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Romero-Moreno JC, Cantero-García M, Huertes-Del Arco A, Izquierdo-Sotorrío E, Rueda-Extremera M, González-Moreno J. Grief Intervention in Suicide Loss Survivors through Cognitive-Behavioral Therapy: A Systematic Review. Behav Sci (Basel) 2024; 14:791. [PMID: 39336006 PMCID: PMC11428494 DOI: 10.3390/bs14090791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 09/05/2024] [Accepted: 09/05/2024] [Indexed: 09/30/2024] Open
Abstract
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.
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Affiliation(s)
- José Carlos Romero-Moreno
- Psicología, Facultad de Ciencias de la Salud, Universidad Internacional de Valencia (VIU), 46003 Valencia, Spain
| | - María Cantero-García
- Psicología, Facultad de Ciencias de la Salud y Educación, Universidad a Distancia de Madrid (UDIMA), 28400 Madrid, Spain
| | - Ana Huertes-Del Arco
- Psicología, Facultad de Ciencias de la Salud y Educación, Universidad a Distancia de Madrid (UDIMA), 28400 Madrid, Spain
- Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain
| | - Eva Izquierdo-Sotorrío
- Psicología, Facultad de Ciencias de la Salud y Educación, Universidad a Distancia de Madrid (UDIMA), 28400 Madrid, Spain
| | - María Rueda-Extremera
- Psicología, Facultad de Ciencias de la Salud y Educación, Universidad a Distancia de Madrid (UDIMA), 28400 Madrid, Spain
| | - Jesús González-Moreno
- Psicología, Facultad de Ciencias de la Salud, Universidad Internacional de Valencia (VIU), 46003 Valencia, Spain
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Shame, depression, and complicated grief among suicide loss-survivors: the moderating role of self-disclosure. Eur J Psychotraumatol 2023; 14:2182820. [PMID: 37052086 PMCID: PMC9987731 DOI: 10.1080/20008066.2023.2182820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
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.
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Aluri J, Haddad JM, Parke S, Schwartz V, Joshi SV, Menon M, Conrad RC. Responding to Suicide in School Communities: An Examination of Postvention Guidance from Expert Recommendations and Empirical Studies. Curr Psychiatry Rep 2023; 25:345-356. [PMID: 37470928 DOI: 10.1007/s11920-023-01431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE OF REVIEW We review the published literature on a school's response after a student dies by suicide ("postvention"). We examine published recommendations based on expert guidance and empirical studies that have evaluated postvention measures. RECENT FINDINGS Experts recommend careful communication with family, staff, and students that adheres to published suicide reporting guidelines. Experts also emphasize the importance of identifying and supporting high-risk students. Few robust, controlled studies have identified effective postvention measures. Effective measures tended to occur in group settings (e.g., group therapy), focus on improving grief symptoms, and involve mental health professionals. Postvention has not been robustly studied in the school context. Expert recommendations and a few evidence-backed studies provide the frame for a coherent, school-based postvention response. Further research is needed to strengthen and expand our collective understanding of effective postvention measures in the school context as youth suicide attempts continue to rise.
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Affiliation(s)
- James Aluri
- Johns Hopkins University, School of Medicine, Department of Psychiatry and Behavioral Sciences, 600 N. Wolfe St., Meyer 3-181c, 21287, Baltimore, MD, USA.
| | - Jessi M Haddad
- Child and Adolescent Psychiatry, New York-Presbyterian Hospital Columbia and Cornell, New York City, NY, USA
| | - Susan Parke
- Div. of Law & Psychiatry, Yale School of Medicine, Department of Psychiatry, New Haven, CT, 06511, USA
- Medical Director, Community Forensic Services, Connecticut Mental Health Center, New Haven, USA
| | - Victor Schwartz
- Wellness and Student Life, CUNY School of Medicine, New York, USA
| | - Shashank V Joshi
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry and Child Development, Stanford University School of Medicine, Stanford, USA
| | - Meera Menon
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, USA
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Levi-Belz Y, Ben-Yaish T. Prolonged Grief Symptoms among Suicide-Loss Survivors: The Contribution of Intrapersonal and Interpersonal Characteristics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710545. [PMID: 36078261 PMCID: PMC9518413 DOI: 10.3390/ijerph191710545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/18/2022] [Accepted: 08/20/2022] [Indexed: 05/13/2023]
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 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.
