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Article

Online Memorialization and Grief After Suicide: An Analysis of Suicide Memorials on the Internet

Karolina Krysinska 1,2

and Karl Andriessen 1,3

Abstract

Although several studies have looked at the phenomenon of online memorialization,

online involvement of those bereaved by suicide (suicide survivors) remains an under-

studied area. The current study analyzed 250 memorials dedicated to those who died

by suicide on two memorialization Web sites: Faces of Suicide and Gone too Soon.

The majority of the memorials was posted by family members of the deceased and

had a format of a letter or an obituary. Though the memorials were written for both

males and females of all ages, 80% of the messages were written for young males.

Fourteen themes were identified, ranging from sadness and expressions of love and

other grief reactions of the bereaved, to acknowledgment of suicide and search for

reasons for the death. Some of the bereaved wrote about their motives for posting

an online memorial. Future studies should determine the impact of involvement in

online memorialization on the grief process of suicide survivors.

Keywords

Internet, memorials, grief, bereavement, suicide

OMEGA—Journal of Death and

Dying

2015, Vol. 71(1) 19–47

! The Author(s) 2015

Reprints and permissions:

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DOI: 10.1177/0030222814568276

ome.sagepub.com

1 KU Leuven – University of Leuven, Leuven, Belgium

2 Black Dog Institute, University of New South Wales, Sydney, NSW, Australia

3 School of Psychiatry, University of New South Wales, Sydney, NSW, Australia

Corresponding Author:

Karolina Krysinska, NHMRC Centre of Research Excellence in Suicide Prevention, Black Dog Institute,

Hospital Road, Randwick NSW 2031, Australia.

Email: [email protected]

Introduction

Suicide is a major public health problem, and according to the World Health Organization (2012), almost one million people worldwide die by suicide every year. Those who are left behind, grieving after the death, are called suicide sur- vivors (Andriessen & Krysinska, 2011; Jordan & McIntosh, 2011a). There is a lack of consensus regarding the definition of a suicide survivor; however, the proposed definitions share several commonalities. They focus on the fact that there existed a relationship between the deceased and the bereaved, on the close- ness of this relationship, and the impact of the loss on the bereaved (Andriessen, 2009; Farberow, 2001). Jordan and McIntosh (2011a) acknowledge the wide range of experiences of the bereaved and define a suicide survivor as “someone who experiences a high level of self-perceived psychological, physical, and/or social distress for a considerable length of time after exposure to the suicide of another person” (p. 7).

Originally, Shneidman (1969) suggested that on the average, six suicide sur- vivors are left behind after the death. However, the first systematic estimation of the number of suicide survivors found that the number varies considerably depending on the type of the relationship, the frequency of contact between the deceased and the bereaved, and the age of the deceased (Berman, 2011). Indeed, a suicide death can affect people in various types of relationships with the deceased: from close family members to more distant relatives, friends, neighbors, and employers (Campbell, 1997). Sometimes there is a distinction made between suicide survivorship and exposure to suicide (Crosby & Sacks, 2002). The former applies to the bereaved who had a personal and close rela- tionship with the deceased, and the latter reflects a situation of a person who did not know the deceased personally but who knows about the death through reports of others or media reports or who has personally witnessed the death of a stranger.

Many suicide survivors and clinicians working with the bereaved after suicide indicate that grief after suicide is unique and different from reactions to other types of loss (Jordan, 2001). They focus on the experience of guilt and shame, social stigma and isolation, as well as the desperate search for the meaning by the bereaved and their increased risk of suicide. Still, research studies find more similarities than differences between suicide bereavement and grief reactions following other types of death (Grad, 2011; Jordan, 2001; Sveen & Walby, 2008). Jordan and McIntosh (2011b) proposed a framework that helps to accommodate both the uniqueness of grief reactions after suicide and reactions, which suicide survivors share with other bereaved. According to this framework, in suicide bereavement, one can find four types of reactions. These range from reactions experienced in bereavement after all types of death (e.g., sorrow and yearning to be reunited with the deceased) to reactions characteristic for bereavement after unexpected deaths (e.g., shock and sense of unreality about

20 OMEGA—Journal of Death and Dying 71(1)

the death) and after violent deaths (e.g., trauma of finding a mutilated body and shattered illusion of personal invulnerability). In addition to these shared reac- tions, suicide survivors experience features that seem unique to suicide bereave- ment, such as anger at the deceased for choosing death over life, and the feeling of abandonment.

Moreover, the type, closeness, and quality of the relationship, preloss prob- lems of the deceased or the survivor, as well as the time since the suicide seem to be important for the grief process (Andriessen, 2009; Grad, 2011). For example, survivors’ reactions might differ as a consequence of previous history of suicid- ality of the deceased and the expectation of death (Sveen & Walby, 2008). Those on a long-term suicide watch might experience after the suicide the feeling of relief (often subjectively perceived as unacceptable and coupled with guilt), while those for whom the death came unexpectedly might react with a shock, accom- panied by numbness and disbelief.

Over the past three decades, due to its increasing availability and ease of use, Internet has become an important source of mental health information and support, also for the bereaved. A decade ago, Vanderwerker and Prigerson (2004) found that approximately half of the bereaved in the United States used Internet and email and that these online resources seemed to improve their quality of life and could protect against mental problems secondary to bereavement. More recent data show that more than half of the bereaved in North America are currently using online mutual bereavement support, such as email lists, Internet forums, and chat rooms (often in combination), while approximately 20% of the bereaved used such support in the past (van der Houwen, Stroebe, Schut, Stroebe, & Van den Bout, 2010). This increasing popu- larity of the Internet among the bereaved has been captured by a bereaved blog writer in the following words: “Maniacal googling is a new stage of grief. After denial and before resignation comes the google stage” (Laura at 11D, 2005; quoted in: Sofka, Noppe Cupit, & Gilbert, 2012, p. 52).

There are many reasons why individuals, including the bereaved after suicide, choose to use online resources. Online bereavement-related activities allow both seeking and maintaining contact with other bereaved and continuing bonds and communication with the deceased (Roberts, 2004a; Sofka et al., 2012). Finding in the digital space others who have gone through a similar experience of loss provides a unique chance to share one’s story in a safe and empathic environ- ment. Given the taboo nature of loss by suicide and the social stigma surround- ing suicide, online information and help might be particularly attractive to the survivors who might be bereft of other support (Berger, Wagner, & Baker, 2005; Feigelman, Gorman, & Jordan, 2009).

Despite the increasing scientific and clinical interest in the subject of grieving online (see recent reviews in Sofka et al., 2012 and Walter, Hourizi, Moncur, & Pitsillides, 2011–2012), not many studies have explored the use of Internet and its impact on the process of grieving in case of suicide survivors. The studies

Krysinska and Andriessen 21

conducted so far include reports on development and qualitative evaluation of Web sites for the bereaved, including adolescent suicide survivors and their support networks (Clark et al., 2004; Hoffmann, 2006), and a qualitative ana- lysis of participation in an online survivor support group and a mailing list (Hollander, 2001). Krysinska and Andriessen (2010) found that a wide range of online material is available for those bereaved by suicide (from personal bereavement Web sites to Web sites of professional services and organizations); however, there is no guarantee that the retrieved material is trustworthy and of good quality. Feigelman, Berman, Beal, and Jordan (2008) explored in detail the participation of parents bereaved by suicide in online support groups and com- pared their loss-related and demographic characteristics with parent survivors who participated in face-to-face support groups. One study (Chapple & Ziebland, 2011) explored how the bereaved by suicide use the Internet. Its results showed that the Internet is used as a source of practical information and peer support, to inform others about the death and to memorialize the deceased.

