International Journal of Environmental Research and Public Health

Editorial

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5 pages, 286 KiB

Open AccessEditorial

What Do We Know about Suicide Bereavement, and What We Can Do to Help Suicide-Loss Survivors?

by Yossi Levi-Belz, Karolina Krysinska and Karl Andriessen

Int. J. Environ. Res. Public Health 2023, 20(8), 5577; https://doi.org/10.3390/ijerph20085577 - 19 Apr 2023

Cited by 4 | Viewed by 2121

Abstract

“Suicide is not only the end of life for the deceased but also the beginning of a highly challenging life for those left behind” [...] Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

Research

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13 pages, 831 KiB

Open AccessArticle

Depression and Suicide Ideation among Suicide-Loss Survivors: A Six-Year Longitudinal Study

by Yossi Levi-Belz and Shai Birnbaum

Int. J. Environ. Res. Public Health 2022, 19(24), 16561; https://doi.org/10.3390/ijerph192416561 - 9 Dec 2022

Cited by 6 | Viewed by 1863

Abstract

Suicide is not only a tragic end of life but also may be the beginning of a very challenging life for those left behind. Suicide-loss survivors (SLSs) are individuals who were exposed to the suicide of a close family member or a friend [...] Read more.

Suicide is not only a tragic end of life but also may be the beginning of a very challenging life for those left behind. Suicide-loss survivors (SLSs) are individuals who were exposed to the suicide of a close family member or a friend and endure highly emotional distress. The psychological stance and reactions of SLS are deeply colored by painful, intense emotions that are expressed through different psychiatric symptoms, including depression and suicide ideation (SI). The present study investigated the long-term effects of interpersonal factors such as social support, self-disclosure, thwarted belongingness, and perceived burdensomeness on depression and suicidal ideation among SLS. One hundred fifty-two Israeli SLS, aged 20–72, participated in this longitudinal study, during which their suicide ideation and depression levels were assessed at four points over six years (T1-baseline, and two (T2), four (T3), and six (T4) years after baseline). At the last time point, interpersonal factors were also assessed. SLSs’ interpersonal variables significantly predicted depression and SI levels beyond their usual trajectories over the years. Significant correlations were found between both perceived burdensomeness and thwarted belongingness and depression levels at all measurement points. Moreover, thwarted belongingness was found to be a significant moderator of the relationship between former and current depression levels, as the contribution of depression-T3 to depression-T4 was lower among SLSs with low thwarted belongingness (b = 0.14, CI = 0.05–0.34) compared with SLSs with high thwarted belongingness (b = 0.25, CI = 0.22–0.45). These findings emphasize the vital healing role of interpersonal factors such as belongingness, as they may attenuate depression and SI symptoms over time. Hence, clinicians should focus on therapies that boost interpersonal interactions and belongingness, as they seem to be crucial stepping stones on the way to recovery. Moreover, national programs should be implemented to offer SLSs targeted interventions to reduce distress and depression in the aftermath of suicide loss. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

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14 pages, 392 KiB

Open AccessArticle

Coping Styles Utilized during Suicide and Sudden Death Bereavement in the First Six Months

by Sharna Mathieu, Racquel Todor, Diego De Leo and Kairi Kõlves

Int. J. Environ. Res. Public Health 2022, 19(22), 14709; https://doi.org/10.3390/ijerph192214709 - 9 Nov 2022

Cited by 2 | Viewed by 2399

Abstract

Individuals bereaved by suicide experience substantial emotional distress and are at risk for poorer mental health, substance use concerns, and suicidal behaviors. This study aimed to explore whether those bereaved by suicide reported different coping styles compared to those bereaved by sudden death [...] Read more.

Individuals bereaved by suicide experience substantial emotional distress and are at risk for poorer mental health, substance use concerns, and suicidal behaviors. This study aimed to explore whether those bereaved by suicide reported different coping styles compared to those bereaved by sudden death in the first six months. It also aimed to determine whether a previous mental health diagnosis (PMHD) and experiencing stigma and/or shame impacted the utilization of adaptive and maladaptive coping. The sample was constituted by individuals bereaved by suicide (n = 142) compared to those bereaved by sudden death (n = 63), six months after loss. The study included immediate family members who were 18 years or older and understood the English language. After controlling for demographics there were no significant differences in coping styles between bereavement types. Regardless of bereavement type, having a PMHD was associated with increased avoidant and problem-focused coping, and stigma and shame were each associated with increased avoidant coping. Women were also more likely to report using adaptive coping. Findings demonstrate no difference by bereavement type and have implications for the tailoring of grief/postvention supports that are sensitive to perceived stigma/shame to better facilitate utilization of adaptive emotion-focused coping, particularly for men and those with pre-existing mental health problems. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

