effects of suicide on siblings: uncertainty and the grief process

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Effects of Suicide on Siblings:Uncertainty and the Grief ProcessKimberly A. Powell a & Ashley Matthys aa Department of Communication Studies , Luther CollegePublished online: 03 Oct 2013.

To cite this article: Kimberly A. Powell & Ashley Matthys (2013) Effects of Suicide on Siblings:Uncertainty and the Grief Process, Journal of Family Communication, 13:4, 321-339, DOI:10.1080/15267431.2013.823431

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Journal of Family Communication, 13: 321–339, 2013Copyright © Taylor & Francis Group, LLCISSN: 1526-7431 print / 1532-7698 onlineDOI: 10.1080/15267431.2013.823431

Effects of Suicide on Siblings: Uncertaintyand the Grief Process

Kimberly A. Powell and Ashley MatthysDepartment of Communication Studies, Luther College

Over 33,000 people die from suicide each year in the United States, leaving nearly 200,000 familymembers grieving. Much has been written about suicide loss and grieving, yet not about the siblingsurvivors of suicide, called the “forgotten mourners.” This qualitative study of in-depth interviewswith 45 sibling survivors of suicide extends the literature on uncertainty management and grief byinvestigating multiple ways in which sibling survivors of suicide experience uncertainty and loss, andthe management responses that result.

The World Health Organization (2011) estimates almost one million people die by suicide everyyear, approximately 33,000 of those in the United States (McIntosh, 2009). The actual numbermay be higher because many go unreported due to the stigma surrounding suicide (Linn-Gust,2001). Reported suicide is the 11th leading cause of death for all ages, and third behind accidentsand homicide for 15–24-year-olds (McIntosh, 2009). For each suicide it is estimated there areat least six family member survivors (Linn-Gust, 2001), so approximately 198,000 survivors peryear in the United States. Though research on suicide survivor grief has increased significantly,it is limited due to the hesitancy of researchers to ask the bereaved to take part in studies(Linn-Gust, 2010). Due to the sensitive nature of suicide, including blaming self and others, andthe shock involved in the suddenness of the act, researchers may consider suicide survivors toosensitive to interview.

In regards to the research that exists on survivors of suicide, suicide bereavement is primarilyfocused in the fields of psychology and nursing on parent/child suicide (Feigleman, Gorman,& Jordan, 2009; Hung & Rabin, 2009), counseling issues and support groups (Callahan, 2000;Myers & Fine, 2007), suicide ideation (Mitchell, Kim, Prigerson, & Mortimer, 2005), adolescentbereavement (Valente, Saunders, & Street, 1988), and more recently the effect of the Internet inbereavement (Chapple & Ziebland, 2011) and the impact on a military unit upon suicide of asolider (Carr, 2011).

As for research on sibling survivors of suicide, referred to as the “forgotten mourners”(McIntosh & Wrobleski, 1988) or “forgotten bereaved” (Dyregrov & Dyregrov, 2005), the fewexisting studies have focused on the level of depression, PTSD, and anxiety following a suicide,finding it to be higher in siblings after a suicide than in a control group (Brent, Moritz, Breidge,

Correspondence should be addressed to Kimberly A. Powell, Department of Communication Studies, 700 CollegeDrive, Luther College, Decorah, IA 52101. E-mail: [email protected]

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322 POWELL AND MATTHYS

Perper, & Canossio, 1996; Brent, Perper, Moritz, Liotus, Schweebs, Roth, et al., 1993; Dyregrov& Dyregrov, 2005). This study adds to the small body of literature on sibling suicide and is uniquein focusing on how siblings communicatively manage their grief and uncertainty. Thus, the resultsof this study can be potentially powerful in assisting bereavement counselors and support groupsworking with families after a suicide. When grief is related to loss of a sibling due to suicide,how does one manage the corresponding grief?

When the sibling bond is broken due to suicide, the surviving sibling(s) suffer a unique lossthat can be overlooked in a society that tends to focus on the loss experienced by the parents.People may tell siblings after a suicide to “be strong for their parents” (Linn-Gust, 2010, p. 54) notrealizing the sibling is experiencing their own grief and loss. Brent and colleagues (1993) foundadolescent survivors of sibling suicide had a seven times greater risk of suffering major depressionin the six months following a suicide than from any other form of loss. To complicate their owngrieving, siblings have the added burden of taking on the role of their deceased sibling for theirparents (Bank & Kahn, 1975) and caretaking for their parents experiencing loss.

Using psychological bereavement and uncertainty management theory (Brashers, 2001) asour theoretical foundations, we examine the unique grief that siblings experience at the loss of asibling to suicide. To explore this literature in more depth, the nature and causes of suicide griefare discussed, followed by an examination of how bereavement and uncertainty can contribute toan understanding of the unique loss experienced by sibling survivors of suicide.

SUICIDE GRIEF

There are many known causes for suicide ranging from depression, mental illness, hopelessness,and peer pressure to a loss, major life change, illness, bullying, and issues with sexual orientation.Many times, suicide is a result of a combination of factors (Linn-Gust, 2001), and unless thereis a suicide note left or the victim was verbal about intentions, the reasons for the suicide remainuncertain. We do know there is a strong link between mental illness and suicide. In an attempt toeducate society that someone dying from suicide is a victim of mental illness or other issues, someadvocate using the language “died by suicide” instead of “committed suicide,” the latter of whichtends to criminalize the act. Despite the cause of suicide, the grief experienced by survivors can beintense and unique compared with other losses because of the level of uncertainty and suddennessof the death.

Grief, commonly referred to as bereavement, is a reaction to loss that may manifest in a varietyof feelings and behaviors. Grief in the United States is culturally a private matter that makesothers uncomfortable (Klass, 2001; Sanders, 1989). In the case of suicide, there is a stigma thatmakes people more uncomfortable talking about the loss. Killing oneself is seen differently thanbeing killed or dying by natural causes or in an accident. Victims of suicide have been labeled“cowards,” “selfish,” and are accused of “taking the easy way out,” thus being blamed for theirdeath in what some have called victimizing the victim.

The labels placed on the act and how others talk about suicide affect the bereaved, complicat-ing the grief process. Survivors who encounter harmful responses have reported more difficultywith grief due to dealing with judgments of others regarding the suicide (Feigelman, Gorman, &Jordan, 2009). The implication for a family is great not only in terms of dealing with the grief, butthe knowledge that suicide runs in families creates fear of another family suicide that complicates

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EFFECTS OF SUICIDE ON SIBLINGS 323

the grief process. Researchers are unsure if the cause is genetic or that once suicide happens ina family it becomes talked about and becomes an option for death (Runeson & Asberg, 2003).Thus, grief is not only for the specific loss, but also for the family’s future and the image of thefamily in the community.

Through the decades of work on bereavement there is a strain of critique regarding how peopledo “grief work” (e.g., Bonanno & Field, 2001; Wortman & Silver, 2001). Stroebe (2001) arguesthat the idea of progressing through specified stages to reach acceptance of a loss has prob-lematized grief as a state of abnormality until grief-work is complete. People experience griefdifferently, thus individual differences in response to loss render any single model of grief inade-quate (Attig, 1996; Davis & Nolen-Hoeksema, 2001). Sibling survivors of suicide may experiencefeelings including sadness of losing the future with their sibling and losing someone who had,in many cases, a similar growing-up experience (Rosenbloom & Whittington, 1993), shame andstigma surrounding the suicide, and guilt of wondering why they could not stop the suicide orwhat they could have done to let their sibling know how much they were loved.

