"The psychological skeleton in the closet": mortality after a sibling's suicide

To study the association between loss of an adult sibling due to suicide and mortality from various causes up to 18 years after bereavement.

We conducted a follow-up study between 1981 and 2002, based on register data representing the total population of Swedes aged 25-64 years (n = 1,748,069).

An elevated mortality rate from all causes was found among men (RR 1.26; 95 % CI: 1.14-1.40) and women (1.27; 1.11-1.45) who had experienced a sibling's suicide. The standardized rate ratio of suicide of bereaved to non-bereaved persons was 2.46 (1.86-3.24) among men and 3.25 (2.28-4.65) among women. We also found some indications of an interrelation between sibling suicide and subsequent deaths from external causes other than suicide in men (1.77; 1.34-2.34) and deaths from cardiovascular disease in women (1.37; 0.99-1.91). An elevated all-cause mortality rate was found after the first year of bereavement in men, while bereaved women experienced higher mortality rates during the first 2 years and after 5 years of bereavement.

Our study provides support for adverse health effects among survivors associated with sibling loss due to suicide. Sibling suicides were primarily associated with suicide in bereaved survivors, although there was an increased mortality rate from discordant causes, which strengthens the possibility that the observed associations might not be entirely due to shared genetic causes.