16 pages, 349 KiB

Open AccessArticle

Psychiatrists’ Experience of a Peer Support Group for Reflecting on Patient Suicide and Homicide: A Qualitative Study

by Millie Tamworth, Helen Killaspy, Jo Billings and Rachel Gibbons

Int. J. Environ. Res. Public Health 2022, 19(21), 14507; https://doi.org/10.3390/ijerph192114507 - 4 Nov 2022

Cited by 5 | Viewed by 2764

Abstract

There is a lack of support for mental health professionals who experience a patient suicide or homicide. This is despite a high likelihood of such an occurrence and the heavy professional and personal toll the experience can take. We conducted 15 interviews with [...] Read more.

There is a lack of support for mental health professionals who experience a patient suicide or homicide. This is despite a high likelihood of such an occurrence and the heavy professional and personal toll the experience can take. We conducted 15 interviews with members of a facilitated peer support group run for consultant psychiatrists who have experienced a patient homicide or suicide. Our interviews explored the trauma of the experience as well as the effectiveness of the group in helping the clinician heal. Our results echoed previous research that the experience can be profoundly traumatic. A professionally facilitated, consultant-only peer group specifically dedicated to suicide and homicide were the key components helping participants to process their grief. Mental health trusts should consider setting up facilitated peer support groups for clinicians who experience patient suicide or homicide. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

11 pages, 343 KiB

Open AccessArticle

Investigating Whether Bereavement by Suicide and Other Unnatural Causes Has a Deterrent Effect on Alcohol or Drug Use in Young Adults

by Alexandra Pitman, Fiona Stevenson and David Osborn

Int. J. Environ. Res. Public Health 2022, 19(20), 13245; https://doi.org/10.3390/ijerph192013245 - 14 Oct 2022

Cited by 1 | Viewed by 1475

Abstract

Bereavement by suicide and other unnatural causes is associated with suicide but evidence regarding risk of substance misuse is inconsistent. This may be due to heterogeneity in patterns of alcohol or drug use after traumatic bereavement; some increasing use to cope with the [...] Read more.

Bereavement by suicide and other unnatural causes is associated with suicide but evidence regarding risk of substance misuse is inconsistent. This may be due to heterogeneity in patterns of alcohol or drug use after traumatic bereavement; some increasing use to cope with the loss and others reducing use. To highlight the problems of focussing on diagnostic thresholds when investigating substance use after traumatic loss, we aimed to test whether people bereaved by suicide or other unnatural causes are more likely to reduce or stop their substance use than people bereaved by sudden natural causes. Using multivariable logistic regression and data from an online survey of 1854 UK-based bereaved adults, we tested the association between bereavement by suicide and other unnatural causes and post-bereavement reduction/cessation in (i) alcohol and (ii) drug use. There were no group differences in the proportions who reduced/stopped alcohol use, but a significantly greater proportion of people bereaved by sudden unnatural causes reduced/stopped drug use post-bereavement than people bereaved by sudden natural causes (AOR = 2.61; 95% CI = 1.44–4.71; p = 0.001; 4.1% versus 1.7%). In sub-group analyses this applied separately to people bereaved by suicide and non-suicide unnatural causes. Research into post-bereavement substance use should accommodate apparent divergent sub-diagnostic patterns. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

13 pages, 614 KiB

Open AccessArticle

Postvention as Prevention: Coping with Loss at School

by Nikita Khalid, Nicole Zapparrata, Kevin Loughlin and Glenn Albright

Int. J. Environ. Res. Public Health 2022, 19(18), 11795; https://doi.org/10.3390/ijerph191811795 - 19 Sep 2022

Cited by 1 | Viewed by 3275

Abstract

Many Pre-K through grade 12 (PK-12) students have experienced traumatic events throughout the pandemic in a myriad of ways including the death of family members and peers, loss of social interaction and increased violence at home. The consequences can be traumatic and manifest [...] Read more.

