RETURNING TO WORK FOLLOWING A

SUICIDE ATTEMPT: AN EXPLORATORY

STUDY

Francis Roy Ph.D.c

Center for Research and Intervention on Suicide

and Euthanasia

University of Quebec in Montreal, Canada

The XXVII World Congress of the International

Association for Suicide Prevention Oslo, Norway,

Sept. 24-28th 2013

Introduction

Recovering from a suicide attempt can be hard and overwhelming

Risk of repetition: 9% to 32% in the first year

Risk of death by suicide: 0,5 to 2% in the first year

Work can promote mental health well-being

Opportunities to develop and use our skills

Social contact and support

Sense of identity and personal achievement

Work can also be a source of psychological distress

Methodology

Qualitative approach: Grounded Theory

24 participants recruited through 6 ER and 3 SPC

Gender: 8 men / 16 women

Age: 22 - 59 years old (mean = 39)

5 professionals / 5 technicians / 3 office workers /

8 service workers / 4 manual workers

Semi-structured interviews focused on the individual’s

experience

Length: 58 – 158 min. (mean = 106 min.)

Results

Suicide attempt (n = 24)

1-12 months = 21 / 12-24 months = 3

15 Drug poisoning / 8 Cutting / 1 Hanging

All at home (or near home)

Work status

21 have RTW: 13 still working full time

4 were back on sick leave

4 were unemployed (1 fired / 3 resignations)

Life events preceding the suicide attempt

and their impact on RTW

Accumulation of stressful life events and difficulties at

home and sometimes at work

Working conditions before the suicide attempt can have a

negative impact on the issue of the reintegration process

For Christine, resignation was a first step toward recovery:

“I realized that I wasn’t happy at work and that my work

environment wouldn’t change. I realized that it was time

for me to go, that it was the easiest aspect of my life that I

could change.”

For Jane, resignation was to the only way to recovery:

“If I go back there again, I sign my own death warrant.

It’s my life! I almost died for work. Is it really worth it ?”

RTW and the recovery process

Work plays an important part in the recovery process.

“For me, work is a lifesaver, work is health. It keeps me busy,

socially and intellectually. After one week being at home, I was

starting to go crazy.” – Veronica

“Suicidal thoughts have stopped soon after I start working

again, with the help of the medication and the restoration of my

self-esteem, and my social life at work” – Mike

“Returning to work was really important for me. I was getting my

life back…. If they have stopped me again, I think I would have

reattempt. When I stay home alone, my thoughts stays

negative… Work is my life.” - Gaston

Feelings and apprehensions about RTW

Fear of having lost their ability to work / loosing their job

Fear of falling sick again

Feeling guilty of having been on a sick leave

Feeling like a stranger, like a different person

“It takes all the space. I dream about it, it’s part of my daily

life. I loose a lot of energy thinking about going back to

work.” – Jane

“I didn’t sleep well the night before. I was so nervous. You’re in

the street, walking to the office, and you only think about

that.” - Martine

Return to work and support offered

Gradual return was favored by many workers (10)

“Gradual return is essential. The first week, you observe, you

relearn how to work. You’re in your office and you feel like a

stranger.” – Jane

Support from supervisor was appreciated.

“I was really lucky because, on my very first day, my boss made

me feel that it was ok. He told me: ‘Nobody knows about it. If you

need to leave early today or if you need to talk, I will be there.

Work can wait. Think about yourself first’.” – Martine

“He was the only person at work who didn’t judge me. Everyday

he came to see me: How are you doing today? If there’s anything,

don’t be shy, come to see me. Don’t wait until its too late”– Gaston

Support from coworkers: To tell or not to tell

Workers felt ashamed. They didn’t want to talk about

it, they wanted to hide from their coworkers.

“Everyone is going to think that I did this to get their attention.

This is why I didn’t want to talk about it. I was ashamed to have

failed. (...) If there was more people who knew about it, I

wouldn’t have been able to return” – Martine

“After the attempt, you feel so ashamed that you just want to

hide. I didn’t talk to anyone. You don’t talk about that. – Carole

Strategies for dealing with coworkers’ curiosity

Support from coworkers: rumors and stigma

One worker had to deal with judgements and stigma:

“When I came back to work, the first thing the guys told me

was: ‘You’ve been on vacation all summer long!’. For them,

depression is impossible. It doesn’t exist.” - Gaston

“Everybody knew about it. Usually, when I arrived at work,

people were friendly with me. But then, when I came back,

people had trouble saying hello to me… communication was

shut down. (…) I tried to figure out what was going on but

nobody answered me. With time, I learned that they all

knew: you can’t hide anything in that shop!” - Gaston

Support from coworkers is a key factor

For Mike, the way that his coworkers welcomed him

facilitated his return to work

“When I came back to work, my colleagues almost roll out

the red carpet for me! All the guys were like ‘Mike!, Mike!

Mike!’. Its the fact that people were happy to see me, that

they acknowledge my work that helped me the most”– Mike

Having a trusted friend as a coworker to rely on

“I’m fortunate to work with my best friend. I was feeling

supported. I was sitting at my desk, knowing that she was

right across whenever I didn’t feel good” - Martine

Support from coworkers is a key factor

Coworkers’ response to disclosure was positive and

they were very supportive in many cases.

“They stopped and they listened carefully to what I told them.

They said: ‘Man, we almost lost you!’.” – Mike

“They told me: ‘You should have called us’.” – Gilles

Workers felt closer to their colleagues after

disclosure, some becoming a confidant for others.

“I have become a confidant for one or two of my coworkers

who were going through a rough patch. I once encouraged

one of them to call the suicide hotline. I told him: ‘And, if you

ever need medication for a few months, its ok. It’s not a

failure, its even a success’.” - Serge

Discussion and conclusion

Return to work plays an important role in the

experience of recovery.

Working conditions before the suicide attempt can

have a negative impact on the reintegration process.

Workers have a lot of apprehensions about RTW

Support from supervisors and colleagues are key

factors in the reintegration process.

THANK YOU!

For more information:

roy.francis@uqam.ca

http://www.crise.ca/eng/iasp2013.asp