This document summarizes a research study on the psychosocial needs and coping strategies of children and adolescents living with a family member who has suicidal behavior. It presents preliminary results from interviews with 7 youths ages 14-20 who had a parent attempt suicide in the past 2 years. The youth were aware of the attempt and experienced stress and fear of further attempts. They closely monitored their parent for warning signs. While friends were a primary support, the youth received little formal support or information. Activities like sports and hobbies helped them cope. The study highlights the need to proactively offer these youth support to help them cope with their situation.

1. PO2-19 – xenia halmov
1
Psychosocial Needs and Coping
Strategies in Children and
Adolescents Living with a Family
Member with
Suicidal Behaviour
Presented by Xénia Halmov
This research was conducted as part of a Masters Degree programme in Social Work, supervised by Annie Devault, Ph.D,
Professor, Université du Québec en Outaouais, Canada.

2. PO2-19 – xenia halmov
2
1. BACKGROUND
The research literature indicates an association between the development
of suicidal behaviours of young people and parental suicide behaviours
(Fleming, Merry, Robinson, Denny, & Watson, 2007; Fotti, Katz, Afifi, & Cox, 2006;
Johnson, Cohen, Gould, Kasen, Brown, & Brook 2002); Johnson, Cohen, Gould,
Kasen, Brown, & Brook, 2002); Klimes-Dougan, Free, Ronsaville, Stilwell, Welsh, &
Radke-Yarrow, 1998). A suicide attempt has a great impact on family
functioning, with heightened feelings of anxiety and fear about further suicidal
behaviour and various other emotional responses (Beautrais, 2004). In Quebec,
Canada, several papers in suicidology emphasize the importance of meeting
the needs of family members of a suicidal person as well as to those bereaved
by suicide (Gouvernement du Québec, 1998; 2010). However, we lack empirical
data on what children and adolescents know about their parent’s suicidal
behaviours and how they cope with the stress of living in a family where a
parent has attempted suicide and may be at risk of attempting.

3. PO2-19 – xenia halmov
3
1. OBJECTIVE
We present the preliminary results of a qualitative exploratory
study on what adolescents know about the suicidality of their
parent, what they thought and felt about it and how they coped
with the situation.
The main objective is to document the real-life experiences and
the psychosocial needs of youth aged 12 - 20 years who live with a
family member who has suicidal behavior. We wanted to know
how these young people perceive their family, the impact the
situation has on them and the way they cope. We also sought to
identify which types of psychosocial support that could best help
them.

4. PO2-19 – xenia halmov
4
2. METHODS
2.1. Participants
Age Gender Siblings Person
who
made
suicide
attempt
Lives with suicidal
parent
Advantaged or
disadvantaged
environment
Studies Work
1 16 F Only
child
Mother Yes, full time. Sees
father
occasionally.
Advantaged Student
2 16 M Brother
19
Mother Part time (50/50).
Father remarried.
Advantaged Student
3 19 M Brother
16
Mother Part time (50/50).
Father remarried.
Advantaged Student Part
time
4 20 F Only
child
Mother Yes, full time.
Father absent,
mother has
boyfriend.
Disadvantaged Student
5 14 F Sisters 17
& 19
Father
and
mother
Full time with
mother, father visits
often.
Disadvantaged Student
6 17 F Sisters 14
& 19
Father
and
mother
Full time with
mother, father visits
often.
Disadvantaged Student
7 19 F Sisters 14
& 17
Father
and
mother
Full time with
mother, father visits
often.
Disadvantaged Student Part
time

5. PO2-19 – xenia halmov
5
2.2. Procedure
We conducted semi-structured interviews with seven adolescents and young
adults between 14 and 20 years old living in a family where a parent had
attempted suicide in the past 2 years.
In the initial project, we were intending to interview younger adolescents,
between 12 and 15 years old. However, most of the crisis centres we initially
contacted refused to participate in the study (without explanation), and the
parents of the younger adolescents we contacted also refused to participate,
mainly because they feared that the interview would reveal to the adolescent the
fact that they made a suicide attempt. Finally, we obtained access to a sample of
participants in a longitudinal study of suicide attempters who had expressed an
interest in being solicited for participating in other research projects. That allowed us
to contact adults who had made a suicide attempt. Because, these adults had
older children our sample will be a little bit older that what we had previously
planned. Although the teenagers and young adults aged between 14 and 20 we
interviewed were older than we initially envisioned, the participants had rich
experiences that they were able to verbalize in detail.

6. PO2-19 – xenia halmov
6
The main themes of the interview were:
(I) The perception of the adolescents of their family situation in general.
(II) The perception of the adolescents of the nature and quality of the
relationships between family members.
(III) The strategies they use to cope with living with a suicidal family
member.
(IV) Their perception of their life in general, their values and beliefs.
(V) Their perception of the social support they receive and their needs
for support.
Each interview was transcribed and rendered anonymous and a content
analyses was undertaken for each interview.

