Spirituality and Religion After Homicide and Suicide: Families and Friends Tell Their Stories

Abstract

This article presents results from seven focus groups (n = 27) with families and friends bereaved by homicide or suicide of a loved one, and focuses on spirituality and religion in the aftermath of these traumatic deaths. In exploring how these deaths affected participants’ spirituality and religion, several themes emerged: parental spirituality and intuition, finding comfort, internal challenges with spirituality and religion, and connection with spiritual and religious communities. Experiences and recommendations for responders are discussed. This research draws comparisons between homicides and suicides to elucidate participants’ unique spiritual and religious needs and better inform tailored approaches.

Keywords

homicide suicide spirituality religion bereavement

Importance of the Issue

Homicide and suicide are major public health issues in the United States. The most recent statistics from the National Center for Injury Prevention and Control report in 2016 is that over 44,965 people died by suicide and over 19,000 people died by homicide (Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, n.d.). A further breakdown of these statistics by age group illustrates that suicide and homicide are the second and third leading causes of death for 15- to 24-year olds and 25- to 34-year olds, respectively (Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, n.d.). Behind each of these deaths lies a less studied public health issue: the number of family members and friends who are left in the aftermath of sudden death tragedies with myriad health burdens and complex resource needs (Mastrocinque, Metzger, Madeira, Lang, Sandys, Navratil, & Cerulli, 2015). Reports roughly estimate that for every suicide loss, six other people are intimately affected (American Society of Suicidology, n.d.), and for every homicide death, 10 people are affected (Holmes, 2004).

Bereavement After Death

After a loved one’s death, the grieving process includes “numbness, pining, disorganisation and despair, [and] reorganisation” (Parkes, 1998, p. 857). The grieving process can include mental health and physical effects, and could become more complicated due to the circumstances of death, the relationship between the deceased and the bereaved, and the support received (see, Ambrose, n.d.). In addition, the response to deaths that are traumatic compared with deaths that are not traumatic, may have unique consequences and a unique grieving process (see, Malone, 2007; Stroebe, Schut, & Finkenauer, 2001).

Studies have examined the consequences of traumatic unexpected death, including examining the specific consequences of violent deaths, such as homicide and suicide, on the bereaved (Murphy, Johnson, & Lohan, 2002). Homicide produces far-reaching and wide-ranging consequences for family and friends (Amick-McMullan, Kilpatrick, & Resnick, 1991; Jacobs, Wellman, Fuller, Anderson, & Jurado, 2016; Mastrocinque et al., 2015; Rynearson & McCreery, 1993; Wellman, 2017; Zinzow, Rheingold, Byczkiewicz, Saunders, & Kilpatrick, 2011), including psychophysiological disorders (e.g., cardiovascular issues, decreased disease resistance; Miller, 2008), complicated grieving (Neimeyer & Burke, 2011; Stroebe et al., 2001), and PTSD (posttraumatic stress disorder; Amick-McMullan et al., 1991; Murphy et al., 2002; Zinzow et al., 2011).

Family and friend responses to suicide are similar in many ways to that of homicide with the important added factor of guilt, often prevalent for families and friends bereaved by suicide (Cerel, Jordan, & Duberstein, 2008; Schneider, Grebner, Schnabel, & Georgi, 2011). A meta-analysis by Sveen and Walby (2008) found health and mental health responses were similar between people bereaved by homicide and suicide, with the important exception of shame and stigma. Additional research has linked stigma and shame to family and friend responses following the suicide of a loved one (Harwood, Hawton, Hope, & Jacoby, 2002; Knieper, 1999). Related, people bereaved by suicide are likely to hide the cause of death from others, including family members (e.g., children; see, Cerel et al., 2008). Notably, although those bereaved by suicide are a unique group, they should not be seen as homogeneous (Bailley, Kral, & Dunham, 1999).

Role of Spiritual and Religious Support

Research supports that seeking support and disclosing emotions about the loss of a loved one can have positive mental and physical health consequences, whereas not disclosing such emotions can affect several dimensions of one’s health (e.g., psychological, social; Pennebaker, Zech, & Rimé, 2001). A possible source of support for those bereaved by homicide or suicide is spirituality and religion; however, the relationship with one’s spirituality and religion in the aftermath of a traumatic death differs among people. Religion has been shown to be an important dimension of well-being for people who are dealing with major life stressors (Pargament, Smith, Koenig, & Perez, 1998), with research also specifically focusing on how faith affects people bereaved by homicide (Armour & Umbreit, 2012). Those bereaved by homicide who have strong self-reported faith prior to the homicide appear to fair better following the homicide, and these findings are supported in cold cases as well (Wellman, 2014). Research with people bereaved by suicide supports that people with higher spirituality experienced lower levels of grief (Meyers, 2006, as cited in Colucci & Martin, 2008). There are myriad challenges in help-seeking, which can include language barriers, affording formalized services, and family pressure to not seek outside help (Provini, Everett, & Pfeffer, 2000). It is important to note that some people who are grieving will rely on their spirituality or religion for support, whether through formalized places or personal worship, and for some people this will be the only support system they seek, as opposed to accessing formal mental health services (Boyd-Franklin & Lockwood, 2008; Walsh, 2008).

Although religion is an important aspect of one’s posthomicide and postsuicide experiences, the type of death can affect one’s relationship with spirituality. For example, forgiveness is a tenet in many religions, and those bereaved by homicide have diverse views on incorporating forgiveness into their posthomicide journeys (Armor & Umbreit, 2012; Hargrave, Froeschle, & Castillo, 2008; Mastrocinque et al., 2015). Many people bereaved by suicide note concerns regarding the tenet in many religions that suicide is a sin (see, Colucci & Martin, 2008; Domino, Cohen, & Gonzalez, 1981; Knieper, 1999).

