Is suicide bereavement different? A reassessment of the literature

A Suicide Prevention Digital Technology for Individuals Experiencing an Acute Suicide Crisis in Emergency Departments: Naturalistic Observational Study of Real-World Acceptability, Feasibility, and Safety

BACKGROUND

Emergency departments (EDs) are the front line in providing suicide care. Expert consensus recommends the delivery of several suicide prevention evidence-based interventions for individuals with acute suicidal ideation in the ED. ED personnel demands and staff shortages compromise delivery and contribute to long wait times and unnecessary hospitalization. Digital technologies can play an important role in helping EDs deliver suicide care without placing further demands on the care team if their use is safe to patients in a routine care context.

OBJECTIVE

This study evaluates the safety and effectiveness of an evidence-based digital technology (Jaspr Health) designed for persons with acute suicidal ideation seeking psychiatric crisis ED services when used as part of routine ED-based suicide care. This study deployed Jaspr Health for real-world use in 2 large health care systems in the United States and aimed to evaluate (1) how and whether Jaspr Health could be safely and effectively used outside the context of a researcher-facilitated clinical trial, and (2) that Jaspr's use would be associated with improved patient agitation and distress.

METHODS

Under the auspices of a nonsignificant risk device study, ED patients with acute suicidal ideation (N=962) from 2 health care systems representing 10 EDs received access to Jaspr Health as part of their routine suicide care. Primary outcome measures included how many eligible patients were assigned Jaspr Health, which modules were assigned and completed, and finally, the number of adverse events reported by patients or by medical staff. Secondary outcome measures were patient agitation, distress, and satisfaction.

RESULTS

The most frequent modules assigned were Comfort and Skills (98% of users; n=942) and lethal means assessment (90% of patient users; n=870). Patient task completion rates for all modules ranged from 51% to 79%. No adverse events were reported, suggesting that digital technologies can be safely used for people seeking ED-based psychiatric services. Statistically significant (P<.001) reductions in agitation and distress were reported after using the app. Average patient satisfaction ratings by site were 7.81 (SD 2.22) and 7.10 (SD 2.65), with 88.8% (n=325) and 84% (n=90) of patients recommending the app to others.

CONCLUSIONS

Digital technologies such as Jaspr Health may be safely and effectively integrated into existing workflows to help deliver evidence-based suicide care in EDs. These findings hold promise for the use of digital technologies in delivering evidence-based care to other vulnerable populations in complex environments.

Mild Cognitive Impairment and Suicidal Ideation Among Adults Aged 65 Years or Older From Low- and Middle-Income Countries

OBJECTIVES

Mild cognitive impairment (MCI) is a unique indicator of underlying distress that may be strongly associated with suicide risk. Despite this, to date, no study has examined the association between MCI and suicidal ideation. Therefore, the present study aimed to examine the association between MCI and suicidal ideation among adults aged ≥65 years from 6 low- and middle-income countries (LMICs; China, Ghana, India, Mexico, Russia, and South Africa).

METHODS

Cross-sectional, nationally representative data from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Self-reported information on past 12-month suicidal ideation was collected. Multivariable logistic regression and meta-analysis were conducted to assess associations.

RESULTS

Data on 13,623 individuals aged ≥65 years were analyzed. The prevalence of suicidal ideation ranged from 0.5% in China to 6.0% in India, whereas the range of the prevalence of MCI was 9.7% (Ghana) to 26.4% (China). After adjustment for potential confounders, MCI was significantly associated with 1.66 (95% confidence interval [95% CI] = 1.12-2.46) times higher odds for suicidal ideation.

DISCUSSION

Mild cognitive impairment was significantly associated with higher odds for suicidal ideation among older adults in LMICs. Future longitudinal studies from LMICs are necessary to assess whether MCI is a risk factor for suicidal ideation.

Initial-Stage Suicide Bereavement Experiences: A Case Study

This study aimed to shed light on the initial-stage bereavement experiences of an individual bereaved by suicide, at three months from the loss of his spouse to suicide. A semi-structured in-depth interview was conducted with the individual, a man in his thirties. The data were analyzed using qualitative assimilation analysis, based on the Assimilation Model and the Assimilation of Problematic Experiences Scale (APES). The APES ratings of the interview revealed that the individual's bereavement was associated with the earlier stages of APES (all scoring under 3.5). In addition, the swift and frequent fluctuations in the APES ratings gave indications that the bereavement was unstable and complicated. It is suggested that mental health professionals could use APES to evaluate suicide bereavement and take note of the APES evaluations in clinical interventions.

Exploring Religion as a Path to Meaning: The Role of "Pastrotherapy" in Supporting Young People's Quest for a Good Life in Nigeria

This paper examines suicide prevalence among Nigerian youth struggling to find meaning in life. Frustrated by unattainable ideals, they experience despair. The study explores religion's role in providing support for meaning-seeking individuals. Utilizing an explorative approach, the paper highlights how religion can play a role in offering solidarity, morality, and hope as vital resources for creating a meaningful life. It introduces "Pastrotherapy" as a pastoral care approach to addressing existential questions. Findings emphasize the importance of religious communities and leaders in promoting resilience and addressing underlying causes of despair. This study reveals how religious beliefs and practices support Nigerian youth facing existential challenges, shedding light on the intersection of religion, meaning-making, and mental health.

