Suicide Loss Survivors Research Articles

What do suicide loss survivors think of physician-assisted suicide: a comparative analysis of suicide loss survivors and the general population in Germany

BackgroundPhysician-assisted suicide (PAS) and voluntary euthanasia remain highly debated topics in society, drawing attention due to their ethical, legal, and emotional complexities. Within this debate, the loss of a loved one through suicide may shape the attitudes of survivors, resulting in more or less favorable attitudes towards this topic.AimsThis study aims to explore and compare the attitudes towards PAS and voluntary euthanasia in a population of suicide loss survivors and the general population, while also considering socio-demographic factors.MethodsA total of 529 participants, 168 of whom were survivors of suicide loss, completed an online questionnaire on their attitudes (NOBAS) and opinions (open response format) towards PAS and voluntary euthanasia, as well as regarding their legalization in Germany. The analysis consisted of both quantitative and qualitative components.ResultsThe entire sample showed positive attitudes towards PAS and voluntary euthanasia in terminally ill persons. Participants were more divided in their attitudes towards PAS in the case of a mental health disorder. Individuals without experienced suicide loss were more liberal regarding legalization in Germany and were more likely to understand the wish for PAS. Survivors of suicide loss were mainly concerned about the consequences for relatives. However, differences between both groups are small.DiscussionThe experience of a loss by suicide influences attitudes towards PAS and voluntary euthanasia. Both groups showed an accepting attitude towards PAS and voluntary euthanasia, but also expressed concerns and fears regarding easy accessibility and consequences for grieving relatives.

Grief Intervention in Suicide Loss Survivors through Cognitive-Behavioral Therapy: A Systematic Review.

Suicide is one of the leading causes of death worldwide, affecting numerous individuals close to the person who died by suicide, including family members, friends, and colleagues. Those affected by the suicide of someone are referred to as "suicide survivors", and the psychological consequences they face are particularly severe. One of these consequences is grief, which is more complicated in survivors of suicide compared with those grieving deaths from other causes, mainly because of the stigma that continues to surround them. Therefore, psychotherapeutic intervention for suicide loss survivors is crucial. This study examines the efficacy of cognitive-behavioral programs for addressing grief and other related variables in suicide loss survivors. The search was conducted in databases including Psycinfo, Academic Search Premier, Medline, APA PsycArticles, E-Journals, Scopus, and PubMed. Five randomized controlled trials were selected, one of which focused exclusively on minors. The results reveal that cognitive-behavioral therapy is effective, although the methodological quality of these studies is not adequate, and the representativeness of the samples is very low. More RCTs are needed on the application of cognitive-behavioral programs to treat grief in suicide loss survivors.

A qualitative study of special operations forces chaplaincy teams' relationship building for suicide prevention, intervention, and postvention.

The U.S. special operations forces (SOF) contribute to a range of complex missions and experience high operational tempo, which may result in heightened professional and personal stressors. Those who are experiencing stressors may be reluctant to seek professional mental health services due to career concerns. The chaplaincy community is at the forefront of bearing and responding to the pain of others including those at risk for suicide. As a formative step to developing a tailored suicide prevention curriculum for the U.S. SOF religious support teams (RSTs), we sought to understand SOF RSTs' common strategies for suicide prevention, intervention, and postvention. We conducted confidential interviews with SOF RSTs via telephone and in person. We used an inductive thematic analysis to code a total of 57 transcripts. SOF RSTs prominently expressed that building relationships with SOF community members was foundational to their suicide prevention, intervention, and postvention practices: (a) Suicide prevention involved being available and cultivating a community of insiders who can provide resources as needed prior to crisis escalation; (b) Suicide intervention involved listening and responding to suicide risk and building autonomy for a suicidal SOF member to seek outside help; (c) Suicide postvention involved reaching out to suicide-loss survivors and grieving together through memorial services. The salient theme of building relationships points to opportunities to capitalize on RSTs' social connections and to enhance skills and resources for military suicide prevention, intervention, and postvention practices. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Social Support Somewhat Mitigates Grieving Problems of Recent Suicide Loss Survivors

Social Support Somewhat Mitigates Grieving Problems of Recent Suicide Loss Survivors

Understanding the complexity of suicide loss: PTSD, complex PTSD and prolonged grief disorder following suicide bereavement

Suicide-bereaved individuals are often confronted with profound grief reactions and have an increased risk for mental health disorders. Little is known about the development of complex post-traumatic stress disorder (CPTSD) following a loss by suicide. This paper aims to assess the prevalence of CPTSD, PTSD, prolonged grief disorder (PGD), and depression as well as to identify sociodemographic and loss-related factors regarding their development. A total of 161 suicide loss survivors (91.3% female) completed a questionnaire, which collected symptoms of grief (TGI-SR+), PTSD, CPTSD (ITQ), and depression (PHQ-D). In total, 12.4% met the diagnosis for CPTSD, 5.0% for PTSD. A total of 22.0% fulfilled the diagnosis for PGD. 41.6% showed at least moderate symptoms of depression. Pearson’s correlation showed that time since loss was negatively associated with PG and PTSD symptoms, kinship to the deceased was associated with PG severity. The sample scored high on all disturbances in self-organization (DSO) symptom clusters typical for CPTSD. A focus on symptoms of CPTSD may be a necessary component in the care of survivors of suicide loss.