Many Pre-K through grade 12 (PK-12) students have experienced traumatic events throughout the pandemic in a myriad of ways including the death of family members and peers, loss of social interaction and increased violence at home. The consequences can be traumatic and manifest themselves in fear, anxiety, anger, isolation, and loneliness. Too often this leads to depression, anxiety, grief, substance use disorders, post-traumatic stress disorder, suicidal ideation and even suicides. This study assesses the impact of an innovative virtual human role-play simulation that prepares PK-12 educators, administrators, and school staff to respond to a student death in the school community by creating communities of support to help manage traumatic loss. The simulation addresses crisis response planning, postvention plans, and provides learners with role-play practice in using evidence-based motivational interviewing communication strategies in conversations with students and colleagues after the occurrence of a death. The sample consisted of educators and staff who were recruited from geographically dispersed areas across the US between January 2021 through December 2021. Matched sample t-tests and ANOVAs were used to assess quantitative data, and a qualitative analysis software, MAXQDA, was used to assess open-ended response data. Results show statistically significant increases in school personnel’s preparedness and self-efficacy to recognize signs of trauma in their students and colleagues, and to approach them to talk about concerns and, if necessary, make a referral to support services. Simulations such as this hold tremendous potential in teaching educators how address trauma due to a student death. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

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16 pages, 588 KiB

Open AccessArticle

Prolonged Grief Symptoms among Suicide-Loss Survivors: The Contribution of Intrapersonal and Interpersonal Characteristics

by Yossi Levi-Belz and Tamir Ben-Yaish

Int. J. Environ. Res. Public Health 2022, 19(17), 10545; https://doi.org/10.3390/ijerph191710545 - 24 Aug 2022

Cited by 9 | Viewed by 3193

Abstract

Background: Suicide-loss survivors (SLSs) are a population with unique characteristics that place them at increased risk for developing grief complications and painful feelings of guilt that may impact their supportive social environment. However, no studies to date have examined the role of intrapersonal [...] Read more.

Background: Suicide-loss survivors (SLSs) are a population with unique characteristics that place them at increased risk for developing grief complications and painful feelings of guilt that may impact their supportive social environment. However, no studies to date have examined the role of intrapersonal and interpersonal variables that may contribute to prolonged grief symptoms (PGS) as outlined by the new DSM-5 criteria. The present study aimed to extend knowledge regarding the role of interpersonal variables, such as perceived burdensomeness, thwarted belongingness, and self-disclosure, in determining the impact of guilt on the development of PGS among SLSs. Method: This study is part of a longitudinal study, though, in this study, we used a cross-sectional examination of the recently completed fourth measurement. Study participants included 152 SLSs aged 22 to 76 who completed questionnaires measuring guilt, depression, perceived burdensomeness, thwarted belongingness, self-disclosure, and PGS using the Prolonged Grief–Revised Inventory. Participants’ demographics and loss-related characteristics, such as time since suicide and participant’s age at the time of suicide, were examined. Results: Confirming the hypotheses, intrapersonal variables (i.e., guilt and depression), as well as interpersonal variables (i.e., perceived burdensomeness, thwarted belongingness, and self-disclosure), contributed significantly to PGS beyond sociodemographic and loss-related factors. Perceived burdensomeness significantly moderated the contribution of guilt to PGS: for participants with high burdensomeness levels, guilt contributed to PGS more strongly than for participants with low burdensomeness. Conclusion: Guilt is an important contributor to PGS among SLSs, and perceived burdensomeness plays a critical role in moderating this contribution. In light of these findings, it can be suggested that SLSs with high levels of guilt should receive special attention and may benefit from therapeutic interventions focusing on reducing maladaptive cognitions that elicit intense guilt or perceived burden. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

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10 pages, 737 KiB

Open AccessArticle

by Raphaela Grafiadeli, Heide Glaesmer and Birgit Wagner

Int. J. Environ. Res. Public Health 2022, 19(16), 10277; https://doi.org/10.3390/ijerph191610277 - 18 Aug 2022

Cited by 6 | Viewed by 2124

Abstract

(1) Background: The aim of the present study was to examine symptom classes of major depressive disorder (MDD), prolonged grief disorder (PGD), and posttraumatic stress disorder (PTSD) in a sample of suicide-bereaved individuals, while accounting for loss-related characteristics. (2) Methods: A latent class [...] Read more.

