What do Suicide Survivors Tell Us They Need? Results of a Pilot Study

Few studies have examined the natural coping efforts used by suicide survivors, or have identified specific problems and needs survivors experience following the death of a significant other by suicide. In the present study, we used a newly developed needs assessment survey to examine four areas of natural coping efforts: practical, psychological, and social difficulties; formal and informal sources of support; resources utilized in healing; and barriers to finding support since the loss. Sixty-three adult survivors of suicide were recruited from suicide survivor conferences and support groups. Results indicate that participants experienced high levels of psychological distress since the suicide, including elevated symptoms of depression, guilt, anxiety, and trauma. Participants experienced substantial difficulties in the social arena (e.g., talking with others about the suicide). The majority of the sample viewed professional help as beneficial; although many informal sources of support were also valued (e.g., one-to-one contact with other survivors). Depression and a lack of information about where to find help served as barriers to help-seeking behaviors for our participants. Participants who reported higher levels of functional impairment were more likely to report higher levels of psychological distress, social isolation, and barriers to seeking help. Future research with a longitudinal and more inclusive sample is needed to build on these preliminary findings and to provide a solid foundation for evidenced-based interventions with survivors.     

Suicide survivors seeking mental health services: a preliminary examination of the role of an active postvention model

Archival data from suicide survivors presenting for treatment from 1999-2005 at the Baton Rouge Crisis Intervention Center (BRCIC) were used to examine differences in those who received an active model of postvention (APM; n=150) compared to those who received a traditional passive postvention (PP, n=206). APM presented sooner for treatment (48 days) than PP (97 days). APM survivors were more likely to have been the survivor of a violent suicide. APM were more likely than PP to attend survivor support group meetings and APM attended more groups. To better understand the efficacy of APM in helping survivors, a prospective evaluation is needed.     

Support Groups for Suicide Survivors: Results of a Survey of Group Leaders

To update and expand Rubey and McIntosh's (1996) survivors of suicide support groups report, SPAN USA completed a survey of U.S. support group leaders (n = 100; 24% completion). There are now more survivor groups (from 280 to 417), and the majority of groups now have a survivor leader (78% vs. 25%). Groups continue to be small (88% < 10 members per session) and meet on a monthly basis (55%). Sharing continues to be a universal experience in groups, which tend to be open‐ended (85%). Current groups are newer, and more operate without a sponsor. Further research is needed to examine group member perspectives and effectiveness of groups.     

Suicide survivors' mental health and grief reactions: a systematic review of controlled studies

There has been a debate over several decades whether suicide survivors experience more severe mental health consequences and grief reactions than those who have been bereaved through other causes of death. This is the first systematic review of suicide survivors' reactions compared with survivors after other modes of death. Studies were identified by searching the PsychINFO and MEDLINE databases. Forty-one studies met the eligibility criteria. A qualitative data analysis was performed. There were no significant differences between survivors of suicide and other bereaved groups regarding general mental health, depression, PTSD symptoms, anxiety, and suicidal behavior. The results regarding the overall level of grief are less clear, depending on whether general grief instruments or suicide-specific instruments are used. Considering specific grief variables, suicide survivors report higher levels of rejection, shame, stigma, need for concealing the cause of death, and blaming than all other survivor groups.     

Development of the Grief Experience Questionnaire

The development of the Grief Experience Questionnaire (GEQ) is reported. This questionnaire is an instrument for measuring various components of grief, including somatic reactions, general grief reactions, search for explanation, loss of social support, stigmatization, guilt, responsibility, shame, rejection, self-destructive behavior, and reactions to a unique form of death. Initial results with the GEQ suggest its potential to differentiate grief reactions experienced by suicide survivors from those experienced by survivors of accidental death, unexpected natural death, and expected natural death. Conclusions support its use in redressing common methodological criticisms of suicide survivor research. Six additional benefits derived from use of this instrument are discussed.     

