The Stigma of Suicide Survivorship and Related Consequences-A Systematic Review

Communication on familial suicide: development of the Family Communication on Suicide Questionnaire

Introduction: Each suicide affects about five close family members, potentially heightening risk for psychopathology and suicide. Communication style is a key factor in mental health and psychosocial wellbeing of families. Family communication after suicide, however, is insufficiently conceptualised and studied. This study aimed to identify different factors of familial communication after suicide of a relative and to develop a questionnaire assessing the functionality of familial communications following the suicide of a family member.Method: Through literature review, categories for the functionality of family communication after a familial suicide were developed. Items assessing family communication strategies were formulated and reviewed for comprehensibility and classification. Based on this review, the FCSQ (Family Communication on Suicide Questionnaire) was then tested in a multistep exploratory factor analysis on a cohort of suicide-bereaved relatives, utilising principal axis factor extraction. Construct validity of the FCSQ was assessed through correlation analysis and internal consistency via coefficient alpha.Results: Fifty-nine participants were enrolled in the study. Psychometric analyses indicated that family communication after a suicide can be divided into three factors, Honest and Emotional, Derogatory, and Stigmatising. Honest and Emotional formed functional communications, while Derogatory and Stigmatising communications formed two dysfunctional dimensions.Conclusions: The FCSQ is a first-of-a-kind questionnaire to assess functionality of family communications after suicide. Factor analysis indicated good factor structure and internal consistency, especially regarding functional communication patterns, while the Derogatory factor requires further analysis. This questionnaire has the potential to fill a crucial gap in clinical and research practice and can help to identify families and family members at risk after the experience of a family suicide.

The Reciprocal Relationship Between Social Support in Bereavement and Posttraumatic Growth-A Random Intercept Cross-Lagged Analysis

Social support can promote posttraumatic growth (PTG) in the general trauma population. However, evidence on the reciprocal predictive relationship between social support and PTG is lacking, particularly among the bereaved. In this longitudinal study, we surveyed 181 adults who had lost first-degree relatives within 1 year at three intervals, each 6 months apart. The study utilized The Scale of Social Support in Bereavement (SSB), which distinguishes four domains of social support for the bereaved: living support, economic support, grief processing and emotion restoration. Additionally, The Posttraumatic Growth Inventory (PTGI) was used to measure PTG. Random intercepts cross-lagged panel model analyses revealed that social support and PTG were positively correlated at each time point at the within-person level. Moreover, at the within-person level, the total social support, as well as social support in the restoration-oriented domains at Time 2, positively predicted PTG at Time 3, but this relationship was not observed for grief processing support. Additionally, PTG at Time 1 positively predicted the receipt of emotion restoration support at Time 2 at the within-person level. The mutual influence between PTG and social support, as well as the differential relationship between types of support and PTG, enriches our understanding of ways to promote positive changes among the bereaved. The findings underscore the importance of restoration-oriented social support for bereaved individuals in facilitating PTG.

Improving responsible Media Reporting on Student Suicide to Reduce Negative Public Opinion: Text Mining Based on Sina Weibo in China

The aims of this study were to explore whether student suicide reporting is consistent with media recommendations for suicide reporting; analyze public opinion and sentiments toward student suicide reports. A keyword search was performed on the WeiboReach platform. This study included 113 student suicide report posts and 176,262 readers' comments on suicide news reports. Hierarchical generalized linear modeling was used to analyze the relationships between adherence to reporting recommendations and negative emotions in readers' comments. None of the media reporting of student suicide was consistent with all of the media recommendations for suicide reporting. Netizens were less likely to post negative comments when the reports describe the suicide method used (OR 1.169, 95% CI 1.022∼1.337), and not specifying the cause of suicide was a protective factor for public negative emotion (OR 0.799, 95% CI 0.707, 0.905). The findings suggest improving responsible media reporting on student suicide to reduce negative public emotion.

Understanding Internalized Stigma's Role in Sex-Specific Suicidal Ideation among Individuals with Bipolar Disorder

Background: The experience of stigma can exert a profound impact on the mental health and well-being of individuals with bipolar disorder (BD). Our study explores which factors of internalized stigma are associated with suicidal ideation and how they differ between the two sexes in a clinical sample of BD patients. Methods: The study follows a cross-sectional study design, employing the Clinical Global Impression for Bipolar Patients (CGI-BP) to evaluate the overall severity of illness and the alteration in patients affected by bipolar disorder, the Internalized Stigma of Mental Illness (ISMI) assessing self-stigma among individuals experiencing mental disorders, and the Columbia Suicide Severity Rating Scale (C-SSRS) identifying and assessing individuals vulnerable to suicide. Descriptive analyses, analysis of variance (ANOVA), and logistic regression analysis were conducted, and 344 BD subjects were recruited. Results: Our ANOVA results revealed a significant association between sex and suicide across ISMI sub-items (p = 0.000). Logistic regression analysis comprised three phases: Discrimination was consistently significant across all phases (p < 0.001), while Alienation and Stereotype emerged as additional predictors of suicide in later phases of the analysis (p < 0.001). Conclusions: Our study contributes to the growing body of literature on internalized stigma, sex, and suicidality among individuals with bipolar disorder. Early intervention programs and prevention strategies are needed.

The Willingness to Intervene Against Suicide Enhanced Questionnaire

The purpose of this study was to test the reliability and validity of the Willingness to Intervene against Suicide Enhanced (WISE) questionnaire. The WISE is a revised version of the Willingness to Intervene against Suicide (WIS) questionnaire, which was based on the theory of planned behavior, and it has consistently predicted the intention to intervene with a suicidal individual. Evaluation of the WIS showed that it was internally consistent with adequate goodness-of-fit indices for three of the four scales. The subjective norms scale did not meet the goodness-of-fit indices standard cutoff criteria. Due to this, the WIS questionnaire has been revised into the WISE. However, the dimensionality of these factors needed to be tested. College students (n = 824) completed an online survey to test the WISE. The data were analyzed using confirmatory factor analysis, reliability analysis, and multiple regression. The WISE was internally consistent, and the scales met acceptable criteria for goodness-of-fit indices. The WISE explained a range of variance in participants' intention to intervene from 12 to 40%.

Stop being a wuss: People's perceptions of men experiencing grief in Australia

ISSUE ADDRESSED

Three years have passed since the Australian Government's Department of Health released its National Men's Health Strategy 2020-2030. Presently, little evidence is available to show whether the strategy has achieved success in rectifying men's mental-ill health, particularly the experience of stigma when expressing vulnerable emotions such as grief. Concurrently, research within the field of psychology continues to show that men experience significant pressure to conform faithfully to their socialised gender role. Given the focus to better men's mental health in Australia, this study ascertained people's perceptions of men experiencing grief.

METHODS

The study adopted social constructionism to explore how participants perceived a fictious character living with grief using a hypothetical vignette by way of convenience sampling. Nine males and seven females who resided in Australia participated in answering seven questions concerning the character's experience of grief.