They may also feel anger at themself for not stopping the suicide or at the sibling for not askingfor help and bringing the grief on the family (Caplan, Mason, & Kaplan, 2000; Davis, Lehman,Wortman, Silver, & Thomson, 1995; Parkes, 1986; Sanders, 1989). Survivors may also experiencetrauma if they found the body (Linn-Gust, 2001, 2010), anxiety about the death (Archer, 1999),or conversely, relief if the sibling who died was consuming family energy and causing stress andworry. The responses to suicide grief vary greatly depending upon the situational, contextual andrelational context.

The unique nature of suicide makes it harder to explain, understand and grieve, making thestated goal of acceptance more unlikely (Nolen-Hoeksema & Larson, 1999) because of themany unanswered questions. Numerous authors (e.g., Attig, 1996, 2001; Bonanno, 2001; Klass,Silverman, & Nickman, 1996; Stroebe, 2001; Wortman & Silver, 1989, 2001) question the valid-ity of acceptance as an expected phase of grief, arguing that grief does not simply end, but is anevolving and complex process that becomes salient at various life stages. Although acceptancemay not be a realistic or even desirable goal for some siblings, if one can recognize the lossintellectually and emotionally and one’s worldview changes to match the new reality, grief canbe managed (Sanders, 1989).

Throughout the grief process, “It is a huge step forward in suicide grief when bereaved peopleare able to let go of their guilt and realize they did everything they could” (Linn-Gust, 2010,p. 34). To manage their grief, siblings must accept that their sibling died by suicide and deal withthe accompanying challenges and lingering questions of cause (Caplan, Mason, & Kaplan, 2000).Managing one’s grief does not mean leaving behind emotional attachments with the person thatis deceased. In fact, continuing bonds with a sibling and remembering his or her life through self-help groups and rituals may provide emotional support and enhance family bonds (Klass, 2001).Making sense out of a suicide, however, may be particularly difficult because the grieved do nothave all the answers and the grief itself is unresolved (Baxter, Braithwaite, Golish, & Olson,2002).

UNCERTAINTY AND THE GRIEVING PROCESS

Since its inception in 1975, Berger and Calabrese’s uncertainty reduction theory (URT) hasbeen influential in understanding how humans deal with uncertainty in a variety of contexts.

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Individuals experience uncertainty when situations are ambiguous, unpredictable, or unfamiliar,when information is unavailable or inconsistent, or when people are unsure about their knowl-edge. According to URT, people seek information in an effort to reduce their uncertainty andenhance their ability to explain and predict others’ behavior. However, as many scholars haveargued, uncertainty reduction may only be one of numerous responses to grief situations (Afifi& Burgoon, 1998; Babrow, 2001; Babrow, Hines, & Kasch, 2000; Baxter & Montgomery, 1996;Brashers, Neidig, Haas, Dobbs, Cardillo, & Russell, 2000). Research has shown that in someinstances, such as acquiring medical information (e.g., Miller & Mangan, 1983), or adopteesdealing with unknown birth parents (Powell & Afifi, 2005) people may avoid seeking informa-tion to maintain their uncertainty and avoid potentially negative findings. As part of living withuncertainty, people must communicatively manage their uncertainty.

Uncertainty management theory (UMT) (Bradac, 2001; Brashers, 2001; Brashers et al., 2000)argues there are a variety of ways in which individuals experience uncertainty and individualsmay not always want to reduce uncertainty. Thus, individuals must manage their uncertainty.UMT, along with normative models (Brashers, Goldsmith, & Hsieh, 2002; Goldsmith, 1992,2001; Goldsmith & Fitch, 1997) suggests uncertainty affects people and relationships in a varietyof ways. In a state of uncertainty one appraises the emotional responses (Brashers, 2007). If onedetermines uncertainty is negative, they will likely want to reduce it; however, if it is determinedthat the uncertainty is comfortable, and likely more positive than reducing that uncertainty, thenthey may decide that maintaining that uncertainty is more desirable (Brashers, 2007). Uncertaintymay not always be appraised as positive or negative, another possibility is a neutral appraisalbased on indifference to the uncertainty because it does not affect one greatly. Such variationsin uncertainty make it necessary to understand how people manage uncertainty and why somemanage it differently than others.

Once one has appraised the uncertainty there are several options for managing that uncertainty.Generally if one appraises uncertainty negatively they will attempt to reduce the uncertainty, per-haps by seeking out information that will reduce the uncertainty, or by seeking social support thatnormalizes the experience, as Scott, Martin, Stone, and Brashers (2011) found in their study oforgan transplant patients. The support of peers who have had a similar experience, for exampleorgan transplantation, can act as sources of information as well as normalizing the experience,thus decreasing uncertainty. If an individual determines uncertainty is desirable, they may main-tain it by avoiding information that would reduce the uncertainty, which may include not talkingto people that may have information, discrediting a source of information, or selectively attendingto information.

An individual may also decide to discount negative information to maintain a state of uncer-tainty. In some instances, when the information is undesirable the individual may decide toincrease the uncertainty by seeking out information that contradicts what they know or believe(Brashers, 2007), or seek social support from others that validate the uncertainty. Throughout theliterature on uncertainty management, information seeking and social support have been the pri-mary strategies people use to manage their uncertainty. In examining situations where uncertaintypersists, we must consider the situational, relational, and contextual factors that impact the wayuncertainty is managed (Brashers et al., 2002).

Suicide is a particular instance of uncertainty set against a backdrop of negative societaljudgment of suicide that complicates the uncertainty experienced. As such, studying sibling sur-vivors of suicide should give us a more nuanced understanding of grief management within this

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particularly complicated context. In the particular context of suicide grief, uncertainty is a com-plex process that some survivors seek to reduce and all work to manage. Understanding the linksbetween uncertainty and sibling suicide loss may help those dealing with a loss due to suicidemanage their unresolved grief. One cannot assume that everyone who experiences suicide loss hasthe same uncertainty. Siblings may wish to maintain some level of uncertainty because knowingwhy their sibling died by suicide may be more painful than not knowing. To further understandsibling survivor’s loss, the goals of this study are to (a) provide insight into sibling suicidesurvivors’ loss, and (b) better understand sibling survivor’s responses to their uncertainty andunresolved grief. The following research questions explore sibling suicide survivors’ uncertaintyand loss.

RQ1: How do uncertainty and loss manifest themselves in the perceptions sibling survivors ofsuicide have of their experience?

RQ2: How do survivors of sibling suicide communicatively manage their uncertainty and loss?

METHOD

To recruit participants, online support group facilitators were asked to pass researcher contactinformation along to potential participants. In addition, a prominent member of a national suicideawareness organization posted information about the study on her Facebook page. A notice of theresearch was also placed in a local publication. Willing participants were asked to call or e-mailthe authors for additional information and to schedule a telephone interview. By not contactingparticipants directly, the researchers were able to avoid the possibility of encountering individ-uals who may not have been emotionally ready to discuss their loss. Additionally, conductingthe interviews via telephone versus face-to-face reduced the unease participants may have feltwith discussing such a difficult topic with a stranger and increased the ability for researchersto contact respondents from a geographically diverse population. The respondents were mailed$25.00 upon completion of the interview, along with a list of resources and support groups forsuicide survivors.