Supportive and non-supportive social experiences following suicide loss: a qualitative study

BackgroundSuicide bereavement entails profound social stressors, including stigma and communication barriers, which can impair social support for suicide loss survivors (SLS). Despite recognized benefits of empathetic interactions, social support, and self-disclosure in mitigating adverse mental health outcomes after suicide loss, we lack a comprehensive understanding of the factors influencing perceived social support among SLS within their broader social environments. To address this gap, our study explores the diverse social experiences of SLS beyond their immediate circles. Specifically, we identify characteristics that define both supportive and non-supportive social experiences of SLS, as well as the facilitators and barriers to social support in the context of suicide bereavement.MethodsIn 2022, we conducted structured online individual interviews with a diverse sample of 18 SLS in Germany. We analyzed these interviews using qualitative content analysis.ResultsWe examined the social experiences of SLS across three phases and social contexts: (1) the immediate aftermath of the loss; (2) during bereavement practices; and (3) over time. Our findings show that proactive responses and personalized mourning rituals significantly enhance SLS’ sense of community support, while encounters characterized by avoidance or intrusive curiosity lead to feelings of isolation. Over time, supportive interactions often emerge from peers with similar experiences, promoting openness and shared vulnerability. Conversely, superficial engagement, along with experiences of others depersonalizing and avoiding conversations about the loss, contribute to a sense of marginalization.ConclusionsOur findings highlight the importance of proactive engagement and open dialogue, calling for societal and communicative shifts toward inclusive and compassionate approaches in addressing suicide loss. This study underscores the need for comprehensive strategies that enhance both suicide and grief literacy and address the taboo and stigma surrounding suicide, ultimately fostering supportive social environments for SLS.

Perspectives of suicide loss survivors: Qualitative analysis of data from a psychological autopsy study of U.S. Army soldiers.

Suicide loss survivors can provide information not otherwise available about the circumstances preceding a suicide. In this study, we analyzed interview data from suicide loss survivors collected as part of a psychological autopsy study of U.S. Army soldiers. Next-of-kin (NOK) (n = 61) and Army supervisors (SUP) (n = 107) of suicide decedents (n = 135) who had died in the last 2-3 months answered open-ended questions about suicide risk factors, ideas for improving suicide prevention, and the impact of the suicide. Responses were coded using conventional content analysis methods to identify common themes. Many NOK (30%) and SUP (50%) did not observe any signs of risk preceding the soldier's suicide. The most common idea regarding suicide prevention from SUP was that the suicide was inevitable, whereas NOK were more likely to emphasize the importance of increasing mental health treatment and reducing stigma. Both NOK and SUP reported negative effects of the suicide, but SUP reported some positive effects (e.g., increased unit connectedness). Results underscore the challenges of using informants to identify soldiers at high risk of suicide, given many respondents did not observe any warning signs. Findings also highlight attitudinal barriers present in the military that, if targeted, may increase soldiers' help-seeking and willingness to disclose their risk.

Meaning Reconstruction After Suicide Loss

Suicide loss is an example of traumatic loss, as suicide loss survivors face unique challenges in processing the loss. Consequently, in this conceptual paper, meaning reconstruction will be defined as a theoretical paradigm beneficial for clients navigating suicide loss. The aim of this manuscript is to provide a general overview of meaning reconstruction theory and to offer concrete suggestions on implementation of the meaning reconstruction theory as it relates to suicide loss. Further, the authors will utilize a hypothetical case study to illuminate the integration of meaning reconstruction for suicide loss survivors.

REAKSI BERDUKA PADA PENYINTAS KEHILANGAN BUNUH DIRI: LAPORAN KASUS

World Health Organization reported that there were more than 700,000 deaths due to suicide each year. Suicide incidents were like stones thrown into calm lakes, causing widespread ripples. Levi-Belz, in his study, stated that each suicide case affected an average of five family members and up to 135 individuals, including partners, colleagues, and the community. Suicide loss survivors were at a higher risk of experiencing complicated grief, depression, and suicide compared to the bereaved due to causes. Stigmatisation of suicide behavior and suicide loss survivors made them reluctant to disclose themselves, leading to less access to the help they needed. This case report described a 51-year-old woman experiencing grief reactions due to her daughter's suicide. She exhibited denial, anger, guilt, and self-blame. Her decision not to disclose her condition to family and relatives forced her to face emotional and mental turmoils on her own. This patient is still in the acute phase of grief reactions and is receiving psychological intervention in an individual setting. The assessment of suicide risk and ongoing observation of persistent psychological symptoms should be conducted periodically.

