk may increase rapidly (acute suicide risk) as a result of sudden overpowering distress, in people both with and without mental disorder .Wyder (2004) examined individua ls who had survived a suicide attempt; 51% reported acting after thinking about their actions for 10 minutes or less. Of those who had been affected by alcohol, 93% had thought about their actions for 10 minutes or less. Impulsive acts make prevention problematic.

ACUTE RISK OF SUICIDEAcute suicide risk may occur in mental disorders, particularly psychotic depression, in which delusions of guilt and loss are prominent features. Mental disorders may be complicated by personality difficulties and the ready availability of alcohol. Dumais et al (2005) investigated cases in which suicide was completed during an episode of major depression. They found that impulsive-aggressive personality disorders and alcohol abuse/dependence were two important independent predictors of suicide in major depression.

CHRONIC RISK OF SUICIDEChronic risk is a common feature of personality disorder, particularly b orderline personality disorder . The personality disorders differ from conditions such as major depressive disorder, which manifest episodes of difficulties. “Personality” refers to the characteristic (long-term) manner in which the individual responds to the environment.

CHRONIC RISK OF SUICIDEWhile personality disorder is a chronic condition, there may be superimposed periods of more acute distress and risk of suicide. Borderline personality disorder , characterized by a pervasive pattern of instability of interpersonal relationships and mood, and marked impulsivity, has a 10% lifetime risk of suicide. Impulsive suicide is usually triggered by adverse life events.

Illustration. Thich Quang Duc burned himself to death in Saigon (Vietnam) in 1963. He wasprotesting the way, in his view, the government was oppressing the Buddhist religion.

Illustration. Jo Shearer, a 56 year old accomplished journalist who suffered intractable pain.She advised colleagues of her intention and ended her life.

THE SOCIOLOGICAL MODEL“Experience indicates that for effective suicide prevention, the appropriate treatment of people with mental disorders is just one of the main component s. Actually, biological and psychological characteristics, and factors pertaining to the cultural, social and physical environment, although more difficult to approach in quantitative ways, should receive much more attention…”Bertolote et al, 2004

DURKHEIM’S CLASSIFICATION OF SUICIDE.Egoistic suicide occurs when an individual is inadequately integrated into

society, and is lonely and socially isolated. Altruistic suicide occurs when the individual is too tightly integrated into society and places the needs of the society above his or her own; examples include the Kamikaze pilot or the suicide bomber. Anomic suicide is the most common and occurs when anomie occurs. Anomie is the condition where social and/or moral norms are confused, unclear, or simply not present . Durkheim observed anomie and the loss of traditional values, as a result of industrialization. This is also evident in current society, in which we are increasingly separated and divided by computer technology, the internet, increasing bureaucracy, and specialization in the workplace. Durkheim rejected pathological mental states as a class of causes of suicide. At most he would concede that a pathological mental state may predispose an individual to commit suicide. The causes, he maintained, were social. In a reassessment of “Suicide”, Durkheim’s dismissal of mental illness as a key determinant of suicide has been described as “baseless”, but his conceptualization of anomic, ego istic and altruistic suicide has been accepted as providing “a means of comprehending recent trends in suicidal behavior” (Robertson, 2006).

The impact of social factors (in pa rticular, anomie) on suicide rates is currently well demonstrated in the North America n Indians, who have the highest suicide rate of all ethnic groups in the United States. This culture is under extreme pressure and family conflict, alcohol abuse and hopelessness are believed to be important factors leading to suicide. The 2003 SARS epidemic in Hong Kong was associated with a marked increase in the suicide rate of the elderly, and biopsychosocial factors have been implicated. Psychosocial stresses have been associated with the suicidal behavior of adolescents in rural china.

The importance of social factors in suicide was recently highlighted in Australia. Page et al (2006) found that across the period 1979 -2003, socioeconomic status differentials in suicide persisted for both men and women. Low socioeconomic status was consistently associated with higher suicide rates, high socioeconomic status was consistently associated with lower rates and middle socioeconomic status was consistently associated with a suicide rate between these extremes.