Christian-based counseling for the suicide survivor: a guide for pastoral therapy

This article addresses the history of stigmatization experienced by suicide survivors, specifically through biblical and theological thought evolving from the Christian Church. Contemporary understandings and attitudes are then assimilated. Four grief stages specific to the grief experience of the suicide survivor are introduced--anger, guilt, shame, and loss--with suggested approaches at each state intended to aid the pastoral counselor in better understanding and ministering to the suicide survivor. A summary of a recommended congregational response is also provided.     

Family survivors of suicide and accidental death: consequences for widows

The impact of completed suicide on the surviving family was studied. Thirteen widows whose husbands had died through suicide were compared with 13 widows whose husbands had died in accidents. The widows' views of their families' functioning, and the extent of life stress and psychiatric symptoms experienced by the widows, were assessed. Interview data suggested more guilt and blaming in suicide survivor families. However, on standardized questionnaires, suicide survivors showed no more family dysfunction, life stress, or psychiatric symptomatology than accident survivors. Both groups acknowledged clinically significant levels of symptoms. The findings raise questions about the validity of generalizations based on the clinical literature regarding the uniquely pathogenic impact of suicide on family functioning.     

Bereavement after a Physician-Assisted Suicide: A Speculation Based on Theory

Despite the recent Supreme Court ruling upholding the ban on physician-assisted suicide, the practice continues in the United States. A majority of Americans support physician-assisted suicide, and several surveys document its use by physicians and nurses. This article explores the anticipated bereavement experience of significant survivors following a physician-assisted suicide. Theoretical approaches to bereavement frame the discussion of possible reactions to suicidal death: (1) psychodynamic, (2) attachment theory, (3) crisis theory, and (4) cognitive theory. Three case scenarios illustrate potential survivor reactions, with suggested intervention approaches.     

Suicidal Behaviors in Surviving Monozygotic and Dizygotic Co‐Twins: Is the Nature of the Co‐Twin's Cause of Death a Factor?

Genetically informative samples can address hereditary and experiential influences on suicide‐related behaviors. The frequency of suicide‐related behaviors was compared in twins from two survivor groups: (1) those whose co‐twins' deaths were suicides (monozygotic [MZ]: n = 47; dizygotic [DZ]: n = 31), and (2) those whose co‐twins' deaths were nonsuicides (MZ: n = 347; DZ: n = 170). The frequency of suicide attempts among suicide survivors was significantly higher in MZ than DZ twins, while the frequency of suicide attempts among nonsuicide twin survivors did not differ between MZ and DZ twins. Twin concordance for suicide attempts more likely reflects a genetic predisposition than a behavioral reaction to the loss.     

Is Suicide Bereavement Different? A Reassessment of the Literature

The question of whether suicide bereavement is different from mourning after other types of deaths has important theoretical and clinical implications. Some recent literature reviews have argued that the differences may be minimal. In contrast, this article suggests that suicide bereavement is distinct in three significant ways: the thematic content of the grief, the social processes surrounding the survivor, and the impact suicide has on family systems. In addition, problems in the methodology used to compare different bereavement experiences are addressed. Some clinical implications of these conclusions, including the need for homogeneous support groups, psychoeducational services, and family and social network interventions are also discussed.     

Predicting Grief Symptomatology among the Suddenly Bereaved

Social scientists have long been interested in the study of grief and bereavement, but only recently has research focused on the aftereffects of sudden loss. Theory and research alike suggest that grief is multidimensional and that specific grief reactions have a unique set of predictors. The purpose of this study is to examine the relative contribution of risk factors in explaining variations in specific grief reactions following a sudden death. Data for this study come from medical examiners' reports and mail-back surveys of survivors of sudden loss from suicide or accident. The results indicate that several characteristics of the survivor, mode of death, and social support are important determinants of grief symptomatology. This research concludes by directing future theoretical and empirical endeavors to examine more fully the role of relational factors in influencing grief experiences following bereavement.     

Do They Suffer More? Reflections on Research Comparing Suicide Survivors to Other Survivors

This article contrasts public perceptions of suicide survivors with conclusions based on comparative studies of suicide, fatal accident survivors, and other survivors. Although suicide is commonly thought to cause a particularly burden-some grief, quantitative studies have often failed to support this. We then offer some interpretations of these findings and suggest future pathways for research.     

