Social acknowledgement as a predictor of post-traumatic stress and complicated grief after witnessing assisted suicide

Background: In Switzerland, right-to-die organizations such as Exit Deutsche Schweiz offer suicide assistance to their members. However, there is limited knowledge of the impact that witnessing assisted suicide has on the post-traumatic stress severity or the grief process of family members. Low perceived social acknowledgement may affect mental health. Methods: A cross-sectional survey of 85 family members who were present at an assisted suicide was conducted in December 2007. The Inventory of Complicated Grief and the Impact of Event Scale were used to assess symptoms of post-traumatic stress disorder (PTSD) and complicated grief (CG) at 14 to 24 months post-loss. Further, the Social Acknowledgement Questionnaire was used to examine the impact that the social environment’s acknowledgement of the end-of-life decision had on respondents’ mental health. Results: As expected, social acknowledgement as a survivor was related to PTSD symptoms and CG. In particular, perceived general disapproval was strongly correlated with all outcome measures, whereas recognition was not significantly related to PTSD or CG (intrusion and avoidance). Conclusion: Family members of patients who use assisted suicide may hesitate to disclose the manner of death, and the community and societal environment may express strong views concerning the end-of-life decision. This can lead to increased levels of PTSD and CG.