Online memorialization, that is, creating and maintaining Web pages or Web sites dedicated to the memory of the deceased, is one of the online activities available to the bereaved (de Vries & Moldaw, 2012; Roberts, 2004b; Sofka, 1997). These Web sites include freestanding Web pages dedicated to an individ- ual deceased (sometimes such Web pages are linked together to form a Web ring), memorial sites, and online cemeteries. With the increasing popularity of social networking Web sites, especially among adolescents and young adults, memorial groups and profiles are being used as venues for grieving and seeking peer support (DeGroot, 2012; Williams & Merten, 2009). Some of the online cemeteries and memorial sites have a general character, and there is no distinc- tion made on basis of the cause of death or age of the deceased (e.g., www.go- netoosoon.org, http://virtualmemorials.com). Other sites are dedicated specifically to the victims of a particular illness or type of death, such as AIDS (e.g., www.thebody.com/memorial), cancer (e.g., http://tributefunds. againstbreastcancer.org.uk), sudden infant grief syndrome (e.g., http://www. sids.org/nmemory), or suicide (e.g., www.suicidememorialwall.com, www.face- sofsuicide.com). Memorialization Web sites and Web pages are often spontan- eously created by family members and friends of the deceased, although there are also memorial Web sites created by funeral homes and other commercial organizations. Online memorialization usually supplements the traditional bereavement rituals, and the memorial sites are maintained along with a physical grave (Roberts, 2004b). Sometimes, due to geographical distance or the nature of loss, especially in case of disenfranchised grief (Doka, 1989), they may replace a traditional grave and provide a unique venue to express the feelings of the bereaved (Mitchell, Stephenson, Cadell, & MacDonald, 2012; Walter et al., 2011–2012).

Studies conducted to date suggest that a relatively large number of Web sites and Web pages memorialize those who died by suicide (Chapple & Ziebland,

22 OMEGA—Journal of Death and Dying 71(1)

2011; Krysinska & Andriessen, 2010; Roberts & Vidal, 2000). Roberts and Vidal (2000) in their study of four online cemeteries identified 10% of online graves as graves devoted to people who took their own lives (this number could be an underestimation: The cause of death was mentioned only in one third of the analyzed memorials). Krysinska and Andriessen (2010) found that personal sui- cide bereavement Web sites, that is, Web sites created by and for suicide sur- vivors, including sites created to memorialize those who died by suicide, were among the most frequently retrieved online resources for the bereaved by sui- cide. Chapple and Ziebland (2011) showed that for some suicide survivors online memorialization is an important supplement to traditional forms of honoring the memory of the deceased, such as a physical grave or a memorial brick. Also studies of social networking Web sites have found memorial profiles and groups dedicated to the memory of young adults and adolescents who died by suicide (DeGroot, 2012; Hiefje, 2012).

Studies of online cemeteries indicate that there are differences between mes- sages dedicated to victims of sudden and violent deaths, including suicide, and those who died a natural death (de Vries & Rutherford, 2004; Lester, 2012; Roberts & Vidal, 2000). The former more frequently include information about the cause of death, a wish that the deceased might (finally) rest in peace, and the attempts to understand and to come to terms with the loss (de Vries & Rutherford, 2004; Roberts & Vidal, 2000). Suicide memorials also con- tain more death-related words, more words reflective of anger and sadness, and fewer references to the self or to the deceased than other types of memorials (Lester, 2012).

Aims of the Study

Despite a growing body of research looking at the types and the contents of messages posted online to memorialize a deceased (e.g., Blando, Graves-Ferrick, & Goecke, 2004; de Vries & Rutherford, 2004), their role in the process of grieving (e.g., Finlay & Krueger, 2011; Nager & de Vries, 2004), and the psy- chological and demographic profile of the bereaved who make online memorials (e.g., Musambira, Hastings, & Hoover, 2006–2007), not much is known about online memorialization of those who died by suicide. It remains unknown who writes online memorials, for whom they are written, which forms they take, and what is their content. The current study aims to fill in this important gap in the knowledge regarding suicide bereavement and the Internet.

Following the nomenclature used in previous research (Blando et al., 2004; de Vries & Rutherford, 2004; Lester, 2012; Roberts & Vidal, 2000), in the current study, an online memorial is defined as a message posted in memoriam of a deceased by a bereaved on an official memorialization site, such as a memorial Web site or an online cemetery. The study looked at (a) the type of relationship between the bereaved who create suicide memorials and the deceased, and the

Krysinska and Andriessen 23

time elapsed between the death and creation of the memorial, (b) the socio- demographic profile (i.e., age and gender) of suicide victims memorialized online, (c) the types of the online memorials, and (d) major themes in the online memorials. In addition, formal features of the memorials, such as length, inclusion of links and photos of the deceased, were included in the analysis.

Method

Material

Memorials created at two memorialization Web sites: Faces of Suicide (www.fa- cesofsuicide.com) and Gone too Soon (www.gonetoosoon.org) were used for the analysis. The Faces of Suicide Web site contains suicide memorials only, while the Gone too Soon online cemetery includes memorials dedicated to individuals who died of all causes, including suicide. These two memorialization sites were chosen for the study, as they are contain large numbers of suicide memorials (N¼1,147 on Faces of Suicide and N¼1,526 on Gone too Soon in October 2012) and are well-maintained sites. In addition, both offer free and open access to the individual memorials.

The U.S.-based Faces of Suicide site is owned and cared for by volunteers from the Parents of Suicides and Friends and Families of Suicides Internet Community. The format of the Faces of Suicide memorials is standardized: Each memorial contains a photo of the deceased, his/her name, date of birth and date of death, home location, and an optional personalized text (Our Remembrance). There is also an option to add a link to a personal memorial Web page. The Gone too Soon memorials also include a number of standard features: name, date of birth and date of death of the deceased, his/her age at death, location, cause of death (here: suicide), information about the creator of the memorial (including relationship to the deceased),

1 date of creation of the

memorial, and number of visitors since the memorial was posted online. Each memorial includes a text written in memoriam of the deceased, which can be a standard text offered automatically by the Web site or a personalized text. There is an option of uploading a photo of the deceased or other picture, including standard pictures offered at the Web site. In addition, the creator of the memor- ial or registered users of the Gone too Soon Web site can light an e-candle, give a gift, leave a photo, or write a tribute at a particular memorial.