Participants

A total of 45 participants who had lost a biological sibling to suicide were interviewed for thisstudy (female = 38 or 84%, male = 7 or 16%). Most of the participants lost a brother to suicide(n = 37 or 82%) while the rest lost a sister (n = 8 or 18%). All participants were Caucasian andlived in 25 states across the United States and two provinces in Canada. They had at least a highschool diploma or its equivalent, some had attended vocational school or received a certificate(n = 4 or 9%), some had a bachelor’s degree or were working towards it (n = 18 or 40%), andthe rest had their master’s degree (n = 11 or 24%). Participants’ ages ranged from 20 to 75 witha mean of 31, and the time elapsed since the death of their sibling ranged from two months to24 years with a mean of three years.

To help the researchers better understand the family context, participants were asked abouttheir parents’ marital status; 21 (or 47%) reported that their biological parents were divorced orseparated before their sibling passed away, 14 (or 31%) said that their parents were married, nine

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participants (or 20%) said that one or both of their parents was deceased, and one participant (or2%) reported that their parents were married at the time of their sibling’s death but had sincedivorced. Most participants had surviving siblings (n = 31 or 69%), while some lost their onlysibling to suicide (n = 14 or 31%). Three sibling pairs were interviewed and two participants losttheir twin sibling to suicide. Six participants, or 13%, revealed that their sibling’s suicide was notthe first in the family, but that a parent or grandparent had previously died by suicide.

Interviews

Telephone interviews were conducted in order to recruit participants from a variety of regions,ages, and backgrounds. Participants were instructed to conduct the interview in a private room.The interviewees were informed of the purpose of the study, that their participation was volun-tary, and that their information would be kept confidential. Per Human Subjects Review Board(HSRB) instruction and given the difficult nature of suicide, the participants were repeatedlyasked for consent during the interview, especially when the interviewer sensed the participantbecoming emotional. The participants were informed that their interview was being audiotapedfor transcription purposes. The interviews lasted from 20 to 70 minutes with an average interviewlength of 41 minutes.

The open-ended, semistructured interview questions were geared toward understanding theinterviewees’ perceptions regarding the suicide, their level of uncertainty and feelings of loss,and how they communicatively manage their loss and corresponding uncertainty regarding thesuicide. Responses to questions regarding circumstances of the sibling’s death, lingering ques-tions about the death, how information was gathered regarding the death, and whether the siblingis at peace with the death were of particular interest to the researchers regarding RQ1 on howuncertainty and loss manifest in siblings’ perception of their experience. Regarding RQ2 on howloss and uncertainty are communicatively managed, researchers analyzed questions regardingcommunication with others about their siblings suicide, how the suicide has impacted relation-ships and communication with family members and friends, and what they tell others about theirsibling’s suicide. Complete answers to questions were analyzed within the context of each partici-pant’s experiences. A full list of interview questions can be obtained by contacting the first author.

Data Analysis

After transcription, a qualitative/interpretive approach was used to understand the depth of thesibling survivors of suicides’ experiences of uncertainty and loss and their responses to theseexperiences (Creswell, 1998; Leininger, 1994; Strauss & Corbin, 1990). Because the goal ofqualitative inquiry is to uncover the meaning individuals assign to a particular phenomenon, thefocus is on how social experience is created, managed and sustained rather than on the analysis ofcause and effect associations between variables (Denzin & Lincoln, 2000; Gulbrium & Holstein,2000).

An interpretive analysis provides a detailed examination of participants’ accounts or recon-structions of their experiences in the unique circumstances in which they occurred. The suicideof a sibling is a crisis or phenomenon that involves numerous deeply felt emotions. An inter-pretive method enabled us to uncover the meaning behind these emotions (Creswell, 1994,

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1998). We attempted to represent the voices of the participants as accurately as possible, whilecategorizing the data (Creswell, 1998; Kvale, 1996).

The data analysis process consisted of four phases. First, to gather a more holistic view of theparticipants’ experiences, both researchers read the entire data set before analyzing individualtranscripts. Ideas about overarching themes in the data were discussed between the researchers,where it became clear that grief was being complicated by uncertainty and communication aboutthe suicide. In the following phases, the response to a question was used as the unit of analysiswithin the context of the participant’s experiences.

In the second phase of data analysis one researcher reread the transcripts with more atten-tion to discovering emergent themes. The constant comparative method of data analysis (Strauss& Corbin, 1990) was used to identify these themes. The categories were continually comparedand contrasted throughout the data analysis, accounting for new insights and discrepant cases(Creswell, 1998). Data analysis continued until reoccurring themes in the interviews becameapparent or a theoretical saturation point was achieved (Creswell, 1998).

A preliminary outline of the categories and their properties was created. Respondents werecategorized as having high, fluctuating or low levels of uncertainty relative to the intervieweepopulation. Participants self-reported their levels of loss and uncertainty through answering spe-cific questions about their knowledge and lack thereof regarding the suicide, and researchersconfirmed loss categories based on emotional response and the distance with which the suicidewas described. For example, those participants that became very emotional during the interviewand explicitly expressed feeling lost and unsure about the suicide were categorized as having highlevels of uncertainty, whereas those that could speak about the suicide and its effects as largelybeing “past” and removed from the current circumstances were categorized as having a low levelof loss and uncertainty.

In the third phase, both researchers read the transcripts according to the outline of categoriescreated to test the categories and properties. Even though many of the participants seemed toexperience similar uncertainties, there were clearly instances in which emotions overlapped anddiverged from this pattern. Consequently, the label "management" is used rather than “accep-tance” (Powell & Afifi, 2005). The categories of management clearly fell into three primarycategories: avoiding information, information gathering and social support.

Finally, one of the researchers further refined the categorization scheme by applying it tothe data. The categories were operationalized in more detail and examples were taken from thedata to illustrate each category. Any discrepancies were discussed between the researchers untilconsensus was reached.

RESULTS

The siblings in this study experienced loss in different ways based on their level of uncertainty.With regard to RQ1 and RQ2, it was often the case that siblings who felt the least uncertaintyhad moved to an acceptance stage of grief and were able to manage their uncertainty. In contrast,siblings with the most uncertainty and loss were in earlier stages of grief and had a comparativelystrong desire to reduce their uncertainty. The uncertainty and loss and management strategies arediscussed next. Quotations from participants are noted with the participant number, followed bythe transcript page, i.e., 15:2.

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How do uncertainty and loss manifest themselves in the perceptions sibling survivors ofsuicide have of their experience?

Lack of uncertainty and peace with the loss: Felt security

Eighteen participants (or 40%) had low levels of uncertainty regarding the death of their sib-ling. The time since the death of their sibling ranged from one year to 24 years, with an average of8.5 years. These participants felt that they knew or understood the reasoning behind their sibling’sdecision to end their life. Although they experienced the shock and devastation that accompa-nies the sudden loss of a loved one, they often expressed that, in hindsight, they recognize theirsibling’s reasons.

Some participants gained the best understanding of their sibling’s thought process througha note left by the deceased. One participant stated that he had no questions regarding why hissibling had died by suicide as she had addressed a letter to him before she passed away (15:2).Although he was deeply affected by his loss and developed depression following the death of thissister, he did not feel the need to search for answers because her note had resolved his uncertainty.Another participant echoed that a letter helped her to understand her brother’s illness and realizethat his actions were not intended to hurt his family members. She stated, “[The note] gave usa glimpse of that inside part that you don’t share with anyone . . . His pain really seemed likethere was no fix for it . . . he never planned to hurt us.” (26:4). Another participant reported thatalthough her brother did not leave a note, she found comfort in reading through journals andletters that he had written, saying that they helped her understand “the depth of his self-loathing”(17:3). Although these participants may not have agreed with their sibling’s act, a note provideda window into their sibling’s mind as they were contemplating suicide and often helped to reduceuncertainty.