Unveiling studies on self-healing practices for suicide loss survivors: A scoping review

This scoping review aimed to examine how self-healing practices had been addressed in the empirical literature on suicide bereavement. Adhering to PRISMA-ScR guidelines, we searched five databases for peer-reviewed studies that reported using self-healing practices, either as a primary or secondary finding and 32 studies were included. The results highlight a substantial research gap in understanding self-healing practices’ definition, implementation, and effectiveness in suicide bereavement. Further studies are necessary to clarify the definition, identify facilitators and barriers to implementation, and explore the applicability of these strategies in diverse contexts, particularly in non-Western and Low-and Middle-income countries.

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.

Peer-support groups for suicide loss survivors: a systematic review

ABSTRACT Despite the increase in research on suicide bereavement, the effectiveness of peer-support group programs in promoting the grief process and mental health of suicide loss survivors remains unclear. The goal of our study was to determine the effectiveness of peer-support group programs for suicide loss survivors. A systematic review (PROSPERO ID: CRD42022307591) of articles published from January 2000 to December 2021 was applied in the databases PubMed, Web of Science, Scopus, and SciELO. Articles written in English, Spanish, or Portuguese with full text availability were included in this review to perform a narrative synthesis of the results and a bias analysis. 12 qualitative and two quantitative studies, were selected. No evidence of efficacy in reducing suicidal behavior was found. Qualitative studies highlighted that these types of groups provide social support, enabling individuals to cope with grief and mitigating psychological discomfort. In conclusion, from evidence-based medicine, results on peer-support groups for suicide loss survivors has a low level of certainty and an insufficient grade of recommendation. Nevertheless, qualitative studies indicate the potential benefits of these programs. The prevailing use of qualitative methodologies accounts for a participatory and subjective epistemology, typical of community programs such as peer-support programs. Finally, both quantitative and qualitative perspectives are necessary for the integration and validation of mutual support groups for suicide survivors in public mental health services.

Interpersonal facilitators of complicated grief and depression in the aftermath of suicide loss: The mediated roles of suicide-related shame and guilt.

Suicide-loss survivors (SLSs) are recognized as an at-risk population for several mental health complications, including complicated grief (CG) and depression. Recent studies have emphasized the contribution of interpersonal factors as well as suicide-related shame and guilt as facilitators of CG and depression among SLSs. In this 6 year longitudinal design study, we examined interpersonal variables as predictors of CG and depression, with suicide-related guilt and shame as mediators. Participants were 152 SLSs aged 18-70 who completed questionnaires assessing thwarted belongingness, self-disclosure, and social support at index measurement (T1); suicide-related shame and guilt and CG and depression were assessed 6 years later (T2). The integrated model revealed that the interpersonal factors of social support and self-disclosure at T1 significantly and negatively predict CG and depression (respectively) at T2. Thwarted belongingness was found to significantly and positively predict both CG and depression through the mediation of suicide-related shame levels. The findings highlight the critical role of interpersonal factors in facilitating CG and depression among SLSs. Theoretical implications relating to healing processes are discussed, as well as focused clinical recommendations, including psychoeducational interventions for addressing interpersonal difficulties and suicide-related shame in the aftermath of suicide loss.

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

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

Using Autotheory to Examine the Projective Field of Blame and Shame Following Suicide: Discussion of Alexis Tomarken’s “The Shroud of Suicide”

ABSTRACT Alexis Tomarken examines her experience of suicide loss following the suicide of several generations of men in her family, and a clinical vignette of a young woman losing her brother to suicide, to construct a theory of how some women survivors of suicide loss may suffer from damaging and stereotyped projections containing blame and creating shame, anger, and other painful feelings. I characterize Tomarken’s methodology as a form of autotheory, a method emerging from feminist scholarship. In my response to Tomarken’s paper, I will describe autotheory and recognize its importance for understanding and theorizing the multilayered experience of suicide loss survivors. I then examine the projective field of shame, blame, and stigma as they reinforce silence, recognizing Tomarken’s voice emerging from this projective field to speak about the cultural expectations for a particular group of women thereby potentially creating a community of resistance to the shroud of silence surrounding suicide loss.