A previous study with people bereaved by homicide supported that homicide affects the health of families and friends, and built on Engel’s biopsychosocial model by suggesting that spirituality be incorporated into addressing one’s holistic health (Engel, 1977; Mastrocinque et al., 2015). It was beyond the scope of that work to focus on how the spiritual needs, experiences, and interactions affect one’s posthomicide experiences. The current study adds to the previous contributions by focusing on these aspects of spirituality, and includes people bereaved by suicide, allowing the rare opportunity to explore the experiences for both of these groups of families and friends, and to discuss tailored resources. The current study utilizes a qualitative approach to add stories of the bereaved to the evolving knowledge of the specific challenges faced by those who experience the death of a family member to homicide or suicide. Qualitative methods were used to drill down the role of spirituality when grieving, and to understand the true needs of the bereaved from providers and the larger systemic response.

Method

Guiding Principles and Theoretical Framework

This research was based on the principles of community-based participatory research (CBPR) (Israel, Schulz, Parker, & Becker, 2001; Rubin & Babbie, 2005). CBPR includes, among other ideas, incorporating community entities as active and equal participants and contributors to the research and research team (Israel et al., 2001). In addition, CBPR research appreciates the identity of the community, and approaches research as a “cyclical and iterative process” (Israel et al., 2001, p. 184). The goal of this CBPR-based study was to determine the consequences of homicide and suicide for family members, to determine if participants received services after the death, and to learn about their experiences with various response systems.

The data for this article stems from seven focus groups with people bereaved by homicide (see, Mastrocinque et al., 2015; Metzger, Mastrocinque, Navratil, & Cerulli, 2015) and people bereaved by suicide. The research team held the homicide focus groups and the suicide focus groups separately, all in New York. In Monroe County, there were 59 suicide deaths in 2014 (New York State Department of Health, 2017),¹ and 39 murders in 2015 (New York State Division of Criminal Justice Services, 2018). The focus groups consisted of family and friends bereaved by homicide and suicide.

Eligibility

Participants were required to be at least 18 years of age and able to read at a fifth-grade reading level. To be eligible for this project as a person bereaved by homicide, any legal cases that may have occurred had to be closed for at least 6 months or deemed a cold case with no immediate resolution pending with an identified defendant. We excluded murder-suicide cases from the focus groups due to fear of having family members from both involved individuals in the same room. A member of the research team provided eligible participants the date, time, and location of the study and a reminder call or e-mail, if preferred. Participants who did not meet the eligibility requirements were provided with support resources.

The University of Rochester’s institutional review board approved both the homicide and suicide focus group protocols. The research team consisted of men and women with diverse areas of expertise including law, criminal justice, mental health, social work, and victimology. In addition, some members of the research team also experienced the death of a family member or friend by homicide or suicide. A mental health provider was present for each group to assess emotional distress or suicidal ideation among the participants. If the focus groups were being held in collaboration with a reoccurring support group, an alternative option was provided for any person who attended the group for support purposes, rather than for research purposes.

Prior to the focus groups, the research team developed a field guide, which contained a list of questions for the focus groups with prompts to help guide conversations if necessary. The prompts addressed concerns such as the mental, physical, and spiritual effects on the participants and their families. The field guide questions asked the participants to discuss their loved ones, additional services the participant received, and what needs were met or not met. Four team members were present for most of the suicide groups, including a mental health counselor with expertise in suicide support who attended all suicide focus groups. Similar to the suicide groups, a counselor with expertise in homicide support was instead included for those focus groups.

Recruitment

We recruited participants via various methods. Community-partner research team members mailed letters advertising the study, announced the study during support group meetings, and sent emails advertising the study to other people bereaved by homicide and suicide, and related service-providing agencies. For the suicide focus groups, the research team also posted an ad in the local newspaper advertising the project. Participants received a $20 gift card for their attendance, parking validation (where appropriate), refreshments, and resource information.

Analysis

We recorded the focus groups, and transcribed these files into a Word document. An investigator on the team deidentified the final transcripts, which provided the data for this project. We then identified reoccurring themes.

Given the heavily prompted nature of the study, the team used framework analysis (Pope, Ziebland, & Mays, 2000). The research team members consistently noted themes of various aspects of health that participants discussed. Based on this consensus, we selected the biopsychosocial model as our framework analysis for the primary papers (Engel, 1977). Engel’s (1977) biopsychosocial model was selected because it illustrates many dimensions of one’s health, and measuring health should incorporate biological, psychological, and social health. Our research team modified the model to include “spiritual health” as it was a component of health that our participants consistently mentioned (see, Mastrocinque et al., 2015).

Each research team member read the transcripts independently. We met together to create a codebook and reviewed the first transcript. We then reviewed the remaining six transcripts independently. The team used consensual qualitative research with the biopsychosocial framework model (Engel, 1977), where we would individually identify themes and compare findings among the researchers and resolve disagreements via consensus. We asked open-ended questions, used induction to describe the participants’ experiences, and systematically checked each other’s coding line by line (Hill, Thompson, & Williams, 1997). The team used rigorous line-by-line coding. Once the results were determined, we sought respondent verification, which confirmed our results, and no changes were made to our coding structure.

In reviewing participants’ discussion of topics such as faith, connection to an afterlife, a higher power, and religious ceremonies, two major concepts emerged: spirituality and religion. Relying on Pargament (1999) to operationalize these concepts, “. . . spirituality is said to be a search for meaning, for unity, for connectedness, for transcendence, for the highest potential” (p. 6). “[R]eligion is being defined as the organizational, the ritual, and the ideological” (Pargament, 1999, pp. 5-6).