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.

After a Suicide Death in a High School: Exploring Students' Perspectives

By the time they leave high school, 17% of adolescents will have experienced the suicide death of a friend, peer, or classmate. While some will be unaffected or experience a brief period of distress following the death, for others the death will cause significant disruption and distress, even increasing their risk of suicidal thoughts and behaviors. It is essential for social workers to be able to support at-risk adolescents after this type of loss. To do this, it is critical to understand the ways that adolescents experience the death, grieve, and recover from the loss. This qualitative study explored adolescents' experiences with grief and loss following an adolescent suicide death in the United States. Thematic analysis of semi-structured interviews with young adults (N = 13) who had been exposed to the suicide death of a peer, classmate, or friend while in high school examined themes about their processing of the death, yielding four themes about sense-making and making meaning about the death. Implications for social workers, schools, and suicide postvention researchers are identified and discussed.

Unpacking the Meaning of Closeness, Reconsidering the Concept of Impact in Suicide Exposure, and Expanding Beyond Bereavement: "Just, I Hope You Don't Forget About Us"

Suicide exposure research has relied on samples of treatment-seeking kin, resulting in an attachment-based model centering bereavement as the most significant form of impact and obscuring other forms of significant and life-altering impact. From a community-based sample (N = 3010) exposed to suicide, we examine a subset (n = 104) with perceived high impact from the death yet low reported closeness to the person who died and analyze qualitative comments (n = 50). On average and out of 5.00, participants rated closeness as 1.56 but impact of death as 4.51. We illustrate dimensions of low closeness and identify themes on the meaning of impact: impact through society and systemic circumstances, impact through history and repeated exposure, impact through other people, impact as a motivator for reflection or change, and impact through shared resonance. Participants reported impact of death as significant or devastating, yet none of their comments reflected experiences typical of bereavement.

Support After Suicide: A Thematic Analysis of Siblings' Experience

Suicide is a worldwide phenomenon resulting in the deaths of more than 700,000 people each year. For every suicide, there are those left behind. The research on sibling's experiences of grief and the support they require after the loss of their sibling is limited. This study explored the experiences of grief and the support siblings bereaved through suicide experienced. Support groups passed on study information to individuals they felt were suitable for participation. Ten adult siblings were interviewed for the study. Thematic analysis was used to find three themes, shared understanding, holding space for grief, and relationships. The findings indicate that siblings desire support from other siblings bereaved through suicide, as well as social support free from stigma that is willing to listen. The relationship between the suicided sibling and the living sibling had effects on the grief experience, as well as parentification, and effects from organisational interaction.

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.

The relationship between suicide bereavement and suicide ideation: Analysis of the mediating effect of complicated grief

People who have experienced suicide bereavement within social relationships are known to have high risk for suicide, which means that their suicide ideation is high. However, little is known about how suicide bereavement leads to suicide ideation. Therefore, this study aims to understand the pathway of suicide bereavement on suicide ideation by analyzing the mediating effect of complicated grief, which does not abate over time and is known to be highly related to suicide ideation. Data of 1224 people aged 19 or older with bereavement (636 bereaved by suicide and 585 by other causes) were obtained from the Longitudinal study on Suicide Survivors' Mental Health (LoSS) WAVE I [2015-2018], the first nationally-representative longitudinal study in South Korea. Suicide ideation, the dependent variable, was measured by the Scale for Suicide Ideation (SSI), and complicated grief, severe grief that does not abate over time, was measured by the Korean version of the Inventory of Complicated Grief (K-ICG). The results show that suicide bereavement was found to have a significant effect on suicide ideation, and that complicated grief plays a mediating role in the path of suicide bereavement to suicide ideation (Effect = 0.667, [0.387, 0.981]). Based on these findings, clinical and policy suggestions were discussed to understand and prevent suicide ideation of people with suicide bereavement.

The Information Seeking Behaviors and Needs of Suicide Survivors During Bereavement

The suicide of one person impacts 60 people, known as suicide survivors. These survivors are at an increased risk for negative mental health outcomes including PTSD, suicidal ideation, and suicide contagion. Despite these consequences, there have not been any information science studies that have explored the information behaviors of people who have recently survived the suicide of a loved one. This article takes a unique approach in combining autoethnography with traditional survey research. One hundred and ninteen participants sourced from a private Facebook suicide bereavement group responded to a survey asking them about their information-seeking after a loved one committed suicide. The qualitative data were fragmented and grouped into like-responses and thematic codes that gave explanation to the research questions. These results are coupled with the author’s ethnographic recounting of a similar experience. Brenda Dervin’s sense-making is employed as the methodological lens through which the study is conducted. It is found that suicide survivors are highly unlikely to have their informational needs met. In the immediate aftermath of their loss, they are most likely to look for information related to the suffering of the deceased. As time passes, they begin to look for information about coping with their loss and preventing suicide of other people; either those close to them or in a larger community scale. Being a survivor motivated many participants to advocacy work. Finally, the author argues that the findings of this article should compel further research and the creation of information policy to aid survivors and prevent suicide contagion.

