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. 2023;14(1):2182820.
doi: 10.1080/20008066.2023.2182820.

Shame, depression, and complicated grief among suicide loss-survivors: the moderating role of self-disclosure

Yossi Levi-Belz  1 , Sami Hamdan  2
Affiliations

Shame, depression, and complicated grief among suicide loss-survivors: the moderating role of self-disclosure

Yossi Levi-Belz et al. Eur J Psychotraumatol. 2023.

Abstract
in English, Spanish, Chinese

Background: Suicide-loss survivors (SLSs) are recognised as an at-risk population for several psychiatric complications, including complicated grief (CG) and depression (SI). However, whereas shame is known as one of the characteristics of this population, knowledge about possible psychological processes which may moderate the contribution of shame levels to CG and depression in the aftermath of suicide loss is sparse. This study examines the role of self-disclosure - the inclination to share personal information with others - as a possible moderator of the associations of shame with CG and shame with depression over time.Method: Participants were 152 suicide-loss survivors, aged 18-70, who completed questionnaires tapping CG and depression at three time points (T1- index measurement, T2-two years after T1. and T3-four years after T1) and questionnaires tapping shame and SD at T3.Results: Hierarchical regression analyses showed that shame significantly and positively contributed to CG at T3 and to depression at T3, beyond the CG/depression trajectories. Notably, two significant interactions were found: Self-disclosure moderated the contribution of shame to CG at T3 and to depression at T3. At lower self-disclosure levels, shame's contribution to CG and depression was higher.Conclusion: The study's findings highlight shame as a significant facilitator of CG and depression in the aftermath of suicide loss. Moreover, the role of interpersonal interaction on SLSs' distress levels and grieving process was underscored, as this interaction may serve as a buffer against the deleterious sequelae of the suicide of a loved one.

Antecedentes: Se reconoce que los sobrevivientes a pérdida por suicidio (DPS) son una población de riesgo para diferentes complicaciones psiquiátricas, incluyendo al duelo complicado (DC) y a la depresión. Sin embargo, pese a que se conoce que la vergüenza caracteriza a esta población, el conocimiento de los posibles procesos psicológicos mediante los cuales los niveles de vergüenza ejercen un papel moderador entre estos, el DC y la depresión luego de un suicidio es escaso. Este estudio evalúa el papel de la divulgación voluntaria – la tendencia a compartir información personal con otros – como un posible moderador de las asociaciones entre la vergüenza y el DC, y entre la vergüenza y la depresión en el tiempo.

Métodos: Los participantes fueron 152 sobrevivientes a pérdida por suicidio entre 18 y 70 años quienes completaron cuestionarios que vinculaban el DC y la depresión en tres momentos (T1 – dato de base; T2 – dos años luego de T1; T3 – cuatro años luego de T1) y también cuestionarios que vinculaban la vergüenza con la depresión en T3.

Resultados: Los análisis de regresión jerárquica mostraron que la vergüenza contribuía de forma significativa y directamente proporcional al DC en T3 y a la depresión en T3, más allá de las trayectorias de duelo complicado / depresión. En particular, se encontraron dos interacciones significativas: La divulgación voluntaria tuvo un efecto moderador entre la vergüenza y el DC en T3, y entre la vergüenza y la depresión en T3. A menores niveles de divulgación voluntaria, la contribución de la vergüenza sobre el DC y la depresión era mayor.

Conclusión: Los hallazgos del estudio resaltan la vergüenza como un facilitador significativo para el DC y la depresión luego de un duelo por suicidio. Asimismo, resaltaron el papel de la interacción interpersonal sobre los niveles de angustia y el proceso de duelo de los sobrevivientes a pérdida por suicidio, pudiendo esta interacción servir para amortiguar las secuelas deletéreas del suicidio de un ser amado.

背景：自杀身亡幸存者 (SLS) 被认为是多种精神并发症的高危人群，包括复杂性哀伤 (CG) 和抑郁。 然而，虽然羞耻被认为是这一人群的特征之一，关于可能在自杀失败后可能调节羞耻水平对 CG 和抑郁作用的心理过程知之甚少。 本研究考查了自我披露—与他人分享个人信息的倾向，作为随时间推移羞耻与 CG 和羞耻与抑郁关联可能的调节者作用。

方法：参与者是 152 名18–70 岁的自杀失败幸存者，在三个时间点（T1-指数测量，T2-T1 后两年和 T3-T1 后四年）完成了探究 CG 和抑郁的问卷调查，在T3 时进行了探究耻辱和 SD的问卷调查。

结果：分层回归分析表明，在 CG/抑郁轨迹之外羞耻对 T3 的 CG 和 T3 的抑郁有显著和正向的作用。 值得注意的是，发现了两个重要的交互作用：自我披露调节了羞耻对 T3 的 CG 和 T3的抑郁的作用。 在较低的自我表露水平下，羞耻对 CG 和抑郁的作用更高。

结论：本研究结果强调了羞耻是自杀失败后 CG 和抑郁的重要促进因素。 此外，强调了人际互动对 SLS 的痛苦程度和哀伤处理的作用，因为这种互动可以缓冲亲人自杀的有害后遗症。

Keywords: Complicated grief; Duelo complicado; depresión; depression; divulgación voluntaria; self-disclosure; shame; sobrevivientes a pérdida por suicidio; suicide-loss survivors; vergüenza; 复杂性哀伤; 抑郁; 羞耻; 自我表露; 自杀失败幸存者.

Plain language summary

Shame significantly and positively contributed to CG and depression at trajectories.Self-disclosure moderated the contribution of shame to CG and depression at T3 beyond their natural trajectories.Interpersonal activities may serve as a buffer against the deleterious effects of suicide in the family.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Flow chart of SLSs who participated in this study.
Figure 2.
Figure 2.
The association between shame and complicated grief at T3 as moderated by levels of self-disclosure (N = 152).
Figure 3.
Figure 3.
The association between shame and depression at T3 as moderated by levels of self-disclosure (N = 152).
See this image and copyright information in PMC

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