(1) Background: The aim of the present study was to examine symptom classes of major depressive disorder (MDD), prolonged grief disorder (PGD), and posttraumatic stress disorder (PTSD) in a sample of suicide-bereaved individuals, while accounting for loss-related characteristics. (2) Methods: A latent class analysis was conducted to identify classes of the suicide bereaved, sharing symptom profiles, in a German suicide-bereaved sample (N = 159). (3) Results: Our analyses revealed three main classes: a resilient class (16%), a class with high endorsement probability for PGD symptoms (50%), and a class with high endorsement probability for combined PGD/PTSD symptoms (34%). Prolonged grief and intrusive symptoms emerged across all classes, while MDD showed low endorsement probability. Our results indicate an association between class membership and time passed since the loss; however, this applies only to the comparison between the PGD and the resilient class, and not for the PGD/PTSD class. (4) Conclusions: Our results may provide information about the predictability of symptom clusters following suicide bereavement. The findings also represent a significant step towards tailoring treatments based on the needs of relevant suicide-bereaved subgroups through a symptom-level approach. Time passed since loss might explain differences between symptom clusters. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

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15 pages, 354 KiB

Open AccessArticle

The Spaces of Peer-Led Support Groups for Suicide Bereaved in Denmark and the Republic of Ireland: A Focus Group Study

by Lisbeth Hybholt, Agnes Higgins, Niels Buus, Lene Lauge Berring, Terry Connolly, Annette Erlangsen and Jean Morrissey

Int. J. Environ. Res. Public Health 2022, 19(16), 9898; https://doi.org/10.3390/ijerph19169898 - 11 Aug 2022

Cited by 6 | Viewed by 3726

Abstract

Research has shown that people bereaved by suicide have an increased risk of mental health problems, suicidality and associated stigma, as well as higher rates of sick leave and increased rates of receiving disability pensions. Peer-led suicide bereavement support groups are perceived to [...] Read more.

Research has shown that people bereaved by suicide have an increased risk of mental health problems, suicidality and associated stigma, as well as higher rates of sick leave and increased rates of receiving disability pensions. Peer-led suicide bereavement support groups are perceived to enhance people’s recovery by enabling shared experiences with others who are bereaved in similar circumstances. The aim of the research was to explore the viewpoints of participants living in Denmark and the Republic of Ireland on these peer-led support groups. This study focused on how the participants experienced being part of the peer-led support and how the participation affected them. We conducted four focus groups, two in Denmark and two in the Republic of Ireland, and two individual interviews, involving a total of 27 people bereaved by suicide. Data were analyzed thematically. The participants’ experiences in the peer-led support groups were in contrast to what they had experienced in their daily lives. They felt alienated in daily living, as they believed that people could not comprehend their situation, which in turn led participants to search for people with similar experiences and join the peer-led support groups. While peer-led support groups may not be helpful for everyone, they created ‘supportive spaces’ that potentially affected the participants’ recovery processes, from which we generated three key themes: (i) ‘A transformative space’, describing how the peer-led support group created a place to embrace change, learning and knowledge about suicide and suicide bereavement and the making of new connections; (ii) ‘An alternative space for belonging and grieving’, describing how the participants felt allowed to and could give themselves permission to grieve; and (iii) ‘A conflicted space’ describing how it was troublesome to belong to and participate in the peer-led support groups. In conclusion, despite the two cultural settings and different organizational approaches, the experiences were comparable. Peer-led support groups can, despite being a conflicted space for some, provide supportive spaces aiding the participants’ recovery process. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

25 pages, 2599 KiB

Open AccessArticle

The Role of Spirituality during Suicide Bereavement: A Qualitative Study

by Austėja Agnietė Čepulienė and Paulius Skruibis

Int. J. Environ. Res. Public Health 2022, 19(14), 8740; https://doi.org/10.3390/ijerph19148740 - 18 Jul 2022

Cited by 6 | Viewed by 3152

Abstract

Background: A loved one’s loss due to suicide can be a traumatic experience and trigger a complex grief process. Although spirituality, defined as a search for the Sacred in a broad sense, can be a resource and an obstacle in coping with the [...] Read more.

Background: A loved one’s loss due to suicide can be a traumatic experience and trigger a complex grief process. Although spirituality, defined as a search for the Sacred in a broad sense, can be a resource and an obstacle in coping with the suicide bereavement process, there is a gap in scientific understanding of the role spirituality plays during the process. Methods: To explore the role of spirituality in people bereaved by suicide, we recruited 11 women who lost a life partner due to suicide. We conducted semi-structured interviews and analyzed the data using reflexive thematic analysis. Results: We identified the following three themes: spirituality is a supportive resource that can be reached for or achieved without conscious involvement; spirituality provides helpful ways to cope with grief; spirituality makes the grief process more difficult. Conclusions: Spirituality, if personally meaningful and supported by others, can function as a resource after a loved one’s suicide and even add to post-traumatic growth after the loss. On the contrary, spirituality-related issues, such as stigmatization and a lack of personally meaningful traditions, can distress the bereaved. Difficult spiritual experiences and questions can become an intricate part of the grief process. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