RESULTS

Inductive thematic analysis yielded three themes which collectively represented perceptions of masculinised grief. Notably, avoid stigma by fixing grief, avoid stigma by quickly getting over grief, and avoid stigma by suppressing the expression of grief. SO WHAT?: The study suggests that a stronger research focus should be targeted towards rectifying stigma resulting from men's expression of vulnerable emotions by incorporating in depth interviews in order to create worthwhile public awareness initiatives. Such initiatives should seek to minimise societal pressures that are placed upon men to ensure conformity to dominant masculine ideologies and their socialised gendered role when experiencing and expressing vulnerable emotions such as grief.

The role of depression and use of alcohol and other drugs after partner suicide in the association between suicide bereavement and suicide: cohort study in the Danish population

BACKGROUND

Although suicide bereavement is associated with suicide and self-harm, evidence regarding mechanisms is lacking. We investigated whether depression and substance use (alcohol and/or other drugs) explain the association between partner suicide bereavement and suicide.

METHODS

Linkage of nationwide, longitudinal data from Denmark for the period 1980-2016 facilitated a comparison of 22 668 individuals exposed to bereavement by a partner's suicide with 913 402 individuals bereaved by a partner's death due to other causes. Using causal mediation models, we estimated the degree to which depression and substance use (considered separately) mediated the association between suicide bereavement and suicide.

RESULTS

Suicide-bereaved partners were found to have a higher risk of suicide (HRadj = 1.59, 95% CI 1.36-1.86) and of depression (ORadj 1.16, 95% CI 1.09-1.25) when compared to other-bereaved partners, but a lower risk of substance use (ORadj 0.83; 95% CI 0.78-0.88). An increased risk of suicide was found among any bereaved individuals with a depression diagnosis recorded post-bereavement (ORadj 3.92, 95% CI 3.55-4.34). Mediation analysis revealed that depression mediated 2% (1.68%; 95% CI 0.23%-3.14%; p = 0.024) of the association between suicide bereavement and suicide in partners when using bereaved controls.

CONCLUSIONS

Depression is a partial mediator of the association between suicide bereavement and suicide. Efforts to prevent and optimize the treatment of depression in suicide-bereaved people could reduce their suicide risk. Our findings might be conservative because we did not include cases of depression diagnosed in primary care. Further work is needed to understand this and other mediators.

Muslim experiences and Islamic perspectives on suicide: a qualitative analysis of fatwa inquiries

Suicide is a rising global public health challenge. Yet, the determinants and magnitude of the problem are understudied in both Muslim-majority countries and Muslim diaspora communities. The overall rarity of suicide events compounded by poor reporting complicates the study of suicide among Muslims. Results across studies are inconsistent and data remains limited due to a myriad of factors. Against this backdrop, this study takes a novel approach to examining the relationship between suicide, Islam, and Muslim cultures through a qualitative analysis of Muslim scholarly responses to suicide-related inquiries (fatwas). The study includes 122 fatwas extracted from Arabic and English fatwa databases based in the Middle East and North America. Through a general inductive approach, both the questions and the answers of each fatwa were analyzed for recurring themes. The analysis yielded four main themes: (1) risk and protective factors; (2) post-suicide matters; (3) prevention; and (4) worldview and conceptualization. The significance and implications of each of these themes are explored in order to advance the understanding of lived experiences, risk factors, and prevention of suicidality in Muslim populations.

Effectiveness and Acceptability of Interventions Offered for Those Bereaved by Parental Loss to Suicide in Childhood: A Mixed Methods Systematic Review

OBJECTIVES

Identify interventions offered for children bereaved by parental suicide, investigate reported effectiveness and explore the acceptability of identified interventions.

METHOD

Six electronic databases were systematically searched for primary studies investigating intervention effectiveness and acceptability, (August 2011 to June 2023). Eligibility required inclusion of participants bereaved by parental suicide during childhood among sample populations. Methodological quality was evaluated applying JBI critical appraisal tools. Narrative synthesis was conducted using parallel-results convergent design.

RESULTS

Of the 22 eligible reports, 19 articles reported on 12 manual-based supports provided during childhood; three papers described users' experiences of various specified intervention types offered following childhood loss. Twenty-one studies reported on interventions offered for heterogeneous participant groups that included children bereaved by parental suicide. Time from loss to intervention generally included both recent (1 < 30mths) and more distant loss, with just one intervention described as solely for recently bereaved children. Eight interventions (n = 12 studies) demonstrated significant positive effects (p < 0.05), for maladaptive grief, mental health, quality of life. Only one study investigated suicide-related outcomes. Qualitative findings (n = 8 studies) facilitated development of four acceptability themes: Perceived utility, Relationships, Components and Delivery.

CONCLUSIONS

Heterogeneity in causes of loss/trauma and relationships with the deceased limit specific conclusions regarding effectiveness/acceptability of reviewed interventions for children bereaved by parental suicide. Few sub-group analyses of effects were reported, and qualitative evidence specifically from children bereaved by parental suicide was limited. Further research is recommended regarding mixed-user interventions, specifically for children bereaved by parental suicide.

Medical Assistance in Dying for Mental Illness as a Sole Underlying Medical Condition and Its Relationship to Suicide: A Qualitative Lived Experience-Engaged Study: Aide Médicale à Mourir Pour Maladie Mentale Comme Seule Condition Médicale Sous-Jacente et Son Lien Avec le Suicide: Une Etude Qualitative Engagée Dans l'Expérience Vécue

OBJECTIVE

This lived experience-engaged study aims to understand patient and family perspectives on the relationship between suicidality and medical assistance in dying when the sole underlying medical condition is mental illness (MAiD MI-SUMC).

METHOD

Thirty individuals with mental illness (age M = 41.8 years, SD = 14.2) and 25 family members (age M = 47.5 years, SD = 16.0) participated in qualitative interviews examining perspectives on MAiD MI-SUMC and its relationship with suicide. Audio recordings were transcribed and analysed using reflexive thematic analysis. People with lived experience were engaged in the research process as team members.

RESULTS

Four main themes were developed, which were consistent across individuals with mental illness and family members: (a) deciding to die is an individual choice to end the ongoing intolerable suffering of people with mental illness; (b) MAiD MI-SUMC is the same as suicide because the end result is death, although suicide can be more impulsive; (c) MAiD MI-SUMC is a humane, dignified, safe, nonstigmatized alternative to suicide; and (4) suicidality should be considered when MAiD MI-SUMC is requested, but suicidality's role is multifaceted given its diverse manifestations.

CONCLUSION

For patient-oriented mental health policy and treatment, it is critical that the voices of people with lived experience be heard on the issue of MAiD MI-SUMC. Given the important intersections between MAiD MI-SUMC and suicidality and the context of suicide prevention, the role that suicidality should play in MAiD MI-SUMC is multifaceted. Future research and policy development are required to ensure that patient and family perspectives guide the development and implementation of MAiD MI-SUMC policy and practice.

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

BACKGROUND

Suicide 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.

METHODS

In 2022, we conducted structured online individual interviews with a diverse sample of 18 SLS in Germany. We analyzed these interviews using qualitative content analysis.

