Background
Mental health services are dependent on family and friends to support patients at risk of suicide. Support for informal carers is lacking despite evidence of caregiver burden, poor health outcomes, and difficult encounters with mental health services. To inform development of tailored resources understanding the experiences of caring for adults in this context is important.
Aim
To develop an understanding of the experiences and support needs of adult informal caregivers of adults at risk of suicide.
Methods
A convergent mixed methods design included an online survey (n= 101) assessing perceived stigma of suicide attempt, quality of life, helpfulness of support services, and experiences and support needs. Semi structured interviews (n=15) gathered experiential accounts. Statistical analyses were conducted with quantitative data, summative content analysis was used for qualitative survey data and reflexive thematic analysis for interview data. Data sets were integrated and through a process of abduction mixed methods interpretations were achieved.
Results
The overarching theme of ‘entering and adjusting to a different and uncertain world’ was generated. Carer uncertainty was acute on entry to the different world,
enduring in the longer term, and inherent in future perspectives. Uncertainty manifested emotionally, psychologically, interpersonally and behaviourally, was
perpetuated by difficult encounters with healthcare providers, and had detrimental effects on mental and physical wellbeing. Stress was propagated by lack of support from mental health services which were the least helpful support agency. Perceived stigma was inversely associated with carer support, caring choice and carer stress and accounts indicated experiences of provider-based stigma. Carers demonstrated an adept ability to balance uncertainty with reasonable hope, which helped them to sustain their caring role. Identified support needs included recognition, information and education, authentic collaboration, tailored peer support and psychosocial interventions with an emphasis on intrapersonal and relational changes.
Conclusion
Effects of caring for an adult at risk of suicide are profound and enduring. Interventions should validate and address uncertainty with regards to both acute and persistent suicidality. Individual and joint or family psychological support and education is required. Longitudinal research should investigate impact and experiences over time.