PREDICTION AND PREVENTIONthe majority of cases, the prediction and prevention of suicide is not possible.

THE IMPACT OF SUICIDE ON OTHERS

IMPACT ON RELATIVES AND FRIENDS . There is surprisingly little standardized data on the effect of relatives and friends of those who suicide. Anecdotally, suicide causes much suffering in at least some relatives and friends. This may be greater when the relationship has been difficult between the person who suicides and those who are left. Some authors believe suicide can represent an aggressive act, an angry rejection and punishment of friends and relatives.

IMPACT ON MENTAL HEALTH PROFESSIONALS. For mental health professionals, suicide of patients is inevitable and has been designated an “occupational hazard” (Ruskin et al, 2004). The impact may be severe. Ting et al (2006) described the impact of client suicide on mental health social workers, which in extreme cases included refusing to see further clients who appear to be at some risk, leaving the place of work and even the state. Alexander et al (2000) studied psychiatrists and reported that following the suicide of a patient, a large proportion develop symptoms suggestive of depression, which last for at least a month, and 15% consider taking early retirement. Dewar et al (2000) studied trainee psychiatrists and found 31% reported the suicide of a patient had an adverse impact on their personal lives. Following a suicide the trainees became “over cautious” in their management of patients, which was to the disadvantage of patients. 9% of trainees considered a change of career, and a small proportion decided not to pursue careers in general adult psychiatry because of its higher risk of patient suicide.

THE IMPACT OF CRITICISM ON SYSTEMS . Scrutiny of systems may ensure the maintenance of high standards. Excessive criticism, however, may be destructive. Critics of systems frequently suggest that additional steps need to be taken to protect patients. This results in the introduction of additional paper work, so that every aspect of patient care is fully documented and staff are more, but not completely, legally protected. A problem which can arise is that staff need to spend so much time on defensive documentation that there is little left to spend with patients.

What are the signs and symptoms for suicide?Warning signs that an individual is imminently planning to kill themselves may include the person making a will, getting his or her affairs in order, suddenly visiting friends or family members (one last time), buying instruments of suicide like a gun, hose, rope, pills or other forms of medications, a sudden and significant decline or improvement in mood, or writing a suicide note. Contrary to popular belief, many people who complete suicide do not tell their therapist or any other mental-health professional they plan to kill themselves in the months before they do so. If they communicate their plan to anyone, it is more likely to be someone with whom they are personally close, like a friend or family member.Individuals who take their lives tend to suffer from severe anxiety or depression, symptoms of which may include moderate alcohol abuse, insomnia, severe agitation, loss of interest in activities they used to enjoy (anhedonia), hopelessness, and persistent thoughts about the possibility of something bad happening. Since suicidal behaviors are often quite impulsive, removing guns, medications, knives, and other instruments people often use to kill themselves from the immediate environment can allow the individual time to think more clearly and perhaps choose a more rational way of coping with their pain.

http://www.medicinenet.com/script/main/art.asp?articlekey=8709



How are suicidal thoughts and behaviors assessed?The risk assessment for suicidal thoughts and behaviors performed by mental-health professionals often involves an evaluation of the presence, severity, and duration of suicidal feelings in the individuals they treat as part of a comprehensive evaluation of the person's mental health. Therefore, in addition to asking questions about family mental-health history and about the symptoms of a variety of emotional problems (for example, anxiety, depression, mood swings, bizarre thoughts, substance abuse, eating disorders, and any history of being traumatized), practitioners frequently ask the people they evaluate about any past or present suicidal thoughts, dreams, intent, and plans. If the individual has ever attempted suicide, information about the circumstances surrounding the attempt, as well as the level of dangerousness of the method and the outcome of the attempt, may be explored. Any other history of violent behavior might be evaluated. The person's current circumstances, like recent stressors (for example, end of a relationship, family problems), sources of support, and accessibility of weapons are often probed. What treatment the person may be receiving and how he or she has responded to treatment recently and in the past, are other issues mental-health professionals tend to explore during an evaluation.