RESULTS

We 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.

CONCLUSIONS

Our 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.

The use of social media after bereavement by suicide: results from a French online survey

BACKGROUND

According to recent research, the Internet and social media are shaping and changing how we die and mourn. However, the use of social media after bereavement by suicide remains poorly understood. Thus, emerging research is needed to better assess the role that social media can play after bereavement by suicide. The objective of our study was to evaluate the use of social media in French people bereaved by suicide and to assess their expectations toward social media.

METHOD

We conducted a national cross-sectional online survey including French people bereaved by suicide assessing their use of social media after the death of their relative. All adults bereaved by suicide were eligible to participate in the study. An online 26-item questionnaire collected sociodemographic and loss-related characteristics and evaluated four dimensions: (1) the use of social media in daily life, (2) the perceived needs regarding suicide bereavement, (3) the use of social media associated with the suicide loss, and (4) the expectations regarding the development of an online resource for people bereaved by suicide and proposals regarding the development of such a resource.

RESULTS

Among 401 participants, 61.6% reported using social media after the death of their relative by suicide, especially those recently bereaved, those receiving counseling and bereaved parents. The participants mainly used social media to reach peers bereaved by suicide and to memorialize, while they expected social media to help them finding information on suicide and accessing bereaved peers. Younger participants were more prone to use social media to memorialize, while bereaved partners and those bereaved by the suicide of a parent were less prone to use them with such aim.

DISCUSSION

A large part of people bereaved by suicide use social media for their grief process, mainly to contact peers bereaved by suicide and to memorialize their loved one. According to or results, social media contributes to contemporary grief processes after suicide bereavement and can be seen as putative means to improve the well-being of people bereaved by suicide.

Breaking the news of the violent death of a close person to children under 18 years of age: A qualitative interview study

Children who lose a close person to suicide or homicide will most likely receive this news from a carer. The caregiver's personal beliefs and approaches to addressing the topic will influence the child. A total of 10 interviews were conducted with carers of children aged 0-17 years, and the data were analyzed using reflexive thematic analysis. Four themes were developed, exploring: (1) how carers attempted to manage the task of delivering the news of death to the child and discussing it using careful wording; (2) how some carers' desire to protect the child from the truth hindered honesty and open conversations; (3) how and why some carers deliberately challenged societal taboos; and (4) how external influences prompted conversations about the topic. The discussion projects potential consequences for the children and their families. It also derives necessary societal changes, support measures, and further research suggestions.

Stereotype-driven emotional responses and their impact on discriminatory intentions towards suicidal individuals

BACKGROUND

This research delves into the role of stereotypes and emotional prejudice in behavioral intentions, particularly towards individuals with suicidal tendencies. The study extends the cognitive-affective-behavioral process model, identifying pathways that negative stereotypes use to impact emotional responses and behavioral intentions.

METHODS

A cross-sectional online survey was conducted in South Korea, utilizing the largest Korean online panel (1,623,938 users) to recruit 552 eligible participants (49.1% male, 50.9% female) aged 20 and above with online access and no history of suicide attempts. The survey assessed negative stereotypes, prejudices, and behavioral intentions related to suicidal thoughts, employing specific measurements.

RESULTS

The findings established the correlation between negative stereotypes and both stigmatized emotional responses and discriminatory intentions. The study uniquely demonstrated that emotional responses act as a bridge between negative stereotypes and behavioral intentions towards suicidal individuals. These findings carry profound implications for health psychology, emphasizing the necessity of modifying attitudes to reduce suicide stigma. It was observed that stereotypical perceptions fuel negative emotions, which in turn provoke various behavioral intentions.

CONCLUSIONS

The study enhances our understanding of the influential role emotional reactions can have in shaping attitudes. It points towards the potential that addressing emotions holds in the stigma process, enabling people to shift their attitudes about stigmatized individuals, thus establishing intervention opportunities for stigma reduction in health psychology.

Suicide Attitudes Among Suicide Loss Survivors and Their Adaptation to Loss: A Cross-Cultural Study in Japan and the United States

Survivors' adaptation to a suicide loss is likely influenced by their attitudes toward suicide and their respective sociocultural contexts. Our study aimed to compare suicide attitudes and their association with depressive symptoms and sense of community safety in Japanese and American suicide loss survivors. A total of 193 Japanese survivors and 232 American survivors completed online surveys. The results show that Japanese survivors tended not to consider suicide as an illness or to recognize that others understood their experience but were more likely than American survivors to consider suicide as justifiable. Regression analyses indicated that taking suicide as a right was associated with depressive symptoms. Further, their sense of being understood by others was positively correlated with perceived community safety in both samples, but justifying suicide and considering it to be an illness was positively related to perceived community safety only among Japanese survivors.

"No miracle cure" interface evaluation of a UK suicide prevention app in a Norwegian context

BACKGROUND

600 Norwegians die by suicide annually. Self-help apps may potentially reach and support suicidal individuals, next of kin, bereaved and professionals with educational information, access to suicide emergency help, hotlines, and coping tools. Knowledge regarding feasible app interface for suicide prevention self-help apps in a Norwegian context is however lacking.

AIM

Evaluate user-friendliness and user interface of the Norwegian version of the British Stay Alive suicide prevention app and assess whether the app could be useful in suicide prevention.

MATERIALS AND METHODS

Eight Norwegian Fountain house members and twelve university students evaluated the app interface, and their experiences were discussed through individual- or focus-group interviews.

RESULTS

Participants perceived app tools as relevant and useful for suicide prevention, however they raised concerns on privacy, evidence base, interface complexity, unintended symbolic value of app colours and content, and suitability in suicidal states.

CONCLUSION

The current Norwegian Stay Alive version has the potential to be user friendly, however improvements of interface are suggested.

SIGNIFICANCE

Stay Alive interface must be adjusted and subjected to reiterative evaluations and feasibility assessments in collaboration with additional stakeholder populations to remedy interface concerns, and identify optimal Norwegian interface design, prior to implementation.

The functions of the dreams of the deceased: A qualitative study of women bereaved by partner's suicide

Suicide bereavement is a challenging experience that affects relationships, feelings, and physical and mental health. The research on dreams during suicide bereavement might deepen the understanding of how the loved one's suicide affects the person and what functions the dreams can have during the bereavement process. Therefore, the goal of the current study was to explore the functions of the dreams of the deceased during suicide bereavement in a sample of 9 women bereaved by their partner's suicide. The data was gathered by conducting semi-structured interviews and analyzed using reflexive thematic analysis. Three themes were generated: dreams function as helping during the process of suicide bereavement; dreams reflect the traumatic aspects of suicide bereavement; dreams function as a space to maintain or sever an ongoing relationship with the deceased. The findings reveal that dreams can function in different ways and can be a valid part of suicide bereavement.