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11 pages, 405 KiB

Open AccessArticle

Tragedies, Fates, Furies and Fuels: Narratives of Individuals Bereaved by Suicide

by Diane Macdonald, Alexandra Nicolopoulos, Kathryn McLachlan, Stephanie Habak, Helen Christensen and Katherine M. Boydell

Int. J. Environ. Res. Public Health 2022, 19(14), 8715; https://doi.org/10.3390/ijerph19148715 - 18 Jul 2022

Cited by 3 | Viewed by 1917

Abstract

Suicide is the leading cause of death for Australians aged 15 to 44, with fifty to sixty per cent of individuals who die by suicide ‘flying under the radar’, dying in this way without receiving formal mental health care or treatment. This paper [...] Read more.

Suicide is the leading cause of death for Australians aged 15 to 44, with fifty to sixty per cent of individuals who die by suicide ‘flying under the radar’, dying in this way without receiving formal mental health care or treatment. This paper explores how people bereaved by suicide interpret and narrate the lead-up to, act and aftermath of a male family member who died by suicide. We used qualitative semi-structured interviews to explore how narratives of suicide were articulated by loved ones bereaved by suicide. Analytic findings were conceptualised through Bamberg’s four layers of cognitive narrative structure–setting, complication, resolution, coda. We derived three complications conveyed by the group as a whole: that the men felt sentenced by fate, charged with fury and were fueled by alcohol. These narratives by individuals bereaved by suicide draw us into the larger picture of meaning-making, the loss of life and finding closure. They also speak to the need for early interventions, as most of these stories are rooted in childhood tragedy that was not sufficiently addressed or supported. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

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14 pages, 346 KiB

Open AccessArticle

“It’s a Living Experience”: Bereavement by Suicide in Later Life

by Trish Hafford-Letchfield, Jeffrey Hanna, Evan Grant, Lesley Ryder-Davies, Nicola Cogan, Jolie Goodman, Susan Rasmussen and Sophie Martin

Int. J. Environ. Res. Public Health 2022, 19(12), 7217; https://doi.org/10.3390/ijerph19127217 - 13 Jun 2022

Cited by 5 | Viewed by 2515

Abstract

Bereavement by suicide for people in later life is significantly under-researched. Research on ageing and suicide has yet to address the experiences of those bereaved by suicide and how such a devastating loss affects the ageing experience. Objectives: We explored the substantive [...] Read more.

Bereavement by suicide for people in later life is significantly under-researched. Research on ageing and suicide has yet to address the experiences of those bereaved by suicide and how such a devastating loss affects the ageing experience. Objectives: We explored the substantive issues involved in bereavement by suicide and its impact on later life. Methods: This was a co-produced qualitative study. Peer researchers with lived experience conducted in-depth interviews with twenty-four people aged 60–92 years. A phenomenological approach informed the data analysis. Main Findings: Themes described included (1) moral injury and trauma; (2) the rippling effect on wider family and networks; (3) transitions and adaptations of bereaved people and how their ‘living experience’ impacted on ageing. Conclusions: It is important to understand how individual experiences of suicide intersect with ageing and the significance of targeted assessment and intervention for those bereaved by suicide in ageing policies and support. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

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10 pages, 1058 KiB

Open AccessArticle

Attitudes toward Suicide and the Impact of Client Suicide: A Structural Equation Modeling Approach

by Irene Pisnoli and Ruth Van der Hallen

Int. J. Environ. Res. Public Health 2022, 19(9), 5481; https://doi.org/10.3390/ijerph19095481 - 30 Apr 2022

Cited by 2 | Viewed by 2435

Abstract

Previous research has revealed that mental health professionals (MHPs) often experience significant short- and long-term impacts in the aftermath of client suicide. Individual differences are significant, yet what factors explain these differences remain unclear. The current study aimed to investigate to what extent [...] Read more.