Psychotropic medication among children who experience parental death to cancer

The psychological consequences of losing a parent to cancer are unclear. We investigated whether experiencing parental death to cancer before 18 years of age increases the risk of psychotropic medication. We used register data of all children born in Denmark between 1 January 1987 and 31 December 2016 (N = 1,488,846). We assessed rate ratios (RRs) with 95% confidence intervals (CIs) for first redeemed prescription of antidepressants, anxiolytics and hypnotics according to parental death status using Poisson multi-state models. We further examined whether the associations differed according to the gender of the deceased parent, child's age at the time of death or the parental length of illness. Cancer-bereaved children had a significantly increased risk of first prescription of psychotropic medication (rate ratio, RR 1.22, 95% confidence interval, CI 1.10-1.34 for males; RR 1.18, 95% CI 1.09-1.28 for females). Associations were strongest if the parent had the same sex as the child and if the parent died within one year of diagnosis. The risk was highest during the first six months after the loss (RR 2.35, 95% confidence interval, CI 1.48-3.73 for males; RR 1.81, 95% CI 1.17-2.80 for females). Children who lose a parent to cancer, particularly in cases when the disease progressed quickly, may need extra psychological support, especially during the first six months after the death.

Existential loneliness and life suffering in being a suicide survivor: a reflective lifeworld research study

Purpose

The aim of the study was to describe the loss of a family member by suicide, based on the lived experience of suicide survivors.

Methods

A phenomenology study with a Reflective Lifeworld Research approach was conducted, consisting of sixteen interviews with eight suicide survivors.

Results

The essence of losing a family member by suicide encompasses experiences of involuntary and existential loneliness, life suffering, and additional burdens in a life that is radically transformed, comprising prolonged and energy-intensive attempts to understand. Life for the family member encompasses a constant fear of being judged and an ambiguous silence, where this silence can both lead to involuntary loneliness and be a source of support and fellowship. Support mechanisms inside the family fall apart, and it becomes obvious that the survivors’ experiences affect others. The loss also implies an active endeavour to maintain the memory of the deceased.

Conclusions

Based on these results, it is important for professionals to accept the survivors as suffering human beings early—from the point of the notification of death—and consider them as patients in need of compassionate care. Such support might reduce life suffering, counteract stigma and involuntary loneliness, and work simultaneously as suicide prevention.

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

Suicide is not only a tragic end of life but also may be the beginning of a very challenging life for those left behind. Suicide-loss survivors (SLSs) are individuals who were exposed to the suicide of a close family member or a friend and endure highly emotional distress. The psychological stance and reactions of SLS are deeply colored by painful, intense emotions that are expressed through different psychiatric symptoms, including depression and suicide ideation (SI). The present study investigated the long-term effects of interpersonal factors such as social support, self-disclosure, thwarted belongingness, and perceived burdensomeness on depression and suicidal ideation among SLS. One hundred fifty-two Israeli SLS, aged 20-72, participated in this longitudinal study, during which their suicide ideation and depression levels were assessed at four points over six years (T1-baseline, and two (T2), four (T3), and six (T4) years after baseline). At the last time point, interpersonal factors were also assessed. SLSs' interpersonal variables significantly predicted depression and SI levels beyond their usual trajectories over the years. Significant correlations were found between both perceived burdensomeness and thwarted belongingness and depression levels at all measurement points. Moreover, thwarted belongingness was found to be a significant moderator of the relationship between former and current depression levels, as the contribution of depression-T3 to depression-T4 was lower among SLSs with low thwarted belongingness (b = 0.14, CI = 0.05-0.34) compared with SLSs with high thwarted belongingness (b = 0.25, CI = 0.22-0.45). These findings emphasize the vital healing role of interpersonal factors such as belongingness, as they may attenuate depression and SI symptoms over time. Hence, clinicians should focus on therapies that boost interpersonal interactions and belongingness, as they seem to be crucial stepping stones on the way to recovery. Moreover, national programs should be implemented to offer SLSs targeted interventions to reduce distress and depression in the aftermath of suicide loss.

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 Role of Spirituality during Suicide Bereavement: A Qualitative Study

Background: A loved one’s loss due to suicide can be a traumatic experience and trigger a complex grief process. Although spirituality, defined as a search for the Sacred in a broad sense, can be a resource and an obstacle in coping with the suicide bereavement process, there is a gap in scientific understanding of the role spirituality plays during the process. Methods: To explore the role of spirituality in people bereaved by suicide, we recruited 11 women who lost a life partner due to suicide. We conducted semi-structured interviews and analyzed the data using reflexive thematic analysis. Results: We identified the following three themes: spirituality is a supportive resource that can be reached for or achieved without conscious involvement; spirituality provides helpful ways to cope with grief; spirituality makes the grief process more difficult. Conclusions: Spirituality, if personally meaningful and supported by others, can function as a resource after a loved one’s suicide and even add to post-traumatic growth after the loss. On the contrary, spirituality-related issues, such as stigmatization and a lack of personally meaningful traditions, can distress the bereaved. Difficult spiritual experiences and questions can become an intricate part of the grief process.

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

BACKGROUND

Suicide is a major public health issue that increases the risk of suicide for those bereaved by suicide themselves. There is a lack of evaluation of the effectiveness and acceptability of suicide postvention services supporting those bereaved by suicide.

AIMS

This review aimed to assess evaluations of postvention services supporting those bereaved by suicide and the acceptability of methods of postvention.

