The sample included five family members of senior people who had committed suicide. The participants were sons, daughters or siblings of an older person who has committed suicide. Participants included three females and two males. Among them, two participants were unemployed without income and three participants were farmers with low incomes. All people had no religious beliefs.
Three themes have been identified and grouped: 1. Initial reactions; 2. Continual effects; 3. Social attitude.
Theme one: initial reactions
This theme reflects the initial reactions of the participants and their perceived experiences of grief. Words such as "heartbroken", "sad" and "unbelievable" were frequently used by the participants. Some participants expressed that they also had suicidal thoughts after their family members committed suicide. For example, participant Zhao says:
“I didn’t want to work. An important people in my life had been lost due to suicide and I wanted to go with her.” (Zhao)
Participant Cao has had a same feeling and similar thoughts (suicide) after her father committed suicide, she says:
“I felt that we (children) were very useless. We didn’t take care of our father well. If we had done so, he might not have died. I wanted to commit suicide too.” (Cao)
After the older family members committed suicide, family members will initially have emotional reactions. The degree of reaction is related to how close the relationship was with the suicidal person. In this study, participants have not only expressed thoughts of suicide (luckily, both the participants hadn’t been planning for their death), but also experienced the psychological effects and expressed their feelings of heartbreak, grief and sadness. Hu described her miserable feelings after her mother committed a suicide.
" When I learnt that she had committed suicide, I was broken, I couldn't accept it, I felt panicked, I was very sad, tears streamed down my face." (Hu)
Another participant, Li says:
“Oops (dialect for shock), it made me tremble and shocked, I felt very sad. I felt restless every day. I didn’t know what I was doing.” (Li)
Stress caused by bereavement can increase the likelihood of onset or worsening of one’s physical or mental disorders. In addition, the medical and economic levels are more likely to be underdeveloped in rural areas, people living in such areas often ignore bereavement caused by suicide and worsen the condition; they hardly seek medical support. For example,
“My son was ill. After the incident, my son was very sad and his condition worsened. He laid in bed all day...” (Cao)
Similarly, Zhao says:
“This incident caused the child's mental illness to relapse.” (Zhao)
This shows that it is very important for the government and relevant departments to consider the impacts on the family members of the senior people who have committed suicide in rural areas.
The suicide of the older person could cause their family members to feel guilty as well.
“I regretted that I was busy with work every day and did not take good care of my mother. If I took good care of my mother, she would not commit suicide.” (Hu)
Similarly, Zhang says:
“I really am a useless person (crying), I didn't have the ability to take care of her when she was alive, due to the hardship of our life. If my mother did not commit suicide, now that the living conditions are getting better, she would have had a better life… so I always feel very guilty.” (Zhang)
In rural China, where economic, social and cultural changes happen rapidly, young people leave to work and earn money to support their families and may not have time to take care of the older people. This causes the family members to perceive a feeling of regret after the older people have committed suicide, and they blame themselves for causing their loved ones’ suicide.
Theme two: continual effects
Continual effects described by the participants were more associated with long-term psychological impacts after their loved one committed suicide. It is more likely to include continual bereavement, worry and stress, and difficulties with life arrangements after the event.
According to Hu, the suicide of her mother has caused continual bereavement which has been lasting for many years. She says:
"Until now, when I wear the cloth shoes and embroidered insoles she made for me, I will think of her, and I feel very sad and want to cry."(Hu)
Another participant, Zhang says:
“When I see other people’s mothers, I think of my mother, and I can’t help crying and I’m sad.” (Zhang)
These continual psychological impacts have been present with most of the family members. In addition, the suicides of the elders brought huge financial pressure to the family due to the funeral costs. All participants worried and stressed about the financial issues. For example, both participants Cao and Zhao experienced the burden of funeral costs.
“I was worried about how to handle the funeral of my father, because the economy was relatively difficult, and the economic pressure in all aspects of burying my father was very high. Where should the funds come from?” (Cao)
“I’m worried about how my sister’s family lives, the family is very poor with no money, how can they afford to bury my sister?” (Zhao)
In traditional Chinese culture, a more decent and costly funeral not only represents the family’s reputation, but also means that more respect is being paid for towards their loved one who passed away. Therefore, most participants expressed that they were worried about funeral costs. Consequently, this has become a psychological burden for most participants. Especially, in rural China, most of the household incomes comes from their field work and odd jobs, this extra cost has made a life-long impact on the participants and their families. The government should consider changing the cultural norm of holding an expensive funeral ceremony and supporting low-income families with funeral costs.