Participants

There were seven focus groups with 27 participants, four groups were with people bereaved by homicide and three groups were with people bereaved by suicide (Table 1). The research team collectively decided not to schedule additional focus groups once the team agreed that saturation was reached. A majority of the participants were women (n = 24). In addition, a majority of the participants were White (n = 19), and the remaining participants were African American (n = 8). The average age of the sample was 50 years old (SD = 14.5), with ages ranging from 23 to 73 years. Although a majority of the participants were married or partnered (n = 13), other participants were single (n = 9), divorced (n = 4), and widowed (n = 1). Of the total sample, a majority of the participants were employed (n = 19) but eight participants reported being unemployed. Finally, regarding highest educational attainment, a few of the participants were high school graduates or had their general educational development (n = 3), many participants had some college education (n = 10), several participants were college graduates (n = 8), and some participants had completed some graduate school or had a professional degree (n = 6).

Table 1.

Participant Demographics.

	Respondents’ bereaved by homicide	Respondents’ bereaved by suicide
Number of participants	12	15
Number of groups	4	3
Participant’s gender
Female	9	15
Male	3	0
Participant’s race
White	4	15
African American	8	0
Participants’ average age	48	51.4
Participant’s employment
Employed	7	12
Unemployed	5	3
Participant’s education (highest attainment)
High school/GED	2	1
Some college	6	4
College graduate	2	6
Graduate school/professional degree	2	4
Participant’s marital status
Single	4	5
Married/partnered	7	6
Divorced	1	3
Widowed	0	1
Number of loved ones	10	16
Loved one’s gender
Female	2	3
Male	8	13
Loved one’s race
White	5	16
African American	5	0
Other	0	0
Loved one’s average age	26	36.25
Loved one’s relationship to participant
Child	5	9
Sibling	5	3
Parent	1	2
Other	2	2

Note. GED = general educational development.

Results

The data yielded four distinct themes: parental and spiritual intuition, finding comfort, internal challenges with spirituality and religion, and connection with spiritual and religious communities (Figure 1). Each of these themes will be presented with quotes to illuminate and give voice to the theme.

Figure 1.

Emerging themes and concepts in the findings.

Parental and Spiritual Intuition

Both groups of bereaved people commonly discussed an intrinsic feeling that something was wrong at the time of their loved one’s death, before receiving any formal notification. This feeling was particularly common for parents whose children died. One person bereaved by suicide described this experience:

I felt his soul rise when he died, like a part of me was going up. . . It was about (time of day) in the morning and I felt it go up. And I could tell it was death. . .

Another person bereaved by suicide described seeing her loved one’s “spirit flying around the house. . . I mean it was just like this black thing that would fly around.” One person bereaved by homicide shared her story of waiting to hear about her loved one’s condition, but knowing something was wrong:

I knew in my heart that he was dead. . . .Finally the doctor came through. . .and he’s, you know, “Well he was shot blah blah blah blah.” I’m like, just, I don’t want to hear it, just tell me, is he alive or is he dead? And he said, “Well, I’m sorry, but we couldn’t, we couldn’t uh, resuscitate him. He died. . . dut, dut, dut.” Well I knew he already died way before that time.

Finding Comfort

Both groups discussed sources of comfort during the immediate period of death. Some of this comfort was from first responders, illustrating the multifaceted importance of first responders. A person bereaved by homicide shared a story of a spiritual responder praying with her loved one during his death, and the participant stressed the importance of knowing, “That he didn’t die alone. That someone was with him.” One person bereaved by suicide shared an emotional story of a police officer who prayed with her, stating, “That was so awesome. And I don’t even know, he knew right away. He just knew. . . He was like an angel that just came down at that minute and it was just strange.”

Other participants found comfort in spiritual visions or in the religious community. Some participants bereaved by homicide discussed having created a spiritual visual memory of what occurred at the time of their loved one’s death, despite not being at the scene of the homicide. For example, one participant described envisioning her loved one with Jesus during the homicide, stating, “I believe in God, and I believe that He was there, and He took [loved one’s name] away.” Another participant bereaved by homicide felt comfort that her loved one was now safe in the afterlife, whereas another person bereaved by homicide found peace through church:

. . . what really helps me is the church. You know I go to church every Sunday and I never thought that I would really do that. But I really like it and it’s soothing to me. And that’s where I found peace at.

Respondents in the suicide groups discussed the importance of connecting to their loved one after the suicide loss. In some situations, this connection was through signs. Those bereaved by suicide shared stories of signs after their loved one’s death, which commonly included inside jokes with their loved ones. One family member who frequently played board games with her loved one had asked her loved one for a sign. The family member bereaved by suicide noted that during a subsequent board game, randomly selected letters spelled out a name meaningful to both the bereaved and the deceased. She stated, “[A]nd to me, that was a sign that just could not be, there’s no way for that to be explained.” Many of these signs were blatant, which one participant noted, “. . . they smack you in the forehead signs that can’t be ‘whatever.’”

Internal Challenges With Spirituality and Religion

Although both groups had internal battles with their individual spirituality and religion, these battles were different. People bereaved by homicide commonly discussed either embracing their faith or being angry with their faith. Those angry with their faith commonly questioned why the homicide happened to them, and also battled with their religious tenet of forgiveness. The juxtaposition with views on forgiveness were extremely evident in some groups. For example, in one homicide group, one participant discussed having been able to forgive the offender, stating “because without that, you’re stuck—you don’t go anywhere,” whereas another participant responded, “Well I’m stuck then, I’m stuck.”

Some people bereaved by homicide felt they were unable to heal without forgiveness or felt they could never get past being angry without forgiveness. One participant shared that as a therapeutic step she wrote a letter to the defendant:

I explained how I felt but I also told him “I forgive you.” I don’t like what you did,. . . my son is dead, and. . . even though you are locked up you still have your life. And I said something about making the best of it, whatever you can.