Previous research has revealed that mental health professionals (MHPs) often experience significant short- and long-term impacts in the aftermath of client suicide. Individual differences are significant, yet what factors explain these differences remain unclear. The current study aimed to investigate to what extent MHPs’ attitudes toward (client) suicide could predict the short- and long-term impacts of client suicide. A total of 213 MHPs, aged between 18 and 75, reported on a client suicide and their attitudes toward (client) suicide using self-report questionnaires. The results indicate that MHPs who believe it is one’s “rightful choice” to die by suicide report less and MHPs who believe “suicide can and should be prevented” report more impact of client suicide. Predictability and preventability of client suicide proved strongly, positively correlated; yet, neither predicted the impact of client suicide. Taken together, these findings highlight the importance of MHPs’ attitudes toward (client) suicide with respect to clients and MHPs (self-)care. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

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11 pages, 321 KiB

Open AccessArticle

Psychosocial Outcomes of Individuals Attending a Suicide Bereavement Peer Support Group: A Follow-Up Study

by Eve Griffin, Selena O’Connell, Eimear Ruane-McAteer, Paul Corcoran and Ella Arensman

Int. J. Environ. Res. Public Health 2022, 19(7), 4076; https://doi.org/10.3390/ijerph19074076 - 29 Mar 2022

Cited by 6 | Viewed by 3050

Abstract

Individuals bereaved by suicide represent an important group in terms of postvention. While peer support groups are often accessed by those bereaved, few studies have examined their impact in terms of physical and mental health wellbeing. The aim of this study was to [...] Read more.

Individuals bereaved by suicide represent an important group in terms of postvention. While peer support groups are often accessed by those bereaved, few studies have examined their impact in terms of physical and mental health wellbeing. The aim of this study was to examine psychosocial outcomes of individuals attending suicide bereavement peer support groups in Ireland. Between August 2020 and June 2021, all members were invited to complete a survey, with new members also surveyed at three- and six-month follow-up, to examine changes in wellbeing, depressive symptoms and grief reactions. Results were analyzed using descriptive statistics and mixed linear regression models. The 75 participants were mostly female, with lower levels of overall wellbeing and a higher prevalence of depressive symptoms and suicidal ideation than the general population. Participants also reported high levels of social adjustment difficulties and grief reactions, which were more pronounced for those more recently bereaved. At follow-up (n = 28), a significant improvement in wellbeing and a reduction in grief reactions were found, adjusting for time since bereavement. Participants identified the groups as creating a safe space and providing a sense of belonging and hope. Notwithstanding the small number of participants at follow-up, these findings underline the enduring mental health challenges for those bereaved by suicide and provide further evidence for the role of peer support in postvention. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

13 pages, 900 KiB

Open AccessArticle

The Reactions of Adolescents, Parents and Clinicians to Participating in Qualitative Research Interviews Regarding Adolescents Bereaved by Suicide and Other Traumatic Death

by Karl Andriessen, Karolina Krysinska, Debra Rickwood and Jane Pirkis

Int. J. Environ. Res. Public Health 2022, 19(1), 452; https://doi.org/10.3390/ijerph19010452 - 1 Jan 2022

Cited by 5 | Viewed by 2928

Abstract

There are concerns that involving adolescents bereaved by suicide and other traumatic death in research may cause distress and harm. However, no study has investigated such bereaved adolescents’ research experiences. In addition, no study has looked at the experiences of parents and clinicians [...] Read more.

There are concerns that involving adolescents bereaved by suicide and other traumatic death in research may cause distress and harm. However, no study has investigated such bereaved adolescents’ research experiences. In addition, no study has looked at the experiences of parents and clinicians as participants in adolescent suicide and traumatic death bereavement research. This study aimed to explore the short-term impact of research participation experienced by adolescents, parents, and clinicians. A total of 61 participants (adolescents, n = 17; parents, n = 12; clinicians, n = 32) filled out a short survey within two weeks of having taken part in a qualitative interview study. Data were analyzed descriptively. Most participants had experienced no distress while participating and no negative effects of participating; rather, participation was experienced as helpful for them and they would highly recommend participating in a study like this to others. A few adolescents and parents reported some distress, related to anxiety about participation and the unpleasantness of grief memories. The study clearly indicates that bereaved adolescents, parents and clinicians can safely participate in research interviews regarding their experiences of grief and help after suicide, generally valuing the opportunity to share their experience. To prevent and mitigate potential distress, training of research staff and implementation of appropriate participant distress protocols are imperative. Future studies could include longitudinal follow-up of participants to assess any longer-term consequences. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

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11 pages, 308 KiB

Open AccessArticle

Ethnic Minority Groups’ Experiences of Suicide Bereavement: A Qualitative Exploratory Study

by Pauline Rivart, Verity Wainwright, Sandra Flynn, Isabelle M. Hunt, Jenny Shaw, Shirley Smith, Barry McGale and Sharon McDonnell

Int. J. Environ. Res. Public Health 2021, 18(22), 11860; https://doi.org/10.3390/ijerph182211860 - 12 Nov 2021

Cited by 4 | Viewed by 3215

Abstract

It is estimated that between 36,000 and 360,000 people are affected by suicide every year in the UK, and a proportion may develop depression and post-traumatic stress disorder, or engage in high-risk behaviours. Recent systematic analyses have revealed a clear gap in research [...] Read more.