Furthermore, there is a specific custom in the countryside about suicide: if an older female person has committed suicide, the family needs to report the tragedy to the person’s maiden family (the woman’s family before she was married). When the person’s maiden family hear the news, they will become angry and perceive the suicide as the older person’s children’s fault, and they are more likely to ask for an expensive and decent funeral. There would be a conflict between the older female’s maiden family and her married family if a deal cannot be made. Thus, the family is very worried and upset about this situation. This has not only caused lifelong pain to family members, but also led to a financial burden to the family. It is more likely to cause large amounts of debt for the family members. Zhang says:
“My brother and I are very scared. Hearing my father telling me how to report the funeral to my uncle's house, I still feel very scared and stressed when I think about it.” (Zhang)
Similarly, another participant Cao says:
“My brother went to report the funeral. My uncle was very angry, he was out of control. I can still recall the scene now, I was very afraid.” (Cao)
Except from the financial burden after the funeral expense, suicide of a loved one not only causes long-lasting psychological impacts on most of the participants, but also effects the future living arrangements for the family members as well as the quality of their life.
“After my mother passed away, no one took care of my children. I can no longer go out to work and earn money. Life is very difficult.” (Hu)
“When I came back home, no one would cook for me. My family is in bad financial condition and no one gave me money to support my education, so I stopped studying.” (Zhang)
In China, a reciprocal family relationship is a strong link for family members to support each other, especially between the older and younger generations. For example, it is more common in the rural areas for the grandparents to look after their grandchildren while their adult children go to work to earn the household income for the whole extended family. Apart from the miserable feelings brought on by the suicide, it can also be a financial disaster for the whole family due to the breakdown of the reciprocal family relationship. It is suggested that the local support services should be available to support these families and intervene with the funeral arrangements and related issues.
As for the long-term psychological effects, time has helped heal participants. Participant Hu says:
“It had already happened, and we must face it. I know that recovering will take a long time, and as time goes by, I would be better.” (Hu)
Another participant Zhao says:
“I thought about it, the dead cannot be resurrected. After a period of time, I will gradually recover.” (Zhao)
In the study, some family members gradually overcome the suicide of their loved one, though there is still hardship. Health professionals should be taking steps to support them.
Theme three: Social attitude
This theme illustrates the attitude of the public and society towards the families of the older people who have committed suicide, and how it creates a sense of social stigma and isolation. In Chinese traditional culture, it is shameful and indecent if an older family member commits suicide. In the eyes of others, it means that the children did not treat the older person well. This brought not only tremendous psychological pressure to the family, but also seriously affected the family’s reputation. In this study, participants felt frustrated by villagers’ gossip. For example,
“I went out in the village, the villagers gossip that my mother died by drinking pesticide, I felt frustrated and I thought that it was disgraceful.” (Zhang)
Similarly, Cao says:
“As a family member, my father's suicide made me ‘lose face’ in front of villagers. The villagers misunderstood me and said that I didn’t respect my father, which caused him to commit suicide. Villagers in the village would laugh at me and say that I didn’t even take care of my father, which had a great impact on my personal pride”. (Cao)
In rural areas where the economy and technology are underdeveloped, people gossip at the door as a means of entertainment. After the elders committed suicide, the villagers often gossiped about the suicide event as an indecent thing and blame the family as the cause of the suicide. Participant Hu perceived discrimination as well as feeling ashamed. She says:
“The neighbors said that if we took good care of her, she would not commit suicide. It is the lack of attentive care that leads my mother to suicide”. (Hu)
Similarly, Li says:
“The villagers said that I was not filial to my mother which is the reason why she committed suicide. My children and grandchildren felt that they have lost face in the village. What can I do? I feel very ashamed now.” (Li)
These excerpts illustrated the negative social attitudes and stigma presented in the study associated with the suicide event in a traditional, specific, cultural setting. People mistakenly believed that the elder committed suicide because their family members were not filial to the older person or did not take good care of them. In this matter, the family perceived the experience of shame and helplessness. The phase ‘what can I do?’ has shown the participant’s vulnerability to this stigmatizing label and situation. More importantly, it had serious impacts on her long-term mental health and quality of life. This suggests that the local government, health professionals and policy makers should think about suicide preventions and interventions in rural areas, as well as reconsidering the social perceptions of suicide.