For some it was important that they not engage in a similar step, feeling that in some way they were not honoring the memory of their loved ones:

It’s not about forgiving. I don’t have to forgive if I choose not to. Cause I can’t forget what you did to my mother, to my family, what it did to everybody you know. Forgiveness you earn it. These people have not earned forgiveness. They have sat behind the shirttails of lawyers.

In addition to forgiveness and anger toward the offender, some people bereaved by homicide expressed anger toward their religion. One participant discussed her anger toward God and shared that a minister said, “[I]t’s not that God let it happen, the person who did it, God gave them free will and they took it upon themselves to do something different with it.”

People bereaved by suicide often discussed their concerns about their religion’s views of suicide and what the consequences would be for their loved ones. This was an immediate concern for one participant who recalled an interaction with the police at the scene of the suicide: “. . . the policemen were great ’cause I said ‘Is he gonna go to heaven?’ And these two guys go, ‘Yes, he’s gonna go to heaven.’” Other respondents bereaved by suicide discussed both internal challenges of disclosing the cause of death to their family members and larger community, including the religious community, and also the internal challenges with how different family members (e.g., the respondent’s spouse) viewed the cause of death being suicide.

Furthermore, one participant bereaved by suicide said that since the death of her loved one, she now believes in the afterlife, stating,

. . . I never believed in the afterlife like I do now. And that’s one of the things that keeps me going, so it’s, if you were to ask me when he was alive do I believe in that? No.

Connection With the Spiritual and Religious Communities

A unique characteristic of those bereaved by suicide was that several participants actively sought a third party (e.g., a medium) to communicate with their loved ones, or in some cases a third party who was able to communicate with the deceased would voluntarily share information with the participant about their loved one (as opposed to loved ones actively seeking a third party). In the latter situation, one participant found the information comforting saying, “I just hugged her and cried. For you to give me that, just that little piece of comfort.” Those bereaved by homicide did not report using similar avenues to communicate with loved ones.

Although both groups discussed connections with the larger religious community, these interactions seemed complex for those bereaved by suicide because of concerns regarding disclosing the cause of death and the resulting religious community’s response. Some participants bereaved by suicide had positive experiences with the religious community in addressing the type of death, which was critical for participants who were concerned that the cause of would elicit a negative response from the religious community. Many participants discussed the individual conflict participants had internally, as well as the controversy with other loved ones disclosing the cause of death to others, including within the religious community. Participants shared their stories of support from the religious community:

The priest that I dealt with,. . . when we met with him we said it’s important that it not be “I wonder what happened? Who knew this?” I wanted it to be acknowledged, recognized, and talked about so that maybe it could help someone else. And he did. You know, he said it was an illness just like cancer or any other illness. So he did, he did a really good job with it.

Similarly, another participant stated:

When my minster made the home visit she said this is not a sin. She said I want to make sure [of] that. And she said we don’t even, you know, like hearing the word “suicide” in some ways. It’s more just a loss of life or an end of life.

Although some participants bereaved by suicide noted the support from their religious communities, including one participant who stressed the supportive nature of a religious-based support group, another participant bereaved by suicide who was nondenominational felt that being nondenominational made it more difficult to find support both with the logistics of funeral planning and for emotional support: “. . . we’re non-denominational. I didn’t know anything about what kind of arrangements to make and the funeral home had nothing for me.” Those bereaved by suicide who were religious also encountered some difficulty after the suicide loss. For example, some grieving groups were too religious for some people, and one person discussed the difficulty of being in a religious place after the death of their loved one:

I tried to go back to church a few times after but for the whole hour I sat there and cried and you know, it was embarrassing and it was causing distress to the people around me so I couldn’t go anymore. I just couldn’t do it.

Participants bereaved by homicide discussed their connections with spiritual and religious communities, but their focus was on ceremonial issues and their personal battle with forgiveness in their religion. The ceremonial issues focused on the logistics of planning a funeral (e.g., what song to play at the place of worship), and issues that arise when families are not in complete agreement. Those bereaved by homicide were diverse in their views of forgiving the offender. Some participants vocalized their forgiveness or potential forgiveness toward the offender, and others could not see how they would ever forgive.

Discussion

The themes illustrate the complex nature of the interplay of spirituality and religion in the face of homicide and suicide. This complexity is directly a factor in how survivors experience interactions with both individual service providers and the larger service systems. The results point to a need for a more tailored approach by providers and the service community to the real needs of survivors. As such, there are some specific recommendations related to the interface with survivors so that the system is more sensitive and informed in response.

The complexity of spirituality and religion for those bereaved by homicide or suicide is difficult to overstate, and our themes illustrate the diversity of views, consistent with existing literature emphasizing that all faith-seeking responses should not be lumped together (Thompson & Vardaman, 1997); that one’s culture, race, and age might influence the appropriate response (Cerel et al., 2008; Clements et al., 2003); and that some people will embrace their spirituality and religion after homicide or suicide, but others might become angry with it (Armor & Umbreit, 2012; Mastrocinque et al., 2015). These complexities and diverse viewpoints are couched in literature emphasizing the importance of spirituality and religion in homicide and suicide responses (Armor & Umbreit, 2012; Boyd-Franklin & Lockwood, 2008).

On this background, an attempt to include mental health resources for families and friends bereaved by homicide and suicide should also be tailored to consider these factors. For example, spiritual meaning-making has been a positive coping strategy in many African American families bereaved by homicide (Sharpe & Boyas, 2011), but for some African American families, counseling is seen as a more secular approach, thus creating a barrier to access formalized mental health services (Boyd-Franklin & Lockwood, 2008). Although our sample was not large or diverse enough to explore such issues, a consistent idea is that the approach must be tailored for the person, and in light of the existing literature, one’s spirituality and religion should be considered and incorporated into mental health approaches. In addition, other barriers to accessing formal mental health care must be considered, including paying for services, believing such personal and private issues should not be shared, and language barriers (Boyd-Franklin & Lockwood, 2008; Provini et al., 2000).

