Postvention Services Research Articles

Understanding impact and factors that improve postvention service delivery: findings from a study of a community-based suicide bereavement support service in England

ABSTRACT This article reports on a two-year study of a community-based suicide postvention support service in the UK. Attention centres on the implementation of four integrated elements within the service model: multi-agency working with real-time suicide surveillance, persistent pro-active contact; volunteer-led support; continuous open-ended support. Our approach involved analysing utilisation data and qualitative techniques, including in-depth interviews with a diverse group of stakeholders. The study is the first of its kind to provide an in-depth examination of an innovative approach focusing on the integrated model and its constituent components. Our findings offer evidence-based examples of collaborative service efforts in implementing real-time interventions, with agencies working together to provide timely, co-ordinated, proactive responses and support with the potential to alleviate suffering and prevent loss of life. The value of volunteer-led support and open-ended access and associated challenges are emphasised. Findings hold promise for international impact with policy implications for services worldwide.

Prevalence of Patient Suicide and Its Impact on Health Care Professionals: A Systematic Review.

This review aimed to examine the impact of patient suicide on health care professionals (HCPs), assess available support resources, and evaluate postvention (i.e., activities designed to support HCPs after a patient suicide) efforts. An integrative systematic review was conducted to evaluate the prevalence of patient suicide and its emotional and professional impacts on HCPs. Searches were conducted in MEDLINE, Embase, CINAHL Plus, and the Cochrane Library in October 2021 and August 2022. Index terms and keywords were related to suicide, patients, and clinicians. Each article was assessed for quality with the Mixed Methods Appraisal Tool. Sixty-six relevant articles were identified. Across studies, the mean±SD percentage of HCPs who experienced a patient suicide was 51%±<1%. Fifty-eight (88%) articles reported on the emotional impact of patient suicide, and 50 (76%) reported on the professional impact of patient suicide. Thirty-three articles described a change in practice habits, which occurred for 51%-100% of professionals in these samples. Perceptions of support ranged widely, with 11%-87% of HCPs feeling that they received sufficient support. HCPs wanted formal support, including referral to counseling (12%-82%), more suicide prevention or postvention training (4%-70%), debriefing or supervision (41%-75%), formal case review (18%-20%), time off (12%), and legal assistance (4%). HCPs can be affected by patient suicide, regardless of practice setting. More information is needed to better understand the implementation of postvention services after patient suicide and to create practical and universally deliverable support services to meet HCPs' needs.

Research, practice, and data informed investigations of child and youth suicide: A science to service and service to science approach

Background: Suicide rates for children and adolescents have been increasing over the past 2 decades. In April 2023, the National Institute of Mental Health (NIMH) convened a two-day workshop to address child and youth suicide. Purpose: The workshop focus was to discuss the state of the science and stimulate a collaborative response between researchers, death investigators, and data collection teams to build a science to service and service to science approach toward understanding - and ultimately preventing – this growing problem of child and youth suicide. Highlights: Topics that meeting participants highlighted as worthy of further consideration for research and practice were: increasing awareness among death investigators, medical examiners, and coroners that child suicide deaths under age 10 years do occur and should be investigated and documented accordingly; emphasizing the value of science based protocols for child and youth death investigations to enhance consistency of approaches; and articulating needs for postvention services to suicide loss survivors. Outcomes: The importance of collecting an accurate and complete cause and manner of death (i.e., unintentional, suicide, homicide, undetermined) among all child decedents, and demographic information such as race, ethnicity, and sexual/gender minority status was underscored as critical for enhanced surveillance. For prevention efforts, approaches to assessing and understanding suicidal thoughts and behaviors among diverse groups of children, and the variability in proximal and distal risk factors are needed to inform opportunities for preventive interventions for diverse communities. The need for consistent measures and processes to improve death investigations, fatality review committees, and coordination between data collection systems and agencies was also raised. Practical applications: Collaborations among researchers, death investigators, and data collection teams can help to fully describe the child and youth suicide crisis and provide actionable information for new research, and prevention and response efforts.