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Affiliation(s)
- Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer 40250, Israel
- Correspondence: ; Tel.: +972-9-8983028; Fax: +972-9-8983022
| | - Tamir Ben-Yaish
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer 40250, Israel
- Clinical Psychology of Adulthood and Aging M.A. Program, Ruppin Academic Center, Emek Hefer 40250, Israel
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Kaspersen SL, Kalseth J, Stene-Larsen K, Reneflot A. Use of Health Services and Support Resources by Immediate Family Members Bereaved by Suicide: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10016. [PMID: 36011651 PMCID: PMC9408753 DOI: 10.3390/ijerph191610016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
The knowledge on health service use, systematic follow-up, and support for families bereaved by suicide remains scarce. This scoping review includes studies from 2010 to March 2022 that investigate the follow-up and support offered by health services, peer support services, and other resources available (e.g., internet-based resources) for families bereaved by suicide. We followed the scoping review framework provided by the Johanna Briggs Institute and performed a double-blinded screening process using Covidence. Data were extracted by four researchers and a thematic analysis was performed to summarize the results. The PRISMA Extension for Scoping reviews was used for reporting results. Of 2385 studies screened by title, 190 by abstract, and 93 by full-text reading, we included 63 original articles of which 24, 29 and 10 were quantitative, qualitative, or mixed-methods studies, respectively. The review shows that we have some knowledge about the need for, and experiences with, health services and support resources for immediate family members bereaved by suicide, but a lack of knowledge about their help-seeking behaviour, patient pathways, systematic follow-up, coordination between services, and long-term outcomes. We need more longitudinal observational studies of health service use and patient trajectories for people bereaved by suicide.
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Affiliation(s)
- Silje L. Kaspersen
- Department of Health Research, SINTEF Digital, Pb. 4760 Torgarden, 7465 Trondheim, Norway
| | - Jorid Kalseth
- Department of Health Research, SINTEF Digital, Pb. 4760 Torgarden, 7465 Trondheim, Norway
| | - Kim Stene-Larsen
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, 0456 Oslo, Norway
| | - Anne Reneflot
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, 0456 Oslo, Norway
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Krysinska K, Andriessen K. Perspectives on family-based suicide prevention and postvention. BJPsych Open 2022; 8:e127. [PMID: 35796241 PMCID: PMC9301768 DOI: 10.1192/bjo.2022.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Suicide remains an important public health problem worldwide. Many countries have developed national suicide prevention policies or guidelines, which often include family-based recommendations regarding suicide prevention, intervention or postvention. A recent systematic review, published in this journal, failed to find evidence of an impact of family-based recommendations in national guidelines on national suicide rates. In this editorial, we review other studies providing promising evidence of effectiveness of family-based interventions in the field of suicide prevention and postvention, and note that further studies are needed, especially in adult and older adult populations.
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Affiliation(s)
- Karolina Krysinska
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Levi-Belz Y. Growing together: interpersonal predictors of posttraumatic growth trajectory among suicide-loss survivors. ANXIETY, STRESS, AND COPING 2022; 35:284-297. [PMID: 34314267 DOI: 10.1080/10615806.2021.1958791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Recent 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. This 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. METHOD Participants 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). RESULTS The 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. CONCLUSIONS These 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.
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Affiliation(s)
- Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel.,Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
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8
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Grafiadeli R, Glaesmer H, Hofmann L, Schäfer T, Wagner B. Suicide risk after suicide bereavement: The role of loss-related characteristics, mental health, and hopelessness. J Psychiatr Res 2021; 144:184-189. [PMID: 34673315 DOI: 10.1016/j.jpsychires.2021.09.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/31/2021] [Accepted: 09/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Suicide bereavement is associated with increased risk for severe negative mental health outcomes and suicidality. The purpose of this study was to examine the association between mental health symptoms and suicidal ideation among suicide bereaved while taking multiple factors into account. METHODS The sample consisted of N = 157 German suicide bereaved who were interested in receiving an online intervention. The Beck Scale for Suicide Ideation (BSS) was used to distinguish between participants with and without suicidal ideation. A hierarchical regression analysis determined the effect of the most common mental health symptoms on suicidal ideation: symptoms of depression (BDI-II), prolonged grief (ICG-D), post-traumatic stress (IES-R), and hopelessness (H-RB). RESULTS No significant differences emerged for sociodemographic or loss-related characteristics between suicide bereaved individuals with and without suicidal ideation. Depressive symptom severity was associated with higher suicidal ideation. When controlling for hopelessness, the effect of depression decreased considerably, while hopelessness itself turned out to be the most important predictor variable. DISCUSSION Increased levels of hopelessness commonly reported by suicide bereaved may represent a stronger risk factor for suicidal ideation than mental health disorders. Screening for and targeting hopelessness appears crucial for suicide prevention in this population.
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Levi-Belz Y, Rotem N. The longitudinal contribution of attachment models and interpersonal factors to posttraumatic growth among suicide-loss survivors. J Clin Psychol 2021; 78:184-200. [PMID: 34191278 DOI: 10.1002/jclp.23204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/13/2021] [Accepted: 06/04/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study aimed to deepen our understanding of the interpersonal facilitators of posttraumatic growth (PTG) among suicide-loss survivors (SLSs) by focusing on the effects of attachment models on PTG in a 4-year longitudinal design. METHOD One-hundred and fity-two SLSs completed a series of questionnaires tapping attachment models, self-disclosure, social support and PTG in a three-wave study design. RESULTS Attachment models, self-disclosure, and perceived social support at T1 were found to predict PTG levels at T2. Self-disclosure alone predicted PTG at T3. Structural equation modeling analysis revealed that interpersonal factors served as mediators of the relationship between attachment models and PTG beyond the PTG trajectory. CONCLUSIONS Attachment models play an important role in facilitating PTG among SLSs. Thus, therapeutic interventions based on attachment models of self and other specifically designed to promote a sense of self-worth and confidence in others may be valuable in facilitating growth among SLSs.