METHODS

Searches of peer-reviewed literature identified 36 studies for inclusion. 22 studies evaluated specific postvention services, 14 evaluated models of postvention.

RESULTS

Using the Mixed Methods Appraisal Tool, mixed-methods and qualitative postvention evaluation and acceptability research produce high-quality studies. Studies rated as low quality reflect poor reporting, rather than ineffective services.

CONCLUSION

Further evaluation of community-based postvention services within the UK is needed. This would evidence that services in the UK are effective in supporting those bereaved by suicide. Evaluation would benefit services in accessing funding, improve service development and provide holistic support.

Are empathy profiles and perceived social support associated with depressive and grief-related symptoms in suicide survivors?

OBJECTIVE

To investigate the link between empathy, perceived social support, and depressive and grieving symptoms in suicide survivors.

METHODS

Scores on the Beck Depression Inventory (BDI), Inventory of Complicated Grief (ICG), Prolonged Grief Disorder (PGD), Interpersonal Reactivity Index (IRI), and the Social Support section of the Interpersonal Questionnaire were collected from 265 survivors. Relations were tested via multivariate regression models.

RESULTS

Lower Perspective Taking (PT) was related with higher levels of BDI score, and higher Personal Distress (PD) was associated with higher BDI, ICG, and PGD scores. Higher levels of Social Support were related with higher BDI and ICG (but not PGD) scores.

CONCLUSION

Empathic PD and PT, and perceived social support are differently associated with depression and grief-related symptoms. Empathy-focused psychotherapies and empowerment of social support may reduce symptoms in suicide survivors.

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.

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

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.

The first 72 hours: Suicide loss survivor experiences with early responders

Exposure to a suicide carries risks for loss survivors including significant and long-standing emotional distress. Early responders play a critical role in shaping survivors' experience and trajectory for seeking support services. Yet, few prior studies explore the nuances of early responders' interactions with loss survivors. The current study explored suicide-bereaved adults' experiences with early responders in the first 72 h after their loss through four group interviews. Participants (N = 15) indicated that interactions with early responders were positive overall. Yet, the lack of resources and referrals provided, and perceived stigmatization of suicide may contribute to survivors' delay in obtaining support services.

Longitudinal Intercorrelations between Complicated Grief and Posttraumatic Growth among Suicide Survivors

BACKGROUND

Suicide survivors are prone to elevated risk for several psychiatric and somatic complications, including complicated grief (CG) and depression. Recent studies have highlighted the possibility of posttraumatic growth (PTG) among suicide survivors. However, to date, no longitudinal study has focused on the relationships between CG and PTG among suicide survivors.

AIMS

In this 18-month longitudinal design study, our goal was to investigate the longitudinal bidirectional associations between PTG and CG, as well as between PTG and depression among suicide survivors.

METHOD

Participants were156 suicide-loss survivors, aged 18-70, who completed questionnaires tapping the CG and PTG at T1 and again after 18 months (T2). Depression was measured only at T2.

RESULTS

The integrated model showed that CG-T1 predicts a reduction in PTG-T2 levels, beyond the trajectory of PTG. Whereas PTG-T1 was negatively correlated with CG-T2 and with depression at T2, this path was only marginally significant in the model.

LIMITATIONS

Voluntary nature of the participants; self-report measures; lack of pre-suicide-loss assessment.

CONCLUSION

The study's findings suggest that CG levels play an important role in facilitating PTG among suicide survivors, with high CG levels impeding the possibility of growth. PTG did not act as a coping strategy to reduce CG. Clinical and research implications are discussed.

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.

Risks of suicide among family members of suicide victims: A nationwide sample of South Korea

OBJECTIVE

Identifying the risks of completed suicide in suicide survivors is essential for policies supporting family members of suicide victims. We aimed to determine the suicide risk of suicide survivors and identify the number of suicides per 100,000 population of suicide survivors, bereaved families of traffic accident victims, and bereaved families with non-suicide deaths.

METHODS

This was a nationwide population-based cohort study in South Korea. The data were taken from the Korean National Health Insurance and Korea National Statistical Office between January 2008 and December 2017. The relationship between the decedent and the bereaved family was identified using the family database of the National Health Insurance Data. Age and gender were randomly matched 1:1 among 133,386 suicide deaths and non-suicide deaths. A proportional hazard model regression analysis was conducted after confirming the cumulative hazard using Kaplan-Meier curves to obtain the hazard ratio (HR) of completed suicide in suicide survivors.

RESULTS

Using 423,331 bereaved families of suicide victims and 420,978 bereaved families of non-suicide deaths as the control group, HR of completed suicide in suicidal survivors was found to be 2.755 [95% confidence limit (CL): 2.550-2.977]. HR for wives committing suicide after husbands' suicide was 5.096 (95% CL: 3.982-6.522), which was the highest HR among all relationships with suicide decedents. The average duration from suicide death to suicide of family members was 25.4 months. Among suicide survivors, the number of suicides per 100,000 people was 586, thrice that of people in bereaved families of traffic accident victims and in bereaved families of non-suicide deaths.

CONCLUSION

The risk of completed suicide was three times higher in suicide survivors than in bereaved families with non-suicide deaths, and it was highest in wives of suicide decedents. Thus, socio-environmental interventions for suicidal survivors must be expanded.