An issue that differed for both the homicide and suicide groups was participants’ interactions with the larger community. Specific to those bereaved by suicide, participants discussed schools or communities not wanting to recognize the death of their loved one as a suicide loss. Such experiences reinforced concerns that those bereaved by suicide expressed regarding disclosing the cause of death. As one participant bereaved by suicide said, “. . . cause suicide is just so bad that you know, it’s a sin.” Family members or friends who encountered schools or communities not recognizing their suicide loss felt their loved one’s entire life was being defined by how their loved one died, and that this failed recognition could have an impact on the larger community’s grieving process (e.g., schoolmates, teachers). Those bereaved by homicide noted that advocacy and community events (e.g., scholarships) were important to them in remembering their loved one; therefore, if communities are not recognizing deaths by suicide, those bereaved by suicide may not have the same opportunity to remember their loved one.

There were several similarities among those bereaved by homicide and those bereaved by suicide in the context of their experiences with spirituality and religion, and the spiritual and religious communities. The similarities for these groups focused on death notification, first responders, and spiritual signs. Both groups discussed the importance of spirituality and religion during the death notification, the immediate process of addressing the details of the death (i.e., wake, funeral, burial), and the postdeath support. Systemic response to suicide is essential for optimal family and friend responses, as it has been shown to be in the case of homicide (Metzger et al., 2015).

It is important that first responders provide support and help without judgment to the family. The emergency or criminal justice first responders may need protocols and working agreements with the faith community to get “spiritual first responders” involved right away. It is also important for various first responders to communicate clearly either before (in protocols and training) or at the scene of a death to avoid mistakenly preventing certain responders at the scene. For example, in one situation, a police officer had initially prevented a spiritual leader from approaching a dying person to pray with that victim, telling the spiritual responder, “[G]et your hands off and leave him alone.” The spiritual responder replied, “Look. . . I’m a minister and I’m praying over him. I’m praying with him.” Spiritual first responders should be prepared to address the immediate postdeath needs of those bereaved, regardless of the specific types of death, which may include a homicide or suicide. Being prepared includes a common concern for people bereaved by suicide regarding whether suicide is a sin, and to be prepared that this question might be immediate (e.g., at the scene). Spiritual first responders should also be prepared to assist with those bereaved who are nondenominational and encountering difficulties with their own emotions and spirituality.

Some unique differences between people bereaved by homicide and people bereaved by suicide focused on disclosing the cause of death, religious tenets, and the use of a third party to connect to their loved ones. People bereaved by suicide emphasized the complications of disclosing the cause of death to others, especially those in the religious community and during religious services. Common concerns for people bereaved by homicide related to forgiveness and anger toward the offender, as well as one’s religion. People bereaved by homicide tended to either embrace their religion or develop an anger toward their religion; however, people bereaved by suicide did not mention this polarity.

Regarding postdeath needs, many families and friends described feeling lost and isolated (see, for example, Mastrocinque et al., 2015). Support groups may help address this issue; however, the fit of the support group is specific for each person. Spiritual first responders need to understand and listen to family and friends’ expressed concerns about support groups that have religious orientations that do not meet their needs. Having specific support groups within religious communities does provide opportunities for religious-tailored support for family members and friends, but some people do not belong to a specific place of worship or subscribe to a particular religion. These individuals may need to find and attend support groups in nondenominational locations, such as community centers and libraries.

The difficulty in attending religious services postdeath was discussed in both the homicide and suicide focus groups. These concerns extended past the specific services for the loved one’s death (e.g., attending a regular mass months later). It might be helpful in these situations to have a support person available for those bereaved during services or to have a support person attend services with them. This service provider could discuss with the survivor how it will be best to participate or be present, and then assist in making that wish a reality for the person/family. Some accommodations might include sitting in a private room with hearing and/or visual accessibility during the services, suggesting that the bereaved person attend a less crowded service, or having the bereaved person sit toward the back of the building or near an exit. These suggestions might provide more comfort and/or flexibility for the family member or friend to address concerns of not being able to sit through an entire service, and feeling like he or she cannot express emotion due to others being closely situated.

An interesting aspect to this research related to isolation is that while the researchers are aware of the great privilege they have in participants being willing to share their personal stories in focus groups, the focus groups themselves may be beneficial for participants. For some participants, they shared this was the first time they were with others who have experienced a similar trauma, and the detailed stories of others’ experiences reduced their isolation. For example, one participant stated she attended the homicide focus group because, “I knew I was gonna be with someone that went through the same thing I went through,” and another person bereaved by homicide stated,

It would’ve been nice to be able to go to a room among others that have experienced the same thing, which in this case, you know right here, there’s three of us to say, “How did you get through this?”

Second, several participants appreciated being able to remember their loved ones and share their experiences with the hope that it would positively affect others (e.g., improved training, increased responder sensitivity). For example, one person bereaved by homicide stated, “I feel that, uh, any support that can be given to families,. . . it’s a good thing. And if I can help, I can help.” Furthermore, there were several moments during the research that participants would appreciate the ability to speak about their loved ones. One participant reflected on how she loved to look at past pictures of her loved one who died by suicide because it showed his entire life was not defined by the way he died, and other participants shared anecdotes recalling memories of laughter and positivity.