Even if a letter was left behind, in some cases a letter increased a sibling’s need to searchfor additional information they felt could help reduce lingering uncertainty. Participants reportedquestioning their sibling’s spouse, coworkers, friends, or anyone who may have interacted withtheir sibling in the days or hours leading up to the suicide. After her brother’s funeral, one womansaid that she spoke with her brother’s friends and learned that his friend had died by suicidemonths before, and that his drug use was more extensive than originally thought (18:3). Thisadditional information was helpful to her in understanding her brother’s actions. One participantexplained how she began “data mining” immediately following her brother’s death. She examinedhis receipts, computer history, his apartment, and medical reports, and spoke with his friends andcoworkers. She found that “it validated on an intellectual level or a logical level that he was avery depressed person and he had all of the perfect elements to drive him to take his own life.But it still made me feel really sad because I thought if something were really that bad for him hewould come to me, I really trusted he would do that” (25:5). Piecing together the events leadingup to the death seemed to reduce uncertainty.

Other participants felt no need to search for information, or even to read a note if one was leftbehind, as they felt there were recognizable signs that their sibling was contemplating suicide.One participant spent months assisting in his sister’s recovery following a stroke that left her“cognitively [and] physically incapacitated,” before she died by suicide. He said, “My take on itis because I was allowed the opportunity to care for her when she was sick, that was such a richexperience that’s the only thing I can think of that has given me complete freedom from the guilt

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and questions about how and what if” (23:3). One participant explained how she and her brotherhad grown up with a parent who was depressed and had contemplated suicide. Her brother hadexpressed suicidal thoughts at a young age, so when he died by suicide at age 29, she experienceda tremendous sense of sadness, but not of uncertainty:

[I understand] it was an illness. I know my brother and can look at pictures of him and say this is aperson who does not have joy in his eyes . . . I made peace very early in the grieving process that hewas not well, was in a tremendous amount of pain and while I miss him and would prefer he not donethis, I would prefer him not be sick anymore and feel the tremendous pain he felt. (24:3).

Because these participants recognized the illness or negative life events that may have triggeredthe suicide, they were not left with high levels of uncertainty about their loss.

The average length of time since the death for this category of participants is significantbecause it is longer than that of participants who experience fluctuating or high levels of uncer-tainty. That is not to say that after time all of their questions will be answered, or that they willmaintain low levels of uncertainty, but generally, more time to process grief seems to correlatewith increased acceptance. Nineteen years after her brother’s death, one participant said, “I cer-tainly had many questions at the time [of my brother’s death]. I have taken action to try to answerthem for myself and talked with my other sister. I went to counseling for months after that hap-pened and addressed one issue trying to sort out my questions” (19:2). Another participant wholost her brother 11 years ago said she was “done asking why” (27:4). She felt the time since thedeath allowed her to accept that there were questions that could never be answered. For theseparticipants, time seemed to reduce their levels of uncertainty.

One final method of reducing participant uncertainty was a personal experience with depres-sion, mental illness, and/or suicidal thoughts. A participant who lost her brother 18 years ago saidthat she “did [have questions] in the past, but I have a lot of similar problems he had so I think Iunderstand why he did it” (19:2). Those participants who also battled depression sometimes feltthat their sibling’s death acted as a sort of “wake-up call” to address their own issues: “[Losingmy brother] helped me deal with a lot of my problems because I understood that he felt the samething I did and I was able to actually talk to my dad about it and he has changed the way he dealswith things as well” (27:2). Because these participants had personally experienced the emotionsthat accompany mental illness or suicidal tendencies, they felt little need to reduce uncertaintybecause they understood their sibling’s thought process.

Fluctuating uncertainty and continuing loss: A lack of knowledge

Sixteen participants (or 36%) experienced fluctuating levels of uncertainty, meaning they wereimplementing uncertainty management strategies, but that they may experience higher or lowerlevels of uncertainty from day to day. The time since the loss of their sibling ranged from twomonths to 17 years, with an average of four years. They may have been in the process of searchingfor answers, attending support groups, seeing a counselor, and generally processing their grief,but also reported lingering questions and unresolved issues surrounding their sibling’s death.

Some participants were categorized as experiencing fluctuating uncertainty because theyreported feeling at peace with the death at times, and at other times experiencing a range ofnegative emotions from denial to anger to guilt. A participant with a background in psychologywent through a “gamut of emotion” in the six months since her brother’s death and reported

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experiencing periods of acceptance and periods of high uncertainty. She stated, “I’m definitelygoing through the process and I mean you can get to one stage and then go back, it’s a mess, it’sall over the place. I’ve accepted it and I think I understand some of the reasons why and I try tobe grateful for the fact that he was in my life” (30:7). At other times, however, she said that shecould get “very angry, and like angry at him” and that she experienced “a lot of guilt . . . youknow like the things, I should’ve said this, or when I had that weird feeling why didn’t I go overthere” (30:5). When asked whether she was at peace with her brother’s death three years after hissuicide, a participant responded, “It depends on the day that you ask me. Some days I accept itand I understand how it happened and why it happened, other days I can’t wrap my mind aroundit” (14:9). She said that she is still “working towards acceptance,” but has not reached the pointwhere she can say that she is at peace with his death.

Participants with fluctuating uncertainty usually had engaged in uncertainty reduction strate-gies, such as attending counseling or going to lengths to piece together evidence that may pointto the reasons for the suicide, but still longed for answers. One participant who lost his twinfound that speaking to the coroner and a detective provided him with additional informationregarding his brother’s death, which he said helped, yet he was still “continuing to work on”coming to terms with his brother’s death (21:3–4). One participant sought information followingher brother’s suicide, but found that “there’s not a lot of information for siblings out there, kindof the forgotten link, you know?” Unlike sibling survivors of suicide who had low uncertaintybecause they had accepted they would never be able to understand certain aspects of their sib-ling’s death, participants with fluctuating uncertainty longed to learn more and felt unresolved intheir uncertainty.

Most participants in this category could envision a time when they would feel peace or accep-tance regarding their sibling’s death, but usually felt that certain conditions had to be met first.These conditions usually involved reducing uncertainty surrounding the death and waiting fortime to heal. A participant who lost her brother two months before the interview actively engagedin suicide awareness and prevention, activities that she felt were helpful in reducing her uncer-tainty, yet she had a lot of questions about her brother’s mindset. She knew about his experienceswith depression and drug withdrawal, but she still felt that “he always had reasons to live.” Shesaid that, “My guess is he was just in a lot of pain and he kind of impulsively acted. Of courseI wonder kind of what pushed him to that point. I wonder if his care had been different if thingswould have been different” (44:2). She said that these questions, in addition to the short timesince his death, kept her from being at peace with her brother’s death, but she expressed, “I thinkI’ll continue to make peace with it, and at the same time I think there’ll always be some partsthat don’t . . . but more and more you know I think I will” (44:5). Another participant explained,“there’s not a set amount of time it takes somebody to heal . . . when somebody loses a familymember to suicide.” Although she’d had people suggest that she should “be over it,” she said,“Well no, I don’t have to be over it . . . I don’t have to respond the way that somebody wantsme to” (13:4). With time and support, these participants felt that they could eventually spend lesstime lingering on their loss and uncertainty regarding their sibling’s death.