7. PO2-19 – xenia halmov
7
3.RESULTS
Awareness of the suicide attempt
All but one of the participants, a 15 year old female who was not
certain if the parent had attempted suicide or not, were aware of the
suicide attempt of their parent and talked about it without being directly
asked about suicide.
Family life in General
All of the youth came from families where their parents are divorced,
and none of the divorces were recent. They lived with the parent who had
made a suicide attempt and they generally had poor relationships with
the parent with whom they were not living primarily. All but one felt that
their most difficult experience was their parents’ separation and the tense
relationship between their parents, more so than the suicide attempt itself.

8. PO2-19 – xenia halmov
8
The one exception was a girl who did not mention the separation but the
intense impact of her mother’s suicide attempt. The positive experiences
they described were often family outings and happy times spent with their
mother.
Warning signs
None of the participants reported that their parent made an overt
suicide threat before they attempted. However, they noticed behavioural
changes, such as withdrawal, apathy, emotional changes and increased
conflicts between divorced parents. These behaviours resulted in the
adolescents feeling vague concerns. In one case the mother told her
daughter that she must not stop her if she attempts suicide. When the
daughter returned from school every day she wondered if she would find
her mother dead. She always checked each room to make sure her
mother had not hanged herself there.

9. PO2-19 – xenia halmov
9
Impact of the suicide attempt on the adolescent
All of the adolescents reported experiencing great stress, and
fear that the parent would attempt again. They all watched their
parent closely to look for signs of another attempt. For example,
three sisters read the text messages their father sent to his ex-wife
to see if he threatened suicide. Another asked her mother every
day when she returned from school how she was feeling, and she
worried whenever her mother was angry or sad. For the participant
who was not sure if her mother had made a suicide attempt or
not, when one of her mother’s friends committed suicide the
adolescent desperately sought her mother to check if she was still
alive. Long after the attempts, even when things were going well
for their parent, the youths were less worried but continued to fear
that their parent would attempt again if things got worse.

10. PO2-19 – xenia halmov
10
Coping strategies and social Support
Friends: All participants reported that friends were their primary source of
support. They all either had a best friend (6/7) or a boyfriend-girlfriend (4/7)
whom they confided in. They also had friends with whom they did things to
distract themselves (5/7), in order to stop thinking about the situation with the
parent, but with whom they did not want to talk about the situation and their
feelings.
Parents: Only one of the adolescents confided in the parent who had
attempted suicide, a female who confided in her mother. One male confided
in his father concerning his mother’s attempt. Overall, participants confided
about other matters more with their mother than their father.
Other family members: Although 5 of the 7 mentioned other family
members as sources of support, none of them discussed the suicide attempt
with them.
Formal support: Only one adolescent sought help from a school counsellor
and another one was offered help at school but refused it. 6 out of 7 had no
one offer to talk to them about the suicide attempt of their parent.

11. PO2-19 – xenia halmov
11
Social-recreational support: The adolescents said that the following
activities helped them get through difficult times: sports (6/7), television (3/7),
surfing the internet (3/7), playing video games (2/7), listening to music (2/7),
writing (2/7), attending school (2/7) and being at work for the 2 participants
who had a job. Three mentioned that having a pet was an important source of
comfort.
Other coping strategies: 3 of the 7 said that checking up on the parent
who had attempted suicide by calling or visiting them was helpful. 6 of the 7
said that they avoided conflicts or ‘opening old wounds’ when in contact with
the parent after the attempt.
Helping others as a coping strategy: 5 of the 7 said that they helped their
friends with their problems by listening and consoling them, and this increased
their sense of self-worth, allowing them to think about other things and others
rather than themselves.
Strengths, values, beliefs and suicidal ideation: The adolescents felt that
their strengths are their ability to listen, to not judge others, to be patient and
persevering, to want to help others in a gentle way, through valuing the family

12. PO2-19 – xenia halmov
12
and friends. What they all wanted most was to have a good relationship with
their family.
All of the participants but one said that they had no suicidal ideation. The
youth that had reported considering suicide said that thoughts were several
years before the parent’s attempt and she had follow-up afterwards with a
therapist.
Perceived needs: Above all, every participant wanted their divorced
parents to have a better relationship. Two participants wanted to know why
their parent attempted suicide. One wanted to be able to be with someone
his age who understood what he was experiencing, someone who has
experienced the same situation, but not recently, not necessarily to talk about
it. One wanted to meet an adult or a professional to discuss the situation and
talk about it. One wanted someone to talk to confidentially.
IMPACT OF THE INTERVIEW: 6 of the 7 participants said at the end of the
interview that they felt good and that the interview helped lessen the burden
they felt.

13. PO2-19 – xenia halmov
13
4. DISCUSSION
Friends are the main source of support for these adolescents whose parent
attempted suicide, although most of them also confided in adults as well. Only one
participant received professional help when she actively sought it out. Only one
person received an offer of help, which was refused. However, a number of
recreational activities were useful in coping with the situation according to the
participants, often with peers. Although 5 of the participants had siblings, no one
mentioned a sibling as a source of support. One mentioned not wanting to make
things worse by bringing up the subject with his brother. One sister was very
protective of the other two younger sisters. None of the youngsters mentioned
receiving any information from adults. Several participants said that if an adult had
offered to talk about the situation they would have accepted the offer. Overall,
they lacked information as well as the opportunity to discuss the situation with an
adult in a safe context. Contrary to our expectations, none of the participants
reported any false beliefs or information about suicide. We wonder about the
benefits of the tendency of the adolescents to be kind and helpful to others. While
this may be a source of feeling valued, it could also lead to them neglecting their
own needs by focusing on others.