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Affiliation(s)
- Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel.,Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | - Noa Rotem
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
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10
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Levi-Belz Y, Feigelman W. Pulling Together - The Protective Role of Belongingness for Depression, Suicidal Ideation and Behavior Among Suicide-Bereaved Individuals. CRISIS 2021; 43:278-288. [PMID: 34130482 DOI: 10.1027/0227-5910/a000784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: While belongingness has frequently been investigated in the general population as an antidote to experiencing depression, suicidal thoughts, and suicidal behavior, it has rarely been evaluated as a protective factor among individuals bereaved by suicide. Aims: We examined whether perceived belongingness could moderate the differences between suicide-bereaved, suicide-exposed, and nonexposed respondents regarding depression, suicide ideation, and suicide attempts. Method: We conducted an online survey of the adult Israeli population (N = 806), with 203 suicide-bereaved, 266 suicide-exposed, and 377 nonexposed respondents. Participants completed several questionnaires tapping depression and suicidality as well as perceived belongingness levels. Results: Individuals bereaved by suicide reported the highest levels of depression, suicide ideation, and suicide attempts in comparison with suicide-exposed and nonexposed individuals. However, belongingness was found to moderate these distinctions concerning suicide ideation and suicide attempts. Limitations: Belongingness was assessed by only a single question, and the online survey suffered from a relatively high nonresponse rate. Conclusion: Our results suggest that belongingness may act as a potent antidote to the adverse mental health consequences among individuals bereaved by suicide. Clinicians should accord adequate attention to fostering social connectedness among their clients bereaved by suicide.
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Affiliation(s)
- Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel.,Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | - William Feigelman
- Sociology Department, Nassau Community College, Garden City, NY, USA
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11
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Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev 2021; 4:CD013668. [PMID: 33884617 PMCID: PMC8094743 DOI: 10.1002/14651858.cd013668.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most counties, often repeated, and associated with suicide. There has been a substantial increase in both the number of trials and therapeutic approaches of psychosocial interventions for SH in adults. This review therefore updates a previous Cochrane Review (last published in 2016) on the role of psychosocial interventions in the treatment of SH in adults. OBJECTIVES To assess the effects of psychosocial interventions for self-harm (SH) compared to comparison types of care (e.g. treatment-as-usual, routine psychiatric care, enhanced usual care, active comparator) for adults (aged 18 years or older) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic reviews [CDSR]), together with MEDLINE, Ovid Embase, and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing interventions of specific psychosocial treatments versus treatment-as-usual (TAU), routine psychiatric care, enhanced usual care (EUC), active comparator, or a combination of these, in the treatment of adults with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratio (ORs) and their 95% confidence intervals (CIs). For continuous outcomes, we calculated mean differences (MDs) or standardised mean differences (SMDs) and 95% CIs. The overall quality of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from 76 trials with a total of 21,414 participants. Participants in these trials were predominately female (61.9%) with a mean age of 31.8 years (standard deviation [SD] 11.7 years). On the basis of data from four trials, individual cognitive behavioural therapy (CBT)-based psychotherapy may reduce repetition of SH as compared to TAU or another comparator by the end of the intervention (OR 0.35, 95% CI 0.12 to 1.02; N = 238; k = 4; GRADE: low certainty evidence), although there was imprecision in the effect estimate. At longer follow-up time points (e.g., 6- and 12-months) there was some evidence that individual CBT-based psychotherapy may reduce SH repetition. Whilst there may be a slightly lower rate of SH repetition for dialectical behaviour therapy (DBT) (66.0%) as compared to TAU or alternative psychotherapy (68.2%), the evidence remains uncertain as to whether DBT reduces absolute repetition of SH by the post-intervention assessment. On the basis of data from a single trial, mentalisation-based therapy (MBT) reduces repetition of SH and frequency of SH by the post-intervention assessment (OR 0.35, 95% CI 0.17 to 0.73; N = 134; k = 1; GRADE: high-certainty evidence). A group-based emotion-regulation psychotherapy may also reduce repetition of SH by the post-intervention assessment based on evidence from two trials by the same author group (OR 0.34, 95% CI 0.13 to 0.88; N = 83; k = 2; moderate-certainty evidence). There is probably little to no effect for different variants of DBT on absolute repetition of SH, including DBT group-based skills training, DBT individual skills training, or an experimental form of DBT in which participants were given significantly longer cognitive exposure to stressful events. The evidence remains uncertain as to whether provision of information and support, based on the Suicide Trends in At-Risk Territories (START) and the SUicide-PREvention Multisite Intervention Study on Suicidal behaviors (SUPRE-MISS) models, have any effect on repetition of SH by the post-intervention assessment. There was no evidence of a difference for psychodynamic psychotherapy, case management, general practitioner (GP) management, remote contact interventions, and other multimodal interventions, or a variety of brief emergency department-based interventions. AUTHORS' CONCLUSIONS Overall, there were significant methodological limitations across the trials included in this review. Given the moderate or very low quality of the available evidence, there is only uncertain evidence regarding a number of psychosocial interventions for adults who engage in SH. Psychosocial therapy based on CBT approaches may result in fewer individuals repeating SH at longer follow-up time points, although no such effect was found at the post-intervention assessment and the quality of evidence, according to the GRADE criteria, was low. Given findings in single trials, or trials by the same author group, both MBT and group-based emotion regulation therapy should be further developed and evaluated in adults. DBT may also lead to a reduction in frequency of SH. Other interventions were mostly evaluated in single trials of moderate to very low quality such that the evidence relating to the use of these interventions is inconclusive at present.