The longitudinal contribution of prolonged grief to depression and suicide risk in the aftermath of suicide loss: The moderating role of self-criticism

BACKGROUND

Suicide-loss survivors (SLSs)-individuals who lost family member to suicide, have been recognized as at risk for several mental health complications, including depression and suicide. Recent studies have emphasized the contribution of prolonged grief (PG) symptoms and suicide-related shame as facilitators of depression and suicide risk in the aftermath of suicide loss. In this six-year longitudinal design study, we examined self-criticism as a moderator of the link between PG and depression and suicide risk, with suicide-related shame mediating these links.

METHOD

Participants were 152 SLSs (130 females) aged 18-70 who completed questionnaires assessing prolonged grief, depression, and suicide risk as well as trauma-related shame and self-criticism.

RESULTS

A moderated mediation model shows that high self-criticism intensified the relations between PG and shame and between shame and depression and suicide risk, above and beyond the contribution of the longitudinal PG trajectory. Importantly, the indirect effects of PG on both depression and suicide risk via shame levels were found only among SLSs with high levels of self-criticism.

CONCLUSION

The findings highlight the critical longitudinal role of self-criticism in facilitating depression and suicide risk among SLSs with higher levels of PG. Theoretical implications relating to healing processes and focused clinical recommendations are discussed, including interventions for addressing self-criticism and suicide-related shame in the aftermath of suicide loss.

Social Reactions After Disclosing Suicide Loss Among Women

Background: Suicide loss is often concealed. While initial evidence suggests that disclosure is important for healthy grieving, observed beneficial effects may depend on social reactions. Aim: The current study aimed to identify social reactions and associated consequences experienced by persons who lost a loved one to suicide (i.e., suicide loss survivors). Method: We conducted qualitative interviews with 22 female adult suicide loss survivors focusing on social reactions after suicide loss. Interviews were transcribed and analyzed using qualitative content analysis. Results: When talking about their loss with others, suicide loss survivors experienced a broad range of social reactions including compassionate and supportive responses, speechlessness and insecurity, curiosity and gossip, stigmatization, and grieving expectations. Depending on these social reactions, disclosing suicide loss was associated with both negative and positive long-term effects. Limitations: The findings are limited to the current female sample. Conclusion: Interventions that help suicide loss survivors in finding supportive confidants, combined with public interventions to decrease public suicide stigma and improve the public's readiness to provide helpful support to suicide loss survivors, could improve grieving outcomes among this group.

Suicide Ideation, Plans, and Attempts Among Military Veterans vs Nonveterans With Disability

Importance

People with disability are at heightened risk for suicide ideation, planning, and attempt, with risk growing as the number of disabling limitations increases. Military veterans have higher rates of suicide deaths and disability relative to nonveterans.

Objective

To evaluate whether veteran status is associated with greater risk for suicide in those with disability.

Design, Setting, and Participants

This survey study used cross-sectional self-reported data from US adults who participated in the 2015-2020 National Survey on Drug Use and Health. Data were weighted to represent the population. Data analysis was conducted from July to August 2022.

Main Outcomes and Measures

Suicide ideation, planning, and attempt served as primary outcomes. Disability status (present or absent) and number of disabling limitations (1, 2, or ≥3) served as factors. Veteran status was determined based on self-report (veteran or nonveteran). Multivariable logistic regression examined suicide ideation, planning, and attempt as a function of veteran status and disability variables.

Results

Participants included 231 099 US veterans and nonveterans, representing 236 551 727 US adults, of whom 20.03% (weighted n = 47 397 876) reported a disabling limitation, 8.92% were veterans (weighted n = 21 111 727; 16.0% aged 35-49 years; 91.0% men; 6.7% Hispanic; 10.9% non-Hispanic Black; and 78.4% non-Hispanic White) and 91.08% were nonveterans (weighted n = 215 440 000; 25.4% aged 35-49 years; 44.0% male; 16.5% Hispanic; 11.7% non-Hispanic Black; and 63.3% non-Hispanic White). Overall, 4.39% reported suicide ideation, planning, or attempt (weighted n = 10 401 065). Among those with no disability, veteran status was associated with higher risk of suicide planning (adjusted odds ratio [AOR], 1.71; 95% CI, 1.17-2.49). Among those with 1 or 2 disabling limitations, being a veteran was associated with a lower risk of suicide planning (AOR, 0.57; 95% CI, 0.34-0.95) and history of attempt (AOR, 0.46; 95% CI, 0.24-0.88).

Conclusions and Relevance

In this study of how suicide risk differs as a function of disability and veteran status, risk for death by suicide was lower among veterans with disability relative to nonveterans with disability. Veteran status may mitigate risk for suicide given increased receipt of more disability-related care through the Department of Veterans Affairs. Further research would extend this line of inquiry by examining the cause and type of disability as well as perceptions of disability on self-worth. It is possible that physical wounds of war are protective because of the meaning and value of service to one's country.

Investigating risk of self-harm and suicide on anniversaries after bereavement by suicide and other causes: a Danish population-based self-controlled case series study

AIMS

To investigate mechanisms of suicide risk in people bereaved by suicide, prompted by observations that bereaved people experience higher levels of distress around dates of emotional significance. We hypothesised that suicide-bereaved first-degree relatives and partners experience an increased risk of self-harm and suicide around dates of (i) anniversaries of the death and (ii) the deceased's birthday, compared with intervening periods.

METHODS

We conducted a self-controlled case series study using national register data on all individuals living in Denmark from 1 January 1980 to 31 December 2016 and who were bereaved by the suicide of a first-degree relative or partner (spouse or cohabitee) during that period, and who had the outcome (any episode of self-harm or suicide) within 5 years and 6 weeks of the bereavement. We compared relative incidence of suicidal behaviour in (i) the first 30 days after bereavement and (ii) in the aggregated exposed periods (6 weeks either side of death anniversaries; 6 weeks either side of the deceased's birthdays) to the reference (aggregated unexposed intervening periods). As an indirect comparison, we repeated these models in people bereaved by other causes.

RESULTS

We found no evidence of an elevated risk of suicidal behaviour during periods around anniversaries of a death or the deceased's birthdays in people bereaved by suicide (adjusted incidence rate ratio [IRRadj] = 1.00; 95% confidence interval [CI] = 0.87-1.16) or other causes (IRRadj = 1.04; 95% CI = 1.00-1.08) compared with intervening periods. Rates were elevated in the 30 days immediately after bereavement by other causes (IRRadj: 1.95, 95% CI: 1.77-2.22).

CONCLUSIONS

Although people bereaved by suicide are at elevated risk of self-harm and suicide, our findings do not suggest that this risk is heightened around emotionally significant anniversaries. Bereavement care should be accessible at all points after a traumatic loss as needs will differ over the grief trajectory.