School-Based Postvention Services: Exploring the Perspectives of Students

Abstract Adolescent suicide is a public health issue with 15 percent of adolescents experiencing the suicide loss of a classmate, acquaintance, or friend. This article reports findings from an online survey of individuals (N = 40) who lost a peer to suicide in middle or high school. The most frequently provided school-based postvention responses were school counselors, outside grief counselors, education on depression and suicide, and assemblies. Participants identified the following student needs from schools following a student suicide death: genuineness and sincerity of response, easy-to-access supports, recognition that students need help and support, awareness that students have different needs following a death, opportunities for commemoration, and flexibility in terms of academic requirements and expectations. Implications for schools are discussed, including the importance of resources for teachers and other staff supporting students, a trauma-informed response, and the careful consideration of the balance of suicide prevention and grief. Most important, it is essential for schools to recognize the magnitude of the impact of a suicide death on students, and that students need help and support from the school.

Trauma-Informed School-Based Postvention Services: Support to Students Following a Suicide Death

Trauma-Informed School-Based Postvention Services: Support to Students Following a Suicide Death

Evaluation of a New Online Program for Children Bereaved by Suicide: The Views of Children, Parents, and Facilitators

Objective: Experiencing the suicide of a parent or a sibling is one of the most disruptive and stressful events in the life of a child or adolescent. Yet, little is known about the effectiveness of support offered to children and adolescents bereaved by suicide. This study aimed to evaluate participant and facilitator’s perceived helpfulness of the new online Let’s Talk Suicide program, piloted in 2021. Method: Thematic Analysis of qualitative interviews with 4 children, 7 parents, and 3 facilitators (N = 14). Results: The analysis identified four themes focused on suicide bereavement specific support, the online environment experiences, expectations and perceived outcomes of the program, and parents’ involvement in the program. Conclusions: The young participants, parents, and facilitators were very positive about the program. They felt that it supported the children in their grief after suicide, helped to normalize their experiences, offered social support from peers and professionals, and enhanced their language and skills to express themselves and to deal with their emotions. Though longitudinal research is needed, the new program seems to address an existing gap in postvention services for children and adolescents bereaved by suicide. HIGHLIGHTS The children felt supported in their grief as it enhanced their skills and language to express themselves. The program also acknowledged the parents and supported them in their parenting role. Future longitudinal studies may enhance the evidence of effectiveness of the program.

Towards an Evidence-Based Model of Workplace Postvention.

This instrumental case study explored what suicide postvention might offer workplaces using the example of a large metropolitan funeral company. A mixed methods approach was utilized to examine staff experiences with suicide bereavement funerals and responses to a bespoke postvention training package. Staff found funerals due to suicide difficult in terms of communication, engagement and emotionality. These challenges were commonly characterized by increased tension and concern. In the absence of a postvention informed approach, staff had developed individual ways to negotiate the identified challenges of this work. The introduction of a staff-informed postvention training package delivered improvements in staff confidence with communication, understanding and management of the impact of suicide bereavement, and increased willingness to share information about postvention services with families and mourners. The findings indicated that benefits of the training could be extended through organizational governance and integration of supports. The findings are used to inform a model of workplace postvention together with a methodology incorporating staff experience and organizational context.

Adolescents' Experiences With School-Based Postvention Services: Needs, Supports, and Recommendations.

This exploratory qualitative study of youth (N = 13) exposed to a peer's suicide death examined responses to the death and needed school-based responses and supports. Youth reported emotions including anger, grief, and fear, described suicide as a profound and impactful experience, and shared beliefs about entitlement to grief. Participants wanted schools to provide support for grief, to feel cared about by adults at school, to receive education about grief and suicide at school, and to have school-based opportunities to commemorate the deceased. Recommendations for schools include strategies for facilitating healthy grieving, supporting students, educating the community, and memorializing the deceased, while remaining cognizant of the need to prevent suicide contagion in the community.

