Amy Y. M. CHOW,
Ph.D., R.S.W., FT., CHt
Associate Professor, Department of Social Work & Social Administration, and
Honorary Fellow of HKJC Centre for Suicide Research and Prevention,
The University of Hong Kong, Hong Kong

• Suicide Prevention Services,
Hong Kong
• 11 participants, who are ex-service users of Project
BLESS, SPS

Prevention
(Primary
Prevention)
Intervention
(Secondary
Prevention)
Postvention
(Tertiary
Prevention)
Suicide
Ideators
Majority of
Suicide
Suicide Research Attempters

Incidence
Rate of
Suicide
Attempts

Incidence
Rate of
Suicide Reattempts
Suicide
Survivors

Adverse
Impact of
Completed
Suicide

• Is Suicide bereavement different from other types of bereavement?

• There were no significant differences between suicide survivors and survivors of other modes of death in general mental health, depression, PTSD symptoms, anxiety, and suicide behavior
• But higher levels of rejection, shame, stigma, need for concealing the cause of death and blaming
(Sveen & Walby, 2008)

Features Supported by the Existing
Research Evidence
• Abandonment and rejection
• Shame and stigma
• Concealment of the cause of death of suicide
• Blaming
• Increased self-destructiveness or suicidality
(Jordon & McIntosh, 2011)

Features Supported by Clinical
Experiences and Survivors’ Accounts
• Guilt
• Anger
• Search for explanation/desire to understand why
• Relief
• Shock and disbelief
• Family system effects/social support/ social isolation
• Activism, obsession with the phenomenon of suicide and involvement with prevention efforts
• (Jordon & McIntosh, 2011)

• Is Chinese suicide bereavement different from that of other cultures?

•自尋短見 (Self searching for undesirable choice)
•輕生 (Depreciating life value)
• 自盡 (Ending by self)
• 厭世 (Life is annoying)
•做傻事 (Doing insane things)
•早
D
上路 (Advanced moving to the path )
(Chow and Yip, 2011)

• Suicide as a means to teach others 死諫
• Suicide as a means to show one ’ s innocence 以死表清白
• Suicide as a means to show one ’ s guilt
以死謝罪
• Suicide as a means to show one ’ s loyalties 不能同月同日生，但願同月同
日死 、陪葬
• Suicide for love 願死也為情
(Chow and Yip, 2011)

“…the question about differences in bereavement….may do nothing to reduce that pain..”
“…the question has real importance, considering that the answer has genuine implications for how we understand the journey of survivors and how we go about offering help to those who must walk this journey…”
(Jordon and McIntosh, 2011, p.21)

• To understand the experiences of suicide bereavement among Chinese
Women in Hong Kong

• Study Site:
– Project BLESS of Suicide Prevention
Services
• Participants:
– Service Users of Project BLESS of Suicide
Prevention Services

• Sampling: Purposive sampling
– Different relationships with the deceased, age group, social economic background and religion.
• Data Collection Methods:
– Individual In-depth Interview
– Semi-structured with an interview guide
– All carried out by Principal Investigator

Case
No.
1
4
5
2
3
8
9
10
11
6
7
Deceased is the…
Son
Husband
Son
Elder Brother
Son
Son
Mother
Daughter
Boy Friend
Mother
Son
Time Since (Months)
17
11
36
10
3
11
5
18
12
8
2
Method
Charcoal Burning
Drug Overdose
Jump
Jump
Hanging
Jump
Jump
Jump
Charcoal Burning
Jump
Jump

• The Impact of suicide (our main focus of this presentation in the specific impact of suicide in the family )
• The Challenge
• The Adjustment

Received the bad news
Viewing the body
Handling the reporters and different professionals

• 咁佢同我講話你個囡囡暈低係街到，咁佢即
刻都唔敢同我講嫁 ….
咁我當時其實我好驚，
咁我啦啦聲啦，又落雨喎，咁我啦啦聲即刻
去搵的士。去既時候呢啲雨落得好大，咁我
好心急，咁警察係咁樣打電話黎 ….
• “I got the call from the Police, telling me that my daughter was fainted and sent to the hospital…I was in great fear and hurriedly got into a cab…It was raining heavily outside and the Police kept calling me…I know it should be something serious…” (case 8)

• 嗰個女仔係歇斯底里咁喊，有記者，有其他
記者，佢係喊住唔俾佢吔影，因為佢嘅遺書
，佢嘅遺誌寫住，最後唔好見報，嗰女仔就
歇斯底里，我當時就掛住嗰住嗰女仔，挂住
我嗰老公，掛住來嘅人
• “His girl friend cried hysterically. Re were reporters. We tried to stop anyone taking photographs as it was my son’s wish not to in the headlines of papers.
He stated it in his death notes…” (case
5)