The memorials analyzed in the study (N¼250; 125 memorials per site) were randomly selected among memorials on the Faces of Suicide and the Gone too Soon Web sites. The material was collected in October/November 2012. A memorial was excluded from the study if it contained only the name, date of birth, and date of death of the deceased or included only a standard message offered by the site. Moreover, memorials devoted to celebrities were excluded

24 OMEGA—Journal of Death and Dying 71(1)

from the study. All analyzed memorials were written in English. There were no limitations related to the country of origin of the suicide, the year of death, or the year in which the memorial was created. On the Gone too Soon Web site, the analysis included the original text of the memorial and text written by the author of the memorial about himself/herself (About me) if the latter was directly related to the content of the memorial. The tributes posted by the visitors of the memor- ial were excluded from the analysis.

For practical reasons related to the structure of the Web site and system of retrieval of individual memorials, the method of random selection of memorials differed between the two Web sites. On the Faces of Suicide Web site, the first memorial (photo) appearing on the refreshed home Web page of the site was selected if it met the study inclusion/exclusion criteria, until 125 eligible memor- ials were found. On the Gone too Soon Web site, suicide memorials were iden- tified using the Search by cause of death option. The selection of individual suicide memorials was based on two random numbers generated online (www.random.org): the first corresponding to the Web page number and the second corresponding to the location of the memorial on the individual Web page.

Analysis

Information related to the following variables was extracted from the analyzed memorials: the type of relationship between the author of the memorial and the deceased (on the Gone too Soon Web site, only information about the relation- ship of the Creators to the deceased was included in the current analysis), the time elapsed between the death and creation of a memorial (information avail- able only at the Gone too Soon Web site), age, gender, and country of origin of the deceased. Also formal features of a memorial, such as memorial length, presence of picture of the deceased (standard at the Faces of Suicide Web site), and a link to a personal memorial site, were analyzed. Based on previous studies (de Vries & Rutherford, 2004; Nager & de Vries, 2004; Roberts, 1999), each memorial was classified according to its type as (a) eulogy/obituary (including formal obituaries, descriptions of and stories about the deceased addressed to the readers), (b) letter to the deceased (a personal message to the deceased, addressed by “you”), and (c) a tribute (a sentiment, a short expression of feelings about the deceased, or his/her death).

Thematic analysis was used to identify, analyze, and report themes within the collected online material (Braun & Clarke, 2006). The analysis had an interpret- ative and deductive character, that is, the process was guided by review of the literature on the psychological reactions frequently found in suicide bereavement (Grad, 2011; Jordan & McIntosh, 2011b) and in general bereavement, (Shuchter & Zisook, 1993; Worden, 2008; Zisook & Shear, 2009). Also, if applicable, themes frequently identified in previous analyses of the content of online

Krysinska and Andriessen 25

memorials were used in the thematic analysis (Blando et al., 2004; Musambira et al., 2006–2007; Nager & de Vries, 2004).

Following Braun and Clarke (2006), the thematic analysis involved several steps: (a) repeated reading and rereading of the retrieved online material, (b) manually coding the material on the basis of the reviewed literature on (suicide) bereavement and online memorialization, (c) collating the relevant coded extracts within major themes, (d) reviewing and refining the themes in order to ensure their internal homogeneity and external heterogeneity, and (e) defining and naming the themes. This process resulted in identification of 14 themes: (a) sadness and missing the deceased, (b) expression of love, (c) other psychological reactions of the bereaved, such as guilt, blame, regret, anger, shock, disbelief, (d) explanation for suicide and desire to understand “why,” (e) mention of reunion, (f) wishing the deceased peace, (g) expressions of gratitude that the deceased has found peace, (h) expressions of gratitude for knowing the deceased, (i) religious and spiritual themes (i.e., quotes from the Bible, reference to God, mention of heaven, angels, continuation of the spirit), (j) reference to family, including mention of the survivors and the family roles of the deceased, and impact of the suicide on the family, (k) description of the deceased, including his/her activities and personality features, (l) acknowledgment of suicide, including descriptions of the circumstances of death and a suicide method, (m) directives to readers, such as personal reflections and advice regarding suicide prevention and possible causes of suicide, and (n) personal comments of the memorial author’s regarding the experience of creating and maintaining an online memorial.

The process of thematic analysis was performed independently by each author of the study. Also, the content of each memorial was analyzed independ- ently to identify the demographic characteristics of the deceased and the bereaved, the type of relationship, time elapsed between the death and creation of a memorial, and the formal characteristics of a memorial, its type, and memorial theme(s). Interrater agreement was achieved in 90% of the memorials; where discrepancies arose, a consensus was achieved through discussion and the negotiated code or theme was used in the subsequent analyses.

Results

Authors of the Memorials

More than half of memorials on both Web sites were written by a parent/parents (27.6%), a sibling/siblings (13.6%), a child/children (9.6%), or a partner of the deceased (8%; Table 1). Where information about the gender of the bereaved was available, it could be observed that mothers, sisters, and daughters were the most frequent authors of the memorials (17.6%, 10%, and 8%, respectively). Two of the memorials at the Gone too Soon cemetery were written by partners

26 OMEGA—Journal of Death and Dying 71(1)

of the deceased (both: wives) on behalf of their child (both: daughters). Other authors of the memorials included friends (8.4%) and family members, such as nieces/nephews and step-family members (5.6%). Also, one memorial was writ- ten by a student of the deceased and one by an acquaintance.

In case of almost one fourth of the memorials (22.8%), it was not possible to identify the relationship between the author of the memorial and the deceased. There were differences between the two Web sites regarding availability of the information about the relationshipbetween the memorialauthorandthedeceased. Due to the standard format requirements of the Web site, information about the relationship was generally available at the Gone too Soon Web site (96.8% of

Table 1. Relationship Between the Authors of the Memorials and the Deceased.

Relationship to the

Deceased Faces of Suicide N (%) Gone too Soon a

N (%) Together N (%)

Parent(s) 36 (28.8) 33 (26.4) 69 (27.6)

Mother 15 (12) 29 (23.2) 44 (17.6)

Father 1 (0.8) 4 (3.2) 5 (2)

Parent(s) unspecified 20 (16) 0 20 (8)

Sibling(s) 8 (6.4) 26 (20.8) 34 (13.6)

Sister 0 24 (19.2) 24 (10)

Brother 0 2 (1.6) 2 (0.8)

Sibling(s) unspecified 8 (6.4) 0 8 (3.2)

Child(ren) 6 (4.8) 18 (14.4) 24 (9.6)

Daughter 2 (1.6) 18 (14.4) 20 (8)

Child(ren) unspecified 4 (3.2) 0 4 (1.6)

Partner 7 (5.6) 13 (10.4) 20 (8)

Wife 3 (2.4) 2 (1.6) 5 (2)

Partner 3 (2.4) f2 (1.6) 3 (1.2)

Ex-partner 0 4 (3.2) 4 (1.6)

Fiancée 1 (0.8) 2 (1.6) 3 (1.2)

Boyfriend 0 1 (0.8) 1 (0.4)

Girlfriend 0 2 (1.6) 2 (0.8)

Family other 2 (1.6) 12 (9.6) 14 (5.6)

Family unspecified 7 (5.6) 2 (1.6) 9 (3.6)

Friend 6 (4.8) 15 (12) 21 (8.4)

Other 0 2 (1.6) 2 (0.8)

Unknown 53 (42.4) 4 (3.2) 57 (22.8)

Total 125 (100) 125 (100) 250 (100)

a Data regarding the Creator of a memorial only, Helpers not included.

