Suicides put spotlight on survivor's guilt

Three suicides in recent days show that when horror strikes, the trauma lingers deeply for those who survive.

Sydney Aiello — a student who lived through the Marjory Stoneman Douglas High School shooting that left 17 people dead in Parkland, Florida, in 2018, and graduated last year — took her life earlier this month. The 19-year-old had been close friends with Meadow Pollack, who was killed in the attack.

Another Parkland shooting survivor who was a sophomore at Marjory Stoneman Douglas High School also passed away this month in an apparent suicide. The student's name has not been released.

And Jeremy Richman, whose daughter Avielle was among the 20 first-graders and six adults killed in the Sandy Hook Elementary School massacre in Newtown, Connecticut, in 2012, was found dead Monday in a suspected suicide.

Aiello's mother told CBS Miami that Sydney struggled with survivor's guilt — a term used to describe the experience of people who live through harm or a life-threatening event while others do not. Many of those who made it out alive after the Holocaust, 9/11, a war, a natural disaster, a violent attack or a plane crash have felt this anguish, which can be powerful enough to lead to suicide, mental health experts say.

"The guilt of being grateful to be alive is heavy," said Patience Carter, who survived the 2016 Pulse nightclub shooting in Orlando, Florida, describing her feelings in a poem she wrote after the attack.

RELATED: Parkland after the Marjory Stoneman Douglas High School Shooting 

22 PHOTOS
Parkland, Fla. keeps memory of shooting alive
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Parkland, Fla. keeps memory of shooting alive
An empty chair is seen in front of flowers and mementoes placed on a fence to commemorate the victims of the mass shooting at Marjory Stoneman Douglas High School, in Parkland, Florida, U.S., February 20, 2018. REUTERS/Carlos Garcia Rawlins 
Daniela Menescal, who was injured by shrapnel during the mass shooting at Marjory Stoneman Douglas High School, wears a t-shirt with the names of the victims of the shooting, as she plays the piano at her house in Parkland, Florida, U.S., April 4, 2018. REUTERS/Carlos Garcia Rawlins 
Daniela Menescal (R), who was injured by shrapnel during the mass shooting at Marjory Stoneman Douglas High School, attends a baseball game her brother is playing in, in Parkland, Florida, U.S., April 5, 2018. REUTERS/Carlos Garcia Rawlins 
Manuel Oliver, the father of Joaquin Oliver one of the victims of the mass shooting at Marjory Stoneman Douglas High School, cries next to his family after painting a mural to commemorate the victims of the shooting and promote gun control in Los Angeles, California, U.S., April 7, 2018. Listening to his son's favourite music, Oliver painted the mural from beginning to end, but as soon as he finished, he broke down and had to walk inside the hotel to mourn. Later he went out again to give interviews to the media to call for more gun control. REUTERS/Carlos Garcia Rawlins
Manuel Oliver, father of Joaquin Oliver one of the victims of the mass shooting at Marjory Stoneman Douglas High School, cries in his hotel room before painting a mural to commemorate the victims of the shooting and promote gun control in Los Angeles, California, U.S., April 7, 2018. Minutes before leaving the hotel room to paint the mural, Oliver put on his son's headphones and played his favourite music. Almost immediately, he started to cry and he had to take them off. REUTERS/Carlos Garcia Rawlins 
A man looks at pictures of the victims of the mass shooting in Parkland on the program during the graduation ceremony for students from the Marjory Stoneman Douglas High School, in Sunrise, Florida, U.S., June 3, 2018. REUTERS/Carlos Garcia Rawlins
Manuel Oliver (R) and Patricia Padauy (2nd R), parents of Joaquin Oliver, one of the victims of the mass shooting at Marjory Stoneman Douglas High School, look at the screen as they wait backstage to receive their son's diploma during his graduation ceremony in Sunrise, Florida, U.S., June 3, 2018. REUTERS/Carlos Garcia Rawlins
Patricia Padauy, the mother of Joaquin Oliver, one of the victims of the mass shooting at Marjory Stoneman Douglas High School, holds up her son's diploma during his graduation ceremony in Sunrise, Florida, U.S., June 3, 2018. REUTERS/Carlos Garcia Rawlins 
Students from Marjory Stoneman Douglas High School, attend their graduation ceremony in Sunrise, Florida, U.S., June 3, 2018. REUTERS/Carlos Garcia Rawlins
Manuel Oliver, father of Joaquin Oliver, one of the victims of the mass shooting at Marjory Stoneman Douglas High School, walks past his son's classmates, during their graduation ceremony in Sunrise, Florida, U.S., June 3, 2018. REUTERS/Carlos Garcia Rawlins
Students from Marjory Stoneman Douglas High School attend their graduation ceremony in Sunrise, Florida, U.S., June 3, 2018. REUTERS/Carlos Garcia Rawlins
Daniela Menescal, who was injured by shrapnel during the mass shooting at Marjory Stoneman Douglas High School, helps her brother practice baseball at their house in Parkland, Florida, U.S., April 4, 2018. REUTERS/Carlos Garcia Rawlins 
Autographed sports t-shirts, pictures and placards are seen among other mementoes at the room of Joaquin Oliver, one of the victims of the mass shooting at Marjory Stoneman Douglas High School, at his house in Parkland, Florida, U.S., April 11, 2018. REUTERS/Carlos Garcia Rawlins 
The entrance to Marjory Stoneman Douglas High School is seen after the police security perimeter was removed, following a mass shooting in Parkland, Florida, U.S., February 18, 2018. REUTERS/Carlos Garcia Rawlins 
A member of the media pushes a cart full of equipment in front of Marjory Stoneman Douglas High School, following a mass shooting in Parkland, Florida, U.S., February 18, 2018. REUTERS/Carlos Garcia Rawlins
A garbage bag full of crime scene tape is seen close to the campus of Marjory Stoneman Douglas High School, after the police security perimeter was removed, following a mass shooting in Parkland, Florida, U.S., February 18, 2018. REUTERS/Carlos Garcia Rawlins 
Patricia Padauy, the mother of Joaquin Oliver, one of the victims of the mass shooting at Marjory Stoneman Douglas High School, talks to a journalist during an interview before attending her son's high school graduation ceremony to receive his diploma, at home in Parkland, Florida, U.S., June 3, 2018. REUTERS/Carlos Garcia Rawlins 
Daniela Menescal, who was injured by shrapnel during the mass shooting at Marjory Stoneman Douglas High School, looks for her belongings inside her clear backpack at her house in Parkland, Florida, U.S., April 4, 2018. REUTERS/Carlos Garcia Rawlins 
The initials of Marjory Stoneman Douglas High School and a placard are placed on the fence at Park Trails Elementary School, following a mass shooting in Parkland, Florida, U.S., April 9, 2018. REUTERS/Carlos Garcia Rawlins 
Manuel Oliver, father of Joaquin Oliver one of the victims of the mass shooting at Marjory Stoneman Douglas High School, holds up a placard as he paints a mural to commemorate the victims of the shooting and promote gun control in Los Angeles, California, U.S., April 7, 2018. As he paints the mural Oliver listens to his son's favourite music on the headphones that belonged to him. The mural depicts his son the day that he died, carrying flowers to his girlfriend for Valentine's day. REUTERS/Carlos Garcia Rawlins 
Carlos Rodriguez (2nd R), student and shooting survivor from Marjory Stoneman Douglas High School, talks with his schoolmates and co-founders of Stories Untold, a movement created to encourage victims of gun violence to share their stories, during a meeting at his house in Parkland, Florida, U.S., April 10, 2018. REUTERS/Carlos Garcia Rawlins 
Pictures of Joaquin Oliver and Aaron Feis, victims of the mass shooting at Marjory Stoneman Douglas High School, are seen on a cross placed in a park to commemorate the victims, in Parkland, Florida, U.S., February 19, 2018. REUTERS/Carlos Garcia Rawlins 
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Haunted by thoughts

