The classification of the sub-types of guilt experienced after suicide bereavement: thematic analysis of qualitative interview data

Guilt after suicide loss arises from perceived omission (not having done enough) or commission (having done something damaging). Guilt after suicide loss is also experienced as guilt arising from survival. Blame may be directed at self or others after suicide loss, implying where guilt should be located. Guilt after suicide loss can be experienced self-destructive but some individuals develop coping strategies to manage their loss and the guilt. The mechanisms underlying the association between suicide bereavement and adverse mental health and social outcomes, including suicide and marital breakdown, are not well understood. Feelings of guilt are reported to be more pronounced after suicide bereavement than after other losses, and this may contribute to adverse outcomes. We aimed to characterise and classify feelings of guilt expressed after suicide loss. We conducted a secondary analysis of interview transcript data from 19 adults bereaved by suicide who were interviewed in 2020, using thematic analysis to explore the phenomenology of experiences of guilt described after suicide loss. Our analysis identified five main themes, of which the first three (Guilt of omission; Guilt of commission; Guilt relating to survival) corresponded to a classification of subtypes of personal guilt experienced by suicide-bereaved adults. The fourth theme (Allocation of blame) identified views on those who were to blame for the suicide, engendering feelings of guilt. The fifth (superordinate) theme captured the emotional, cognitive, and behavioural consequences of guilt, which included self-destructive behaviours but also descriptions of coping strategies. The proposed taxonomy arising from this thematic analysis, and descriptions of the subtypes of guilt experienced after suicide loss, contribute to an improved understanding of the role of guilt to the burden of suicide bereavement. Further work is needed to investigate the contribution of each subtype of guilt to adverse mental health and social outcomes after suicide loss.