A systematic review on the protective factors that reduce suicidality following childhood exposure to external cause parental death, including suicide

Abstract

• Most individuals exposed to parental suicide do not die by suicide. • Socioecological model can be applied to show protective factors for suicide. • Resilience and posttraumatic growth can be observed among bereaved adults. • Additional studies are needed on processes that lead to PTG. Exposure to parental death in childhood has been associated with increased suicide risk among offspring, although few studies have examined protective factors that reduce suicide risk in this cohort. This systematic literature review aimed to synthesise primary studies on the protective factors that reduce suicidality following childhood exposure to external cause parental death, including suicide. These factors are also regarded as having ‘buffering’ effects that may promote posttraumatic growth and resilience. A systematic literature review was conducted in accordance with guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Ovid MEDLINE, Cochrane Library, Ovid PsycINFO, Web of Science, CINAHL via EbscoHost and Ovid EMBASE were searched. Two researchers independently screened the articles, performed data extraction and assessed quality of evidence. Of the 1976 studies identified, 23 were included for review. Most studies provided evidence of individual, interpersonal and environmental-level factors which lower an individual's risk of subsequent suicidality following parental death, including suicide. Five studies made specific reference to resilience and gave evidence that bereaved offspring were well-adjusted and showed normative development. Two studies examined posttraumatic growth suggesting some offspring can develop more prosocial traits through the bereavement process. There were limited studies mentioning posttraumatic growth which did not allow researchers to study its development and how it differs or complements the development of resilience. Most studies also had limited sample sizes. Bereaved children have the capacity to adapt to parental death as they transition to adulthood although further research is needed to differentiate individuals who demonstrate resilience from those who exhibit posttraumatic growth.