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Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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Levi-Belz Y, Aisenberg D. Interpersonal predictors of suicide ideation and complicated-grief trajectories among suicide bereaved individuals: A four-year longitudinal study. J Affect Disord 2021; 282:1030-1035. [PMID: 33601675 DOI: 10.1016/j.jad.2021.01.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/03/2020] [Accepted: 01/01/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Survivors of suicide loss (suicide survivors) are recognized as an at-risk population for several psychiatric complications, including complicated grief (CG) and suicide ideation (SI). Recent studies have emphasized the contribution of interpersonal factors, such as thwarted belongingness and perceived burdensomeness, on distress and suicidality. However, no longitudinal study has examined the predictive values of these interpersonal factors on CG and SI trajectories among suicide survivors to date. In this 42-month prospective design study, we examined interpersonal variables as predictors of CG and SI over time. METHOD Participants were 152 suicide survivors, aged 18-70, who completed questionnaires tapping thwarted belongingness, perceived burdensomeness, CG, and SI at index measurement (T1) and again after 18 months (T2) and 40 months (T3). RESULTS The integrated model showed that thwarted belongingness and perceived burdensomeness predicted SI and CG levels over time, both directly and indirectly. Thwarted belongingness was found to have a high predictive value on SI levels, whereas perceived burdensomeness was predictive of CG levels. LIMITATIONS The voluntary nature of the participants; self-report measures; lack of pre-suicide-loss assessment. CONCLUSION The study's findings highlight the critical role of interpersonal factors in facilitating CG and SI among suicide survivors. Those with higher levels of thwarted belongingness and perceived burdensomeness presented increased prospects of both SI and CG. Theoretical implications relating to healing processes are discussed, as well as focused clinical recommendations, including psychoeducational interventions for addressing PB and TB among suicide survivors.
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Affiliation(s)
- Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel.
| | - Daniela Aisenberg
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
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13
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Wagner B, Hofmann L, Grafiadeli R. [Psychological Interventions for People Bereaved by Suicide: A Systematic Review]. PSYCHIATRISCHE PRAXIS 2020; 48:9-18. [PMID: 32688428 DOI: 10.1055/a-1182-2821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Suicide bereavement is a significant risk factor for psychological and somatic disorders. However, to date there exists only a limited number of suicide bereavement interventions, and little is known about their efficacy. METHODS A computerized search in databases such as PsychINFO, PubMed, Medline was conducted. Randomized controlled trials (RCTs) that compared an intervention for suicide bereaved to a control condition were included after a quality assessment of two independent researchers. In total, six studies with N = 473 participants were included. Cohen's d was used to calculate the effect sizes. RESULTS The results indicated small to medium effect sizes for within-group differences for the main outcomes in the intervention condition, while no significant between-group differences were revealed. CONCLUSIONS Interventions for suicide bereavement can reduce mental health symptoms, however the results do not appear robust between group comparisons. Thus, it could not be demonstrated that an intervention following the suicide of a close relative is more effective than no intervention or an unspecific intervention. Future research should focus on high-quality intervention studies.