Our themes suggest several recommendations; funeral homes and religious communities could play a pivotal role in meeting the needs of those affected by sudden death, as well as emergency responders and law enforcement. Funeral parlors might offer suicide-specific materials to assist families with both funeral planning and emotional support. This information might be especially helpful for people who are nondenominational.

When a family or friend has to disclose a sudden death to a larger community, including the religious community, the disclosure can provide an opportunity for a larger discussion to offer support to, and garner support from, others who might not have disclosed similar experiences. It could also be the impetus for larger community discussions about needed support, resources, and prevention. It is important to note that spiritual and religious communities might be the only place families and friends go to for support. Some people are likely to go to the spiritual or religious community before, or if ever, connecting to mental health services for a variety of reasons. Research supports that in addition to stigma, barriers to help-seeking include access to care, cost, and lack of knowledge about mental health services (Gulliver, Griffiths, & Christensen, 2010).

In addition, some people may avoid mental health services because the treatment approach may be too secular, and therefore, not incorporating a spiritual or religious component that a specific person might need (Boyd-Franklin & Lockwood, 2008). Some work discusses that mental health practitioners’ tailored approaches might be to incorporate a client’s religious leader or, more generally, that mental health practitioners may rethink using a completely secular approach to counseling for all clients (Boyd-Franklin & Lockwood, 2008). In addition, one’s spiritual or religious beliefs might also influence one’s receptivity to psychotropic medication (Medlock, 2015). These reasons emphasize that the spiritual and religious communities might be a key connection point for people bereaved by homicide or suicide to access support or to receive information on where to access tailored resources.

Limitations

As with all studies, this article has some limitations, which must be taken into account when considering the results. This is a single site study in a community that has a high crime rate and an early death rate for inner-city youth. The community has outreach and intervention strategies to address sudden deaths, and routine suicide awareness events. The participants self-selected in, and provided data based on recalling events that were not validated through secondary sources. As a qualitative study with relatively small number of participants, the generalizability of the results needs to be approached with caution. For instance, there is the limitation of the small number of groups held (N = 7). In addition, the subgroup of survivors is even smaller so one cannot reasonably conclude that the results speak for all mothers, siblings, and so forth. Given the nascent stage of research gleaning survivors’ perspectives, this article provides important information elucidating how we can better understand and address survivors’ experiences after the death of a loved one, which can lead to interventions that can be created, disseminated, and tested.

Also noteworthy as a limitation was that although we did not recruit women specifically, all suicide focus group participants were women. A recent report provided by the Suicide Prevention Resource Center (2016) noted that men between the ages of 35 and 64 years account for 40% of suicide deaths despite being only 19% of the population. The large majority of the decedents in our suicide group were men (81%), which is consistent with the emerging issue of men taking their own lives. More information is needed to understand the experiences of bereaved men who have lost a family or friend to suicide. Future studies might seek to recruit participants from venues where men frequent (e.g., barber shops).

Despite these limitations, there is an understanding of the importance of exploring the intersection of religion and spirituality with the types of mental health challenges frequently observed in family and friends’ postsuicide response (Boehnlein, 2006). It is necessary to incorporate examining potential faith-based approaches when discussing response systems.

Conclusion

Although there are noted similarities in addressing these two traumatic deaths, a tailored approach is needed to adequately address the unique needs of each population that suffers sudden deaths among their loved ones. The current results inform potential future approaches to assist those bereaved by homicide or suicide, which are inexpensive and easy to implement. We should be cautious, however, that emergency and first responders are trained on the benefits of making spiritual and religious connections for those bereaved in a respectful and culturally appropriate manner. One should not assume spirituality and religion as an appropriate coping avenue for all family members and friends. Finally, people bereaved by suicide commonly discussed the desire to connect to their loved one through a third party (i.e., clairvoyant), but families and friends should be aware of potential scams of third parties preying on vulnerable families and friends for financial benefit.

Footnotes

Acknowledgements

The authors express their sincerest appreciation to the families and friends of those bereaved by homicide and suicide who participated in the study and shared their stories with them. They thank Dr. David Skiff for his insight regarding the spirituality component of this research. The authors also acknowledge Sue Case, Victoria Pietruszka, and Aylin Turhan for their assistance in transcribing the transcripts for this study.

Authors’ Note

The authors presented preliminary findings at the American Society of Criminology Conference in San Francisco, CA, in November 2014 and appreciated audience feedback.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by the National Research Service Award NIMH T32 MH18911 (Caine), the Innovations in Community Scholarship Award (Mastrocinque), the University of Rochester Medical Center, Department of Psychiatry Grant (Mastrocinque), and the Faculty Development Committee Grant, York College of Pennsylvania (Mastrocinque).

Notes

Author Biographies

Jeanna M. Mastrocinque is an assistant professor in the Department of Law and Justice Studies at Rowan University whose research interests focus on the intersection of victimization and health with attention to specific underserved populations. She has led, and been a part of, several research projects focusing on families and friends of homicide victims, families and friends who have experienced a suicide loss, and intimate partner violence in the deaf population.

Taylor Hartwell is a MA student in the Department of Criminology, Law, and Society at George Mason University. Prior to attending George Mason University, Taylor received her Bachelor of Science in Criminal Justice and Psychology from York College of Pennsylvania. Her research interests include corrections, victimology, social inequalities, and the intersection of health and the criminal justice system.

Jed W. Metzger is an associate professor of Social Work at Nazareth College who has worked as a clinical social worker for the past 34 years. He co-founded a not-for-profit 501 c3 organization whose mission is to end murder and offer needed support to the family and friends of homicide victims. He has additional professional and scholarship interests in working with children, youth and families involved in the child welfare and children’s mental health systems, international contexts including trafficking, needs of children of deployed soldiers and efforts aimed at decreasing homelessness and poverty.

