Response to: Media depictions of possible suicide contagion among celebrities: A cause for concern and potential opportunities for prevention – The role of grief

To the Editor

Sinyor et al. (2019) discuss suicide contagion and media coverage of celebrity suicides in relation to the suicides of Chester Bennington and Kate Spade. The authors acknowledge that causation of suicide is multifactorial but do not acknowledge the role of grief in suicide contagion. Grief is particularly difficult for those bereaved by suicide.

Close relationships contribute to our emotional and physiological well-being. Contemporary grief models consider manifestations of grief, be they emotional, cognitive, behavioural, social, cultural or spiritual, to be attributable to the disruptive loss of a close psychophysiological ‘attachment relationship’. It is likely that our relationships with celebrities, albeit enjoyed unilaterally, also contribute to well-being through attachment systems. In addition, bereavement disrupts self-identity, as self-identity is shaped by those we love, likely including celebrities.

There is an elevated risk of suicide and suicidal ideation in the bereaved, attributable to grief. This risk is particularly raised in those suicide bereaved. For example, active suicidal ideation was found in 43% of those seeking treatment for complicated grief following suicide bereavement (Tal et al., 2017). For Chester Bennington, acute grief was likely contributory to his suicide; he was a close friend of Chris Cornell and committed suicide on Cornell’s birthday, 2 months after Cornell’s own suicide. This is poignant because birthdays and anniversaries typically trigger upsurges in grief intensity. For Kate Spade, grief over loss of her spousal attachment relationship, caused by marital breakdown, was potentially contributory to her suicide.

Whilst grief is a natural process, it is recognised that intense or prolonged grief is more likely in those with (1) a bereavement or loss that is particularly close, unnatural or unexpected, (2) past or current history of mental illness, (3) childhood attachment difficulty or trauma or (4) substance abuse. Public information indicates that both Bennington and Spade had risk factors for complicated grief and, hence, had elevated suicide risk.

Medical professionals are well placed to help the bereaved (Shear et al., 2017). Suicide postvention would benefit if medical professionals were better equipped with (1) comprehensive understanding of grief, (2) awareness of psychiatric and medical risks of acute bereavement and (3) knowledge of best practice care of the bereaved, including those impacted by suicide.

For mainstream media, revision of reporting guidelines following suicide to include validation of the grief response and its accompanying intense emotions, together with information about available specialised grief and suicide support, would represent an important addition to harm reduction following suicide.