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Hill NTM, Robinson J, Pirkis J, Andriessen K, Krysinska K, Payne A, Boland A, Clarke A, Milner A, Witt K, Krohn S, Lampit A. Association of suicidal behavior with exposure to suicide and suicide attempt: A systematic review and multilevel meta-analysis. PLoS Med 2020; 17:e1003074. [PMID: 32231381 PMCID: PMC7108695 DOI: 10.1371/journal.pmed.1003074] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/21/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Exposure to suicidal behavior may be associated with increased risk of suicide, suicide attempt, and suicidal ideation and is a significant public health problem. However, evidence to date has not reliably distinguished between exposure to suicide versus suicide attempt, nor whether the risk differs across suicide-related outcomes, which have markedly different public health implications. Our aim therefore was to quantitatively assess the independent risk associated with exposure to suicide and suicide attempt on suicide, suicide attempt, and suicidal ideation outcomes and to identify moderators of this risk using multilevel meta-analysis. METHODS AND FINDINGS We systematically searched MEDLINE, Embase, PsycINFO, CINAHL, ASSIA, Sociological Abstracts, IBSS, and Social Services Abstracts from inception to 19 November 2019. Eligible studies included comparative data on prior exposure to suicide, suicide attempt, or suicidal behavior (composite measure-suicide or suicide attempt) and the outcomes of suicide, suicide attempt, and suicidal ideation in relatives, friends, and acquaintances. Dichotomous events or odds ratios (ORs) of suicide, suicide attempt, and suicidal ideation were analyzed using multilevel meta-analyses to accommodate the non-independence of effect sizes. We assessed study quality using the National Heart, Lung, and Blood Institute quality assessment tool for observational studies. Thirty-four independent studies that presented 71 effect sizes (exposure to suicide: k = 42, from 22 independent studies; exposure to suicide attempt: k = 19, from 13 independent studies; exposure to suicidal behavior (composite): k = 10, from 5 independent studies) encompassing 13,923,029 individuals were eligible. Exposure to suicide was associated with increased odds of suicide (11 studies, N = 13,464,582; OR = 3.23, 95% CI = 2.32 to 4.51, P < 0.001) and suicide attempt (10 studies, N = 121,836; OR = 2.91, 95% CI = 2.01 to 4.23, P < 0.001). However, no evidence of an association was observed for suicidal ideation outcomes (2 studies, N = 43,354; OR = 1.85, 95% CI = 0.97 to 3.51, P = 0.06). Exposure to suicide attempt was associated with increased odds of suicide attempt (10 studies, N = 341,793; OR = 3.53, 95% CI = 2.63 to 4.73, P < 0.001), but not suicide death (3 studies, N = 723; OR = 1.64, 95% CI = 0.90 to 2.98, P = 0.11). By contrast, exposure to suicidal behavior (composite) was associated with increased odds of suicide (4 studies, N = 1,479; OR = 3.83, 95% CI = 2.38 to 6.17, P < 0.001) but not suicide attempt (1 study, N = 666; OR = 1.10, 95% CI = 0.69 to 1.76, P = 0.90), a finding that was inconsistent with the separate analyses of exposure to suicide and suicide attempt. Key limitations of this study include fair study quality and the possibility of unmeasured confounders influencing the findings. The review has been prospectively registered with PROSPERO (CRD42018104629). CONCLUSIONS The findings of this systematic review and meta-analysis indicate that prior exposure to suicide and prior exposure to suicide attempt in the general population are associated with increased odds of subsequent suicidal behavior, but these exposures do not incur uniform risk across the full range of suicide-related outcomes. Therefore, future studies should refrain from combining these exposures into single composite measures of exposure to suicidal behavior. Finally, future studies should consider designing interventions that target suicide-related outcomes in those exposed to suicide and that include efforts to mitigate the adverse effects of exposure to suicide attempt on subsequent suicide attempt outcomes.
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Affiliation(s)
- Nicole T. M. Hill
- Orygen, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Jo Robinson
- Orygen, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Karolina Krysinska
- Orygen, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Amber Payne
- Orygen, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Northeastern University, Boston, Massachusetts, United States of America
| | - Alexandra Boland
- Orygen, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Alison Clarke
- Orygen, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Allison Milner
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Katrina Witt
- Orygen, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Stephan Krohn
- Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Amit Lampit
- Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
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Andriessen K, Krysinska K, Kõlves K, Reavley N. Suicide Postvention Service Models and Guidelines 2014-2019: A Systematic Review. Front Psychol 2019; 10:2677. [PMID: 31849779 PMCID: PMC6896901 DOI: 10.3389/fpsyg.2019.02677] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/13/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Suicide bereavement can have a lasting and devastating psychosocial impact on the bereaved individuals and communities. Many countries, such as Australia, have included postvention, i.e., concerted suicide bereavement support, in their suicide prevention policies. While little is known of the effectiveness of postvention, this review aimed to investigate what is known of the effects of postvention service delivery models and the components that may contribute to the effectiveness. Method: Systematic review and quality assessment of peer reviewed literature (Medline, PsycINFO, Embase, EBM Reviews) and gray literature and guidelines published since 2014. Results: Eight studies and 12 guidelines were included, with little evidence of effectiveness. Still, providing support according to the level of grief, involvement of trained volunteers/peers, and focusing the interventions on the grief, seem promising components of effective postvention. Conclusions: Adopting a public health approach to postvention can allow to tailor the service delivery to needs of the bereaved individuals and to align postvention with suicide prevention programs.