Krysinska and Andriessen 27

analyzed memorials), while only 57.4% of memorials at the Faces of Suicide site included this information. Inaddition, on the Gone too Soon Web site information was available about the number of authors of a memorial. The majority of the memorials (N¼112; 90%) was written by one person (Creator), while 13 memor- ials (10%) were written by more than one author (i.e., Creator and Helpers).

Information regarding the period of time elapsed between the death and creation of a memorial was available at the Gone too Soon Web site only (Figure 1). On the average, the memorials were posted 4.5 years after the death. Fifty-six memorials (45%) were posted during the first 12 months after death, including 15 (12%) posted within the first month after the suicide (this included one memorial written on the day of suicide and two written on the day after the death). Five memorials were posted after more than 20 years after the suicide, including one memorial posted 45 years after the death.

Formal Features of the Memorials

On the average, memorials found on the Gone too Soon Web site were longer than memorials on Faces of Suicide (M¼162, SD¼235.2 and M¼40, SD¼42.4; words, respectively). The shortest memorials on both Web sites had only three words (e.g., “[name], beloved son.,” “kind and caring”),

22 the

longest memorial on the Gone too Soon Web site contained 1,746 words and on

Figure 1. Length of time elapsed between a suicide and creation of a memorial on the

Gone too Soon Web site (N¼125).

28 OMEGA—Journal of Death and Dying 71(1)

the Faces of Suicide site 252 words. All memorials on the Faces of Suicide Web site had a photo of the deceased (format requirement of the Web site) and 23 messages included a link to a Web site dedicated specifically to the memory of the deceased. On the Gone too Soon site, 102 memorials were accompanied by a photo of the deceased, 14 had no photo, while the remaining 9 memorials had other type of a picture (e.g., a picture selected from a selection of standard options available at the site). One memorial on the Gone too Soon Web site offered a link to a Web site dedicated to the memory of the deceased.

The Deceased

Regarding the gender of the deceased, 80% of the memorials on both analyzed Web sites were dedicated to males (N¼200) and 20% to females (N¼50). The average age of the deceased on both Web sites together for both genders was 29.5 years (SD¼11.8) (M¼30; SD¼12.9 on the Faces of Suicide and M¼29; SD¼10.6 on the Gone too Soon Web site). The youngest memorialized suicide victim was 13 years old, the oldest 67 years old. There were no statistically significant differences between the age of males and females on the same site and between sites.

The memorials were dedicated mostly to the deceased by suicide who lived in the United States (N¼156; 62%) and in the United Kingdom (N¼75; 30%). Other countries included Australia, Canada, Ireland, South Africa, New Zealand, and Brazil. There were differences between the two Web sites: Ninety-two percent of memorials on the Faces of Suicide site were dedicated to those who lived in the United States (N¼115), while memorials on the Gone too Soon site were mostly written for those who lived in the United Kingdom (N¼74; 59%) and in the United States (N¼41; 33%).

Type of the Memorial

There were differences between the two analyzed Web sites regarding the type of posted memorials. On the Faces of Suicide site, approximately half of the memorials were letters: personal messages addressed to the deceased (N¼69; 55%). The remaining memorials were obituaries: descriptions of the deceased or his/her activities addressed to the reader or formal obituaries (N¼44; 35%). On the Gone too Soon site, 71% of memorials were obituaries (N¼89) and 20% were letters to the deceased (N¼25). Tributes (together 9%) were infrequent at both sites (N¼12 at Faces of Suicide and N¼11 at Gone too Soon).

Themes

The content of the analyzed material was categorized into 14 themes (Table 2). The majority of memorials (88%) contained more than one theme, and there

Krysinska and Andriessen 29

were statistically significant differences between the two memorial sites in regard to the most frequent themes. Description of the deceased, explanation of suicide, references to family, feelings of the bereaved, acknowledgment of suicide, peace wish, and comments regarding online memorialization were found more often at the Gone too Soon site than on the Faces of Suicide Web site.

Sadness and missing the deceased, expression of love. The two most frequent themes on both sites were sadness and missing the deceased (81.6%) and words of love addressed to the deceased (61.6%). Examples of the former category included expressions such as “You are terribly missed every second of every minute of every day. (. . .),” “I miss your smile, your music, and your beautiful soul.”, and “[name] is gone but never forgotten.” Examples of the latter category included: “We will love you forever, you are with us for always—you are missed and loved more each day.” and “(. . .) And we will love and cherish him forever.”

Description of the deceased. Another common theme on both Web sites was description of the personality and favorite activities of deceased (39.2%), such as “[he] had a heart of gold especially when it came to his family” and “[name] was a great friend. Always up for a giggle and always a shoulder to cry on when needed.”

Table 2. Themes in Online Memorials.

Theme

Faces of Suicide

N (%)

Gone too Soon

N (%)

Together

N (%)

Missing/sadness 100 (80) 104 (83.2) 204 (81.6)

Expressions of love 70 (56) 84 (67.2) 154 (61.6)

Description of the deceased 30 (24) 68 (54.4) 98 (39.2)**

Explanation of suicide 33 (26.4) 53 (42.4) 86 (34.4)*

Reference to family 23 (18.4) 52 (41.6) 75 (30)**

Feelings of the bereaved 23 (18.4) 49 (39.2) 72 (28.8)**

Acknowledgment of suicide 13 (10.4) 59 (47.2) 72 (28.8)**

Wishing the deceased peace 10 (8) 33 (26.4) 43 (17.2)*

Reunion 17 (13.6) 19 (15.2) 36 (14.4)

Religious/spiritual 16 (12.8) 19 (15.2) 35 (14)

Gratitude that the deceased found peace 12 (9.6) 20 (16) 32 (12.8)

Gratitude for having known the deceased 12 (9.6) 7 (5.6) 19 (7.6)

Directives to readers 6 (4.8) 13 (10.4) 19 (7.6)

Comments about online memorialization 0 8 (6.4) 8 (3.2)*

*p < .05 (Fisher’s exact test); **p < .005 (Fisher’s exact test).

30 OMEGA—Journal of Death and Dying 71(1)

Explanation of suicide. Approximately one third of the memorials (34.4%) on both analyzed memorialization sites expressed the desire to understand “why?” the suicide has happened, the inability to understand the reasons for the suicide, and presented the perceived explanations for the suicide.

Examples of the search for the answer “why?” included the following: “Twelve months on we still ask Why , Thats all i can ask [name] why.” and “we keep asking ourselves why this has happend, but we are getting no answers, and we never will.” The impossibility to understand the reasons for suicide was expressed by phrases such as “He left no clue to anyone,” “. . . i wish i could tell you why he did what he did, but i’m unable to!!!!!,” and “no-one knows the reason why [name] chose to leave this world early, only he has the answers to those questions.”