THE SAD PERSONS SCALE, WHICH IDENTIFIES RISK FACTORS FOR SUICIDE AS FOLLOWS:

Sex (male)Age younger than 19 or older than 45 years of ageDepression (severe enough to be considered clinically significant)Previous suicide attempt or received mental-health services of any kindExcessive alcohol or other drug useRational thinking lostSeparated, divorced, or widowed (or other ending of significant relationship)Organized suicide plan or serious attemptNo or little social supportSickness or chronic medical illness


YOU CAN HELPIntervention

Three Basic Steps:

1. Show you care

2. Ask about suicide

3. Get help

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•Step One:•Show You Care•Be Genuine

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YOU CAN HELPShow you careTake ALL talk of suicide seriously

• If you are concerned that someone may take their life, trust your judgment!

Listen CarefullyReflect what you hearUse language appropriate for age of person involved

• Do not worry about doing or saying exactly the "right" thing. Your genuine interest is what is most important.

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YOU CAN HELPBe GenuineLet the person know you really care.Talk about your feelings and ask about his or hers.

• "I'm concerned about you… how do you feel?“• "Tell me about your pain.“• "You mean a lot to me and I want to help.“• "I care about you, about how you're holding up.“• "I'm on your side…we'll get through this."

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Step Two• Ask About Suicide• Be direct but non-confrontational

Talking with people about suicide won't put the idea in their heads. Chances are, if you've observed any of the warning signs, they're

already thinking about it. Be direct in a caring, non-confrontational way.

Get the conversation started.

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YOU CAN HELPYou do not need to solve all of the person's problems – just engage them. Questions to ask:

• Are you thinking about suicide?• What thoughts or plans do you have?• Are you thinking about harming yourself, ending your life?• How long have you been thinking about suicide?• Have you thought about how you would do it?• Do you have __? (Insert the lethal means they have

mentioned)• Do you really want to die? Or do you want the pain to go

away?

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YOU CAN HELPAsk about treatment:

• Do you have a therapist/doctor?• Are you seeing him/her?• Are you taking your medications?

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YOU CAN HELPKnow Referral Resources

• Resource sheet: Create referral resource sheet from your local community

• Psychiatrists/Psychologists• Other Therapists• Family doctor/pediatrician• Local medical centers/medical universities• Local mental health services• Local hospital emergency room • Local walk-in clinics• Local psychiatric hospitals

• Hotlines• National Suicide Prevention Lifeline: 1-800-273-TALK• www.suicidepreventionlifeline.org• 911: In an acute crisis, call 911

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http://www.suicidepreventionlifeline.org/

YOU CAN HELPReassure the person that help is available and that you will help them get help:

• “Together I know we can figure something out to make you feel better.”• “I know where we can get some help.”• “I can go with you to where we can get help.”• “Let's talk to someone who can help . . . Let's call the crisis line now.”

Encourage the suicidal person to identify other people in their life who can also help:

• Parent/Family Members• Favorite Teacher• School Counselor• School Nurse• Religious Leader• Family doctor

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YOU CAN HELPOutline a safety plan

• Make arrangements for the helper(s) to come to you OR take the person directly to the source of help - do NOT leave them alone!

• Once therapy (or hospitalization) is initiated, be sure that the suicidal person is following through with appointments and medications.

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WHAT IS THE TREATMENT FOR SUICIDAL THOUGHTS AND BEHAVIORS?

Those who treat people who attempt suicide tend to adapt immediate treatment to the person's individual needs. Those who have a responsive and intact family, good friendships, generally good social supports, and who have a history of being hopeful and have a desire to resolve conflicts may need only a brief crisis-oriented intervention. However, those who have made previous suicide attempts, have shown a high degree of intent to kill themselves, seem to be suffering from either severe depression or other mental illness, are abusing alcohol or other drugs, have trouble controlling their impulses, or have families who are unwilling to commit to counseling are at higher risk and may need psychiatric hospitalization and long-term outpatient mental-health services.