Predictors of Stigma, Guilt, and Shame among Adults Bereaved by Fatal Overdose

With the spectacular rise of US overdose deaths, bereavement for these affected families has become a matter of increasing concern. Qualitative research has highlighted the role of stigmatization as well as guilt and shame among this population. However, the magnitude and pre-death predictors of stigmatization, guilt, and shame have yet to be assessed quantitatively. In the current study, we assess the magnitude of stigmatization, guilt, and shame among 115 adults bereaved by overdose by drawing comparisons with 185 adults bereaved by suicide. Results revealed no significant differences regarding overall levels of stigmatization, guilt, and shame between the overdose and suicide bereaved. Among the overdose bereaved, regression models indicated a number of pre-death factors associated with stigmatization, guilt, and shame, such as the frequency of the decedent's drug use, family drug use severity, and interpersonal conflict between the bereaved and the decedent. Implications and future directions for research are discussed.

When a Child Dies by Suicide: An Interpretative Phenomenological Analysis Study

Suicide is a global concern for the well-being of families. When parents experience their child's death by suicide, their well-being can be substantially impaired. This study aimed to explore the lived experiences of parents whose children died by suicide. Data were collected from 25 mothers through interviews between 2019 and 2021 and analyzed using interpretive phenomenological analysis. The data revealed five superordinate themes, including (1) who am I; (2) the unrelenting questions; (3) my existence on earth is brutal and cruel; (4) grief; and (5) the meaning. Each superordinate theme includes two to four supporting clusters. Parents' grief associated with a child's suicide is overwhelming and paralyzing but is often a journey to find the meaning or the reason for the death. Parents are traumatized and emotionally vulnerable. Healthcare providers need to support parents who lose their children to death by suicide.

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

BACKGROUND

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.

METHOD

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).

RESULTS

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.

CONCLUSION

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.

Role of the Psychiatric Nurse in Improving the Psychosocial Health of Families After Suicide

Suicide is defined as death that occurs as a result of deliberate self-harming behavior with the intention of ending one's life. Each suicide has many physical, economic and psychological short and long-term effects on the individual, family, friends and society. The death of an individual as a result of suicide creates a traumatic effect for family members and causes family members to experience various psychosocial problems. For this reason, it is very important to focus on the consequences of suicide in family members who have lost due to suicide, to evaluate the family's reactions to suicide, and to provide the needed psychosocial support. In this context, in this review, it is aimed to review the literature on the psychosocial problems experienced by families who have lost due to suicide and to present up-to-date information on the role of psychiatric nurse in improving the psychosocial health status of families.

Perceptions of grief reactions in family members of incarcerated individuals: A vignette-based experiment

We examined perceptions of individuals grieving the loss of a family member to incarceration. Participants (N = 1095) were randomized to a vignette that varied by race-ethnicity, crime type, and grief trajectory to assess their perceptions. Results indicated: (1) participants perceived prolonged grief as less appropriate than resilience; (2) Black family members grieving someone who committed a violent crime as more appropriate compared to White family members; and (3) women endorsed both grief trajectories as more appropriate and indicated greater comfort supporting the family member. Lastly, participants indicated prolonged, White and Latinx grievers should seek therapy more than resilient or Black individuals.

Suicide stigma measures: A scoping review

BACKGROUND

Worldwide, approximately 800,000 people die by suicide every year, and non-fatal suicidal thoughts and behaviours are common. Stigma is likely a major barrier to preventing suicide. The purpose of our review is to scope the development, psychometric properties and use of measures that explicitly seek to measure the construct of suicide stigma.

METHODS

We conducted a scoping review. We searched PubMed, PsycINFO, Embase and CINAHL using search terms related to suicide, stigma and measures/scales with no date limits. We included any measure the authors defined as measuring suicide-related stigma. Only peer-reviewed articles published in English were included.

RESULTS

We included 106 papers discussing 23 measures of suicide stigma; 82 provided data on psychometric properties. Measures assessed personal or public stigma; and stigma toward a range of suicidal phenomena (e.g., suicidal thoughts, those bereaved by suicide). 'Stigma' definitions varied and were not always provided. The Grief Experience Questionnaire, Suicide Opinion Questionnaire and Stigma of Suicide Scale were the most commonly cited. Measures varied in the strength of their psychometric properties.

LIMITATIONS

We only included papers in English. Because we included any measures authors defined as measuring suicide stigma, we may have included measures not commonly considered as measures of suicide stigma, and conversely we might have excluded relevant measures because they did not use the term 'stigma'.

DISCUSSION

This review aimed to assist in better understanding available suicide stigma measures, their strengths and weaknesses and current uses, and will inform the development of future suicide stigma measures.

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.

Two sides of the same coin? The association between suicide stigma and suicide normalisation

AIMS

Evidence suggests that suicide stigma (i.e. negative attitudes towards persons affected by suicide/suicidality) and suicide normalisation (i.e. liberal attitudes towards suicide) are both associated with increased suicide risk. Despite conceptual similarities and potential interaction, suicide stigma and suicide normalisation have usually been investigated separately. We used cross-sectional data from a community sample to test the association between suicide stigma and suicide normalisation as well as to identify their respective determinants and consequences.

METHODS

Participants were N = 3.269 adults recruited from an established online-panel using quotas to reflect the composition of the German general population with regard to age, gender, education and region. We collected information about suicide stigma, suicide normalisation, intentions to seek help for suicidality, current suicidality, suicide literacy, negative mood and socio-demographic variables. We used regression modelling to determine the association between suicide stigma and suicide normalisation as well as to identify their determinants and consequences.

RESULTS

Suicide stigma and suicide normalisation were inversely associated so that higher suicide stigma scores were linked to lower suicide normalisation. More suicide stigma was associated with reduced intentions to seeking professional help, increased willingness to seek help from family and friends and lower odds to experience current suicidality, however the association between suicide stigma and intentions to seek professional help diminished after controlling for confounding variables. Increased suicide normalisation was linked to reduced intentions to seek help from professionals or family and friends, as well as higher odds to experience current suicidality, even after controlling for confounding variables.

CONCLUSIONS

Our findings suggest that interventions to reduce public suicide stigma are at risk to unintentionally increase suicide normalisation, which appears to be a key barrier to seeking help for suicidality. Future research should therefore identify strategies to improve attitudes towards persons affected by suicidality that avoid normalisation, i.e. do not convey the message of suicide as an acceptable solution for difficult life situations. One strategy with great potential to safely reduce public suicide sigma could be interventions that stimulate interpersonal contact with affected persons sharing their recovery story.

Experiences With Suicide Loss: A Qualitative Study

To better understand suicide loss survivors' experiences and barriers to accessing support and mental health care, 28 (21 women and 7 men) suicide loss survivors were interviewed. Using qualitative analysis of 28 in-depth, semi-structured phone interviews data, three categories emerged: Life before Suicide, Life after Suicide, and Meaning of Life. This deeper understanding of suicide loss survivors along with inclusion of experiences of male and rural participants' suicide loss, fill previously identified research gaps. Our findings suggest importance in providing emotional support and mental health resources to those with suicide intent or experiences with suicide loss. Most importantly, the recognition of suicide loss survivors extends beyond the immediate family and includes cousins, friends, and work associates. Recognition of extended suicide loss survivors' bereavement will provide additional opportunities for healthcare providers to effectively intervene with this vulnerable population.

