Interventions for people bereaved through suicide

Experiencing bereavement through suicide is a major stressor that increases the risks of social, physical and mental problems and suicidal behaviour. There is a need for psychosocial and professional support programs for people bereaved by suicide.

SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Question

What systematic reviews are there on the effects of bereavement interventions for suicide survivors?

Identified literature

Three relevant systematic reviews with low/medium risk of bias were identified [1−3]. In addition, one primary study was identified [4]. The primary study was not assessed for risk of bias.

Table 1. Systematic reviews with low/medium risk of bias.

Included studies Population/Intervention Outcome
Andriessen at al 2019a [1]
8 publications (literature search restricted to year 2014 to 2019)

3 controlled studies: 2 RCT and one retrospective cross-sectional study

5 studies without control group

Overall study quality was weak

In addition, 12 guidelines are summarised.
Population:
Mainly first degree family members

Interventions in original studies:
Suicide postvention in the controlled studies:
1. CBT-based psychoeducation compared to no treatment.
2. Intensive grief therapy program with antidepressant medication compared to Intensive grief therapy program without antidepressant medication.
3. Community based crisis response team (StandBy) compared no postvention

Time to assessment ranged from shortly after intervention up to 12 months follow-up.
Outcomes in controlled studies:
Different scales and indexes in the three studies including:
Scales for quality of life, grief or complicated grief, psychological distress, suicidality, depressive symptoms, work performance, impaired relationship, index of capability

Narrative summary of effects in controlled studies:
The community-based crisis intervention program reported decreases in suicidality. Other measures yielded mixed results regarding grief, mental health or suicidality by the community based crisis intervention, mindfulness-based retreat and CBT-based psychoeducation.
Authors' conclusion:
“Hence, while some evidence is emerging, this review found little evidence of effective models of postvention service delivery”
Andriessen et al 2019b [2]
12 publications reporting on 11 studies.
Prospective controlled studies conducted in USA (8 studies), the Netherlands (1), Australia (1) and Belgium (1).
Overall study quality was weak
Population:
People bereaved by suicide.
First degree relatives or spouses (7 studies, 8 publications), Students with a deceased friend or other bereaved (4 studies)
Interventions in original studies:
Group interventions (6 studies: 3 with active control interventions, 3 with passive)
Family-oriented interventions (2 studies with passive control interventions, 1 with treatment as usual)
Individual interventions (2 studies with active control interventions).
The duration varied from one session in one study to a series of more than 20 weeks in another.
Outcome was measured immediately post-intervention in some studies and up to 8 months after in others.
Outcomes:
Study findings includes grief, psychosocial and suicide-related outcomes.
Narrative summary of effects:
While there was some evidence of the effectiveness of interventions for uncomplicated grief, evidence of the effectiveness of complicated grief was lacking.
Interventions which seem to show promise include supportive, therapeutic and educational approaches, involve the social environment of the bereaved, and comprise a series of sessions led by trained facilitators.
Authors' conclusion:
“There is a clear need for additional methodologically sound studies in this area. Specifically, selection procedures, sample sizes, randomization, and the use of appropriate measures are crucial. As people bereaved by suicide are at risk of adverse grief, mental ill-health, and suicidal behaviour further research across the life-span is essential to prevent grief and mental health ramifications.”
Linde et al 2017 [3]
7 studies were included

Prospective intervention studies with follow-up or pre- post measurements.

Studies were conducted in the USA (4), the Netherlands (1), Canada (1) and Belgium (1).
Overall study quality was weak
Population:
People at high risk for complicated grief such as children, parents, partners (4 studies) spouses or partners to the deceased (2).

Intervention:
Secondary or tertiary preventive interventions designed for people with high risk for, or experiencing, complicated grief.

Group interventions (5 studies: 1 pre-post measurement, 2 with active control interventions, 2 with inactive control interventions)

Individual intervention (1 with an active control intervention)

Mixed group/individual (1 with an inactive control intervention)
Interventions lasted between 2 to 16 weeks, in the majority about eight weeks.

Outcome was measured directly post-intervention in 5 of the studies. In two studies follow-up ranged between six to 12 months.
Outcome:
Uncomplicated and complicated grief, suicide related outcomes

Narrative summary of effects:
Five of the seven interventions were effective in reducing grief intensity on at least one outcome measure.

Bereavement groups tend to be effective in lowering the intensity of uncomplicated grief, as are writing interventions in lowering suicide-specific aspects of grief.