High uncertainty and perpetual loss: A need for closure and information

Eleven participants (or 24%) continued to experience high levels of uncertainty and lack ofclosure following the loss of a sibling to suicide. The time since the death of their sibling ranged

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from four months to eight years, with an average of 2.4 years. Some participants with high lev-els of uncertainty felt that they knew their sibling very well and never thought they would endtheir life. Though he knew that his brother was struggling with alcoholism and difficult emotionsfollowing a military deployment, one participant said that he couldn’t make peace with the deathbecause “I can’t understand why he did what he did and until I understand why I can’t makepeace with it” (2:5). Another participant stated, “Knowing my family history, my dad leaving,was something she could never forgive . . . She and I talked about that our entire lives, so for herto leave her children [by suicide] still boggles my mind” (3:2). Participants who felt very closeto their siblings were shocked to find that they would choose to end their life. One participantsummarized this sentiment: “I just still can’t believe he would be the type of person that woulddo something like that” (7:3).

Participants in this category sometimes felt there had been no warning signs, such as depres-sion or dramatic life changes. One participant still could not find any potential answers, even afterreading toxicology reports, attending counseling, and speaking with officers who had respondedto the scene. She said, “Nobody had any idea. He had never dealt with depression. There were nofinancial issues. Nobody really knows what was in his head that day” (4:2). Another participantwho knew that her brother was having marital and financial problems expressed that, “Nobodyunderstood the depths of what was going on” so his death still elicited feelings of “shock anddisbelief” (40:2). Because they felt that there had been no previous thoughts of suicide, theseparticipants described unresolved anger that lasted beyond the initial shock of losing a loved oneunexpectedly.

Most participants in this category expressed a profound desire to ask their sibling “why.”Questions lingered about what the tipping point may have been, why they did not reach outto loved ones for assistance with their feelings, what had been going wrong in their lives, etc.Participants understood that these questions may never have a concrete answer as they can neverask their deceased sibling. One participant stated, “I went through the why, why, why, but I thinkother than actually talking to her and asking her, I don’t have any more questions that could beanswered” (3:2). Because they never suspected that their siblings were suicidal, there may nothave been any noticeable warning signs, and there may never be a concrete answer to lingeringquestions, participants in this category were left with high levels of uncertainty and a feeling ofperpetual loss.

How do survivors of sibling suicide communicatively manage their uncertainty and loss?

Whether participants experienced low, fluctuating, or high levels of uncertainty, all implementeduncertainty management strategies. In order to manage the uncertainties that surfaced as theyexperienced grief, participants relied on various communicative strategies. Three primary cate-gories of uncertainty management strategies surfaced in the data: (a) avoiding information, (b)gathering information, and (c) social support.

Avoiding information

Though the majority of participants were working to reduce uncertainty, a few were attemptingto maintain their uncertainty because they had appraised their uncertainty level as acceptable. For

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example, one participant had experienced depression herself, and stated that “psychologicallyand physiologically I’ve been in his shoes and I understand that deep depression.” Because ofthis, she chose not to read her brother’s suicide note and said, “I know everything I want toknow” (12:2). Another participant found learning more about her sibling’s death had been ahurtful experience. She said, “Sometimes finding out things isn’t that great, like I read some ofmy brother’s journals that hurt my feelings” (37:3). As such, she chose not to read any furtherand to maintain her uncertainty. A third participant was upset when she learned that her brotherhad tried to get medical help in dealing with his mental illness but was unable to receive financialassistance for treatment (28:3), so she chose to stop investigating his death for fear of discoveringmore disturbing information. In these cases, the effects, or potential effects, of learning moreabout the death of their sibling were not perceived as helpful in the grief process, so maintaininga state of uncertainty by not seeking out further information and avoiding discussions with peoplethat may provide more information were key in maintaining a desirable level of uncertainty aboutthe suicide.

Gathering information

Those participants with initial high uncertainty employed a variety of information gatheringtechniques to reduce their uncertainty. They sought information about the particular act of suicideby their sibling as well as educating themselves and others on suicide generally.

Seeking information about the suicide

Some survivors read suicide notes or pieced together the thought process and actions of theirsibling as ways to gather information about the act, thereby reducing their uncertainty. Readingcoroner’s reports, police reports, toxicology reports, speaking with those close to their sibling,looking at receipts or other documents, and visiting the scene of the death were all reported asinformation-gathering strategies. A participant who lost her twin regarded gathering informationas a double-edged sword: “I got the information I wanted,” she said, “but with the informationcomes the pain of knowing, without it comes the pain of not knowing.” Ultimately, however,she concluded that digging for information “was what I needed to do. It’s not what other peopleneed to do but it’s who I am, even if it makes it more hard for me” (20:2). Participants said thatthese strategies were “helpful” (33:3, 12:3) and were “part of processing what happened” (16:2).Suicide, by nature, is full of uncertainties because most often the victim is the only one presentat the act. As such, trying to piece together what exactly happened is important information forsome survivors who appraise their uncertainty as negative. They gather information in an attemptto understand why the suicide happened, which is key for managing their grief and reducing theiruncertainty.

Seeking and disseminating information about suicide

Many participants reported that educating themselves and others about suicide was a posi-tive uncertainty management mechanism, which also provided important social support. Theysometimes became support group facilitators, learned about suicide through online resources or

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books, and/or participated in walks to raise money and awareness for suicide prevention. For oneparticipant, education was a positive way to deal with the loss of her brother:

Several years after he died I started working in the suicide prevention and after care field and startedworking for a crisis line and support groups for others who had lost someone to suicide. And I try toexplain to people about mental illness and seeking help, so that’s the only positive thing I can thinkthat came out of his death is the help I have provided to other people based on my experience. (36:4)

These participants felt that educating oneself and others about suicide proved to be an effectiveway to manage uncertainty, as well as a way to deal with their loss.

Social support

As Brashers (2007) has written, social support can be an important uncertainty managementstrategy. In the case of suicide survivors it proved key for many survivors in managing theiruncertainty, particularly because the grief of a sibling due to suicide is frequently overlooked ordownplayed in relation to the loss felt by the parents. This support came in the form of supportgroups, friends and family.

Connecting with other survivors of suicide

All of the survivors had reached out to other survivors of suicide via the Internet or throughface-to-face support groups. Connecting with other suicide survivors via online support groups“gave me a purpose,” said one participant who lost her brother five years ago (11:3). “I knew thatI couldn’t just go on being a sister who lost her brother and best friend to suicide. I had to dosomething positive about it or it was going to take the best of me away. Once I found out aboutthe overnight walk I really wanted to do that for my brother and do something positive,” she said(11:3). For some participants, these venues also provided a connection to other survivors, whichmade this particular participant “realize that these families [who have also survived a suicide]look just as normal as our family and it can happen to anybody. They don’t have to be messedup” (11:3). This type of support served to “normalize” (Scott, Martin, Stone, & Brashers, 2011),what is seen as a very abnormal situation by society. This normalizing function was interpreted byparticipants as integral to their healing from the loss. Receiving support from the suicide survivorcommunity and giving purpose by reaching out to other survivors was an important uncertaintymanagement strategy.