The perceived reasons for the suicide included mental illness, such as depres- sion, schizophrenia, and substance abuse (e.g. “He battled with mental health issues for (. . .) years. He sadly decided that taking his life was the only way that he could truly be happy.”), and negative life events, such as divorce, miscarriage, bullying, and physical illness (e.g. “Died as a result of bullying”). The mental pain and suffering experienced by the deceased was also mentioned as the pos- sible reason for taking the decision to end one’s own life. This has been men- tioned in the context of psychological vulnerability of the deceased (e.g., “. . . it seems you were too kind, too trusting and too gentle a soul to endure the harshness you endured until you could go no further.”), mental health issues (e.g., “Depression sent him to a dark place which over time became unbearable for him.”), and inability to cope with the challenges of life (e.g., “My beautiful (. . .) that thought the pain of living was much harder than the pain of dying.”).

Reference to family. References to the family were found in approximately one third of the memorials (30%) and included mentioning of the family roles of the deceased (e.g., “[name] was a lovein son (. . .) and dad”), mention of the bereaved (e.g. “(. . .) he left behind 2 beautiful children and a family who sadly miss him”), and impact of the death on the family (e.g., “Her suicide devastated our family, and we can never be the same again.”).

Acknowledgment of suicide. Approximately one third of the memorials included acknowledgment of the suicide (28.8%). Such statements ranged from informa- tion about the date of death and age of the deceased (e.g. “My dearest (. . .) committed suicide [date].,” “He was (. . .) years old when he died on that cold, snowy (. . .) afternoon.”), to descriptions of circumstances and method of sui- cide, including hanging, gunshot, overdose, and jumping from heights.

Psychological reactions of the bereaved. Psychological reactions of survivors were expressed in approximately 29% of the memorials. Some of the bereaved wrote about the initial shock following the death (e.g., “Her death was a huge

Krysinska and Andriessen 31

shock to everyone I knew and the consequences surrounding her death made many in the school very sad.”), acknowledged that the suicide has changed their life forever (e.g., “My life is not ever going too be the same without my baby.”), and wrote that they will never forget the moment when they received the news about the death (e.g., “I will never for my whole life long forget receiving that phone call from her (. . .) the moment my life changed forever.”). Some of the bereaved shared the pain of not being able to bid farewell to the lost friend or relative (e.g. “Every time I hear your name, tears are brought to my eyes and the thought of it upsets me, because there were no goodbyes.”). The belief in the continuing presence of the deceased was also expressed in several memorials (e.g., “LOOK DOWN ON US (. . .) AND LOOK AFTER US AS WE KNOW YOU ARE BY OUR SIDES”).

Some of the bereaved also expressed their general psychological pain (e.g., “He left his [relationship] hurt to the point where no word can describe her pain.”), while others stressed the enduring nature of their grief reactions (e.g. “A grieving parent is someone who feels as if they just lost their child yesterday, no matter how much time has passed . . ..”). In a few memorials, the bereaved have acknowledged that although the suffering of the person who died by suicide is finished, the pain of the bereaved just begins (e.g., “His suffering is over, but for those of us left behind, it has only just begun.”). Although not frequently, some of the bereaved expressed online their anger at the deceased, for example

(. . .) cos I live for the day I will meet [relationship] again ,first i will give him a big

hug then boy will i give him what for for doing this to us , but he will always know

he is loved and always will be.

Another emotional reactions expressed in the analyzed online memorials were self-blame for not seeing the cues to suicide (e.g., “We wish we could have seen the signs sooner to help”) or for unwillingly and unknowingly having contrib- uted to the suicide (e.g., “I hope everyone who has lost someone to suicide or has a mentally ill relative is careful when they choose a hospital. I still have guilt about this.”). Some of the guilt of the bereaved was expressed in “if only . . .” statements (e.g., “I just wish I could have spoken to her the night she died and maybe, just maybe she’d still be here now.”). Some of the memorials written by parents expressed the feeling of untimely death (e.g., “(. . .). Being his [relation- ship] has really made a hole in my heart, i feel that i should have passed away before [name].”). The analyzed memorials also included words of regret for what might have been (e.g., “I am so grief stricken over what could have been the best years of our life together.”) and regret that the deceased did not see or was not able to see the love of those around him/her (e.g., “(. . .) What you didn’t realize or see was how much you were loved! I for one would have done anything for you!”). In a few cases, the authors of memorials blamed mental health services (e.g., “[name] died after suffering a long period of depression caused by

32 OMEGA—Journal of Death and Dying 71(1)

Post-Traumatic-Stress. Another failed victim of the MENTAL HEALTH SERVICE.”) or a specific person (e.g., “What can I say?? (. . .) She left a note blaming [relationship] (. . .)”) for the death.

Some of the memorials included words of consolation in the form of letter (usually a poem) from the deceased and addressed to the bereaved. This included the following example: “Be not burdened with times of sorrow/ I wish you the sunshine of tomorrow./ My life’s been full, I savored much/ Good friends, good times, a loved one’s touch.”

Peace wish/gratitude; reunion. Approximately 18% of the analyzed memorials on both Web sites included a peace wish for the deceased (e.g., “RIP [name]. I hope you are finally at peace.”), and authors of 13% of the memorials expressed gratitude that the deceased has found peace (e.g., “We miss you terribly each day but know you’re at peace after all you’ve been through.”). The theme of reunion with the deceased (e.g., “you will always be in my heart and one day we will be together forever.”) was found in approximately 14% of all the memorials.

Religion/spirituality. Fourteen percent of memorials included religious and spiritual themes. These ranged from general blessings (e.g., “God Bless Us All”) and words of gratitude (e.g., “We thank God for this precioius gift, and are grateful for having been blessed to have had her in our lives”) to acknowledgments of the God’s will as the reason for the suicide (e.g., “God saw he was hurting and and took him home to rest in his arms for eternity”) and religious consolation for the bereaved (e.g., “I’m following the path God laid for me I took his hand when I heard him call (. . .) Lift up your hearts and share with me/God wanted me now . . .”). In some memorials, religion and spirituality were expressed in the context of reunion (e.g., “(. . .) can’t wait to see you in Heaven. You are in my heart and every prayer”), a peace wish, and gratitude for the peace that the deceased has found after death (e.g., “He is safe in the arms of the Lord now,” “hope you have found Peace in God’s Arms”). One of the memorials expressed the peace wish for the deceased and asked for God’s forgiveness for the suicide (“RIP [name], May God Forgive You x”).

Gratitude for knowing the deceased. Approximately 8% of the analyzed memorials contained expressions of gratitude for knowing the deceased, for example, “I will forever cherish everything you’ve ever given me (. . .). I’ll forever miss my best [relationship] in the whole world.” and “We are grateful for the rich memories of your laugh, humor, wisdom and deep insight and caring.”

Directives to readers. Directives to readers were found in approximately 8% of the memorials. These included personal reflections and advice regarding suicide pre- vention and possible causes of suicide, such as “We need to bring awareness to mental to save many people from taking their own lives.” and “please all i ask is

Krysinska and Andriessen 33

if there are any people out there feeling down, or have problems . . . then please please talk to some one . . . .” Some of the bereaved shared their experience of coping with the loss with the readers, for example, “(. . .) Don’t ever let anyone tell you to get over it. Until they have walked in your shoes, then they don’t know how you feel exactly.” or asked the readers to leave an online condolence note or an e-candle (e.g., “Please feel free to light a candle or leave a tribute/ condolense, ty for coming by to meet my [name].”). Authors of some memor- ials asked the readers to remember and to honor the deceased in a particular way (e.g., “I would ask that you do not ‘remember’ how [name] died but how he lived.”).