Evaluating Postvention Services and the Acceptability of Models of Postvention: A Systematic Review.

Background: Suicide is a major public health issue that increases the risk of suicide for those bereaved by suicide themselves. There is a lack of evaluation of the effectiveness and acceptability of suicide postvention services supporting those bereaved by suicide. Aims: This review aimed to assess evaluations of postvention services supporting those bereaved by suicide and the acceptability of methods of postvention. Methods: Searches of peer-reviewed literature identified 36 studies for inclusion. 22 studies evaluated specific postvention services, 14 evaluated models of postvention. Results: Using the Mixed Methods Appraisal Tool, mixed-methods and qualitative postvention evaluation and acceptability research produce high-quality studies. Studies rated as low quality reflect poor reporting, rather than ineffective services. Conclusion: Further evaluation of community-based postvention services within the UK is needed. This would evidence that services in the UK are effective in supporting those bereaved by suicide. Evaluation would benefit services in accessing funding, improve service development and provide holistic support.

Minding Mental Health: Clinicians’ Engagement with Youth Suicide Prevention

Suicidal ideation and deaths among children and adolescents have seen an unprecedented rise over the last ten years, recently further exacerbated by the COVID-19 pandemic. This research explores mental health professionals’ approaches to delivering suicide prevention treatment services. Using insights from Giddens’ structuration theory, the study examines licensed mental health professionals’ (1) reflections on suicide prevention trainings for those in their profession, (2) appraisals of available treatment options, and (3) assessments of postvention services provided to professionals who encounter a client suicide. Additional attention was given to the structural impacts of the COVID-19 pandemic on intervention services. Data were collected through qualitative interviews with youth mental health clinicians in the state of Texas. Results underscore the interplay between structural influences and practitioner innovations in the delivery of these essential services to a vulnerable population. This study underscores the agency of mental health professionals in navigating the demands of a difficult profession.

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

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.

Evaluating the Outcomes for Bereaved People Supported by a Community-Based Suicide Bereavement Service.

Background: Postvention services aim to support people bereaved by suicide and reduce the adverse impacts associated with suicide bereavement. StandBy Support After Suicide is a community-based suicide bereavement service that provides support and a coordinated response for people bereaved by suicide. Aims: We aimed to evaluate the effectiveness of the StandBy service in reducing suicidality, grief reactions associated with suicide bereavement, and social isolation among clients. Method: A retrospective cross-sectional design using an online survey was used to compare StandBy clients with people bereaved by suicide who did not access the StandBy service. Results: Among people whose most recent loss to suicide was within the past 12 months, people supported by StandBy were significantly less likely to be at risk of suicidality, experience a loss of social support, and experience social loneliness compared with people bereaved by suicide who had not accessed the StandBy service. Limitations: Owing to the use of a cross-sectional design, it was not possible to determine changes over time. Conclusion: Postvention in the form of a community-based crisis intervention, at the time of or close to a suicide, is effective in reducing adverse outcomes associated with suicide bereavement, and an important aspect of suicide prevention.

Suicide postvention practices in schools: School psychologists' experiences, training, and knowledge.

Suicide is a leading cause of death of school-aged youth, with adolescent and young adult populations considered to be most at risk for suicide clusters and contagion effects. Suicide clusters have been documented in school districts across the United States, though the degree to which schools are prepared to provide postvention services in the wake of a suicide is presently unclear. The current study sought to ascertain school psychologists' training, experiences and access to school district protocols in general postvention, and specifically in suicide contagion effect prevention. Perceptions of suicide postvention knowledge and self-efficacy from 111 school psychologists in the state of North Carolina were assessed using the Perceived Postvention Competency Survey. Descriptive and multivariate analyses were conducted to identify associations between school psychologist characteristics and perceived competency. More than half of respondents reported limited knowledge, preparedness, and confidence in suicide postvention, and even lower degrees of competency in preventing suicide contagion effects. Formal training in postvention and years worked were significantly associated with both perceived knowledge and self-efficacy. Recommendations to enhance school psychologists' postvention competence are offered, and directions for future research to expand upon this preliminary work are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Adapting Digital Social Prescribing for Suicide Bereavement Support: The Findings of a Consultation Exercise to Explore the Acceptability of Implementing Digital Social Prescribing within an Existing Postvention Service.