Communicating positive memories

Many participants chose to manage their grief by remembering their sibling and continuingto talk about their life, not only the negative circumstances surrounding their death. Participantsreported sharing funny stories about their sibling with friends and family, remembering the thingsthey would have liked to do, and honoring their life by focusing on good memories. These mem-ories ranged from the commonplace, such as remembering receiving “dorky souvenirs” from thesibling’s travels (10:5), to the more adventurous, like the participant who chose to rememberhis sister by going kayaking, one of her favorite activities (23:7). When asked whether she feltdifferently about her brother now versus when he was still living, one participant explained that

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“even though he was depressed for most of his life, those core values . . . I’ve never witnessedsomebody in life or death that has had that much strength and loyalty” (25:9). Similarly, anotherparticipant discussed how she did not like to dwell on her sister’s death, but rather on the positivethings she did in life “to remind us who she was; not who she died being.” She stated that hersister’s suicide was the “legacy she left,” but when she discussed her sister with others she would“really think of who she was and not talk too much about her actual decision to end her life . . .

because that’s not who she was” (3:4). By remembering the positives of their sibling with familyand friends, survivors were able to shift the focus from the death to the life of their sibling andbetter manage the lingering uncertainties.

Relief of blame

Regardless of the level of uncertainty surrounding the death, many participants sought to reas-sure themself, parents, and others who knew the deceased that they are not to blame for thesuicide. This form of social support was essential for participants to move beyond initial stages ofgrief to begin managing their loss. One participant who had spoken with her brother and encour-aged him the night before he died said that, “I know he knew I meant that and I loved him andwas always here for him and I know that’s all I could do to make a difference” (24:3). Anotherparticipant gained a deeper understanding of depression after her brother’s death, which helpedher to realize that a mental illness, not her own actions, was the cause of his suicide. Upon learn-ing this, she encouraged her father to seek treatment for his depression and sought professionalhelp in managing her own grief as well (29:4).

Participants reported talking with friends, family, and other suicide survivors to better under-stand their deceased sibling and to check with each other to be sure they didn’t miss any “signs”that could have prevented the suicide. Participants acknowledged that there were circumstancesbeyond their control and their parents’ control that may have contributed to the suicide, therebyreducing their self-blame and allowing them to reduce their uncertainty. By implementing theseuncertainty management strategies of avoiding information, gathering information and/or seek-ing social support, participants were able to manage the uncertainty of their sibling’s suicide andcontinue processing their loss.

DISCUSSION

This study of sibling survivors of suicide lends insight to grief processes and strategies to managethem in an often overlooked and understudied group. Specifically, it extends the understandingof suicide and grief processes through the use of uncertainty management theory (Brashers et al.,2000), providing insight to the contextual and relational dilemmas that complicate uncertaintyand loss and make some management strategies more effective than others. To understand howindividuals manage the unknowns of suicide, we sought to examine the meaning of uncertaintyacross individuals and the way in which it was managed.

In regards to RQ1 this study found that sibling survivors of suicide experience a wide range ofgrief processes that are complicated by uncertainty, which is consistent with previous studies onloss. For example, Powell & Afifi (2005) found that adult adoptees dealing with unknown birthparents also experienced varying degrees of loss based in part on the amount of information they

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had on their birth parent. However, unlike adult adoptees, for suicide survivors traditional griefstages of shock and denial are complicated by intense feelings of blame and uncertainty due tothe sudden nature of the act. In the context of suicide, loss and uncertainty are intertwined andinseparable. Uncertainty about why their sibling chose to die by suicide, how it was done, whatwas the “last straw” led to lingering uncertainty that complicated the grief process leaving manysurvivors in a state of uncertainty looking for cause and someone or something to blame for thesuicide.

Although some participants reported reaching a level of acceptance, or peace with their sib-ling’s suicide, consistent with UMT, there were frequent lingering uncertainties they had tomanage. As Brashers et al. (2000) proposed, uncertainty is an ongoing feature of a person’scircumstances they must learn to manage, yet how individuals manage their uncertainty is basedin part on their family members’ social support, as well as their own appraisal of the uncertaintyand loss. This is consistent with our findings in that survivor appraisal of their uncertainty andloss varied greatly depending on the level of social support they received or sought from othersurvivors, family and friends.

Studying communication within the specific context of suicide survivors adds to the litera-ture on uncertainty management strategies. Regarding RQ2, we found that survivors of siblingsuicide were actively attempting to manage their uncertainty and loss primarily through informa-tion, which includes avoiding information about the suicide or conversely, gathering informationabout the suicide, and educating themselves and others on suicide generally. Survivors were alsoseeking out social support by reassuring parents and others they were not to blame for the sui-cide, and emphasizing the present and future instead of dwelling on the past. Even though inmost circumstances when uncertainty was high the siblings attempted to engage in uncertaintyreduction efforts, the results of this study question the covering law perspective of URT (Berger& Calabrese, 1975) that people are always motivated to reduce their uncertainty.

There are situations in which “ignorance is bliss” (Afifi & Burgoon, 1998; Powell & Afifi,2005). The siblings who chose to maintain their current level of uncertainty did so for fearof upsetting their parent or discovering something could have been done to stop the suicide.Uncertainty was not necessarily something that was desired, but something that was maintained,endured, or reduced. Yet, for some siblings the anxiety that resulted from the discrepancy betweenthe known and unknown became too intense to manage, which resulted in more active informa-tion seeking and social support strategies. When the loss was at its greatest immediately followingthe suicide, participants chose to seek information to reduce their uncertainty, while only a fewrationalized there was no amount of information that could answer the “why” question or bringthe sibling back.

Though not included in our results as an active uncertainty management strategy, it was inter-esting to learn that time served as an implicit uncertainty management technique that played animportant role in dealing with the loss as well as in reducing uncertainty. As time passed, thedesire to answer questions about the suicide seemed to lessen, thus reducing the overall feelingsof uncertainty. For some, time seemed to lessen the salience of their feelings of loss and thus theirappraisal of the uncertainty went from negative to neutral or acceptable; for others, time becameproof that there is some information they will never have regarding the suicide, so they mustaccept the lingering uncertainties. Though we would not argue that “time heals all wounds”, thisstudy does seem to suggest that time has an effect on salience of loss and corresponding appraisalof uncertainty.

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Though several scholars have illuminated uncertainty management strategies (Brashers, 2001;Brashers, Goldsmith, & Hsieh, 2002; Brashers, Neidig, Haas, Dobbs, Cardillo, & Russell, 2000),this study of sibling survivors of suicide has added to the growing list of uncertainty managementtechniques in the context of loss in terms of time as an implicit uncertainty management tech-nique, and specific forms of social support in the forms of seeking reassurance to absolve blame,remembering the lost sibling frequently in positive terms to recast the negative event that causedthe uncertainty, and normalizing the experience of a suicide survivor. Specifically, this researchsupports the findings of Scott, Martin, Stone, & Brashers (2011) when studying organ transplantpatients that social support from peers is a form of uncertainty management in that they can befirsthand sources of information and can “normalize” the experience of a transplant, or in the caseof this study, of a suicide.

For sibling survivors, “normalizing” the experience as compared to societal judgments onsuicide or reframing the sibling who died as a victim not a criminal was an important toolfor managing survivor uncertainty about the suicide and its meaning. Sibling suicide survivorsreceived validation from other survivors online and in support groups. All of the managementtechniques revealed in this study resulted in sibling survivors of suicide in this study striving foran acceptable level of uncertainty (Bradac, 2001).