Comments about online memorialization. Comments regarding the experience of writing an online memorial and sharing the grief after suicide with others online were found in eight memorials (6.4%) on the Gone too Soon Web site (this theme was not found on the Faces of Suicide Web site). Some of the bereaved wrote about the need to honor the memory of their loved one on the Internet (e.g., “[name], my [relationship], was born and lived in [place]. Its painful having to set up this memorial site but me, [name] and [name] felt like we had to.” and “(. . .) i sadly lost both my [relationship] (. . .) I joined this site to help me greive in my own way . . . My [relationship] may have gone but will never be forgotten xx.”). Others expressed gratitude to the readers and shared their positive experience of online memorialization, for example “thank you everyone for your kindness in lighting candles for my [relationship] (. . .). It has been such a hard time since [name] died, and this site really helps xx” and “About me–well what can I say im just a normal person who has found great calming in this website. Being able to do something for my [relationship]. Just hope he likes it!!.”

Discussion

The current study gives a valuable insight into the online memorialization of individuals who died by suicide. It provides information about the relationship of the memorial authors to the deceased, the period of time elapsed between the death and creation of the memorial, as well as the age, gender, and country of origin of the deceased. It describes the formal features of the memorials, their types, and themes found in messages posted in the online cemeteries.

Our analysis showed that the majority of the memorials’ authors was nuclear family members of the deceased: parents, siblings, and children. Other memor- ials were posted by (ex-)partners, members of step-family, and other family relations. Also friends of the deceased, and in individual cases students and acquaintances, wrote online memorials. Similar results have been found in previous studies of online memorials (Blando et al., 2004; de Vries & Rutherford, 2004; Roberts & Vidal, 2000). Also, studies of grief after suicide indicate that suicide affects individuals in different relationships with the

34 OMEGA—Journal of Death and Dying 71(1)

deceased (Berman, 2011; Campbell, 1997). Although information about the gender of the memorial’s author was not available in all cases, it could be observed that females were more frequent memorial authors than males. A similar finding was reported by de Vries and Rutherford (2004) and Roberts and Vidal (2000) in their studies of online cemeteries, and by Finlay and Kueger (2011) in the analysis of memorial Web sites created by bereaved parents. Although the majority of analyzed memorials was written by one person, one memorial in ten on the Gone too Soon Web site, where this information was available, was written by a group of the bereaved. This phenomenon of coau- thorship of online memorials was also reported by Roberts (2004a), who stressed the double function of online memorialization: continuing bonds with the deceased and strengthening existing bonds with the living. The latter may be of special significance to suicide survivors, who still often experience social stig- matization and might find it difficult to share their grief (Cerel, Jordan, & Duberstein, 2008; Grad, 2011). Creating an online memorial with others, who knew and cared about the deceased, might offer additional venues of support and expressing one’s own grief. Future studies looking at the process of creating and maintaining online memorials after suicide might provide more information and insight regarding this important issue.

Regarding the length of time elapsed between the death and posting of the memorial, approximately half of the memorials on the Gone too Soon Web site were written during the first twelve months after the suicide, including memorials posted within the first month after the death. There were also memorials written between one and twenty years after the loss, although in general there was a negative correlation between the number of memorials and the length of time passed since the death. We were able to find only one study (Roberts & Vidal, 2000) that reported on the estimated period of time between the death and posting the memorial. Its results were similar to results of the current analysis: Approximately 70% of memorials were posted within the first five years after the loss, and 7% of memorials were created more than 20 years later (3% in the current study, which included one memorial written 45 years after the death). These results seem to reflect research findings and clinical observations regarding the course of the grief process after suicide and other type of loss (e.g., Stroebe & Schut, 2010; Worden, 2008). The need to share the loss with others, to write about it, and to find its meaning seem to be common psychological reactions, which help to accept the reality of loss, to work through the pain, and to adjust to the environment without the deceased (Worden, 2008). They might also be a part of the confrontation-avoidance dual process of grieving (Stroebe & Schut, 2010) and decrease with time as the bereaved accepts the reality of life after the loss. On the other hand, online memorialization might reflect the enduring nature of continuing bonds with the deceased (Klass, Silverman, & Nickman, 1996; Maple, Edwards, Minichiello, & Plummer, 2013).

Krysinska and Andriessen 35

The analyzed memorials were dedicated to both males and females in all age groups, although the majority of memorials was written for young adult males. The 4:1 ratio of male to female suicide victims memorialized in both Web sites and the predominance of young adults in the studied sample might be related to the high rates of suicide among young adult males in the Anglo-Saxon countries (De Leo & Evans, 2004; Pitman, Krysinska, Osborn, & King, 2012). Previous studies of general online cemeteries (de Vries & Rutherford, 2004; Roberts & Vidal, 2000) and memorials dedicated to victims of AIDS (Blando et al., 2004) also found that the majority of memorials were dedicated to males. It is possible that the predominance of male online graves reflects the mortality patterns in the Western countries and is related to the phenomenon of gender discrimination after death (Kastenbaum, Peyton, & Kastenbaum, 1976) and sexism in socio- cultural meaning of male and female suicidality (Canetto & Sakinovsky, 1998).

Regarding the country of origin of the deceased, the analyzed memorials were created by and dedicated most frequently to those who lived in English-speaking countries, mostly in the United States and in the United Kingdom. This result might reflect cross-cultural differences in the bereavement rituals and the grief process, such as degree of personal disclosure (Pennebaker, Zech, & Rime, 2001), degree of inclusion of the Internet in the socially constructed death system (Kastenbaum, 2011; Sofka et al., 2012), or sharing the circumstances of the death online (Sade-Beck, 2004). However, it is also possible that this observation is an artifact of the study methodology: selection of two English language-based Web sites and inclusion of memorials in the English language only in the analysis.

Our study found a variety of types of memorials in the analyzed material. Obituaries and personal messages to the deceased (i.e., letters) were the most frequently posted online messages; tributes were found in one in ten memorials. Roberts (2004a) observed that online memorialization might serve two func- tions: support continuing bonds with the deceased and strengthen existing bonds with the living. Indeed, personal messages addressed directly to a relative or a friend who died by suicide, such as mention of reunion, expression of love and sadness after the loss, or a peace wish, might serve the first function. The second function could be served by creating the memorials together with others (as discussed earlier) or including directives to readers in the memorials. Although there is no research evidence available to support this claim, it can be speculated that descriptions of the personality and activities of the deceased, usually very positive (sometimes even idealized), which were frequently found in the current analysis and in other studies of online memorials (e.g., Blando et al., 2004; Nager & de Vries, 2004), might serve both functions. Reminiscing about the lost family member or a friend might strengthen the bond with the departed, as well as introduce him or her to the visitors at an online cemetery. In a similar vein, description of the family roles of the deceased and mention of survivors might serve both functions.

