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.

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.

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.

Published: 12/10/2020
Report no: ut202035
Registration no: SBU 2020/723