In understanding the uncertainty management strategies of suicide survivors, this studystresses the importance of practitioners and family members to managing uncertainty and grief(Miller-Havens, 1996; Peluso, 2002). Dyregrov & Dyregrov (2005), in their study of adoles-cent suicide survivors in Norway, found a great need for help for survivors, particularly siblingswho are often overlooked because of the focus on parents who undergo the most obvious loss.Participants in this study echoed this need given that society and their parents tended to over-look or minimize their loss, and focus instead on the parents’ loss of a child. As one participantstated: “People always want to know how the parents are doing . . . and the immediate reac-tion of the surviving siblings is to be supportive to your parents because it’s so out of characterto see them falling apart like that” (36:5). Though the family dynamics and communication aregreatly affected by a suicide and cause great stress and pain to sibling survivors, they are typicallyoverlooked in the bereavement process.

Perhaps most useful to practitioners and sibling survivors is a focus on open communicationabout the suicide. Open communication regarding feelings and lowering expectations of oneselfare key to bereavement and social support after a suicide (Jaques, 2000). However, Demi andHowell (1991) found that often the need to hide the pain, from society or a bereaved parent,interfered with healing the pain. If the grief remains unresolved into adulthood, well-being isaffected. As one participant shared, when others find out her sibling died by suicide their “jawdrops and they don’t want to hear it any more.”

This stigma and silencing in society regarding suicide can be counteracted by more opennessregarding suicide, and especially by open communication within the family regarding the sui-cide and social support between survivors. Juhnke & Shoffner (1998) tested a Family DebriefingModel that focuses on mutual discussion of perceptions and feelings regarding suicide and hasbeen shown to reduce anger, anxiety, blame, and guilt while realizing the importance of familydiscussions of a suicide. Participants in this study who could openly talk with surviving siblingsand/or parents about their lost sibling tended to reach a manageable level of uncertainty morequickly than those who could not.

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In light of the practical and theoretical contributions of this study, limitations must also bementioned. The majority of the respondents in this study were female and white having losta brother to suicide, which may have privileged their experiences in the findings, though themajority of suicide victims in the United States are White and male (World Health Organization,2011). Also, individuals who responded to our request for participants were seeking support fortheir loss, indicating they were processing the grief. It would be telling to see how those notseeking support to deal with their grief were managing their uncertainty, though recruitment ofparticipants would be difficult and very sensitive.

This study is one of very few attempting to understand the unique grieving processes of siblingsurvivors of suicide, an area that needs more study. A longitudinal study of the grieving process todetermine more specifically how time affects grieving and uncertainty would lend understandingto the effects of time on suicide bereavement. Also, a future study could investigate the role ofgender in suicide and grief. Most of the respondents in this study were sisters who lost a brotherand reported mothers displaying grief more visually than fathers. Societal expectations of genderand grieving may affect suicide grief management processes.

With the number of suicides increasing every year, and thus a growing population of siblingsurvivors, there is a need to understand the levels of grief complicated by the uncertainty theyexperience. This study provides additional evidence of the extent and range of loss, uncertainty,and uncertainty management experienced by sibling survivors of suicide, as well as the impor-tance of acknowledging the grief siblings experience at the loss of a sibling to suicide, and theimportance of open communication about suicide as an important tool for managing grief.

ACKNOWLEDGMENTS

This research was funded by a Luther College Undergraduate Research Grant and an ICF/

McElroy Faculty/Student Research Grant. The authors would like to thank the sibling survivorsof suicide who participated in this project for their assistance with this research.

REFERENCES

Afifi, W. A., & Burgoon, J. K. (1998). “We never talk about that”: A comparison of cross-sex friendships and datingfriendships on uncertainty and topic avoidance. Personal Relationships, 5, 255–272.

Archer, J. (1999). The nature of grief: The evolution and psychology of reactions to loss. New York, NY: Routledge.Attig, T. (1996). How we grieve: Relearning the world. New York, NY: Oxford.Attig, T. (2001). Relearning the world: Making and finding meanings. In R. A. Neimeyer (Ed.), Meaning reconstruction

and the experience of loss (pp. 33–54). Washington, DC: American Psychological Association.Babrow, A. S. (2001). Uncertainty, value, communication, and problematic integration. Journal of Communication, 51,

553–574.Babrow, A. S., Hines, S. C., & Kasch, C. R. (2000). Managing uncertainty in illness situation: An application of problem-

atic integration theory. In B. Whaley (Ed.) Explaining Illness: Research, Theory and Strategies (pp. 41–67). Hillsdale,NJ: Lawrence Erlbaum Associates.

Bank, S., & Kahn, M. D. (1975). Sisterhood-brotherhood is powerful: Sibling sub-systems and Family therapy. FamilyProcess, 14, 311–337.

Baxter, L., Braithwaite, D., Golish, T. D., & Olson, L. (2002). Contradictions of Interaction for Wives of Elderly Husbandswith Adult Dementia. Journal of Applied Communication Research, 30, 1–26.

Baxter, L. A., & Montgomery, B. M. (1996). Relating: Dialogues & dialectics. New York, NY: Guilford.

Dow

nloa

ded

by [

Uni

vers

ity o

f U

tah]

at 0

7:48

02

Dec

embe

r 20

14


Berger, C. R., & Calabrese, R. J. (1975). Some explorations in initial interaction and beyond: Toward a developmentaltheory of interpersonal communication. Human Communication Research, 1, 99–112.

Bonanno, G. A. (2001). New direction in bereavement research and theory. American Behavioral Scientist, 44, 718–726.Bonanno, G. A., & Field, N. P. (2001). Examining the delayed grief hypothesis across 5 years of bereavement. American

Behavioral Scientist, 44, 798–817.Bradac, J. J. (2001). Theory comparison: Uncertainty reduction, problematic integration, uncertainty management, and

other curious constructs. Journal of Communication, 51, 456–476.Brashers, D. E. (2001). Communication and uncertainty management. Journal of Communication, 51, 477–498.Brashers, D. E. (2007). A theory of communication and uncertainty management. In B. Whaley & W. Samter (Eds.),

Explaining communication (pp. 201–218). Mahwah, NJ: Lawrence Erlbaum Associates.Brashers, D. E., Goldsmith, D. J., & Hsieh, E. (2002). Information seeking and avoiding in health contexts. Human

Communication Research, 28, 243–258.Brashers, D. E., Neidig, J. L., Haas, S. M., Dobbs, L. K., Cardillo, L. W., & Russell, J. A. (2000). Communication in the

management of uncertainty: The case of persons living with HIV or AIDS. Communication Monographs, 67, 63–84.Brent, D. A., Perper, J. A., Moritz, G., Liotus, L., Schweebs, J., Roth, C., et al. (1993). Psychiatric impact of the loss of

an adolescent sibling to suicide. Journal of Affective Disorders, 28, 249–256.Brent, D. A., Moritz, G., Breidge, J., Perper, J., & Canossio, R. (1996). The impact of adolescent suicide on siblings and

parents: A longitudinal follow-up. Suicide and Life-Threatening Behavior, 26, 253–259.Callahan, J. (2000). Predictors and correlates of bereavement in suicide support group participants. Suicide &

Life-Threatening Behavior, 30(2), 104. Academic Search Complete, EBSCOhost (accessed June 1, 2011).Caplan, G., Mason, E. A., & Kaplan, D. M. (2000). Four studies of crisis in parents of prematures. CommunityMental

Health Journal, 36, 25–45.Carr, R. B. (2011). When a soldier commits suicide in Iraq: Impact on unit and caregivers. Psychiatry: Interpersonal &

Biological Processes, 74(2), 95–106. doi:10.1521/psyc.2011.74.2.95Chapple, A., & Ziebland, S. (2011). How the Internet is changing the experience of bereavement by suicide: A qualitative

study in the UK. Health: An Interdisciplinary Journal for the Social Study of Health, Illness & Medicine, 15(2),173–187. doi:10.1177/1363459309360792