HOW CAN PEOPLE COPE WITH SUICIDAL THOUGHTS?

In the effort to cope with suicidal thoughts, silence is the enemy. Suggestions for helping people survive suicidal thinking include engaging the help of a doctor or other health professional, a spiritual advisor, or by immediately calling a suicide hotline or going to the closest emergency room or mental-health crisis center. In order to prevent acting on thoughts of suicide, it is often suggested that individuals who have experienced suicidal thinking keep a written or mental list of people to call in the event that suicidal thoughts come back. Other strategies include having someone hold all medications to prevent overdose, removing knives, guns, and other weapons from the home, scheduling stress-relieving activities every day, getting together with others to prevent isolation, writing down feelings, including positive ones, and avoiding the use of alcohol or other drugs.

HOW CAN PEOPLE COPE WITH THE SUICIDE OF A LOVED ONE?

Grief that is associated with the death of a loved one from suicide presents intense and unique challenges. In addition to the already significant pain endured by anyone who loses a loved one, suicide survivors may feel guilty about having not been able to prevent their loved one from killing themselves and the myriad conflicting emotions already discussed. Friends and family may be more likely to experience regret about whatever conflicts or other problems they had in their relationship with the deceased, and they may even feel guilty about living while their loved one is not. Therefore, individuals who lose a loved one from suicide are more at risk for becoming preoccupied with the reason for the suicide while perhaps wanting to deny or hide the cause of death, wondering if they could have prevented it, feeling blamed for the problems that preceded the suicide, feeling rejected by their loved one and stigmatized by others.


Some self-help techniques for coping with the suicide of a loved one include avoiding isolation by staying involved with others, sharing the experience by joining a support group or keeping a journal, thinking of ways to handle it when other life experiences trigger painful memories about the loss, understanding that getting better involves feeling better some days and worse on other days, resisting pressure to get over the loss, and the suicide survivor's doing what is right for them in their efforts to recover. Many people, particularly parents of children who commit suicide, take some comfort in being able to use this terrible experience as a way to establish a memorial to their loved one. That can take the form of everything from planting a tree or painting a mural in honor of the departed to establishing a scholarship fund in their loved one's name to teaching others about surviving child suicide. Generally, coping tips for grieving a death through suicide are nearly as different and numerous as there are bereaved individuals. The bereaved person's caring for him- or herself through continuing nutritious and regular eating habits and getting extra, although not excessive, rest can help strengthen their ability to endure this very difficult event.


Quite valuable tips for journaling as an effective way of managing bereavement rather than just stirring up painful feelings are provided by the Center for Journal Therapy. While encouraging those who choose to write a journal to apply no strict rules to the process as part of suicide recovery, some of the ideas encouraged include limiting the time journaling to 15 minutes per day or less to decrease the likelihood of worsening grief, writing how one imagines his or her life will be a year from the date of the suicide, and clearly identifying feelings to allow for easier tracking of the individual's grief process.

To help children and adolescents cope emotionally with the suicide of a friend or family member, it is important to ensure they receive consistent caretaking and frequent interaction with supportive adults. All children and teens can benefit from being reassured they did not cause their loved one to kill themselves, going a long way toward lessening the developmentally appropriate tendency children and adolescents have for blaming themselves and any angry feelings they may have harbored against their lost loved one for the suicide. For school-aged and older children, appropriate participation in school, social, and extracurricular activities is necessary to a successful resolution of grief. For adolescents, maintaining positive relationships with peers becomes important in helping teens figure out how to deal with a loved one's suicide. Depending on the adolescent, they even may find interactions with peers and family more helpful than formal sources of support like their school counselor.

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Functional somatic syndromes