Renae Carapella-Johnson is a licensed mental health counselor and national certified counselor with extensive experience in individual therapy, crisis intervention and training. Renae has provided numerous workshops on mental health topics to community members and mental health professionals. She is an active member of the Steuben County Suicide Prevention Coalition, as well as a member of the Disaster Mental Health Team for Steuben, Chemung and Schuyler Counties.

Peter K. Navratil is a licensed clinical social worker and a credentialed alcoholism and substance abuse counselor. Peter is the co-owner and Clinical Director of Tree of Hope Counseling in Rochester, NY where he is engaged in full-time clinical practice.

Catherine Cerulli is a professor of Psychiatry at the University of Rochester, the Director of the Laboratory of Interpersonal Violence and Victimization at the University of Rochester (UR) School of Medicine and Dentistry, and the Director of the Susan B. Anthony Center. She is a licensed attorney with a PhD in criminal justice. Using CBPR principles, she has worked with victims as research advisors.

References

Ambrose

(n.d.). Traumatic grief: What we know as trauma responders. Retrieved from http://www.restoringconnections.ca/assets/pdf/ambrose_traumatic_grief.pdf

American Society of Suicidology. (n.d.). Surviving after suicide factsheet. Retrieved from http://www.suicidology.org/Portals/14/docs/Resources/FactSheets/SurvivingAfterSuicide.pdf

Amick-McMullan

Kilpatrick

D. G.

Resnick

H. S.

(1991). Homicide as a risk factor for PTSD among surviving family members. Behavior Modification, 15, 545-559. doi:10.1177/01454455910154005

Armour

Umbreit

(2012). Survivors of homicide victims: Factors that influence their well-being. Journal of Forensic Social Work, 2, 74-93. doi:10.1080/1936928x.2012.750253

Bailley

S. E.

Kral

M. J.

Dunham

(1999). Survivors of suicide do grieve differently: Empirical support for a common sense proposition. Suicide and Life-Threatening Behavior, 29, 256-271. doi:10.1111/j.1943-278X.1999.tb00301.x

Boehnlein

(2006). Religion and spirituality in psychiatric care: Looking back, looking ahead. Transcultural Psychiatry, 43, 634-651. doi:10.1177/1363461506070788

Boyd-Franklin

Lockwood

T. W.

(2008). Spirituality and religion: Implications for psychotherapy with African American families. In Walsh

(Ed.), Spiritual resources in family therapy (2nd ed., pp. 141-155). New York, NY: Guilford Press. doi:10.1111/j.1752-0606.2012.00342.x

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (n.d.). Web-Based Injury Statistics Query and Reporting System (WISQARS). Retrieved from www.cdc.gov/injury/wisqars

Cerel

Jordan

Duberstein

(2008). The impact of suicide on a family. Crisis, 29, 38-44. doi:10.1027/0227-5910.29.1.38

10.

Clements

P. T.

Vigil

G. J.

Manno

M. S.

Henry

G. C.

Wilks

Das

. . . Foster

(2003). Cultural perspectives of death, grief, and bereavement. Journal of Psychosocial Nursing, 41, 18-26.

11.

Colucci

Martin

(2008). Religion and spirituality along the suicidal path. Suicide and Life-Threatening Behavior, 38, 229-244. doi:10.1521/suli.2008.38.2.229

12.

Domino

Cohen

Gonzalez

(1981). Jewish and Christian attitudes on suicide. Journal of Religion & Health, 20, 201-207. doi:10.1007/bf01561181

13.

Engel

(1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129-196. doi:10.1126/science.847460

14.

Gulliver

Griffiths

K. M.

Christensen

(2010). Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. BMC Psychiatry, 10(1), 113. doi: 10.1186/1471-244X-10-113.

15.

Hargrave

T. D.

Froeschle

Castillo

(2008). Forgiveness and spirituality. In Walsh

(Ed.), Spiritual resources in family therapy (2nd ed., pp. 301-322). New York, NY: Guilford Press. doi:10.1111/j.1752-0606.2012.00342.x

16.

Harwood

Hawton

Hope

Jacoby

(2002). The grief experiences and needs of bereaved relatives and friends of older people dying through suicide: A descriptive and case-control study. Journal of Affective Disorders, 72, 185-194. doi:10.1016/s0165-0327(01)00462-1

17.

Hill

C. E.

Thompson

B. J.

Williams

E. N.

(1997). A guide to conducting consensual qualitative research. The Counseling Psychologist, 25, 517-571. doi:10.1177/0011000097254001

18.

Holmes

(2004, November). Life after death. Black Enterprise, 35(4), 184.

19.

Israel

B. A.

Schulz

A. J.

Parker

E. A.

Becker

A. B.

(2001). Community-based participatory research: Policy recommendations for promoting a partnership approach in health research. Education for Health, 14, 182-197. doi:10.1080/13576280110051055

20.

Jacobs

K. A.

Wellman

A. R. P.

Fuller

A. M.

Anderson

C. P.

Jurado

S. M.

(2016). Exploring the familial impact of cold case homicides. Journal of Family Studies, 22, 256-271. doi:10.1080/13229400.2015.1065195

21.

Knieper

A. J.

(1999). The suicide survivor’s grief and recovery. Suicide and Life-Threatening Behavior, 29, 353-364.

22.

Malone

(2007). In the aftermath: Listening to people bereaved by homicide. Probation Journal, 54, 383-393. doi:10.1177/0264550507083537

23.

Mastrocinque

J.M.

Metzger

Madeira

Lang

Pruss

Sandys

Navratil

P.K.

Cerulli

(2015). I’m still left here with the pain: Exploring the health consequences of homicide on families and friends. Homicide Studies, 19(4), 326-349. doi:10.1177/1088767914537494

24.

Metzger

J.W.