Lived Experiences of Suicide Bereavement within Families: A Qualitative Study

BACKROUND

The lifetime prevalence of suicide exposure in the family is estimated at 3.8% in the general population. Familial bonds can constitute a crucial factor in determining individual bereavement outcomes via the interactional and communicational aspects of the bereavement process within the family. However, the literature on the lived experiences of suicide bereavement within the family remains scarce.

METHOD

Our objectives were to qualitatively (a) assess the impact of suicide on different types of family members, (b) evaluate the interactions between the familial and individual bereavement processes, and (c) obtain precise insights into the familial interactions that occur following a suicide. We performed a qualitative study by conducting semidirected interviews with family members who had been bereaved by suicide. Computer-based and manual thematic analyses were used for data analysis. In order to mitigate biases related to the qualitative design of the data collection, two main measures were undertaken, namely triangulation and saturation.

RESULTS

Sixteen family members bereaved by suicide participated in our study, including a majority of women (n = 12). Mean age of participants was 56.4 and mean duration of suicide bereavement was 10.5 years. Most of the relatives deceased by suicide were middle-aged men who died by hanging or firearm. A total of six themes emerged from the analyses, namely (1) "familial trauma", (2) "external adversity", (3) "individual bereavement and familial interactions", (4) "communicational and relational processes within the family", (5) "perceived help and support within the family" and (6) "evolution over time".

CONCLUSION

We reported that suicide bereavement significantly impacts internal familial interactions via complex emotional and communication processes. Family conflicts, taboos or cohesion can occur in the aftermath of a suicide. We also found that familial coping strategies can shape individual reactions to the death on the part of each member of the family.

Psychosocial determinants of adolescent suicide: A national survey

BACKGROUND

Suicide is a global health problem with considerable variability across countries in its prevalence and correlates. The aims of this study were to: (a) explore the prevalence and psychosocial determinants of adolescent suicidal ideation, and (b) explore the perceived stigma of suicide among adolescents.

METHOD

A nationally representative electronic survey was utilized to collect data from school adolescents. The Joanna Briggs Institute critical appraisal checklist for studies reporting prevalence data was used to design the survey. The study collected data on adolescents' suicidal ideation, depression, self-esteem, stigma of suicide, family functioning, educational stress, and anxiety levels. A representative sample of 647 Jordanian school adolescents was included.

RESULTS

The prevalence of suicidal ideation among school adolescents was 11%. Suicidal ideation was significantly higher among respondents who were boys and enrolled in public schools, had a mental health problem, a family history of suicidal attempt, a lower self-esteem, and higher depressive symptoms. The majority of school adolescents agreed with the descriptions of people who take their own lives as being "lost" (70%), "coward" (53%), "stupid" (51%), and "lonely" (49%).

CONCLUSION

There is no typical suicide victim, and there are no specific characteristics that can point out those who are suicidal. Suicide remains a complex phenomenon that is embedded in its sociocultural context. Collaborative efforts from Jordanian policy makers, healthcare providers, researchers, and educators are needed to develop culturally appropriate screening and prevention approaches to address suicide among adolescents. Nurses have a significant role in helping adolescents experiencing suicidal ideation and their families restore, maintain, and/or promote their mental health and wellbeing.

The Needs, Use and Expectations of People Bereaved by Suicide Regarding Online Resources: An Online Survey

BACKGROUND

Online resources constitute a new and effective way to obtain support or information during bereavement processes. However, little is known about the needs, use and expectations of people bereaved by suicide regarding online resources.

METHOD

The objective of our national cross-sectional online survey was to collect the use, needs and expectations of people bereaved by suicide regarding online resources. The data were collected from July to October 2021 through a 26-item online questionnaire hosted on the website LimeSurvey.

RESULTS

A total of 401 respondents fully completed the questionnaire. Their mean age was 45.7. The majority of participants were women bereaved by the suicide of their child or partner. Half of the participants were bereaved for less than 3 years and benefited from counselling during their bereavement process. Three-quarters of the participants used the Internet for their bereavement process, mainly to obtain information on suicide bereavement and suicide prevention and to access testimonies of other people bereaved by suicide. Three-quarters of the participants found that available online resources for people bereaved by suicide are insufficient and expected a dedicated web platform to be developed. Finding information on suicide bereavement and on suicide prevention, discussing with a mental health professional and accessing testimonies of other people bereaved by suicide were expected by a majority of the participants regarding the future platform. Receiving counselling and being bereaved by the death of a child were the most important factors in explaining patterns of use and expectations regarding online resources.

DISCUSSION

Our results offer precise insights into the needs, use and expectations of people bereaved by suicide regarding online resources. The development of web platforms offering access to reliable information on suicide bereavement and on suicide prevention to peers bereaved by suicide and help to seek counselling are urgently needed.

Querschnittstudie zum Versorgungsstand von Familien nach Suizid und Suizidversuch eines Elternteils in Bayern

Hintergrund

In Bayern wurde 2019 mit 1520 Fällen die höchste absolute Anzahl von Suiziden in Deutschland registriert. Suizid als Todesursache ist besonders belastend für Angehörige und das Risiko von betroffenen Kindern, selbst im weiteren Lebensverlauf Suizid zu begehen, ist signifikant erhöht. Frühe und spezifische Ansätze der sog. psychosozialen Notfallversorgung sind nach hoch belastenden Lebenserfahrungen, wie Suizid im Nahfeld, fachlich indiziert.

Ziel der Arbeit

Ziel der Querschnittstudie ist es, die Versorgungssituation von Familien nach Suizid und Suizidversuch eines Elternteils in Bayern zu erheben und dadurch Bedarfe zu erkennen.

Methoden

Daten zu Versorgungsangeboten, der (Selbst)einschätzung der Kompetenzen zu traumaspezifischen Aspekten und der grundsätzlichen Beurteilung der Versorgungssituation und -qualität in Bayern wurden bei 108 Jugendämtern und Beratungsstellen per telefonischer Befragung erhoben und deskriptiv ausgewertet.

Ergebnisse

Fälle von Suizid/-versuch kommen in der Beratungs- und Betreuungsrealität von Mitarbeitenden in Jugendämtern und Beratungsstellen vor. Die am häufigsten genannte Hilfe ist die Weitervermittlung in andere zumeist heilkundliche Angebote. 80 % der befragten Mitarbeitenden in Beratungsstellen und Jugendämtern halten die Einführung einer zentralen Notfallrufnummer für Familien und Fachkräfte für sinnvoll.

Schlussfolgerung

Fachkräfte sehen den Bedarf für Beratung bei den Betroffenen und wollen diesem auch in der eigenen Einrichtung entsprechen, fühlen sich jedoch in Folge begrenzter interner und externer Angebote sowie eigener Qualifikation dafür nicht ausreichend ermächtigt. Die Angebote, in die weitervermittelt wird, sind in den meisten Fällen weder spezifisch, passgenau noch kurzfristig verfügbar, was angesichts des hohen Erkrankungsrisikos der betroffenen Kinder und Jugendlichen einen kritischen Faktor darstellt. Es besteht ein Bedarf für unmittelbar erreichbare spezifische Unterstützung sowohl für Fachkräfte als auch für betroffene Familien, z. B. durch eine Notfallrufnummer.