An integrative systematic review of online resources and interventions for people bereaved by suicide

Suicide bereavement is frequent in the general population and it can have deleterious consequences on the mental health and social functioning of the bereaved individuals. However, those bereaved can face substantial barriers to receive support, and online resources may improve the accessibility of support. This systematic review aimed at examining the use and benefits of online resources dedicated to people bereaved by suicide and appraising the quality of the research in this field. Systematic review according to PRISMA guidelines, involving searches in Pubmed, Scopus and Web of Science, conducted in August 2020. The integrative systematic review involved extracting and merging qualitative and quantitative data. Quality assessment was conducted with the Mixed Methods Appraisal Tool (MMAT). The review included 12 studies, mostly of moderate quality. Online resources are predominantly used by middle-aged women, parents who lost their child by suicide, and recently bereaved individuals. Online resources offer a way for help-seeking around the clock for less educated, more disadvantaged and isolated people. People bereaved by suicide use online resources to seek and share support, share and find information, memorialize their loved one and for meaning-making. Negative effects of online resources are rare. The evidence on the use and benefits of online resources for people bereaved by suicide remains scarce but show encouraging results regarding their positive impact on the mental and psychosocial health of the users.

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.

Sinnverneinung. Warum der assistierte Suizid uns alle angeht

Der Artikel beantwortet die Frage nach der ethischen Bewertung des assistierten Suizids auf neue Weise: indem er die Verneinung von Lebenssinn, wie sie sich in Suiziden oft ausspricht, in den Mittelpunkt rückt. Anders als üblich fasst er die Sinnfrage nicht als bloß individualethische, sondern als sozialethische Angelegenheit auf. Denn der nahezu unvermeidbaren Orientierung am Ziel eines sinnvollen Lebens ist eine grundlegende soziale Verbindung eingeschrieben: eine implizite Wertschätzung von Menschen als potenziellen Sinnquellen und als Subjekten von Urteilen über Lebenssinn. Suizide neigen dazu, diese Verbindung zu negieren. Dieses Verständnis des Suizids kann eine Reihe von evaluativen und normativen Annahmen aufklären und begründen, die in der Debatte um den assistierten Suizid eine prominente Rolle spielen.

Places of living and places of dying: the case for preventing suicide in residential long-term care

This commentary addresses the increasing public health problem of suicide in later life and presents the case for preventing suicide in residential long-term care settings. We do so by examining this issue from the perspective of three levels of stakeholders - societal, organisational and individual - considering the relevant context, barriers and implications of each. We begin by discussing contemporary societal perspectives of ageing; the potential impact of ageism on prevention of late-life suicide; and the roles of gender and masculinity. This is followed by a historical analysis of the origin of residential long-term care; current organisational challenges; and person-centred care as a suicide prevention strategy. Finally, we consider suicide in long-term care from the perspective of individuals, including the experience of older adults living in residential care settings; the impact of suicide on residential care health professionals and other staff; and the impact of suicide bereavement on family, friends and other residents. We conclude with recommendations for policy reform and future research. This commentary aims to confront the often unspoken bias associated with preventing suicide among older adults, particularly those living with complex medical conditions, and invoke an open dialogue about suicide prevention in this population and setting.

Exposure to suicide in the family and suicidal ideation in Portugal during the Covid-19 pandemic: The mediating role of unbearable psychache

Objectives

This study tested the mediation effects of two facets of psychache – bearable and unbearable – in the relationship between exposure to suicide in the family and suicidal ideation in Portugal during the Covid‐19 pandemic.

Methods

Two hundred and forty‐four adults aged between 19 and 64 participated. Two groups were defined: one exposed to suicide in the family (n = 42) and a control group (n = 192).

Results

Path analysis using structural equation modelling tested a mediation model. Results demonstrated that unbearable psychache fully mediated the relationship between exposure to suicide and suicidal ideation, even when controlling for the mediation effects of depressive symptoms, the presence of a psychiatric diagnosis, and years of education.

Conclusions

These results suggest that rather than considering just the global experience of psychache in individuals exposed to suicide, researchers and clinicians should look to the presence of unbearable psychache given its contribution to suicidal ideation.

Practitioner points

Unbearable psychache fully mediated the relationship between exposure to suicide in the family and suicidal ideation

It is not the global experience of psychache that contributes to suicide ideation in individuals exposed to suicide in the family rather the presence of unbearable psychache

The longitudinal contribution of attachment models and interpersonal factors to posttraumatic growth among suicide-loss survivors

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.

Pulling Together - The Protective Role of Belongingness for Depression, Suicidal Ideation and Behavior Among Suicide-Bereaved Individuals

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.