Survivor's guilt usually develops in a setting where it's easy for a person to think, "It could have happened to me and didn't," said Dr. Edward Silberman, a psychiatrist at Tufts Medical Center in Boston. It strikes because one of the hardest concepts for humans to accept is the notion they can't control an event, so they try to create a false sense of control by blaming themselves, he explained.

"People have an easier time blaming themselves and therefore maintaining an illusion of controllability than accepting that there was absolutely nothing that they could do," Silberman told TODAY.

"Because if there's nothing you can do, then what's to prevent another tragedy, another bad outcome from happening again? Then people feel as though life is essentially walking through a minefield and something terrible could happen at any time… (they feel) pessimism about how the world works and what the future will be like."

Patients who feel survivor's guilt brood and ruminate about what they could have done to prevent the terrible outcome, said Silberman, who counseled people after the Boston marathon bombing in 2013. Symptoms also include low mood, loss of interest in usual activities and a preoccupation by the tragedy.

Patients experience excessive guilt and are haunted by thoughts such as, "How come I survived the event? The persons who died instead of me were nicer than me, better than me. It's not fair that I got to live and they didn't," said Dr. Laurel Williams, chief of child and adolescent psychiatry at Texas Children's Hospital and an associate professor of psychiatry and behavioral sciences at Baylor College of Medicine.

"It can be extremely disruptive. If you're not getting the treatment you might need for PTSD and/or depression, it could certainly take up a good percentage of your day thinking about it," Williams noted.

"It may color your actions, what you might do moving forward for yourself because you're sitting there thinking, 'I don't deserve to be alive.'"