Implications of stigma towards mental health problems on suicide risk in people with mental health problems: a systematic review

Stigma associated with psychological problems is a major concern that negatively affects people living with different symptomatology, sometimes with serious consequences for their health.

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

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.

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

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

Characteristics of Survivors of Suicide Seeking Counseling From an NGO in Denmark: Analyses of a National Database

OBJECTIVE

The loss of a friend or family member to suicide, i.e., surviving suicide, can be devastating. Yet, little is known regarding the support received by survivors of suicide. We aimed to examine the characteristics of survivors of suicide who sought counseling from a Danish volunteer organization.

METHOD

Data on all users of the Danish Network for those Affected by Suicidal Behavior (NASB) were obtained during 2012-2018. Information on age, sex, relation, time of loss, municipality was analyzed, and geographical driving distances calculated.

RESULTS

Altogether, 1,268 survivors of suicide (mean age 43.3; 29.8% of all suicides) received counseling from NASB. In all, 81.8% of service users had lost a partner or first-degree relative; those being spouses/partners (15.3%), parents (28.5%), children (19.0%), and siblings (15.4%). Female service users (71.1%) outnumbered males (28.7%). A third of users sought counseling within 6-months of the death. A help-seeking rate of 6 users per 10 suicide deaths was found within close proximity to a counseling venue; equivalent of 5.5 (95% CI: 5.0-6.0) users per 100,000 inhabitants. Each additional 10 km of driving distance was associated with a 15% lower rate of use (b: -0.015; 95% CI: 0.027 to 0.003; p = 0.013).

CONCLUSION

Geographical proximity to help centers was important and could suggest that support might be lacking in some parts of the country. It seems likely that more than 0.6 persons per suicide might seek counseling from volunteer organizations if services were available within short driving distance.HIGHLIGHTSMore than one out of three who sought support after a suicide death were partners or first-degree relatives and only a third of users who sought counseling did so within 6-months of the death. Also, female sought counseling more frequently than males.Approximately 5.5 people per 100,000 inhabitants sought help after a suicide in areas where a counseling venue was within short driving distance.Based on the region with most counseling venues, 6 survivors would seek support per 10 suicide deaths.

Silence and Sounds: An Autoethnography of Searching for Spirituality during Suicide Bereavement in Life and Research

In this article, I used autoethnography to describe and analyze my experience of being bereaved by suicide and researching spirituality during suicide bereavement. The culture silenced my grief, and this is congruent with the experiences of my research participants. The religious community, in my case, did not help me and added to my spiritual and psychological pain. The silenced parts of my loss started to make sounds, such as psychological disturbances, but also as unconscious and conscious choices, which led to immersing myself in the research of spirituality during suicide bereavement. Research on the topic goes hand in hand with my search for spirituality during suicide bereavement and reviewing my loss. My story suggests that despite the negative experiences with Catholic priests, spirituality during suicide bereavement can become a vital resource to find meaning for the loss and the pain of grief and can take many different and even unexpected forms.

Three Sibling Survivors' Perspectives of their Father's Suicide: Implications for Postvention Support

This qualitative case study describes three adult siblings' experiences and their perceptions of support connected with the time before and after their father's suicide. At the time of the suicide, participants were ages 1, 5, and 8 years old. We considered commonalities and disparities among the three survivors' perceptions. We also considered how their reported experiences compared to extant literature on child survivors of parent suicide. Our findings suggest that, although the siblings experienced the same traumatic event, each had unique perceptions of the parent's suicide. Immediately prior to closing each interview, to deescalate from the intense topic of suicide, participants offered their impressions of potentially therapeutic children's books and how bibliotherapy may or may not support surviving children. Participants' perceptions of selected children's picture books offer insights about opening communication and addressing challenges specific to a parent's suicide. Implications for teachers, parents, and school-based mental health professionals are provided. We conclude that postvention must consider and monitor each child's perceptions and provide individualized interventions that encourage open communication and support adaptive coping to navigate the intense grief associated with a parent's suicide.

Professional helpers' experiences of assisting the bereaved after drug-related deaths: A knowledge gap

Background and aims: Drug-related death (DRD) is a major public health concern in the Nordic countries, in the rest of Europe and in the US. After a DRD, approximately 10–15 next of kin will be left behind. People bereaved after sudden and unexpected deaths have a documented higher risk of reduced quality of life, daily functioning, and early death. It is important to know the resources professional helpers have available to them, the barriers and possibilities they face in their work, and how they can respond to the needs of the bereaved. This knowledge can help prevent severe health and social consequences of bereavement following a DRD. In this systematic review, the aim was to explore knowledge regarding professional helpers’ experiences of providing assistance to people bereaved after a DRD. Methods: Inclusion criteria were empirical studies of professional helpers’ first-person perspectives on meeting the bereaved after a DRD. Quantitative, qualitative, and mixed-method studies were included. Results: The results show that there are no studies addressing professional helpers’ experiences of providing assistance to the bereaved after a DRD. Conclusion: There is a vital need to develop more knowledge of professional helpers’ perspectives. This knowledge is important not only to improve education and the quality of health and social services, but also to help raise awareness of the bereaved after a DRD.

Predictors of prolonged grief in an internet-based grief therapy for people bereaved by suicide

Internet-based cognitive-behavioural grief therapy (ICBGT) has proven to be effective for people bereaved by suicide, however the extent to which patients can benefit from therapy seems to differ. This study investigates predictors of initial grief as well as change in grief severity following treatment in an ICBGT for people bereaved by suicide. Data was gathered from a randomized control trial including 57 people participating in a 5-week intervention. Change in grief symptoms was calculated using absolute change scores of grief. In order to examine best overall combination of independent variables, best subset regressions were conducted. Higher levels of pre-test grief were associated with worse sleep quality (β = 0.32, p = .002), lower self-esteem (β = -0.37, p = .002), lower support seeking (β = -0.38, p = .006), and a higher need for social support (β = 0.28, p = .028). A greater reduction in grief severity was associated with higher self-efficacy (β = -0.49, p = .001), higher attachment anxiety (β = -0.31, p = .017) and higher pre-test grief symptoms (β = -0.39, p = .006). Attention should be paid to the intensity of grief, the attachment style and a positive self-image, as these variables seem to influence the extent, to which patients' symptoms of PGD subside following ICBGT. To specifically target factors of patients that require improvement, further studies are needed.