Workplace exposure to suicide among Australian mental health workers: A mixed-methods study

Workplace exposure to suicide attempts and deaths has been widely recognized as an occupational hazard for mental health and social care workers, including mental health nurses. Research consistently demonstrates the adverse impact on professionals. This paper explores the results of an online survey examining suicide exposure and impact. Of the 3010 Australian adult participants who identified exposure to suicide attempts and/or deaths in a larger study, 130 indicated that the most impactful suicide attempt and/or death exposure was that of a client or service user. While distress levels were relatively low among participants with workplace exposure, the qualitative content from 53 participants provides illumination into this experience. Themes that emerged in the qualitative responses include impact on the professional, organization response, and lack of adequate resources and supports to prevent suicide. Previous research has examined the impact of suicide exposure among professionals specifically, but this is the first known study of participants in a community sample who identified the most impactful suicide attempt or death exposure they had experienced was that of a client in a mental health setting. Workplace exposure among mental health workers is common and can have both deleterious and positive effects. Bereavement focused outcomes, where the loss of an attachment relationship is the focus, does not capture the full range of experiences in workplace exposure. Systemic issues in mental health care contribute to further distress among exposed workers, and this requires additional investigation and response.

Parental death by external causes and risk of hospital-treated deliberate self-harm in bereaved offspring

Previous studies have reported an increased risk of hospital-treated deliberate self-harm (DSH) in offspring who have lost a parent, but inconclusive findings regarding differences between loss from suicide and accidents. The present study aimed to investigate the association between parental death by external causes before age 18 and hospital-treated DSH, and potential differences between different accidents and suicide. This nested-case-control study was based on data from longitudinal Norwegian registers. Subjects comprised 12,526 people born between 1970 and 2003 who received acute somatic treatment because of DSH at hospitals and associated services between 2008 and 2013 (cases), and 222,362 controls matched for gender and date of birth with no recorded DSH treatment. Information concerning deceased parent's death and offspring's DSH treatment and socioeconomic data was merged. Data were analysed with conditional logistic regression. Results indicated that offspring who had lost a parent to suicide (OR 2.32, 95% CI 1.92-2.80) and death by accidents such as falls, poisoning, and drowning (OR 1.79, 95% CI 1.38-2.33) had a significantly increased risk of hospital-treated DSH compared to offspring who had not experienced such loss. Parental bereavement from transport accidents and other external causes were not associated with significantly increased risks. No differences were evident for different genders of deceased, ages at bereavement, or genders of bereaved. The improved identification of bereaved offspring at particular risk of hospital-treated DSH should be utilized to implement effective prevention and treatment programs in specialist healthcare aimed at the individuals at highest risk.

Do interpersonal events buffer or worsen depressive and grief related symptoms in people bereaved through suicide?

Life events can heighten emotional suffering related to the loss of a close relative or friend by suicide, while supportive social relationships may promote coping. We investigated the impact of stressful events and perceived social support on depressive and grief symptoms in 378 help-seeking Italians bereaved through suicide. While we did not observe a significant effect of interpersonal stressors, perceived social support did have a buffering role on the intensity of depressive symptoms but not of grief-related suffering. Focusing on expanding and capitalizing on clients' perceived social networks could strengthen postvention programs. Further research on the role of interpersonal factors is needed.

Reasons for living among those with lived experience entering the suicide prevention workforce

This study explored reasons for living among those with lived experience of suicide entering the suicide prevention workforce. The study recruited 110 participants from two Roses in the Ocean training programs (79% female, mean age 46.5). Responses to open-ended survey questions about reasons for living were analyzed using qualitative content analysis method. Connection to others and service were the most commonly stated reasons for living. Other categories included orientation toward future, life, self, pleasure, and spiritual reasons and values. These findings can be used in further research and design of support programs for peer specialists.

Making Sense of the Unique Pain of Survivors: A Psychoeducational Approach for Suicide Bereavement

Grief, guilt, abandonment, anger, shame, and rejection are the most common feelings experienced by suicide survivors, who differ from other bereaved individuals for the intensity of these feelings. Moreover, suicide risk and psychiatric disorders associated with suicidality are more frequent in people who have lost a loved person by suicide. Given the complexity and the consequences linked to the suicide of a loved person, it is necessary to act promptly. Among the various strategies, psychoeducation has proved effective for several mental disorders and for suicide bereavement. It is a therapeutic intervention aimed at identifying and understanding the psychological features associated with the mental pain of suicide survivors, to facilitate the management of the illness and the recognition of relationships in the social environment. We developed a psychoeducational group that took place at the Suicide Prevention Center of the Sant'Andrea Hospital in Rome. It was a homogeneous, finite-group composed of 8-12 suicide survivors and conducted by two trained psychologists supervised weekly by the Director of the Suicide Prevention Center. The intervention comprised 21 weekly sessions of 90 min. Each session concerned a determined topic and began with the presentation of the issue, continued with specific exercises, and finished with a group discussion. The main goals of the group were to provide support, normalize the reactions of the survivors, and assist them in reducing their emotional suffering and their thoughts about suicide, investigate the potential presence of suicide risk, implement prevention strategies, and integrate the loss of the loved person. The psychoeducational approach we delivered for suicide survivors allows individuals to interact with other individuals in the same situation in order to help them resume the normal course of life, placing the suicide of a loved person in a broader perspective.