It's very much not a rational guilt, but it's a symptom within post-traumatic stress disorder (PTSD) and depression, which are risk factors for suicide, she said.

There are effective treatments for both illnesses, so people can get through survivor's guilt and recover. Therapy can help people accept that something terrible happened and there was nothing they could do about it, but they are not helpless in the face of everything in life, Silberman noted.

RELATED: Lookback at the Pulse nightclub shooting 

20 PHOTOS
Pulse nightclub shooting
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Pulse nightclub shooting
An aerial view shows the Pulse gay night club after a mass shooting in Orlando, Florida, U.S. June 12, 2016. REUTERS/Carlo Allegri
Friends and family members embrace outside the Orlando Police Headquarters during the investigation of a shooting at the Pulse nightclub, where people were killed by a gunman, in Orlando, Florida, U.S June 12, 2016. REUTERS/Steve Nesius TPX IMAGES OF THE DAY
Friends and family members embrace outside the Orlando Police Headquarters during the investigation of a shooting at the Pulse nightclub, where people were killed by a gunman, in Orlando, Florida, U.S June 12, 2016. REUTERS/Steve Nesius
Friends and family members embrace outside the Orlando Police Headquarters during the investigation of a shooting at the Pulse nightclub, where people were killed by a gunman, in Orlando, Florida, U.S June 12, 2016. REUTERS/Steve Nesius
ORLANDO, FL - JUNE 12: FBI agents investigate near the damaged rear wall of the Pulse Nightclub where Omar Mateen allegedly killed at least 50 people on June 12, 2016 in Orlando, Florida. The mass shooting killed at least 50 people and injuring 53 others in what is the deadliest mass shooting in the country's history. (Photo by Joe Raedle/Getty Images)
ORLANDO, FL - JUNE 12: FBI agents investigate near the damaged rear wall of the Pulse Nightclub where Omar Mateen allegedly killed at least 50 people on June 12, 2016 in Orlando, Florida. The mass shooting killed at least 50 people and injuring 53 others in what is the deadliest mass shooting in the country's history. (Photo by Joe Raedle/Getty Images)
ORLANDO, FL - JUNE 12: FBI agents investigate near the damaged rear wall of the Pulse Nightclub where Omar Mateen allegedly killed at least 50 people on June 12, 2016 in Orlando, Florida. The mass shooting killed at least 50 people and injuring 53 others in what is the deadliest mass shooting in the country's history. (Photo by Joe Raedle/Getty Images)
Friends and family members embrace outside the Orlando Police Headquarters during the investigation of a shooting at the Pulse night club, where as many as 20 people have been injured after a gunman opened fire, in Orlando, Florida, U.S June 12, 2016. REUTERS/Steve Nesius TPX IMAGES OF THE DAY
Demetrice Naulings sobs outside the Orlando Police Headquarters where police are interviewing witnesses in the investigation of a shooting at the Pulse nightclub, where people were killed by a gunman, in Orlando, Florida, U.S June 12, 2016. REUTERS/Steve Nesius
Concerned friends and family of victims of the Pulse nightclub shooting wait outside of the Orlando Police Department on Sunday, June 12, 2016. (Joe Burbank/Orlando Sentinel/TNS via Getty Images)
Ray Rivera, DJ at the Pulse nightclub, is consoled by a friend outside of the Orlando Police Department on Sunday, June 12, 2016. (Joe Burbank/Orlando Sentinel/TNS via Getty Images)
Police stand in front of one of the houses that officials indicated was connected to the Orlando shooter in Port St. Lucie, Florida, U.S. June 12, 2016. REUTERS/Joe Skipper
An aerial view shows the Pulse gay night club after a mass shooting in Orlando, Florida, U.S. June 12, 2016. REUTERS/Carlo Allegri
Police stand in front of one of the houses that officials indicated was connected to the Orlando shooter in Port St. Lucie, Florida, U.S. June 12, 2016. REUTERS/Joe Skipper
ORLANDO, FL - JUNE 12: FBI agents investigate near the damaged rear wall of the Pulse Nightclub where Omar Mateen allegedly killed at least 50 people on June 12, 2016 in Orlando, Florida. The mass shooting killed at least 50 people and injuring 53 others in what is the deadliest mass shooting in the country's history. (Photo by Joe Raedle/Getty Images)
ORLANDO, FL - JUNE 12: FBI agents investigate near the damaged rear wall of the Pulse Nightclub where Omar Mateen allegedly killed at least 50 people on June 12, 2016 in Orlando, Florida. The mass shooting killed at least 50 people and injuring 53 others in what is the deadliest mass shooting in the country's history. (Photo by Joe Raedle/Getty Images)
Officers arrive at the Orlando Police Headquarters during the investigation of a shooting at the Pulse nightclub, where people were killed by a gunman, in Orlando, Florida, U.S June 12, 2016. REUTERS/Steve Nesius
An aerial view shows the Pulse gay night club after a mass shooting in Orlando, Florida, U.S. June 12, 2016. REUTERS/Carlo Allegri
Orlando Police Chief John Mina and other city officials answer the media's questions about the Pulse nightclub shooting in Orlando, Florida June 12, 2016. REUTERS/Kevin Kolczynski
Police lock down Orange Avenue around Pulse nightclub, where people were killed by a gunman in a shooting rampage in Orlando, Florida June 12, 2016. REUTERS/Kevin Kolczynski
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Asking about suicidal thoughts