Exploring the mental health correlates of overdose loss

Despite the exorbitant rise in overdose-related deaths, little is known about the mental health burden associated with this form of loss. Using validated self-report instruments, the present study investigated the prevalence of pathological symptoms of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), major depressive disorder (MDD) and generalized anxiety disorder (GAD), and suicide risk among a sample of overdose loss survivors (n = 115). Comparison groups consisting of other sudden loss survivors (suicide and sudden-natural loss) were employed to illuminate any shared or unique mental health challenges. Consistent with this study's primary hypothesis, results indicated that the overall mental health burden of overdose loss is substantial. Specifically, after controlling for a number of covariates, overdose loss survivors were approximately three times more likely to meet the symptom severity threshold for PGD, PTSD, and MDD compared to sudden-natural loss survivors. Overdose loss survivors also appeared to be at risk for GAD symptoms and suicide, but differences were non-significant after accounting for a number of covariates. Overall, this study is the first to examine this particular constellation of mental health outcomes associated with overdose bereavement, underscoring the need for additional empirical and clinical attention placed on this burgeoning population.

Social stigma of suicide in South Korea: A cultural perspective

This study examined suicide stigma in relation to Korean cultural characteristics, such as Collectivism, Chemyon sensitivity (concern about losing a socially acceptable face), the tendency toward conformity, and the emphasis on the interdependent self. We found that these characteristics were connected to suicide stigma in Korea. Those with high Chemyon sensitivity tended to perceive that suicidal people were incompetent, immoral, selfish, and deviated from society. Conformity tendency was positively associated with five stigma factors: incompetence, glorification, immorality, selfishness, and social exclusion. Those who perceived themselves as interdependent tended to consider suicidal people incompetent, lacking morality, self-centered, and deviant.

The Effectiveness of Self-Esteem-Related Interventions in Reducing Suicidal Behaviors: A Systematic Review and Meta-Analysis

Suicide is a serious social issue and is often treated using psychological interventions. The current systematic review and meta-analysis aimed to investigate the effectiveness of self-esteem-related interventions on suicidal behaviors. A systematic literature search for randomized controlled trials (RCTs) including a self-esteem component was conducted on 29 May 2021 and updated on 4 April 2022. In total, 12 studies were included in the systematic review and five studies were included in the meta-analysis. Small effect sizes were found for suicidal ideation at post intervention [g = -0.24, 95% CI (-0.48, 0.00)] and a 3-month follow-up [g = -0.36, 95% CI (-0.62, -0.11)]. However, these results should be interpreted cautiously due to the limited number of included studies and varied sample population. In conclusion, the current review suggests that future intervention studies should incorporate self-esteem enhancement in the treatment of suicidal behaviors, especially for suicidal ideation.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=250882.

Very Young Child Survivors' Perceptions of Their Father's Suicide: Exploring Bibliotherapy as Postvention Support

Each year in the United States, 7000 to 30,000 children experience their parent's suicide. Due to the stigma associated with suicide, feelings of guilt, and intense grief, surviving family members avoid talking about suicide. Over time, children struggle with confusion and intense emotions associated with their parent's suicide. In this study, seven adults, who reported being younger than six years old at the time of their father's suicide, participated in individual semi-structured interviews. Participants' responses highlight the challenges that young children face due to limited memories of their deceased parent. Interviews concluded with an opportunity for participants to review and express their impressions of 10 children's picture books. Participants offered impressions about how these books may or may not be helpful in supporting young child survivors. Implications for applied practice include considering how children's literature may open communication and assist children in navigating Worden's tasks of grief: (a) accepting the reality of their parent's death; (b) facing the grief and pain; (c) adapting to life changes due to their father's suicide, in particular adapting to altered family relationships; and (d) building memories of the deceased loved one, when possible, to ensure healthy attachment to the deceased parent. Participants' insights provide considerations for selecting children's literature for bibliotherapy. Due to young child survivors' increased risk for attempting and completing suicide, supporting child survivors of parent suicide not only addresses postvention needs but aligns with suicide prevention.

Spirituality and Religiosity during Suicide Bereavement: A Qualitative Systematic Review

A loved one’s loss to suicide can be a traumatic experience and trigger a difficult grief process, identity changes, a loss of the sense of meaning and a spiritual crisis. Spirituality and/or religiosity (S/R) can be both an important resource and a source of stigmatisation during suicide bereavement. This study aims to synthesise the extant findings about S/R during suicide bereavement in qualitative studies. After an exhaustive selection of articles, the current review utilised a total of 484 citations and seven studies. A thematic synthesis yielded five major themes related to S/R during suicide bereavement: the need to be helped by the religious community without being judged; S/R-related experience of the deceased as a figure who continues to exist; S/R experienced without a conscious choice; conscious reach towards S/R themes; not relating to S/R during suicide bereavement. These findings indicate that the role of S/R during suicide bereavement is complex and varies from providing help to serving as a source of suffering. Hence, practitioners and religious communities should be mindful of the S/R themes during suicide bereavement.

Development of an online suicide prevention program involving people with lived experience: ideas and challenges

BACKGROUND

Fear of stigmatization, self-stigmatization, and insufficient information can lead to secrecy, reduced help-seeking, lower self-esteem, and lower self-efficacy among people affected by suicidality or suicide. Therefore, we developed an online suicide prevention program aiming to improve knowledge about suicidality and suicide stigma.

METHODS

Inspired by the Australian program The Ripple Effect, a German team comprising people with lived experience of suicide, researchers, and clinicians was established for developing an online suicide prevention program. Therefore, we oriented on guidelines for evidence-based health information, for reporting on suicide, and on dealing with suicidality. The lived experience team discussed and developed concept, structure, and content of the program. This manuscript presents summaries of protocols from 16 team meetings and 3 written text reviews to outline the program development process. A summative evaluation 3 years after program development began was qualitatively analyzed based on thematic analysis.

RESULTS

Between 2018 und 2021, the lived experience team (n = 10) discussed possibilities of support in suicidal crises, attitudes towards suicide, content, and design of the online program. In a structured process, six members of the lived experience team reviewed the content. Eight persons shared their lived experience of suicide in video reports by focusing on constructive ways of dealing with suicidality or a loss by suicide, conveying hope and encouraging people to continue living. Team members recommended greater public and patient involvement from the application stage, as well as more financial and personnel resources.

CONCLUSIONS

Through contributions to discussions and text reviews, the lived experience team shaped decisions in the program development process. While involving persons with lived experiences of suicide, it is important to consider that suicidality is 1. emotionally challenging, 2. a stigmatized issue, and 3. that the aspect of safety must be a priority. A distinction must be made between the duty of care based on actual risk and inappropriate overprotection. Hereby, transparency, autonomy, and a clear structure appeared to be helpful. For further research, we recommend a structured formative review process of the development of the program. Additionally, we recommend discussing the purpose and the specific design of the evaluation with a lived experience team in advance. Trial registration German Clinical Trial RegisterDRKS00015071 on August 6, 2018.

The stigmatization of suicide: A study of stories told by college students in China

This study unpacks the dimensions of suicide stigma through an analysis of the stories told by college students in China. The phronetic iterative approach was used to analyze the interview data of 30 college students. Findings showed that college students use the strategy of othering in creating a distinction between us and them. Those who attempt or die by suicide are labeled as irresponsible, fragile, impulsive, and attention-seeking. Suicides of ingroup members are usually described as controllable, while the suicides of outgroup members are often deemed uncontrollable. Finally, suicides lead to a status loss for individuals and their social groups.