of mastery, factors that are known to influence the amount of burden experienced by SO’s (Wolk-Wasserman, 1986; Barrowclough, 2005; Magne-Ingvar & Öjehagen, 2005; Van Erp, Place & Michon, 2009), considering the attempt which their family member or friend consciously did, which is also a contrast to schizophrenia patients, who come to suffer from the illness, and could therefore weigh heavier. It was found that two SOs of one suicide attempter mostly experience different amounts of burden following the attempt, despite the fact that the characteristics of the attempter and context are expected to be similar. The amount of burden experienced by SOs was positively correlated with the number of attempts of, and with the amount of psychiatric help received by their relative or friend. This indicates that SOs who have experienced more attempts of their relative or friend and whose relative or friend receives more intensive psychiatric help (e.g. admission), which are likely to be related to the severity of the psychiatric disorder, experience more burden. It is unknown if severity of the psychiatric disorder has an influence on the burden experienced by SOs of SP since this factor was not included in studies on this subject. We found that more females than males reported a need for help. SOs who experience higher levels of overall burden, SOs who experience strain in the relationship with their relative or friend and SOs who are worried more about the safety, health and future of their family member or friend more often report a need for help. The reported need for help was also positively correlated with the amount of psychiatric help the attempters received, which suggests that the severity of the attempt or of the psychiatric disorder (leading to admission or other treatment) may also influence the help needed by SOs. This may also explain the higher percentage of SOs reporting a need for help (74%) in the study of Kjellin and Östman (2005) on SOs of admitted suicide attempters.
This study has several limitations. One limitation of this study is the small sample size and selective inclusion. Although we did reach the number of SOs required according to our power calculation, we had aimed for more. In this study only 56 SOs were willing to cooperate, whereas SOs of approximately 827 suicide attempters in our catchment area were expected to have been eligible for inclusion. Possibly people were reluctant to participate because they wanted to leave what had happened behind them. This was in fact the reason given for non-participation by most of the SOs who decided not to participate. Another possible cause of the low response may be that professionals in the hospitals and mental healthcare institutions found it difficult to raise the issue of the study to the SOs or suicide attempter due to stigma (by association). Stigmatization by health professionals can consist of negative attitudes, prejudice and behaviour like hostility and discrimination concerning people with mental disorders (Henderson et al., 2014). Research found that the attitudes of mental health professionals towards mentally ill people were as negative as the attitudes of the general population (Lauber, Anthony, Ajdacic-Gross & Rössler, 2004; Nordt, Rössler & Lauber, 2006) and also their implicit attitudes were negative, which means that they tended to evaluate the mentally ill in a negative manner (Kopera et al., 2014). Stigma does