Suicidal Thoughts and Behaviors Among Swedish Suicide-Bereaved Women: Increased Risk Associated With the Loss of a Child, Feelings of Guilt and Shame, and Perceived Avoidance From Family Members

Previous studies have shown that suicide-bereaved individuals may suffer increased risk of suicidal thoughts and behaviors (STBs) due to traumatic grief. In this paper, we present the self-reported rate of STB among Swedish suicide-bereaved women (N = 293). Data was collected in a cross-sectional anonymous survey on the homepages of Sweden’s leading suicide survivor organization, SPES. We used logistic regression to evaluate risks (of any STB event) related to losing a child compared to other relatives and the experience of social avoidance from family members, as well as feelings of shame and guilt. The self-reported rate of suicidal thoughts, plans, and attempts was 60, 24, and 5 percent, respectively, considerably higher than in the general population. Results showed that all of the investigated variables were independent risk factors for STB (ORs ranged between 1.29 and 2.69). Women who had both lost a child and experienced family avoidance reported the highest STB rate (87.5%), and we found an interaction effect between these two risk factors (OR = 3.45; 95% CI = 1.05–11.32) that was related to self-reported shame. It is concluded that perceived responsibility for someone else’s suicide, and the social avoidance associated with it, may play an important role for suicide survivors and should be targeted by postvention activities.

Komplizierte Trauer erfassen: Ein systematischer Review

Ziel Überblick englisch- und deutschsprachiger Messinstrumente zur Diagnostik von klinisch relevanten Trauerverläufen und Trauer in ihrer Multidimensionalität.

Methodik Systematischer Literaturreview.

Ergebnisse Insgesamt konnten 22 Inventare extrahiert werden, die sich unterteilen lassen in allgemeine und spezielle Verfahren zur Akutdiagnostik sowie Verfahren zur Früherkennung. Alle Inventare weisen überwiegend gute psychometrische Kennwerte auf.

Diskussion International existiert eine Vielzahl an Messverfahren. Für den deutschen Sprachraum liegen 3 allgemeine und 3 spezielle Inventare vor.

Schlussfolgerung Bislang fehlen deutschsprachige Verfahren zur Früherkennung schwieriger Trauerverläufe.

Lessons Learned: Forty Years of Clinical Work With Suicide Loss Survivors

The author has been a grief therapist in private practice for almost 40 years. The largest percentage of his clients have been suicide loss survivors, and in this article, the author reflects on the “lessons learned” about how grief therapy with survivors is both the same as, and very different from, work with clients bereaved after other types of losses. After briefly reviewing some of the empirical literature about differences between suicide bereavement and grief after other modes of death, the author argues that perhaps the most distinguishing and difficult aspect of a suicide loss is the “perceived intentionality” of the death, and the related “perceived responsibility” for the death. The author goes on to identify a number of tasks of psychological reintegration after a suicide loss that can serve as a template for treatment goals for clinicians and clients alike. These include the cultivation of a very specific type of secure and nurturing therapeutic alliance; extensive psychoeducation about suicide, trauma, and grief; the need to help the client repair the psychological continuing bond with the deceased; and providing gentle support for the survivor in rebuilding an assumptive world that has been shattered by the suicide of a loved one. Finally, the article concludes with a discussion of the clinical implications of these differences for work with suicide loss survivors.

Emotional Distress Among Suicide Survivors: The Moderating Role of Self-Forgiveness

Grief after suicide entails unique challenges and difficulties, such as intense feelings of anger and guilt, as well as various psychological risks. The current study examined the contribution of self-forgiveness (SF) to emotional distress (e.g., depressed mood and suicidal ideation) among suicide-loss survivors, compared with bereavement following sudden and expected death types. Bereaved individuals (N = 309; aged 18-84) completed questionnaires measuring SF, depressed mood, suicidal ideation, demographics, and personal characteristics concerning the bereavement. A significant interaction between SF and type of loss was found, in which suicide-loss survivors with low levels of SF manifested the highest levels of depression and suicidal ideation compared with other subgroups. The findings reflect the importance of SF as a protective factor against depression and suicidality among suicide-loss survivors as well as the possible efficacy of forgiveness-based interventions in this population.

Feelings of Blameworthiness and Their Associations With the Grieving Process in Suicide Mourning

AIMS

This study focuses on identifying the correlates associated with the emergence of feelings of blameworthiness associated with a suicide or other traumatic death and its associations with grief complications.

METHODS

Based on a mailed questionnaire survey of 575 mostly white and economically advantaged bereaved parents, 462 who lost a child to suicide, 48 to a drug overdose, 37 to ordinary accidents, and 24 to natural causes, we utilized chi-square tests, correlations and multiple regression analysis to compare and contrast patterns in the data.

RESULTS

Findings showed feelings of blameworthiness associated with grief difficulties, complicated grief, PTSD, depression and other mental health difficulties among suicide bereaved parents. Results among suicide bereaved parents also showed that being stigmatized by socially significant others, having a mixed or negative relationship with the deceased child prior to the death and a less happy marriage, among those presently married couples, all contributed to higher feelings of blameworthiness among these bereaved.

CONCLUSION

Based on these findings, feelings of blameworthiness could serve as a good shorthand indicator of grief problems since it correlates so well with other grief difficulties and mental health problem measures. The importance of peer support is essential for avoiding the downward spiral associated with feelings of blameworthiness that can occur at any time during the grieving process.