It is estimated that between 36,000 and 360,000 people are affected by suicide every year in the UK, and a proportion may develop depression and post-traumatic stress disorder, or engage in high-risk behaviours. Recent systematic analyses have revealed a clear gap in research on suicide bereavement in minority ethnic groups. This study aimed to understand the experiences and support needs of individuals from ethnic minority backgrounds bereaved by suicide and was the first in the UK to investigate this matter. The study was a secondary analysis of data. Participants were 7158 people residing in the UK who completed an online survey about their experiences of suicide. Free-text qualitative responses of 227 participants who did not identify as White British were analysed using thematic analysis. Four themes were identified: maladaptive coping strategies, emotional processes following suicide, lack of support from agencies, and the importance of mental health awareness. Ethnic minority groups reported a lack of support despite attempts to engage with services, noted the prevalence of stigma within ethnic minority groups, and expressed a need to tackle this. These preliminary results suggest that ethnic minority individuals require visible and accessible services that can successfully engage with and support them. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

Review

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24 pages, 1178 KiB

Open AccessReview

The Impact of Colleague Suicide and the Current State of Postvention Guidance for Affected Co-Workers: A Critical Integrative Review

by Hilary Causer, Johanna Spiers, Nikolaos Efstathiou, Stephanie Aston, Carolyn A. Chew-Graham, Anya Gopfert, Kathryn Grayling, Jill Maben, Maria van Hove and Ruth Riley

Int. J. Environ. Res. Public Health 2022, 19(18), 11565; https://doi.org/10.3390/ijerph191811565 - 14 Sep 2022

Cited by 8 | Viewed by 4979

Abstract

People bereaved by suicide are affected psychologically and physically and may be at greater risk of taking their own lives. Whilst researchers have explored the impact of suicide on family members and friends, the area of colleague suicide has been neglected and postvention [...] Read more.

People bereaved by suicide are affected psychologically and physically and may be at greater risk of taking their own lives. Whilst researchers have explored the impact of suicide on family members and friends, the area of colleague suicide has been neglected and postvention guidance for supporting surviving colleagues is often poorly developed. This critical integrative review explored the impact of colleague suicide on surviving co-workers and reviewed postvention guidance for workplaces. Systematic searches found 17 articles that met the inclusion criteria. Articles were appraised for quality and extracted data were analysed using a thematic network method. Article quality was moderate. Two global themes were developed: impact of a colleague suicide comprised themes of ‘suicide loss in the workplace’; ‘professional identities and workplace roles’; ‘perceptions of professional uniqueness’; and ‘professional abandonment and silencing’. Postvention following a colleague suicide comprised ‘individualised responses’; ‘the dual function of stigma’; and ‘complex pressure on managers’. A unifying global network ‘after a colleague suicide’ describes the relationships between all themes. A series of disconnects between existing postvention guidance and the needs of impacted workers are discussed. This review demonstrates the need for robust, systemic postvention for colleagues impacted by the complex issue of colleague suicide. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

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12 pages, 1341 KiB

Open AccessReview

Scoping Review of Peer-Led Support for People Bereaved by Suicide

by Agnes Higgins, Lisbeth Hybholt, Olivia A. Meuser, Jessica Eustace Cook, Carmel Downes and Jean Morrissey

Int. J. Environ. Res. Public Health 2022, 19(6), 3485; https://doi.org/10.3390/ijerph19063485 - 15 Mar 2022

Cited by 15 | Viewed by 4501

Abstract

Suicide bereavement support groups are a widely available format of postvention service. Although other reviews have addressed peer-led bereavement interventions, no review has focused specifically on peer-led support for people bereaved by suicide. Informed by a framework for undertaking scoping reviews, we conducted [...] Read more.