Cognitive behavioural programs were helpful for a subpopulation of people who had high levels of suicidal ideation.
Authors' conclusion:
“Studies investigating grief interventions for suicide survivors are rare and the results of these studies need to be interpreted with caution due to notable methodological limitations. Nevertheless, the preliminary results indicate some positive effects of interventions in reducing grief intensity and suicide-specific aspects.”

References

  1. Andriessen K, Krysinska K, Kolves K, Reavley N. Suicide Postvention Service Models and Guidelines 2014-2019: A Systematic Review. Front Psychol. 2019;10:2677.
  2. Andriessen K, Krysinska K, Hill NTM, Reifels L, Robinson J, Reavley N, et al. Effectiveness of interventions for people bereaved through suicide: a systematic review of controlled studies of grief, psychosocial and suicide-related outcomes. BMC Psychiatry. 2019;19(1):49.
  3. Linde K, Treml J, Steinig J, Nagl M, Kersting A. Grief interventions for people bereaved by suicide: A systematic review. PLoS ONE. 2017;12(6). Available from: https://doi.org/10.1371/journal.pone.0179496.
  4. Gehrmann M, Dixon SD, Visser VS, Griffin M. Evaluating the Outcomes for Bereaved People Supported by a Community-Based Suicide Bereavement Service. Crisis. 2020:1-8.
Published: Report no: ut202035 Registration no: SBU 2020/723

Literature search

MedLine via Ovid 2020-09-21

Suicide bereavement support

/ = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ab,ti = Abstract or title; .tw = Abstract or title; .kf = Keywords; .kw = Keywords, exact; .af = All fields; AdjX = Proximity operator with a specified number , adj3 retrieves records with search terms within two terms from each other; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. Suicide/ or Suicide, Completed 39 463
2. Exp Bereavement/ 13 358
3. (suicide adj8 (bereave* or grie* or mourn* or loss)) .ab,kf,ti 833
Intervention:
4. Exp Social Support/ 71 565
5. Self-Help Groups/ 9 128
6. Exp Psychotherapy/ 196 579
7. Exp Counseling/ 44 235
8. Community Mental Health Services/ 18 554
9. Or/4-8 321 746
10. Postvention*.ab,kf,ti 168
11. Support*.ab,kf,ti 1 568 851
12. Intervention*.ab,kf,ti 1 019 239
13. Counsel*.ab,kf,ti 111 488
14. Group*.ab,kf,ti 3 773 897
15. outreach.ab,kf,ti 13 980
16. Therap*.ab,kf,ti 2 975 126
17. Psychotherap*.ab,kf,ti 47 039
18. Service*.ab,kf,ti 536 185
19. Or/10-18 8 185 054
Combined sets:
20. 1 and 2 and 9 248
21. 3 and 19 533
22. 20 or 21 672
Limits:
23. Specific year range: 2000 - 512
Final   512

Scopus via scopus.com 2020-09-21

Suicide bereavement support

TLE-ABS-KEY = Title, abstract or keywords; ALL = All fields; W/x = Proximity operator with a specified number , W/3 retrieves records with search terms within three terms from each other; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. TITLE-ABS-KEY(suicide W/7 (bereave* OR grie* OR mourn* OR loss)) 1 288
Intervention:
2. TITLE-ABS-KEY(postvention*) 269
3. TITLE-ABS-KEY(support*) 5 441 691
4. TITLE-ABS-KEY(intervention*) 1 470 028
5. TITLE-ABS-KEY(counsel*) 244 639
6. TITLE-ABS-KEY(group*) 8 424 851
7. TITLE-ABS-KEY(outreach) 30 749
8. TITLE-ABS-KEY(therap*) 5 541 536
9. TITLE-ABS-KEY(psychotherapy*) 161 764
10. TITLE-ABS-KEY(service*) 2 657 901
11. 2 OR 3 OR […] 10 19 740 574
Combined sets:
12. 1 AND 11 877
Limits:
13. 2000 - 692
Final   692