14. PO2-19 – xenia halmov
14
5. LIMITATIONS
Since the sample size is small one cannot generalize these findings to
the general population. What is reported is a portrait of how some
adolescents react to a suicidal parent, but more extensive research is
needed to determine how typical these reactions are. Since we recruited
participants whose parent had attempted suicide, but survived the
attempt, it is possible that in retrospect the participants may have
minimized the seriousness, knowing that the parent had survived. We did
not have access to the medical records of the parent who attempted
suicide. However, many of these parents suffered from a mental disorder.
Consequently, we cannot tell to what extent the reactions are in
relationship to the suicidal behaviour and to what extent they may be
shared by anyone living with a parent who has a mental disorder.

15. PO2-19 – xenia halmov
15
6. IMPLICATIONS FOR PRACTICE
The lack of support offered suggests that support should be
systematically and proactively offered to children and adolescents
when their parent has suicidal behaviours in order to help them find
effective strategies to cope with the stress associated with living with
a suicidal parent. They may also benefit from more information
about their parent’s mental disorder (if diagnosed), and information
on suicide in general once it is known in the family that the person is
suicidal. However, the concerns they expressed suggest that it
would be very important to address the problem carefully in order to
not dramatize the situation and to make sure that the children and
adolescents do not feel that they are responsible for the adult’s
safety.
It seems that when their parent told them that they did not want
to commit suicide anymore, this helped a lot to relieve the stress. A
family meeting with a professional after the attempt could be an

16. PO2-19 – xenia halmov
16
opportunity to help the children involved. When professionals and
volunteers working in suicide prevention are aware of the suicidal
thoughts of a person even before an attempt is made, it could be
useful if they would systematically verify if there are children involved
and see that these children get support, especially proper
information, access to a helpline 24/7, and emotional support. These
children may also benefit from the help of an adult member of the
family in whom they could confide and express their worries.
Training programs in suicide prevention and intervention should
always include a section on how to support the families of suicidal
individuals, including the children. Children with suicidal parents
need information, help and support to help them cope with a
suicidal parent and we suggest that this help should be offered
proactively.

17. PO2-19 – xenia halmov
17
7. IMPLICATIONS FOR FUTURE RESEARCH
This is a small exploratory study. It would be interesting to
interview more adolescents and children to obtain further
data on the impact of the suicidal behavior of their parent,
their coping strategies and their needs. We could not
interview younger children, so a future study is needed on
what younger children know and do not know about their
parent’s suicidality, and what they do when they know
and everyone around them thinks they do not know.

18. PO2-19 – xenia halmov
18
REFERENCES
Beautrais, A. L. (2004). Support for Families, Whanau and Significant Others After a Suicide Attempt. A literature review and
Synthesis of Evidence. Christchurch, Canterbury Suicide Project, Christchurch School of Medicine & Health Sciences, 51 p.
Fleming T., Merry S., Robinson E., Denny, S. & Watson, P. (2007). Self-Reported Suicide Attempts and Associated Risk and
Protective Factors Among Secondary School Students in New Zealand. Australian and New Zealand Journal of Psychiatry.
41(3), p. 213-21.
Fotti, Katz, Afifi, & Cox (2006). The Associations Between Peer and Parental Relationships and Suicidal Behaviors in Early
Adolescents.Canadian Journal of Psychiatry, 51(11), p. 698-703.
Gouvernement du Québec (Ministère de la Santé et des Services sociaux) (1998). Stratégie québécoise d’action face au
suicide : S’entraider pour la vie.Québec : Publications du Québec, 94 p.
Gouvernement du Québec (Santé et services sociaux) (2010). Prévention du suicide. Guide de bonnes pratiques à
l’intention des intervenants des centres de santéet de services sociaux. Québec : Publications du Québec, 83 p.
Johnson, J. G., Cohen, P., Gould, M., Kasen, S., Brown, J. & Brook, J. S. (2002). Childhood Adversities, Interpersonal
Difficulties, and Risk for Suicide Attempts during Late Adolescence and Early Childhood. Arch Gen Psychiatry, 59,
p. 741-749.
Klimes-Dougan B., Free, K., Ronsaville, D., Stilwell, J., Welsh, J., & Radke-Yarrow, M. (1998). Suicidal Ideation and Attempts:
A Longitudinal Investigation of Children of Depressed and Well Mothers. Journal of the American Academy of Child and
Adolescent Psychiatry, 38(6), p. 651-659.
Xénia Halmov, student, Master’s Degree programme in Social Work
Supervision: Annie Devault, Ph.D, Professor, Université du Québec en Outaouais.