Suicide bereavement support groups are a widely available format of postvention service. Although other reviews have addressed peer-led bereavement interventions, no review has focused specifically on peer-led support for people bereaved by suicide. Informed by a framework for undertaking scoping reviews, we conducted a systematic review according to PRISMA-ScR guidelines. Searches conducted in May 2021 of peer-reviewed literature in MEDLINE (EBSCO), CINAHL Complete (EBSCO), PsycINFO (EBSCO), EMBASE (Elsevier), AMED (EBSCO), ERIC (EBSCO), Web of Science (Core Collection), ASSIA (Proquest), and Global Index Medicus. The search was not limited by language, and all studies were included to full text screening. The search identified 10 studies conducted between 1994 and 2020 in five countries. The selected papers were subjected to quality assessment. The interventions included face-to-face groups, telephone and online groups/forums and were evaluated using a variety of methodologies, which made comparison and synthesis challenging. Thematic analysis resulted in four themes: motivation, impact, aspects of intervention which hindered/enhanced outcomes, and recommendations for the practice of peer support made by the authors. While there were methodological limitations to most studies included in this review; the studies do indicate the potential benefit of peer-led support to those bereaved through suicide. Future studies should provide a definition of ‘peer’ and a clear description of the intervention being evaluated. As the field matures there is a need for more rigorous evaluation of peer interventions with representative samples, studies that compare the impact of various types of peer interventions, and studies of the peer group processes. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

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18 pages, 510 KiB

Open AccessReview

Continuing Bonds after Loss by Suicide: A Systematic Review

by Rebecca Goodall, Karolina Krysinska and Karl Andriessen

Int. J. Environ. Res. Public Health 2022, 19(5), 2963; https://doi.org/10.3390/ijerph19052963 - 3 Mar 2022

Cited by 14 | Viewed by 3435

Abstract

The concept of continuing bonds as an alternative to detachment from the deceased person has gained traction in grief literature over the years. Those bereaved by suicide are likely to experience various grief reactions and may be at-risk for adverse grief and mental [...] Read more.

The concept of continuing bonds as an alternative to detachment from the deceased person has gained traction in grief literature over the years. Those bereaved by suicide are likely to experience various grief reactions and may be at-risk for adverse grief and mental health outcomes. However, it remains unclear how those bereaved by suicide experience continuing bonds. To address this gap, we conducted a systematic review according to PRISMA guidelines. Searches of peer-reviewed literature in Medline, PsycINFO, Embase, Emcare, EBM Reviews, and Scopus identified 15 studies (2 quantitative and 13 qualitative) reporting on 12 samples, published between 2010 and 2021. The study quality of the quantitative studies was poor, but it was fair amongst the qualitative studies. People bereaved by suicide experienced continuing bonds across a variety of domains and reported mostly positive experiences. Factors that tended to have an impact on the expression of continuing bonds included time since bereavement, relationship to the deceased, social expectations, sex of the bereaved, and the ability of the bereaved to make meaning of the death. The review concludes that most participants reported positive experiences with continuing bonds. However, discrepancies between males and females and between those bereaved by suicide and those bereaved by other causes warrants further investigation. In addition, longitudinal community-based research involving representative samples is needed to understand the evolution and experience of continuing bonds over time in those bereaved by suicide and to inform future efforts in supporting them. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

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7 pages, 642 KiB

Open AccessBrief Report

The “Forgotten Grievers”: The Impact of Pupil Suicide on Post-Trauma and Grief Symptoms in School Staff

by Noa Tiech Fire, Yari Gvion, Sarit Alkalay and Gil Zalsman

Int. J. Environ. Res. Public Health 2022, 19(19), 12160; https://doi.org/10.3390/ijerph191912160 - 26 Sep 2022

Cited by 2 | Viewed by 1703

Abstract

Background: The suicide of a pupil impacts survivors greatly, but most studies on the subject do not consider school staff, and do not differentiate between the various professional domains. Our aim was to investigate the existence of differences in symptoms of complicated grief [...] Read more.

Background: The suicide of a pupil impacts survivors greatly, but most studies on the subject do not consider school staff, and do not differentiate between the various professional domains. Our aim was to investigate the existence of differences in symptoms of complicated grief as well as post-trauma symptoms after a pupil’s suicide, among school staff in four domains: counsellors, psychologists, principals and home-room teachers. Method: Eighty-four staff members from schools that lost pupils to suicide within the past five years were assessed for symptoms of complicated grief and trauma. All reported their symptoms using self-report scales. Results: Principals and home-room teachers had significantly higher complicated grief and post-trauma symptoms. The main limitations of this study are that the data were collected via self-report questionnaires, which can introduce bias. Additionally, the sample is relatively small and comprises mainly women. Conclusions: School professionals in domains receiving less coping and crisis training, and those with supervisory responsibilities (principals and home-room teachers) show more symptoms of trauma and complicated grief after a pupil’s suicide, and require special attention. More preparatory training would surely benefit them and assist them in coping with such crises. Full article

(This article belongs to the Special Issue Suicide Bereavement and Postvention: Advances in Research, Practice and Policy)

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