36 OMEGA—Journal of Death and Dying 71(1)

The length of the analyzed memorials varied, from a few words to long messages. There were differences between the two memorialization Web sites regarding the length of the memorials and their formal features. On the average, memorials on the Faces of Suicide Web site were shorter, included more links to other Web sites, and were more often addressed to the deceased than messages on the Gone too Soon site. The observed differences could be related to the format requirements of the site, for example, on the Faces of Suicide, all memor- ials are expected to include a photo of the deceased. Although several earlier studies have reported similar variations in the lengths of the memorials (Blando et al., 2004; de Vries & Rutherford, 2004; Lester, 2012), only Roberts and Vidal (2000) provided information regarding availability of links and photos in three online cemeteries. Similar to the results of our analysis, the links to other sites were infrequently found and the majority of photos was posted in just one cemetery (Roberts & Vidal, 2000). It is possible that in addition to formal fea- tures of cemeteries and psychological needs of the individual bereaved, the infor- mal style and climate of a Web site influences the contents and the formal features of the memorials (Roberts & Vidal, 2000).

The analysis of the content of suicide memorials posted on the Faces of Suicide and the Gone too Soon Web sites revealed a wide range of themes, and the majority of the memorials contained more than one theme. A similar variety of themes was found in previous studies of online cemeteries (Blando et al., 2004; de Vries & Rutherford, 2004; Roberts & Vidal, 2000). In addition, there were differences in the frequency of themes between the two Web sites. It is possible that the observed differences are related to the average length of the memorials posted and the climate of the cemetery (Roberts, 2004a).

The wide range of emotional, cognitive, and behavioral reactions described by the bereaved by suicide in the online messages seem to fit well the framework of Jordan and McIntosh (2011b). According to this framework, grief reactions following a suicide range from reactions experienced in bereavement after all types of death, reactions common for bereavement after sudden and after violent death, to reactions specific for bereavement after suicide. The expressions of love, sadness, and missing the deceased, as well as the yearning to be reunited with the deceased and gratitude for knowing him or her, seem to reflect grief reactions shared by the bereaved regardless of the type of loss (Shuchter & Zisook, 1993; Zisook & Shear, 2009). Similarly, the descriptions of the psycho- logical pain of the bereaved and of the never-ending nature of their grief reac- tions (in some of the memorials accompanied by words of consolation, usually in the form of a poem, from the deceased) seem to be common grief reactions (e.g., Roberts & Vidal, 2000). Also, the notion of untimely death expressed in memor- ials posted by parents who lost their child to suicide can be found in parental grief reactions regardless of the cause of death (Murphy, 2008; Weisman, 1973).

Search for explanations and the desire to understand “why?” the suicide has happened, frequently found in our study, is a common reaction of suicide

Krysinska and Andriessen 37

survivors, shared with bereaved after other sudden and violent death (Neimeyer & Sands, 2011). In the study by Roberts and Vidal (2000), search for motives and explanations for the death was one of the distinguishing features of online memorials dedicated to individuals who died a sudden death, including suicide victims. Acknowledgment of the suicide, including description of the circum- stances and the method of death, was found in approximately 30% of the analyzed memorials. Some of the bereaved also wrote about the very moment of receiving the news of the suicide. Talking and writing about the details of a sudden and violent loss might be one of the coping mechanisms (Lattanzi & Hale, 1984–1985; Neimeyer, van Dyke, & Pennebaker, 2009). Such attempts to gain control and to understand an unexpected and often traumatic death were previously found in the online memorials dedicated to those who died by suicide and other sudden and violent deaths (Finlay & Krueger, 2011; Roberts & Vidal, 2000). In some of the memorials, the bereaved also expressed other reactions frequently found after sudden deaths, such as the shock following receiving the news about the suicide, and the regret that there was no time to bid farewell to the lost friend or relative (Rando, 1996). Also blaming others and oneself for the death, sometimes accompanied by anger, was found in the current study. Although these reactions might accompany grief after other types of sudden and violent deaths, they seem quite frequent in bereavement after suicide (Armour, 2007; Jordan & McIntosh, 2011b). A few of the analyzed memorials contained expressions of anger at the deceased for taking the decision to take his or her own life, and remarks that although the suffering of the person who died by suicide is finished, the pain of the bereaved has just began. According to Jordan and McIntosh (2011b), these reactions might be specific to suicide bereavement where the victim is simultaneously the perpetrator.

Religion and spirituality might be valuable resources in coping with the inter- personal loss (Wortmann & Park, 2008), and such themes were found in previ- ous studies of online memorialization (de Vries & Rutherford, 2004; Finlay & Krueger, 2011; Roberts & Vidal, 2000). In his comparison of the linguistic con- tents of suicide memorials and memorials dedicated to those who died of natural causes, Lester (2012) reported that the former included fewer references to reli- gion than the latter. In our study, online memorials contained acknowledgments of the God’s will as the reason for the suicide, words of religious consolation for the bereaved, and mention of reunion, to the peace wish and gratitude for peace found after the death. The author of one of the memorials asked God’s forgive- ness for the suicide. The role of religion and spirituality in coping with loss by suicide still remains a relatively understudied area (Vandecreek & Mottram, 2009), and results of the current study provide some insights into survivors’ spontaneous expressions of religiosity.

De Vries and Rutherford (2004) observed that peace for the deceased was a frequent theme in suicide memorials and memorials dedicated to people who died from substance abuse. In our study, wishing the deceased peace and

38 OMEGA—Journal of Death and Dying 71(1)

being grateful that he or she has found peace was found in approximately 15% of the memorials. In some of the messages, these themes were linked to religion/ spirituality or expressed in the context of mental pain and suffering experienced by the person who died by suicide.

It is possible that more frequent users of the Internet (Gilbert & Massimi, 2012) and those who use writing as a means of coping with the loss (Pennebaker et al., 2001) are more likely to create online memorials. The current study found comments posted by some of the memorials’ authors regarding their personal experience regarding online memorialization. Although setting up an online memorial was emotionally challenging for some of the bereaved, in general the comments indicated that the online experience has been helpful in coping with the loss and included words of gratitude to the readers for the support received. These comments could be affected by the mechanism of positive self- selection: only those who find the experience satisfactory and evaluate it posi- tively continue to maintain the online graves (Roberts, 1999). Nonetheless, other studies of online memorialization have found similar positive comments regard- ing involvement in online memorialization (Roberts, 2006).

Implications for Clinical Practice and Future Research

Studies on Internet use by the bereaved, including those grieving after a suicide, show that on the average, the bereaved spend 7 to 8 hr online per week using interactive online resources, such as online forums, chats, and email lists (Feigelman et al., 2008; van der Houwen, Stroebe et al., 2010). A survey of Web memorial authors revealed that 74% of them visited the online grave at least daily in the first month after writing the message, and more than half of them visited the memorial site at least weekly in the following months (Roberts, 2004a). Our study supported the observation of Chapple and Ziebland (2011) regarding the popularity of the online resources, including setting up Web site memorials, among suicide survivors.