Creswell, J. W. (1994). Research design: Qualitative & quantitative approaches. Thousand Oaks, CA: Sage.Creswell, J. W. (1998). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks, CA:

Sage.Davis, C. G., Lehman, D. R., Wortman, C. B., Silver, R. C., & Thomson, S. C. (1995). The undoing of traumatic life

events. Personality and Social Psychology Bulletin, 21, 109–124.Davis, C. G., & Nolen-Hoeksema, S. (2001). Loss and meaning: How do people make sense of loss? American Behavioral

Scientist, 44, 726–741.Demi, A. S., & Howell, C. (1991). Hiding and healing: Resolving the suicide of a parent or sibling. Archives of Psychiatric

Nursing, 5(6), 350–356.Denzin, N. K., & Lincoln, Y. S. (2000). Introduction: The discipline and practice of qualitative research. In N. K. Denzin

& Y. S. Lincoln (Eds), Handbook of qualitative research (2nd ed) (pp. 1–30). Thousand Oaks, CA: Sage.Dyregrov, K., & Dyregrov, A. (2005). Siblings after suicide: The “forgotten bereaved.” Suicide and Life-Threatening

behavior, 35(6), 714–724.Feigelman, W., Gorman, B. S., & Jordan, J. R. (2009). Stigmatization and suicide bereavement. Death Studies, 33(7),

591–608. doi:10.1080/07481180902979973Goldsmith, D. J. (1992). Managing conflicting goals in supportive interaction: An integrative theoretical framework.

Communication Research, 19, 264–286.Goldsmith, D. J. (2001). A normative approach to the study of uncertainty and communication. Journal of

Communication, 51, 514–533.Goldsmith, D. J., & Fitch, K. (1997). The normative context of advice as social support. Human Communication Research,

23, 454–476.Gubrium, J. F., & Holstein, J. A. (2000). Analyzing interpretive practice. In N. K. Denzin & Y. S. Lincoln (Eds.),

Handbook of qualitative research (2nd ed.) (pp. 1–30). Thousand Oaks, CA: Sage.Hung, N. C., & Rabin, L. A. (2009). Comprehending childhood bereavement by parental suicide: A critical review of

research on outcomes, grief processes, and interventions. Death Studies, 33(9), 781–814. doi:10.1080/07481180903142357

Dow

nloa

ded

by [

Uni

vers

ity o

f U

tah]

at 0

7:48

02

Dec

embe

r 20

14


Jaques, J. D. (2000). Surviving suicide: The impact on the family. The Family Journal: Counseling and Therapy forCouples and Families 8(4), 376–379.

Juhnke, G. A., & Shoffner, M. F. (1998). The family debriefing model: An adapted critical incident stress debriefing forparents and older sibling suicide survivors. The Family Journal: Counseling and Therapy for Couples and Families,7(4), 342–348.

Klass, D. (2001). Continuing bonds in the resolution of grief in Japan and North America. American Behavioral Scientist,44, 742–763.

Klass, D., Silverman, P. R., & Nickman, S. L. (1996). Continuing bonds: New understandings of grief . Washington, DC:Taylor & Francis.

Kvale, S. (1996). InterViews: An introduction to qualitative research interviewing. Thousand Oaks, CA: Sage.Leininger, M. (1994). Evaluation criteria and critique of qualitative research studies. In J. M. Morse (Ed.), Critical issues

in qualitative research methods (pp. 95–115). Thousand Oaks, CA: Sage.Linn-Gust, M. (2001). Do they have bad days in heaven?: Surviving the suicide loss of a sibling. Albuquerque, NM:

Chellehead Works.Linn-Gust, M. (2010). Rocky roads: The journeys of families through suicide grief . Albuquerque, NM: Chellehead Works.McIntosh, J. L. (for the American Association of Suicidology) (2009). U.S.A. suicide 2006: Official final data.

Washington, DC: American Association of Suicidology, dated April 19, 2009, downloaded from http://www.suicidology.org.

McIntosh, J. L., & Wrobleski, A. (1988) Grief reactions among suicide survivors: An exploratory comparison ofrelationships. Death Studies, 12, 21–39.

Miller-Havens, S. (1996). Grief and the birth origin fantasies of adopted women. In D. Klass, P. H. Silverman, & S. L.Nickman (Eds.), Continuing bonds: New understandings of grief (pp. 273–294). Washington, DC: Taylor & Francis.

Miller, S. M., & Mangan, C. E. (1983). Interacting effects of information and coping style in adapting to gynecologicstress: Should the doctor tell all? Journal of Personality and Social Psychology, 45, 223–236.

Mitchell, A. M., Kim, Y., Prigerson, H. G., & Mortimer, M. K. (2005). Complicated grief and suicidal ideation in adultsurvivors of suicide. Suicide and Life-Threatening Behavior, 35, 498–506. doi: 10.1521/suli.2005.35.5.498

Myers, M. F., & Fine, C. (2007). Touched by suicide: Bridging the perspectives of survivors and clinicians. Suicide &Life-Threatening Behavior, 37(2), 119–126. Retrieved from EBSCOhost.

Nolen-Hoeksema, S., & Larson, J. (1999). Coping with loss. Mahwah, NJ: Lawrence Erlbaum Associates.Parkes, C. N. (1986). Bereavement: Studies of grief in adult life (2nd ed.). London and New York: Tavistock.Peluso, P. R. (2002). Counseling families affected by suicide: An interview with Iris Bolton. The Family Journal:

Counseling and Therapy for Couples and Families, 10(3), 351–357.Powell, K. A., & Afifi, T. D. (2005). Uncertainty management and adoptees’ ambiguous loss of their birth parents. Journal

of Social and Personal Relationships, 22, 129–151.Rosenbloom, C. A., & Whittington, F. J. (1993). The effects of bereavement on eating behaviors and nutrient intakes in

elderly widowed persons. Journal of Gerontology, 48, S233–S229.Runeson, B., & Asberg, M. (2003). Family history of suicide among suicide victims. American Journal of Psychiatry,

160(8), 1525–1526.Sanders, C. M. (1989). Grief: The mourning after. New York: John Wiley & Sons.Scott, A. M., Martin, S. C., Stone, A. M., & Brashers, D. E. (2011). Managing multiple goals in supportive interactions:

Using a normative theoretical approach to explain social support as uncertainty management for organ transplantpatients. Health Communication, 26(5), 392–403.

Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. NewburyPark, CA: Sage.

Stroebe, M. (2001). Bereavement research and theory: Retrospective and prospective. American Behavioral Scientist, 44,854–865.

Valente, S. M., Saunders, J., & Street, R. (1988). Adolescent bereavement following suicide: An examination of relevantliterature. Journal of Counseling & Development, 67(3), 174. Retrieved from EBSCOhost.

World Health Organization. (2011). Suicide prevention. Retrieved from http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ on July 23, 2011.

Wortman, C. B., & Silver, R. C. (1989). The myths of coping with loss. Journal of Consulting and Clinical Psychology,57, 349–357.

Wortman, C. B., & Silver, R. C. (2001). The myths of coping with loss revisited. In M. S. Stroebe, R. O. Hansson,W. Stroebe, and H. Schut (Eds.), Handbook of bereavement research: Consequences, coping, and care, (pp. 47–62).Washington, DC: American Psychological Association.

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