Abstract
BACKGROUND: Bereavement, particularly by suicide, is associated with an excess risk of mortality and of physical and psychological morbidity. Use of alcohol as a coping mechanism is suggested as a contributing factor. However, studies describing substance use after bereavement rely on diagnostic data, lacking a more fine-grained understanding of patterns of substance use when grieving. We aimed to use mixed methods to compare patterns of substance use after bereavement by suicide and other sudden deaths among young adults in the UK. METHODS: Using an online survey throughout 37 UK higher education institutions we collected free text responses from 1,854 young adults who had experienced sudden bereavement. We conducted content analysis of free text responses to an open question about patterns of alcohol and drug use following the bereavement, measuring frequencies of coded categories. Collapsing these categories into binary outcomes reflecting increased use of alcohol or drugs, we used multivariable logistic regression to quantify the associations between mode of bereavement and increased post-bereavement substance use. RESULTS: Of 1,854 eligible respondents, 353 reported bereavement by suicide, 395 by accidental death, and 1,106 by sudden natural causes. The majority of the sample reported no increase in their use of alcohol (58%) or unprescribed drugs (85%) after the bereavement. Overall 33% had increased their alcohol use at some point after the bereavement, whilst 12% had increased their use of drugs. People bereaved by suicide were significantly more likely to describe an increase in substance use (adjusted OR = 1.29; 95% CI = 1.00-1.66; p = 0.049) than people bereaved by sudden natural causes, as were people bereaved by non-suicide unnatural deaths (adjusted OR = 1.32; 95% CI = 1.03-1.68; p = 0.026). CONCLUSION: Just under half of young UK adults who experience sudden bereavement increase their alcohol use afterwards, and very few increase their use of drugs. People bereaved by suicide or non-suicide unnatural deaths may be more likely than people bereaved by sudden natural causes to use substances as part of the grieving process, and may have a greater need for monitoring of potential harms. Understanding the reasons for substance use will help primary care and bereavement practitioners screen and address needs appropriately.