This paper describes a consultation exercise to explore the acceptability of adapting digital social prescribing (DSP) for suicide bereavement support. Bereavement by suicide increases the risk of suicide and mental health issues. Social prescribing improves connectedness and empowerment and can provide digital outcomes-based reporting to improve the capacity for measuring the effectiveness of interventions. Our aim was to consult on the acceptability and potential value of DSP for addressing the complexities of suicide bereavement support. Our approach was underpinned by implementation science and a co-design ethos. We reviewed the literature and delivered DSP demonstrations as part of our engagement process with commissioners and service providers (marrying evidence and context) and identified key roles for stakeholders (facilitation). Stakeholders contributed to a co-designed workshop to establish consensus on the challenges of providing postvention support. We present findings on eight priority challenges, as well as roles and outcomes for testing the feasibility of DSP for support after suicide. There was a consensus that DSP could potentially improve access, reach, and monitoring of care and support. Stakeholders also recognised the potential for DSP to contribute substantially to the evidence base for postvention support. In conclusion, the consultation exercise identified challenges to facilitating DSP for support after suicide and parameters for feasibility testing to progress to the evaluation of this innovative approach to postvention.

Suicide and sudden death bereavement in Australia: A longitudinal study of family members over 2 years after death.

Grief reactions change over time. However, only a limited number of studies, and none in Australia, have analysed changes in individual grief reactions longitudinally. The aim is to examine changes in grief reactions, mental health and suicidality of close family members bereaved by suicide, 6, 12 and 24 months after their loss compared with those bereaved by other forms of sudden death, adjusting for confounding factors. Participants were 142 adult family members bereaved by suicide and 63 by other sudden death, followed up at 6, 12 and 24 months in Queensland, Australia. The Grief Experience Questionnaire, Depression Anxiety Stress Scale and Beck Scale for Suicide Ideation were used as main outcomes. Mixed-effects linear and logistic regressions were utilized for statistical analyses. There were significant differences in rejection, stigmatization, shame and responsibility between the suicide and sudden death bereaved over the 2-year period, after adjusting for potential confounding factors. Rejection, stigmatization, search for explanation, somatic reactions and symptoms of depression and anxiety (Depression Anxiety Stress Scale) declined significantly over time in both groups. Rejection and somatic reactions showed group-by-time interaction effects, with a decrease in the suicide bereaved and no change in the sudden death bereaved. Loss of social support and suicidal ideation did not show a group or time effect. Although our findings confirm that there are several common dimensions to experiencing a sudden death of a family member, several differences were found between the suicide and non-suicide sudden death bereaved including significantly higher levels of rejection, stigmatization, shame and responsibility remaining in the suicide compared to sudden death bereaved 2 years after their loss. These findings should be considered in clinical practice and when designing postvention services in Australia.

Providing support following exposure to suicide: A mixed method study.

Exposure to suicide and the associated impacts for those left behind can be long lasting and traumatic. Literature has predominantly examined the experience of suicide and impact from the perspective of those closest to the deceased-with studies primarily focused on kin relationships. Appropriate and timely support delivered by skilled professionals, through the provision of postvention support, has been suggested as a way to reduce morbidity and mortality associated with exposure to suicide. The evidence regarding what support, for whom, and the timing of support is scarce. As an extension of this scarcity, there is minimal research examining the ways in which provision of this postvention (that is, support following exposure to suicide) support impacts workers. This paper explores service use data gathered to evaluate a nation-wide Australian suicide postvention service, in conjunction with qualitative data from those providing postvention support to those exposed to suicide to understand who accesses support and the impact of providing such support on service providers. Postvention workers provide insight into the demands of responding to suicide, the pressure of being on call, and the ways in which they are able to maintain their well-being through external supervision.