Despite the accumulating evidence regarding the popularity of Internet use during bereavement, very little is known about the impact of online activities on the grief process and the psychological and somatic well-being of the bereaved. Only a few methodologically sound studies, including controlled randomized trials, have been conducted to date to evaluate the effectiveness of professional (Wagner, Knaevelsrud, & Maercker, 2006, 2007) and self-help (van der Houwen, Schut, van den Bout, Stroebe, & Stroebe, 2010) interventions for the bereaved. Many studies, mostly qualitative research, show high levels of satisfaction among the bereaved involved in online activities, including online memorializa- tion (e.g., Chapple & Ziebland, 2011; Roberts, 2004a). However, the majority of these studies is not free from common problems in research on Internet users, such as positive self-selection of participants (i.e., only people who are satisfied continue to use the Web sites and participate in research), lack of a comparison

Krysinska and Andriessen 39

group, instability and changing membership of online groups, privacy issues, and lack of follow-up (Eysenbach, Powell, Englesakis, Riso, & Stern, 2004; Stroebe, van der Houwen, & Schut, 2008).

Stroebe et al. (2008) observed that some Internet enthusiasts question the need to evaluate the efficacy of online support for the bereaved as long as the resources are provided for free, people use them voluntarily, and there is assur- ance that online information does not have adverse effects or is not misleading. However, they caution against accepting these assumptions without proper investigation. Indeed, it seems too early to provide recommendations regarding effective and helpful use of online resources and activities for the bereaved. On the one hand, it has been suggested that involvement in online bereavement- related activities, such as memorialization, may be a valued addition to trad- itional bereavement activities, as it creates connections with others who have suffered a loss and has a potential for enhancing a relationship with the deceased (Roberts, 2004a). The Internet can help to maintain a continuing bond with the deceased through honoring his or her memory, tending the online grave and communicating with him or her via online messages (de Vries & Moldaw, 2012; Roberts, 2004a). For some individuals, expressing their feelings and thoughts in writing can be of therapeutic value (Lattanzi & Hale, 1984–1985). The anonym- ity offered online (also to the authors of online memorials) might be particu- larly important to those who experience stigma and lack of social support, including suicide survivors and those who are trying to cope with disenfran- chised grief.

On the other hand, concerns about possible dangers of seeking information and support via the Internet have been raised by both professionals and the bereaved. Suicide survivors indicate that finding prosuicide sites can be very distressing, and like other bereaved, they warn against treating the online activ- ities as a substitute for face-to-face contacts (Chapple & Ziebland, 2011). Maintaining online memorials in public spaces, such as cemeteries and individ- ual Web pages, can also be challenging for those bereaved who experience shame related to losing a significant one to suicide (Chapple & Ziebland, 2011). The impermanence of the Internet material, including online memorials, can be a source of additional stress or loss. Searching information and peer support on the Internet, including online communities centered around memorialization sites, raises concerns about the quality and trustworthiness of the advice and referral resources shared among the bereaved (Krysinska & Andriessen, 2010). Concerns have also been raised about the reluctance to let go and the ruminative ways of grieving among some of authors and visitors of online cemeteries (Stroebe et al., 2008). Last, but not least, dealing with the online legacy of the deceased, such as material left on a social networking site (and possibly also photos of the deceased and messages left for him/her or in his/her name on a virtual grave), might be experienced as facing an online ghost and result in add- itional emotional and cognitive distress (Hiefje, 2012).

40 OMEGA—Journal of Death and Dying 71(1)

Conclusions of Stroebe et al. (2008) regarding the effectiveness of memoria- lization activities on resolving the grief process still seem a fitting research agenda for the future, including studies involving suicide survivors. Stroebe et al. (2008) stress the need

to learn why people memorialize loved ones (. . .) and how their reasons for doing

so relate to adaptation to bereavement. For whom does memorializing represent a

gradual relinquishment of the tie and moving on through the grief process, and

when does it reflect an inability to let go and an overly intense preoccupation with

and clinging to the deceased loved one? (p. 560)

Limitations

The current study provides valuable insight into the forms and contents of online memorials dedicated to those who died by suicide. However, the study has several limitations. The analysis was based on material randomly retrieved from two memorialization Web sites and included only messages written in English. Given the differences between the two analyzed memorialization Web sites and the impact of sociocultural factors on the process of grief and bereave- ment (Walter et al., 2011–2012), it can be expected that memorials posted on other Web sites and in other languages might differ in regard to their contents and formal features. It is possible that self-censorship affect the levels of self- disclosure of the authors of the memorials (Roberts, 1999). In addition, only those who feel comfortable online and those who have a positive experience might be likely to get involved in online memorialization and continue main- taining an online memorial (i.e., self-selection bias; Roberts, 1999). Last, but not least, our study analyzed suicide memorials only. No comparison group(s) were used, such as memorials created for those who died other sudden and violent deaths or memorials dedicated to those who died a natural death. Hence, it is not possible to indicate which of the study findings are unique for bereavement after suicide and which have a more universal character.

Conclusions

The Internet has become a valuable and popular resource of information and support, also frequently used by the bereaved. The current study provides a valuable insight into the contents of online memorials written by suicide sur- vivors in memory of their family members, friends, and acquaintances. Our study found a wide range of themes expressing both the pain of being separated from the deceased and the struggle to find meaning of the loss. The themes and forms of the analyzed memorials indicated the two functions of online memoriali- zation: continuing bonds with the deceased and strengthening bonds with the living.

Krysinska and Andriessen 41

Some of the bereaved after suicide also shared their motivation for making an online memorial and their positive experience on a memorialization Web site.

The online involvement of the bereaved has become an important new researched area, although a number of research questions, also relevant for clinical practice, remain unanswered. Lack of longitudinal studies, partly a con- sequence of the challenges and ethical issues involved in conducting research with online populations, makes it impossible to indicate whether involvement in online memorialization effectively helps the bereaved to cope with the loss or hinders this process by encouraging rumination and reluctance to let go. Although there is rich literature regarding the online involvement of the bereaved after many types of death, those bereaved by suicide remain a relatively understudied group. Future studies could show which types of resources on the Internet, including memorialization Web sites, can be helpful for suicide survivors.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publica-

tion of this article.

Notes

1. The authors of the memorials at the Gone too Soon Web site are divided into Creators and Helpers.

2. All quotations in the text are verbatim (sentence structure, punctuation, spelling, and capitalizations as present in the original). Personal details, such as names, dates, and places, have been removed.

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Author Biographies

Karolina Krysinska, PhD, is a project coordinator at the NHMRC Centre of Research Excellence in Suicide Prevention at the Black Dog Institute in Sydney,

46 OMEGA—Journal of Death and Dying 71(1)

Australia and a post-doc researcher at the KU Leuven – University of Leuven, Belgium. Karolina’s research interests include risk and protective factors in sui- cide, suicide prevention, thanatology, psychology of trauma, and psychology of religion. She is an author and coauthor of book chapters and peer-reviewed articles on various aspects of suicide, psychology of religion, trauma, and bereavement.

Karl Andriessen, MSuicidology, is a researcher at the Research Unit Parenting and Special Education, KU Leuven – University of Leuven, and a freelance staff member at the Federation of Tele-Onthaal (Tele-Help), Ghent, Belgium. He is a co-chair of the Special Interest Group on Suicide Bereavement of the International Association for Suicide Prevention. Since 2014, he is an Anika Foundation PhD Student at the School of Psychiatry, University of New South Wales, Sydney, Australia.

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