Shame, depression, and complicated grief among suicide loss-survivors: the moderating role of self-disclosure

ABSTRACT Background: Suicide-loss survivors (SLSs) are recognised as an at-risk population for several psychiatric complications, including complicated grief (CG) and depression (SI). However, whereas shame is known as one of the characteristics of this population, knowledge about possible psychological processes which may moderate the contribution of shame levels to CG and depression in the aftermath of suicide loss is sparse. This study examines the role of self-disclosure – the inclination to share personal information with others – as a possible moderator of the associations of shame with CG and shame with depression over time. Method: Participants were 152 suicide-loss survivors, aged 18–70, who completed questionnaires tapping CG and depression at three time points (T1- index measurement, T2-two years after T1. and T3-four years after T1) and questionnaires tapping shame and SD at T3. Results: Hierarchical regression analyses showed that shame significantly and positively contributed to CG at T3 and to depression at T3, beyond the CG/depression trajectories. Notably, two significant interactions were found: Self-disclosure moderated the contribution of shame to CG at T3 and to depression at T3. At lower self-disclosure levels, shame’s contribution to CG and depression was higher. Conclusion: The study’s findings highlight shame as a significant facilitator of CG and depression in the aftermath of suicide loss. Moreover, the role of interpersonal interaction on SLSs’ distress levels and grieving process was underscored, as this interaction may serve as a buffer against the deleterious sequelae of the suicide of a loved one.

Growing together: Longitudinal trajectory of posttraumatic growth among suicide-loss survivors and its interpersonal predictors

Introduction: BackgroundRecent studies have indicated that grieving after suicide loss can be particularly complex and traumatic. However, studies have recognized the opportunity for personal growth among suicide-loss survivors.ObjectivesThis study signifies an effort to develop a comprehensive understanding of the underlying interpersonal facilitators of posttraumatic growth (PTG) among suicide-loss survivors in a longitudinal design.MethodsParticipants included 189 suicide-loss survivors (155 females), aged 21–73, who completed questionnaires of thwarted belongingness (TB), perceived burdensomeness (PB), and self-disclosure at T1. Moreover, participants were assessed on PTG levels at T1, 18 months (T2), and 42 months (T3).ResultsThe integrated mediation model indicated that both TB and PB contributed to the PTG trajectory. PB and self-disclosure contributed to PTG at T3 beyond the PTG trajectory across time. We also found self-disclosure to mediate the association of TB and PTG at T2 and T3.ConclusionsThese findings suggest that interpersonal factors play critical roles in contributing to PTG over time among suicide-loss survivors. Basic psychoeducational interventions designed to foster interpersonal behaviors may facilitate achieving PTG among survivors in the aftermath of suicide loss.Disclosure of InterestY. Levi-Belz Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no

The Clinical Utility of Spirituality and Religion in Meaning-Making Theory for Suicide Loss Survivors: A Scoping Review

In the case of violent/traumatic loss due to a completed suicide, there can be an overwhelming and complicated grief reaction followed by a spiritual need for the process of sense making and finding meaning. Some emerging literature on suicide loss survivors (SLSs) denotes that suicide loss is more similar to other forms of bereavement but is uniquely characterized by high levels of shame, guilt, self-blame, and stigma. This article examines themes within the current literature on the bereavement process, meaning-making theory, religion, and spirituality. The aim of this scoping review was to consider the question concerning the clinical utility of accompanying meaning-making interventions with a spiritually informed approach for SLS. The research was conducted through a scoping review. Records were identified through database searches of ProQuest (N = 93); OMNI (N = 184); and EBSCO (N = 63). Through a process involving identification, screening, and eligibility guided by inclusion and exclusion criteria, a total of 25 (N = 25) articles were used. These articles were analyzed in-depth for commonalities. Grief experiences, religious and spiritual experiences and meaning-making were three themes that emerged from the literature. In conclusion, this review elevates the importance of an integrated clinical counselling approach that encourages meaning-making within the context of spirituality to promote positive psychotherapy outcomes and growth for SLSs.

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

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.

Perceived Determinants of Disclosing Suicide Loss.

Background: People who lost a loved one to suicide (i.e., suicide loss survivors, SLS) often struggle to talk about their experiences. However, previous studies suggest beneficial effects of disclosure among this group. Aims: This study aimed to identify determinants of disclosing suicide loss. Method: We conducted qualitative interviews with 22 female SLS focusing on determinants of disclosing suicide loss. Interviews were transcribed and analyzed using qualitative content analysis. Results: We identified contextual factors, perceived risks, and perceived benefits as determinants of disclosing suicide loss. Contextual factors included social settings and characteristics of conversation partners. Perceived risks included emotional distress among oneself and others as well as stigma-related risks of disclosing. Perceived benefits included participants' desire for authenticity and social support, as well as positive effects for grieving and fighting suicide stigma. Limitations: Findings are limited to the current female sample. Conclusion: SLS need support in identifying safe places for disclosure and in developing coping strategies to deal with suicide stigma and emotional distress experienced by themselves and others. Future research should investigate the general public's ability and attitudes to provide support after suicide loss and investigate disclosure decisions among male SLS.