If you have a loved one who is suffering from survivor's guilt, PTSD or depression and you are worried they are thinking about suicide, both mental health experts advised talking about it very directly.

"Ask, 'How bad is it? Are you having thoughts about dying? About killing yourself?'" Silberman advised.

"It's always OK to say, 'I'm concerned for you. I'm wondering if… maybe you think your life is not worth living,'" Williams added. "You're never going to make somebody become suicidal just because you're asking them… You want to acknowledge the pain they're experiencing and help them deal with the pain."

The first step could be connecting them with therapist or counselor. Suicide is the third leading cause of death for young people and those who endured the horror at Parkland or survived other trauma are at risk, Williams said.

If you or someone you know is at risk of suicide please call the U.S. National Suicide Prevention Lifeline at 800-273-8255, text TALK to 741741 or go to SpeakingOfSuicide.com/resources for more additional resources.

RELATED: States with tough gun laws 

25 PHOTOS
States with the toughest gun laws
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States with the toughest gun laws

24. Indiana

Grade: D-

Source: gunlawscorecard.org

(Photo credit should read KAREN BLEIER/AFP/Getty Images)

T-23. North Carolina

Grade: D-

Source: gunlawscorecard.org

(Chuck Liddy/Raleigh News & Observer/MCT via Getty Images)

T-23. New Hampshire

Grade: D

Source: gunlawscorecard.org

(Photo credit should read DOMINICK REUTER/AFP/Getty Images)

T-21. Virginia

Grade: D

Source: gunlawscorecard.org

(Photo by Jabin Botsford/The Washington Post via Getty Images)

T-21. Ohio

Grade: D

Source: gunlawscorecard.org

(Photo by Spencer Platt/Getty Images)

20. Nebraska

Grade: D

Source: gunlawscorecard.org

(Photo via Getty Images)

19. Wisconsin

Grade: C-

Source: gunlawscorecard.org

(Photo by John Gress/Corbis via Getty Images)

18. Nevada

Grade: C-

Source: gunlawscorecard.org

(Photo via Getty Images)

T-16. Michigan

Grade: C

Source: gunlawscorecard.org

(Photo via Getty Images)

T-16. Iowa

Grade: C

Source: gunlawscorecard.org

(Photo by Luke Sharrett/Bloomberg via Getty Images)

15. Oregon

Grade: C

Source: gunlawscorecard.org

(Photo via REUTERS/Lucy Nicholson)

14. Colorado

Grade: C

Source: gunlawscorecard.org

(Photo via REUTERS/Rick Wilking/File Photo)

13. Pennsylvania

Grade: C

Source: gunlawscorecard.org

(Photo credit should read DOMINICK REUTER/AFP/Getty Images)

12. Minnesota

Grade: C+

Source: gunlawscorecard.org

(Photo via AOL)

11. Delaware

Grade: B

Source: gunlawscorecard.org

(Photo via Getty Images)

10. Washington

Grade: B

Source: gunlawscorecard.org

(Photo via Getty Images)

9. Rhode Island

Grade: B+

Source: gunlawscorecard.org

(Photo by Kenneth C. Zirkel via Getty Images)

8. Illinois

Grade: B+

Source: gunlawscorecard.org

(Photo via REUTERS/Jim Young)

7. Hawaii

Grade: A-

Source: gunlawscorecard.org

(Photo via Getty Images)

T-5. New York

Grade: A-

Source: gunlawscorecard.org

(Photo via REUTERS/Shannon Stapleton)

T-5. Maryland

Grade: A-

Source: gunlawscorecard.org

(Photo credit BRENDAN SMIALOWSKI/AFP/Getty Images)

4. Massachusetts

Grade: A-

Source: gunlawscorecard.org

(Photo via Getty Images)

3. New Jersey

Grade: A-

Source: gunlawscorecard.org

(Photo by Mark Makela for The Washington Post via Getty Images)

2. Connecticut

Grade: A-

Source: gunlawscorecard.org

(Photo via Getty Images)

1. California

Grade: A

Source: gunlawscorecard.org

(Photo credit MARK RALSTON/AFP/Getty Images)

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