Table 3.
Schematic diagram of key themes from the qualitative data.
| Theme | Description of Theme | Sub-Themes |
|---|---|---|
| Moral Injury and Trauma | The overall sense of failing responses and trauma to prevent, bearing witness to, or learning about the suicide and how this transgresses deeply held moral beliefs and expectations linked to the sense of negative judgement and stigma from others. Moral injury was strongly associated with feelings of guilt and shame associated with traumatic loss. | Poor engagement and lack of appropriate care from professionals |
| Critical of own failure to prevent/save | ||
| Feeling helpless and calls for help unrecognised | ||
| Being left alone to deal with grief | ||
| Lack of insight from others including avoidance | ||
| Being given unsolicited advice/careless thoughtless comments from others | ||
| Lack of physical/practical support | ||
| Perception of having failed from others/shame/stigma and guilt | ||
| Grappling with conflicted feelings towards the person who died | ||
| Use of metaphors to express dramatic experiences and incongruities in situations that emerged | ||
| Rippling effects | Positive and negative The effect on self (beliefs about self), significant others (partners, children, friends, wider family) and wider social networks (acquaintances, work colleagues, neighbours, community) is evident both in the aftermath as well as the longer term impact and consequences. |
Igniting of existing or previous traumas |
| Expositing quality of relationships | ||
| Lack of care from people close to them | ||
| Taking up care roles and new responsibilities | ||
| Invisibility as a mature person | ||
| Own unmet needs/disappointment | ||
| Providing substitute care | ||
| Being unable to assert own needs | ||
| Impact on physical and mental health of own and others | ||
| Fear/awareness of suicide in self/others | ||
| Significance of key people reaching out | ||
| Making sense of disruption to expected natural order | ||
| Adaptation and transformation to the living experience in later life | How the bereaved person reflected with time on the impact of suicide on themselves and their lived experiences particularly as they became older. How they learned to adapt following the loss by suicide and connected with peers. This related to the importance of disclosure talking, listening and validation of experiences following loss through suicide and meaning-making about their own lives and life with the person. | Timing of help seeking |
| Quality of responses to help seeking e.g., family doctor | ||
| Recognising different types of pain | ||
| Suicidal thoughts and behaviour | ||
| Radical acceptance of loss | ||
| Temporal perspectives/time lost vs. time left | ||
| Marking anniversaries/meaning of significant events | ||
| Peer support/peer education/activism | ||
| Role of professionals in recognising bereavement by suicide |