The Monetary Value of Human Lives Lost to Suicide in the African Continent: Beating the African War Drums

Background: Suicide is an important public health problem in the African continent whose economic burden remains largely unknown. This study estimated the monetary value of human lives lost due to suicide in the African continent in 2017. Methods: The human capital approach was applied to monetarily value the years of life lost due to premature mortality from suicide deaths (SD) among 54 African countries. A 3% discount rate was used to convert future losses into their present values. The sensitivity of monetary value of human lives lost to changes in discount rate and average life expectancy was tested. Results: The 75,505 human lives lost from suicide had a grand total monetary value of International Dollars (Int$) 6,989,963,325; and an average present value of Int$ 92,576 per SD. About 31.1% of the total monetary value of SD was borne by high-income and upper-middle-income countries (Group 1); 54.4% by lower-middle-income countries (Group 2); and 14.5% by low-income countries (Group 3). The average monetary value per human life lost from SD was Int$ 234,244 for Group 1, Int$ 109,545 for Group 2 and Int$ 32,223 for Group 3. Conclusions: Evidence shows that suicide imposes a substantive economic burden on African economies. The evidence reinforces the case for increased investments to ensure universal coverage of promotive, preventive, curative and rehabilitative mental health services.

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

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

Coping Strategies and Considering the Possibility of Death in Those Bereaved by Sudden and Violent Deaths: Grief Severity, Depression, and Posttraumatic Growth

BACKGROUND

Bereavement by sudden and violent deaths can lead to increased grief severity, depression, and reduced posttraumatic growth compared to those bereaved by natural causes. These outcomes can be affected by coping strategies and whether a survivor had been "prepared" for the death. The present study examined the effect of coping and considering the possibility of death on grief severity, depression, and posttraumatic growth in those bereaved by sudden deaths.

METHODS

Participants bereaved by suicide, accident, or combat deaths completed an online survey about demographics (including the cause of death), coping, grief severity, depression, and posttraumatic growth. A factor analysis of the coping measure yielded factors representing three coping strategies: avoidant coping, supportive coping, and active coping. These three strategies, the causes of death and considering the possibility of death were used as predictors of either grief severity, depression, or posttraumatic growth in multivariate linear regression models.

RESULTS

Each coping strategy and cause of death was differentially associated with grief severity, depression, and posttraumatic growth. Specifically, supportive coping and active coping were each only associated with higher posttraumatic growth. In contrast, avoidant coping was associated with all outcomes (higher grief severity and depression and lower posttraumatic growth). In addition, accidents and suicides (compared to combat deaths) had independent effects on grief severity and posttraumatic growth. Considering the possibility of death interacted with avoidant coping and also with supportive coping to predict grief severity in combat-loss survivors.

DISCUSSION

Findings highlight the differential contributions of coping strategies and their complex relationships with cause of death in contributing to grief severity, depression, and posttraumatic growth. Avoidant coping contributed to negative outcomes and inhibited posttraumatic growth, suggesting its importance as a target for therapeutic intervention. Although supportive and active coping facilitated posttraumatic growth, they had less of a role in mitigating grief severity or depression in this study. Although considering the possibility of death appeared to mitigate negative outcomes among survivors of combat death, avoidance of that possibility is likely protective for the majority of family members whose loved ones return home safely.

Survivors' perceptions of support following a parent's suicide

Children who experience a parent's suicide are vulnerable to an increased risk for mental health disorders and suicide attempts. In this study, 17 adults, each a child survivor of their parent's suicide, shared their perceptions of support following the suicide. Helpful experiences included opening communication about suicide and offering individualized support. Unhelpful experiences included judgment and blame, silence regarding suicide, and a heightened awareness of the surviving parent's challenges. Individuals most helpful in meeting the child's needs included those with preexisting relationships. In particular, our findings emphasize the critical need for honest, open, and age-appropriate communication about the parent's suicide.

Non-suicidal self-injury, suicide ideation, and past suicide attempts: Comparison between transgender and gender diverse veterans and non-veterans

BACKGROUND

Transgender and gender diverse (TGD) individuals, especially veterans, experience elevated rates of non-suicidal self-injury (NSSI) and suicide related behaviors compared to gender majority individuals. Research has yet to compare TGD veterans to non-veterans or look at correlates of NSSI and related behaviors to suicide related outcomes. This study examines prevalence and suicide related correlates of NSSI among TGD veterans and TGD non-veterans.

METHOD

Data analyzed in the were part of the Trans Lifeline Mental Health Survey. Both TGD veterans (N = 313) and non-veterans (N = 3,972) completed an online, cross-sectional survey that included self-report measures of NSSI, suicidal ideation (SI), and suicidal attempt (SA) along with lifetime hospitalization and avoidance of care due to NSSI.

RESULTS

Results of this paper indicate that prevalence of NSSI, SI, and SA are elevated in both the TGD veterans and non-veteran subpopulations. Further, veterans compared to non-veterans have a lower prevalence of NSSI but higher prevalence of hospitalization when self-harm is inflicted, reflecting more healthcare utilization or increased severity of NSSI episodes. Additionally, veterans were less likely to avoid care due to NSSI. Further, veteran status seemed to be a protective factor against demographic differences that increased rates of NSSI history in non-veteran TGD individuals.

LIMITATIONS

The limitations of this study include its cross-sectional study design, one question assessing SA, and few TGD male veterans.

CONCLUSION

NSSI is an important risk factor in future suicide related outcome such as SI and SA. Further, differences in healthcare utilization among TGD veterans and non-veterans are apparent.