Embase via embase.com 2020-09-21

Suicide bereavement support

/de = Term from the EMTREE controlled vocabulary; /exp = Term from EMTREE including terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ti,ab,kw = Title, abstract or author keywords; NEAR/x = Proximity operator with a specified number , NEAR/3 retrieves records with search terms within two terms from each other; * = Truncation; ’ ’ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. ‘suicide’/exp 59 665
2. ‘bereavement support’/exp 783
3. ‘bereavement’/exp 9 048
4. ‘grief’/exp 13 235
5. 3 OR 4 19 752
6. 1 AND 2 33
7. 1 AND 5 987
8. (suicide NEAR/8 (bereave* OR grie* OR mourn* OR loss)) :ti,ab,kw 955
Intervention:
9. ‘support group’/exp 12 491
10. ‘psychotherapy’/exp 273 302
11. 15 OR 16 284 156
12. Postvention*:ti,ab,kw 180
13. Intervention*:ti,ab,kw 1 419 451
14. Support*:ti,ab,kw 2 011 002
15. Counsel*:ti,ab,kw 161 411
16. Group*:ti,ab,kw 5 246 057
17. outreach:ti,ab,kw 19 817
18. Therap*:ti,ab,kw 4 194 717
19. Psychotherap*:ti,ab,kw 67 150
20. Service*:ti,ab,kw 707 511
21. 12 OR 13 OR […] 20 10 984 326
Combined sets:
22. 7 AND 11 153
23. 8 AND 21 615
24. 6 OR 22 OR 23 736
Limits:
25. Publication year: 2000 - 598
Final   598

PsycInfo via ebsco.com 2020-09-21

Suicide bereavement support

The search result, usually found at the end of the documentation, forms the list of abstracts; DE = Term from the APA thesaurus of Psychological Index Terms; MA = Term from the MeSH controlled vocabulary; SU = All keyword terms, including author keywords, MeSH terms, and APA Psychological Index terms; TI = Title; AB = Abstract; TX = All Text. Performs a keyword search of all the database's searchable fields; Nx = Proximity operator with a specified number , N3 retrieves records with search terms within three terms from each other; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. DE “Suicide” 32 300
2. DE “Bereavement” OR DE “Grief” 16 835
3. TI (suicide N7 (bereave* OR grie* OR mourn* OR loss)) OR AB (suicide N7 (bereave* OR grie* OR mourn* OR loss)) OR SU (suicide N7 (bereave* OR grie* OR mourn* OR loss)) 1 388
Intervention:
4. DE “Support Groups” OR DE “Group Psychotherapy” OR DE “Mental Health Services” OR DE “Community Mental Health Services” OR DE “Psychotherapy” 145 156
5. TI(postvention* OR intervention* OR support* OR counsel* OR group* OR outreach OR therapy OR psychotherapy OR service*) OR AB(postvention* OR intervention* OR support* OR counsel* OR group* OR outreach OR therapy OR psychotherapy OR service*) OR SU (postvention* OR intervention* OR support* OR counsel* OR group* OR outreach OR therapy OR psychotherapy OR service*) 2 212 930
Combined sets:
6. 1 AND 2 AND 4 126
7. 3 AND 5 963
8. 6 OR 7 1 003
Limits:
9. Source type: Academic Journals 714
10. 2000 478
Final   478

CINAHL via ebsco.com 2020-09-21

Suicide bereavement support

MW = Word in CINAHL Subject Heading; MH = Exact CINAHL Subject Heading; SU = All keyword terms, including author keywords and subject headings; TI = Title; AB = Abstract; TX = All Text. Performs a keyword search of all the database's searchable fields; Nx = Proximity operator with a specified number , N3 retrieves records with search terms within three terms from each other; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. (MH “Suicide”) 18 682
2. (MH “Bereavement+”) 14 099
3. TI (suicide N7 (bereave* OR grie* OR mourn* OR loss)) OR AB (suicide N7 (bereave* OR grie* OR mourn* OR loss)) OR SU (suicide N7 (bereave* OR grie* OR mourn* OR loss)) 586
Intervention:
4. (MH “Support Groups”) 10 611
5. (MH “Psychotherapy”) 20 988
6. 4 OR 5 31 435
7. TI(postvention* OR intervention* OR support* OR counsel* OR group* OR outreach OR therapy OR psychotherapy OR service*) OR AB(postvention* OR intervention* OR support* OR counsel* OR group* OR outreach OR therapy OR psychotherapy OR service*) OR SU (postvention* OR intervention* OR support* OR counsel* OR group* OR outreach OR therapy OR psychotherapy OR service*) 2 959 242
Combined sets:
8. 1 AND 2 AND 6 65
9. 3 AND 7 392
10. 8 OR 9 428
Limits:
11. Academic Journals 345
12. Publication Date: 2000 318
Final   318
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