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Affiliation(s)
- Karl Andriessen
- Centre for Mental Health, School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Karolina Krysinska
- Centre for Mental Health, School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Kairi Kõlves
- WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, QLD, Australia
| | - Nicola Reavley
- Centre for Mental Health, School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
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Johannsen M, Damholdt MF, Zachariae R, Lundorff M, Farver-Vestergaard I, O'Connor M. Psychological interventions for grief in adults: A systematic review and meta-analysis of randomized controlled trials. J Affect Disord 2019; 253:69-86. [PMID: 31029856 DOI: 10.1016/j.jad.2019.04.065] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/30/2019] [Accepted: 04/08/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The present meta-analysis evaluates the efficacy of psychological interventions for grief in bereaved adults and explores the possible moderating influence of various study characteristics. METHODS A systematic literature search was conducted by two reviewers who independently searched electronic databases, reviewed and selected eligible studies, and evaluated their methodological quality. RESULTS A total of 31 randomized controlled trials (RCTs) were included in the meta-analysis. Statistically significant pooled effects of psychological intervention on grief symptoms were found for both post-intervention (Hedges's g = 0.41, p > .001, K = 31) and follow-up (g = 0.45, p > .001, K = 18). While generally robust, the effect was smaller at post-intervention when adjusting for possible publication bias (g = 0.31). Compared with the remaining studies, larger post-intervention effect sizes were found for studies with (1) individually delivered interventions (Beta = 0.49, p < .001), (2) the ICG-(R)/PG-13 questionnaire as the grief instrument (Beta = 0.46, p < .001), (3) participants who were ≥6 months post-loss (Beta = 0.58, p < .001), (4) participants included based on high baseline symptom levels (Beta = 0.40, p = .002) and (5) higher study quality (Beta = 0.06, p = .013). LIMITATIONS The included studies were methodologically heterogeneous and their methodological quality varied considerably. Moreover, there were some indications of publication bias. CONCLUSIONS Given the recent introduction of Prolonged Grief Disorder in the ICD-11, the results of the present meta-analysis are timely and of clinical relevance. Based on our results, psychological intervention appears efficacious for alleviating grief symptoms in bereaved adults, with several study characteristics as possible moderators of the effect. The interpretability of the results, however, is challenged by some limitations of the available research, including possible publication bias.
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Affiliation(s)
- M Johannsen
- Unit for Bereavement Research, Aarhus University, Denmark; Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark.
| | - M F Damholdt
- Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - R Zachariae
- Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark
| | - M Lundorff
- Unit for Bereavement Research, Aarhus University, Denmark; Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark
| | - I Farver-Vestergaard
- Unit for Bereavement Research, Aarhus University, Denmark; Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark
| | - M O'Connor
- Unit for Bereavement Research, Aarhus University, Denmark; Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark
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Andriessen K, Krysinska K, Hill NTM, Reifels L, Robinson J, Reavley N, Pirkis J. Effectiveness of interventions for people bereaved through suicide: a systematic review of controlled studies of grief, psychosocial and suicide-related outcomes. BMC Psychiatry 2019; 19:49. [PMID: 30700267 PMCID: PMC6354344 DOI: 10.1186/s12888-019-2020-z] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/09/2019] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Suicide bereavement is a risk factor for adverse outcomes related to grief, social functioning, mental health and suicidal behaviour. Consequently, suicide bereavement support (i.e., postvention) has been identified as an important suicide prevention strategy. However, little is known about its effectiveness. To redress this gap, this review aimed to assess the evidence of effectiveness of interventions for people bereaved by suicide, and appraise the quality of the research in this field. METHODS We conducted a systematic review according to PRISMA guidelines. Searches of peer-reviewed literature in Medline, PsycINFO, Embase and EBM Reviews identified 12 papers reporting on 11 relevant studies conducted between 1984 and 2018. RESULTS Across studies, there was a wide variety of intervention modalities, study populations, control groups, and grief, psychosocial and suicide-related outcome measures. Overall, the quality of studies was weak. While there was some evidence of the effectiveness of interventions for uncomplicated grief, evidence of the effectiveness of complicated grief interventions was lacking. Based on this scant evidence, interventions which seem to show promise include supportive, therapeutic and educational approaches, involve the social environment of the bereaved, and comprise a series of sessions led by trained facilitators. CONCLUSIONS There is a clear need for additional methodologically sound studies in this area. Specifically, selection procedures, sample sizes, randomization, and the use of appropriate measures are crucial. As people bereaved by suicide are at-risk of adverse grief, mental ill-health and suicidal behaviour, further research across the life-span is essential to prevent grief and mental health ramifications.
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Affiliation(s)
- Karl Andriessen
- 0000 0001 2179 088Xgrid.1008.9Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Melbourne, VIC 3010 Australia ,0000 0004 4902 0432grid.1005.4School of Psychiatry, University of New South Wales, Hospital Rd, Randwick, NSW 2031 Australia
| | - Karolina Krysinska
- 0000 0001 2179 088Xgrid.1008.9Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Melbourne, VIC 3010 Australia ,0000 0004 4902 0432grid.1005.4Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052 Australia
| | - Nicole T. M. Hill
- 0000 0001 2179 088Xgrid.1008.9Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052 Australia
| | - Lennart Reifels
- 0000 0001 2179 088Xgrid.1008.9Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Melbourne, VIC 3010 Australia
| | - Jo Robinson
- 0000 0001 2179 088Xgrid.1008.9Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052 Australia
| | - Nicola Reavley
- 0000 0001 2179 088Xgrid.1008.9Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Melbourne, VIC 3010 Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Melbourne, VIC, 3010, Australia.