Hope, help, and healing: Culturally embedded approaches to suicide prevention, intervention and postvention services with native Hawaiian youth.

Suicide rates have reached their highest documented levels in the United States with the greatest increases among indigenous youth, including Native Hawaiians. Culturally informed, effective prevention and treatment services are needed now more than ever for Native communities to heal and flourish. Multicomponent prevention and service strategies rooted in indigenous values and approaches show the most promise. Native Hawaiian communities are united around a common goal of suicide prevention, intervention and postvention, linking cultural meanings to improve understanding and guide local efforts. This paper highlights important cultural values to consider when developing and implementing suicide prevention, intervention and postvention. Strategies build upon the strengths of Native Hawaiian youth and their respective communities. Native Hawaiian sayings anchor each level and serve to organize a set of culturally informed and culturally embedded programs and approaches along the continuum of prevention, intervention and postvention. Application of indigenization to suicide prevention enhances connections to people and place, inspiring hope among Native Hawaiian youth, their families and their communities. (PsycINFO Database Record

Parents' Experiences of Suicide-Bereavement: A Qualitative Study at 6 and 12 Months after Loss.

The death of a child by suicide is a severe trauma, placing parents at greater risk of psychological morbidity and physical health problems compared to other causes of death. However, few studies have examined the aftermath and bereavement experience for parents following the death of a child to suicide, limiting the ability to guide effective postvention services through empirical research. The current study, which was part of a larger longitudinal investigation of suicide bereavement in Queensland, Australia, examined the individual experiences of both mothers and fathers bereaved by suicide over time, specifically at the six month and 12 month time points after their loss. Bereaved parents who had provided written consent to be contacted for research purposes were identified through the Queensland Suicide Register, and took part in individual, semi-structured interviews. Generic qualitative analysis identified three key themes: searching for answers and sense-making, coping strategies and support, and finding meaning and purpose. Some participants showed indications of meaning-making and post-traumatic growth at 12 months after the suicide. According to the dual process model of bereavement, it is likely that participants were still oscillating between sense-making and meaning making, indicating that adapting to bereavement is a dynamic and fluctuating process.

Postvention is prevention—The case for suicide postvention

ABSTRACTThere is now convincing empirical evidence that exposure to suicide increases the risk of subsequent suicide, as well as other negative mental health sequelae, in those who have been exposed. This article provides a review of this empirical evidence. It also concludes that this substantial evidence base makes the compelling case that all suicide prevention programs need to include postvention services as a direct form of suicide prevention with a population of people known to be at heightened risk for suicide themselves: suicide loss survivors.

An Aboriginal youth suicide prevention project in rural Victoria

ABSTRACTObjective: To describe an Aboriginal youth suicide prevention project developed by Njernda Aboriginal Corporation.Method: This is a descriptive study of an Aboriginal youth suicide prevention project developed by Njernda Aboriginal Corporation based in Echuca, Victoria. Information about the program was obtained from interviewing the project worker and the social and emotional wellbeing worker. Further information was obtained about the program by examining activity registers, program flyers and posters.Results: The Aboriginal youth suicide prevention project was designed and implemented by Njernda Aboriginal Corporation over a period of three years. The main components of the project were building resilience, early intervention response and immediate postvention support. Resilience was built through the Bullroarer program, the Red Dust Healing program and community awareness programs. Another program, the Jekkora group was developed and implemented as an early intervention response. A postvention service is in the planning stage.Conclusions: During a three-year period Njernda Aboriginal Corporation established community resilience building and early intervention programs. Developing and implementing a comprehensive suicide prevention plan at the community level requires adequate time as well as support from mainstream services. These findings therefore have implications for future planning of Aboriginal suicide prevention projects.