RETURNING TO WORK FOLLOWING A SUICIDE ATTEMPT: AN EXPLORATORY STUDY Abstract: Recovering from a suicide attempt can be hard and overwhelming, with the risk of reattempt markedly high during the first months after discharge. Repetition has also been found to be a strong predictor for completed suicide. Within the first 12 months after an episode of deliberate self-harm, the risk of suicide increases 20 to 100 times in comparison to the general population's risk. Returning back to work can be a critical step in the recovery process following a suicide attempt. Work not only provides the financial resources needed for material well-being but also fosters opportunities to develop and use skills, establishes points of social contact and support, and solidifies our sense of identity and personal achievement. However, little is known about the conditions supporting successful work reintegration following a suicide attempt. Return to work can be difficult, particularly when the suicide attempt took place onsite at the workplace or if colleagues were involved in the suicidal crisis. Employees may be concerned about returning to work, fearing what their colleagues will think of them and how they will react. Managers and colleagues may avoid contact with the person, not knowing what to say and fearing to cause more damages. The purpose of this study is to gain a better understanding of the factors involved in the reintegration process among a group of employees absent from work following a suicide attempt. A total of 24 people aged between 22 and 60 years old and working in different organisations were interviewed. Participants were recruited after they were treated for a suicide attempt in general hospital emergency rooms in Montreal and through Suicide Prevention Centers in the Greater Montreal area. A qualitative approach was used, grounded theory, to analyse the return-to-work process. Semi-structured interviews averaging 90 minutes in length were recorded then transcribed word by word. Analysis of the data enabled the reconstruction of an individual's experience at various stages of the work reintegration process, their interpretation of these events, and their responses to the difficulties they met. This presentation will explore the different trajectories of workers returning back to work following a suicide attempt. Finally, a model will be proposed to help in understand the reintegration process and recommendations for practice will be discussed.

1. 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

2. 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

3. 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.)

4. 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)

5. 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 ?”

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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.

14. THANK YOU!
For more information:
roy.francis@uqam.ca
http://www.crise.ca/eng/iasp2013.asp