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Lev-Ari L, Levi-Belz Y. Interpersonal theory dimensions facilitate posttraumatic growth among suicide-loss survivors: An attachment perspective. DEATH STUDIES 2018; 43:582-590. [PMID: 30285584 DOI: 10.1080/07481187.2018.1504351] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 05/09/2018] [Accepted: 06/04/2018] [Indexed: 06/08/2023]
Abstract
Many studies have highlighted the deleterious psychological impact of suicide on bereaved individuals. We examined the psychological processes facilitating posttraumatic growth (PTG) among 124 suicide-loss survivors, focusing on attachment styles, perceived burdensomeness, and thwarted belongingness. Securely attached individuals achieved higher PTG than insecurely attached individuals. Perceived burdensomeness and thwarted belongingness both mediated and moderated the associations between attachment and PTG. Anxiously or avoidantly attached individuals who also had a high level of perceived burdensomeness were the least likely to achieve PTG. Thus, these individuals may derive particular benefit from attachment-based therapeutic interventions focusing on interpersonal relationships.
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Affiliation(s)
- Lilac Lev-Ari
- Behavioral Sciences Department, Ruppin Academic Center , Emek Hefer , Israel
| | - Yossi Levi-Belz
- Behavioral Sciences Department, Ruppin Academic Center , Emek Hefer , Israel
- The Suicide and Mental Pain Study Center, Ruppin Academic Center , Emek Hefer , Israel
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Gøtzsche PC, Gøtzsche PK. Cognitive behavioural therapy halves the risk of repeated suicide attempts: systematic review. J R Soc Med 2017; 110:404-410. [PMID: 29043894 DOI: 10.1177/0141076817731904] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective To study whether cognitive behavioural therapy decreases suicide attempts in people with previous suicide attempts. Design Systematic review and meta-analysis. Setting Randomised trials that compare cognitive behavioural therapy with treatment as usual. Participants Patients who had engaged in any type of suicide attempt in the six months prior to trial entry resulting in presentation to clinical services. Main outcome measure Suicide attempt. Results We included ten trials, eight from Cochrane reviews and two from our updated searches (1241 patients, 219 of whom had at least one new suicide attempt). Cognitive behavioural therapy compared to treatment as usual reduced the risk of a new suicide attempt; risk ratio 0.47; 95% confidence interval 0.30-0.73; p = 0.0009; I2 = 57%. Only seven suicides were reported (3 versus 4). One trial had an unusually large effect; if this trial is excluded, the risk ratio becomes 0.61 (0.46-0.80) and the heterogeneity in the results disappears (I2 = 0%). Conclusions Cognitive behavioural therapy reduces not only repeated self-harm but also repeated suicide attempts. It should be the preferred treatment for all patients with depression.
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Affiliation(s)
- Peter C Gøtzsche
- Nordic Cochrane Centre, Rigshospitalet, 7811, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Pernille K Gøtzsche
- Nordic Cochrane Centre, Rigshospitalet, 7811, Blegdamsvej 9, 2100 København Ø, Denmark
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20
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Linde K, Treml J, Steinig J, Nagl M, Kersting A. Grief interventions for people bereaved by suicide: A systematic review. PLoS One 2017; 12:e0179496. [PMID: 28644859 PMCID: PMC5482439 DOI: 10.1371/journal.pone.0179496] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/31/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Adaption to the loss of a loved one due to suicide can be complicated by feelings of guilt, shame, responsibility, rejection, and stigmatization. Therefore people bereaved by suicide have an increased risk for developing complicated grief which is related to negative physical and mental disorders and an increased risk for suicidal behavior. Grief interventions are needed for this vulnerable population. The aim of this systematic review was to provide an overview of the current state of evidence concerning the effectiveness of interventions that focus on grief for people bereaved by suicide. METHODS We conducted a systematic literature search using PubMed, Web of Science, and PsycINFO for articles published up until November 2016. Relevant papers were identified and methodological quality was assessed by independent raters. A narrative synthesis was conducted. RESULTS Seven intervention studies met the inclusion criteria. Two interventions were based on cognitive-behavioral approaches, four consisted of bereavement groups, and one utilized writing therapy. As five of the seven interventions were effective in reducing grief intensity on at least one outcome measure, there is some evidence that they are beneficial. Bereavement groups tend to be effective in lowering the intensity of uncomplicated grief, as are writing interventions in lowering suicide-specific aspects of grief. Cognitive-behavioral programs were helpful for a subpopulation of people who had high levels of suicidal ideation. LIMITATION On average, methodological quality was low so the evidence for benefits is not robust. The stability of treatment effects could not be determined as follow-up assessments are rare. Generalizability is limited due to homogeneous enrollments of mainly female, white, middle-aged individuals. CONCLUSIONS People bereaved by suicide are especially vulnerable to developing complicated grief. Therefore, grief therapies should be adapted to and evaluated in this population. Prevention of complicated grief may be successful in populations of high risk individuals.