Notifying other members
Arranging the funeral
Revisiting the scene

• 地一日都喺屋企，即係我好似 … 亦都
唔敢出門口，諗緊點辦呢，點通知佢
屋企人呢 … 因為佢有阿爸阿媽呢
• “…I kept on thinking how to notify other family members…He still has his aged parents…” (Case 2)

• 有 ..
咁當時呢 ,d 人亦都叫我唔好去架啦
.
你係佢媽媽 , 你唔好去啦佢話 , 叫我同
我先生都唔好去 … 所以既野都係我個
大女去搞 , 因為呢 , 佢地呢就話如果我
地去搞呢樣野會令到我個仔好唔安落 ,
日後 ..
個心唔舒服 , 佢已經揀左呢條路 ,
即係佢地 d 人話 .
• “Other suggested me not to go the funeral as we are parents…I left everything to my eldest daughter to arrange…Yet, I am unsettled…” (Case
1)

To explore or not
To move or not
To share or not

• 即但係果時我拒絕，因為果時我好驚
，我唔想去俾人知。其實到呢刻而家
呢刻我唔想俾人知，即除非果啲人 …
有啲人都唔知，同埋呢我個女唔喺度
住呢，有啲人鄰居呀，啲人唔知我個
女自殺嫁，咁可能呢樣野都減輕左我
個壓力
• “ I don’t want other to know about it…Not knowing about the death of my daughter as well as her suicide…It helps to reduce my stress….”(Case 8)

Birthdays
Festivals:
Lunar New
Year, Mid-
Autumn
Fathers’
Day or
Mothers’
Day
Public
Examination
Result
Dissemination

• Digestion of Bad News
• Dissemination of Bad News
• Viewing of Body
• Handling of Mass Media
• Organ Donation
• Autopsy
• Police Investigation
• Claiming of Body
(Chow, 2006)

Death of
Loved
One
Trauma
Mysteries
Self-
Inflicted
Events

Non-judgmental attitude, patience, and respect
STIGMATIZATION : Shame
TRAUMA
suddenness, violence, & preventability
GRIEF
relationship, role, and
Functions
Trauma Work Bereavement
Counselling

• Pretense of being OK
– Do not want to upset others by pretending to be OK
– Cries only at night time when no one sees
– Pretend to be strong and tough

• Conspiracy of Silence
– Difficulties in breaking the bad news to other family members
– No one wants to talk about it
– The name of the deceased is not mentioned
– Highly avoidance of the word suicide and death
– Other communications are reduced too

• New roles to play
– Stronger role in caring for widowed parent
(for cases of parental death)
• Guilt-driven
• Worries that the surviving parent will commit suicide too
• Self-blaming parent that need special attention
– Caring for younger sibling (parental death)
– Be a good child (for case of death of siblings)
– Be a mom and be a dad (death of spouse)

• Over concern about contagious effect of suicide
– Will my family be cursed?
– Hyper surveillance with distressed signs of other family members?
– Worries about one’s self-control
• Face of the family
– I wish he/she died of illness
– Newspaper report
– Avoidance of social gathering, feared of being asked about the suicide

• Family Intervention in suicide bereavement
– Working with reduced genuine communication within family
• Facilitation of genuine communication
• Discussion of shared responsibilities in the adjustment
• Family Education
– Stress Management: to reduce risk of suicide

• Sample: restricted to self-selected service recipients, small sample size
• Design: single group analysis and cross-sectional, limited validated measurements

• survivors themselves are potential attempters of the future. It is evidenced that survivors’ own risk is usually higher than non-suicide counterparts (Jordon, 2001) or higher selfdestructive impulses (Cain, 1972; Calhoun, 1982)
• survivors who can openly share their pain of losing their loved one through suicide can be great teachers for the potential attempters who rarely think about of the impact of suicide towards others.

Chow, A. Y. M. (2006). The day after: The suicide bereavement experience of Chinese in Hong Kong. In C. L.W. Choan and A.
Y. M. Chow (Eds.). Death, dying and bereavement: The Hong
Kong Chinese Experience . (pp. 293-310). Hong Kong: Hong
Kong University Press.
Chow, A. Y. M., & Yip, P. S. F. (2011). Grief after suicide: A Hong
Kong Chinese perspective. In J. R. Jordon & J. L. McIntosh
(Eds.). Grief After Suicide: Understanding the Consequences and Caring for the Survivors (pp. 427 - 466). New York, NY:
Routledge.
Jordon, J. R., & McIntosh, J. L. (2011). Is suicide bereavement different? A framework for rethinking the question. In J. R.
Jordon & J. L. McIntosh (Eds.). Grief After Suicide:
Understanding the Consequences and Caring for the Survivors
(pp. 19 - 42). New York, NY: Routledge.

Sveen, C. A., & Waley, F. A. (2008). Suicide survivors’ mental health and grief reactions: A systematic review of controlled studies. Suicide and Life-Threatening Behavior , 38(1), 13-29.
Van der Wal, J. (1989-90). The aftermath of suicide: A review of empirical evidence. Omega , 20(2), 149-171.