Mastrocinque

J.M.

Navratil

P.K.

Cerulli

(2015). Improving systematic response in the face of homicide: Family and friends of homicide victims’ service needs. Violence and Victims, 30(3), 522-532. doi: 10.1891/0886-6708

25.

Medlock

M. M.

(2015). A light pierces the darkness: A reflection on spirituality and suicide. Spirituality in Clinical Practice, 2, 282-284. doi:10.1037/scp0000081

26.

Miller

(2008). Counseling crime victims: Practical strategies for mental health professionals. New York, NY: Springer.

27.

Murphy

S. A.

Johnson

L. C.

Lohan

(2002). The aftermath of the violent death of a child: An integration of the assessments of parents’ mental distress and PTSD during the first 5 years of bereavement. Journal of Loss & Trauma, 7, 203-222. doi:10.1080/10811440290057620

28.

Neimeyer

Burke

(2011). Complicated grief in the aftermath of homicide: Spiritual crisis and distress in an African American sample. Religions, 2, 145-164.

29.

New York State Department of Health. (2013). Data use policy statement. Retrived from: https://www.health.ny.gov/about/data_use.htm

30.

New York State Department of Health (2017). (n.d.). Vital statistics of New York State 2014. Table 38: Selected causes of death by resident county New York state – 2014. Retrieved from https://health.ny.gov/statistics/vital_statistics/2014/table38.htm

31.

New York State Division of Criminal Justice Services. (2018). Index crimes reported to police: 2013-2017. Retrieved from http://www.criminaljustice.ny.gov/crimnet/ojsa/indexcrimes/Monroe.pdf

32.

Pargament

K. I.

(1999). The psychology of religion and spirituality? Yes and no. The International Journal for the Psychology of Religion, 9, 3-16. doi:10.1207/s15327582ijpr0901_2

33.

Pargament

K. I.

Smith

B. W.

Koenig

H. G.

Perez

(1998). Patterns of positive and negative religious coping with major life stressors. Journal for the Scientific Study of Religion, 37, 710-724. doi:10.2307/1388152

34.

Parkes

(1998). Coping with loss: Bereavement in adult life. British Medical Journal, 316, 856-859. doi:10.1136/bmj.316.7134.856

35.

Pennebaker

Zech

Rimé

(2001). Disclosing and sharing emotion: Psychological, social and health consequences. In Stroebe

M. S.

Stroebe

Hansson

R. O.

Schut

(Eds.), Handbook of bereavement research: Consequences, coping and care (pp. 517-539). Washington, DC: American Psychological Association. doi:10.1037/10436-022

36.

Pope

Ziebland

Mays

(2000). Qualitative research in health care: Analysing qualitative data. British Journal of Medicine, 320, 114-116. doi:10.1002/9780470750841.ch7

37.

Provini

Everett

J. R.

Pfeffer

C. R.

(2000). Adults mourning suicide: Self-reported concerns about bereavement, needs for assistance, and help-seeking behavior. Death Studies, 24, 1-19. doi:10.1080/074811800200667

38.

Rubin

Babbie

(2005). Research methods for social work. Victoria, Australia: Thomson.

39.

Rynearson

E. K.

McCreery

J. M.

(1993). Bereavement after homicide: A synergism of trauma and loss. The American Journal of Psychiatry, 150, 258-261. doi:10.1176/ajp.150.2.258

40.

Schneider

Grebner

Schnabel

Georgi

(2011). Is the emotional response of survivors dependent on the consequences of the suicide and support received? Crisis, 32, 186-193. doi:10.1027/0227-5910/a000081

41.

Sharpe

Boyas

(2011). We fall down: African American experience of coping with the homicide of a loved one. Journal of Black Studies, 42, 855-873. doi:10.1177/0021934710377613

42.

Stroebe

Schut

Finkenauer

(2001). The traumatization of grief? A conceptual framework for understanding the trauma-bereavement interface. The Israel Journal of Psychiatry and Related Sciences, 38, 185-201.

43.

Suicide Prevention Resource Center. (2016). Preventing suicide among men in the middle years: Recommendations for suicide prevention programs. Retrieved from http://www.sprc.org/sites/default/files/resource-program/SPRC_MiMYReportFinal_0.pdf

44.

Sveen

C.-A.

Walby

(2008). Suicide survivors’ mental health and grief reactions: A systematic review of controlled studies. Suicide and Life-Threatening Behavior, 38, 13-29. doi:10.1521/suli.2008.38.1.13

45.

Thompson

Vardaman

(1997). The role of religion in coping with the loss of a family member to homicide. Journal for the Scientific Study of Religion, 36, 44-51. doi:10.2307/1387881

46.

Walsh

(2008). Integrating spirituality in family therapy: Wellsprings for health, healing, and resilience. In Walsh

(Ed.), Spiritual resources in family therapy (2nd ed., pp. 31-64). New York, NY: Guilford Press. doi:10.1111/j.1752-0606.2012.00342.x

47.

Wellman

(2014). Faith without answers: The use of religion among cold case homicide survivors. Omega: Journal of Death and Dying, 69(1), 19-39. doi:10.2190/OM.69.1.b

48.

Wellman

(2017). Research on understanding the surviving families of homicide. In Browning

S. W.

van Eeden-Moorefield

(Eds.), Contemporary families at the nexus of research and practice (pp. 165-183). New York, NY: Routledge.

49.

Zinzow

H. M.

Rheingold

A. A.

Byczkiewicz

Saunders

B. E.

Kilpatrick

D. G.

(2011). Examining posttraumatic stress symptoms in a national sample of homicide survivors: Prevalence and comparison to other violence victims. Journal of Traumatic Stress, 24, 743-746. doi:10.1002/jts.20692