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Affiliation(s)
- Katja Linde
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Jana Steinig
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Michaela Nagl
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
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Leavey K, Hawkins R. Is cognitive behavioural therapy effective in reducing suicidal ideation and behaviour when delivered face-to-face or via e-health? A systematic review and meta-analysis. Cogn Behav Ther 2017. [DOI: 10.1080/16506073.2017.1332095] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Katie Leavey
- Department of Psychology, James Cook University, McGregor Road, Cairns 4870, Australia
| | - Russell Hawkins
- Department of Psychology, James Cook University, McGregor Road, Cairns 4870, Australia
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Abstract
PURPOSE OF REVIEW There is increasing recognition that a minority of bereaved persons experiences persistent and disabling grief symptoms, also termed complicated grief. We review currently proposed criteria for complicated grief in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) and the International Statistical Classification of Diseases and Related Health Problems (ICD-11), highlight controversies with regard to establishing complicated grief as a psychiatric disorder, summarize recent complicated grief treatment research within a cognitive behavioral treatment framework, and establish a novel and systematic research agenda for complicated grief treatment. RECENT FINDINGS Clinicians should be wary of overdiagnosis and misdiagnosis of complicated grief. Recent changes to definitions of complicated grief may threaten generalizability and clinical application of research findings. Universal treatment, treatment for at-risk groups and preventive complicated grief treatment appear ineffective. Although medication is often prescribed to bereaved persons, evidence for its effectiveness is equivocal. Face-to-face and internet-based cognitive behavioral therapy techniques appear most effective in targeting complicated grief. However, little is known about what, how, and for whom treatment works best. SUMMARY In light of these findings, we recommend systematic investigation of: what works best in complicated grief treatment, by conducting well designed, stepped effectiveness trials and treatment component dismantling studies; how it works, by conducting investigations on therapeutic theories and examining mediators of therapeutic change; and for whom it works, by examining potential moderators of treatment effects.
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Farré A, Portella MJ, De Angel L, Díaz A, de Diego-Adeliño J, Vegué J, Duran-Sindreu S, Faus G, Tejedor C, Álvarez E, Pérez V. Benefits of a Secondary Prevention Program in Suicide. CRISIS 2016; 37:281-289. [DOI: 10.1027/0227-5910/a000388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: The effectiveness of suicide intervention programs has not been assessed with experimental designs. Aim: To determine the risk of suicide reattempts in patients engaged in a secondary prevention program. Method: We included 154 patients with suicidal behavior in a quasi-experimental study with a nontreatment concurrent control group. In all, 77 patients with suicidal behavior underwent the Suicide Behavior Prevention Program (SBPP), which includes specialized early assistance during a period of 3–6 months. A matched sample of patients with suicidal behavior (n = 77) was selected without undergoing any specific suicide prevention program. Data on sociodemographics, clinical characteristics, and suicidal behavior were collected at baseline (before SBPP) and at 12 months. Results: After 12 months, SBPP patients showed a 67% lower relative risk of reattempt (χ2 = 11.75, p = .001, RR = 0.33 95% CI = 0.17–0.66). Cox proportional hazards models revealed that patients under SBPP made a new suicidal attempt significantly much later than control patients did (Cox regression = 0.293, 95% CI = 0.138–0.624, p = .001). The effect was even stronger among first attempters. Limitations: Sampling was naturalistic and patients were not randomized. Conclusion: The SBPP was effective in delaying and preventing suicide reattempts at least within the first year after the suicide behavior. In light of our results, implementation of suicide prevention programs is strongly advisable.
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Affiliation(s)
- Adriana Farré
- Department of Psychiatry – Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
- Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Universitat Autònoma de Barcelona (UAB), CIBERSAM, Barcelona, Spain
| | - Maria J. Portella
- Department of Psychiatry – Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | | | - Ana Díaz
- Department of Psychiatry – Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Javier de Diego-Adeliño
- Department of Psychiatry – Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Joan Vegué
- CPB Centres Salut Mental, Barcelona, Spain
| | - Santiago Duran-Sindreu
- Department of Psychiatry – Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | | | - Carmen Tejedor
- Department of Psychiatry – Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Enric Álvarez
- Department of Psychiatry – Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Víctor Pérez
- Department of Psychiatry – Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
- Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Universitat Autònoma de Barcelona (UAB), CIBERSAM, Barcelona, Spain
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Rosner R. Prolonged grief: setting the research agenda. Eur J Psychotraumatol 2015; 6:27303. [PMID: 25994020 PMCID: PMC4439410 DOI: 10.3402/ejpt.v6.27303] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 02/02/2015] [Accepted: 02/26/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Prolonged grief disorder is proposed for the International Classification of Diseases (ICD-11), though it was rejected as a diagnosis for DSM-5. OBJECTIVE This review outlines findings and defines important areas for future research viewed from a lifespan perspective. RESULTS The development and psychometric evaluation of measures for the new diagnosis is paramount, specifically for children and adolescents. Treatments need to be adapted for specific subgroups and research findings have to be disseminated into various professional settings.
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Affiliation(s)
- Rita Rosner
- Department of Clinical and Biological Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany;
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