Emotional Impact of a Video‐Based Suicide Prevention Program on Suicidal Viewers and Suicide Survivors

In light of continuing concerns about iatrogenic effects associated with suicide prevention efforts utilizing video‐based media, the impact of emotionally‐charged videos on two vulnerable subgroups—suicidal viewers and suicide survivors—was explored. Following participation in routine suicide education as a part of the U.S. Air Force Suicide Prevention Program's video‐based community briefing, a sample of young active duty airmen demonstrated small decreases in positive emotional states and larger decreases in negative emotional states, especially among suicidal females. No evidence of iatrogenic effects were observed among suicidal or survivor subgroups when compared to controls. Results support the use of video‐based media as a safe educational strategy that might actually serve to decrease emotional distress among vulnerable subgroups.     

Possessions and Self in the Identity Work of Survivors of Domestic Violence

Domestic violence has serious consequences for survivors, including severe effects on psychological well‐being and identity. This article reveals the previously hidden possession experiences and identity work of domestic violence survivors. Using a novel visual research method that features material objects as visual stimuli to elicit data, we found possessions were critical in the complex identity work undertaken by survivors. Emergent themes detailing the role of possessions in coping with ongoing self‐threats by an intimate partner provide empirical support for the conceptualization of diametrically opposed selves, the Prescribed Self and Agentic Self. These opposite and compartmentalized selves enabled survivors to cope with extreme disintegration and destabilization of self by the abuser. As well as the conceptual and methodological contributions we make to the possessions‐self literature in consumer research and psychology, this research is valuable for designing social service programs to help survivors cope with the effects of domestic violence on identity.     

Suicide Survivors Groups: Results of a Survey

Little is known about the nature of suicide survivors groups. Survey responses by 149 U.S. and Canadian groups are characterized as follows: (1) they are most often sponsored by mental health or social service agencies or have no sponsor; (2) groups have operated an average of 8 to 9 years; (3) fewer than 10 people typically attend monthly or twice monthly meetings; (4) group experience predominantly involves sharing personal experiences; (5) leadership generally involves either trained facilitators, mental health professionals, or both; (6) most groups are open ended; (7) all social/ethnic, income, and adult age groups are served, but few children and teenagers attend; and (8) referrals come predominantly by word-of-mouth or medical and religious sources. Further research is required regarding survivor group attributes and processes.     

CYBER COMMUNITY IN THE VALLEY OF THE SHADOW OF DEATH

This article provides an examination of the communicative needs and practices of those who have survived the loss of a loved one to suicide. Based on a study of a face-to-face support group for parents of children lost to suicide, and over 10,000 e-mails from a number of online support groups for survivors of the loss of a loved one to suicide, this article discusses intense communicative relations, exclusion from the general society, self-accrediting of experts in grief, reconstruction of identity to include the loss, ownership of the suicide, and rebuilding community.     

Interventions for suicide survivors: a review of the literature

Mourning after suicide is frequently a difficult experience. Research suggests that suicide survivors may be at elevated risk for several psychiatric and somatic complications. Despite this, very little research has focused on developing and empirically evaluating clinical interventions for this population. This paper attempts to stimulate interest in intervention research by reviewing three relevant areas: (a) studies of the perceived needs of survivors; (b) implications of the research on general bereavement interventions for work with survivors; and (c) research documenting the efficacy of specific interventions for adult survivors. Recommendations for future studies are discussed.     

Survivors of suicide do grieve differently: empirical support for a common sense proposition.

Previous empirical investigations have produced mixed results on the question of whether mode of death differentially affects grief. To further investigate the influence of suicide on grief, 350 previously bereaved university students completed a questionnaire package consisting of several standardized measures. Participants were separated into four groups based on the mode of death experienced as either survivors of suicide (n = 34), accident (n = 57), unanticipated natural (n = 102), or anticipated natural (n = 157) deaths. Hierarchical multiple regression analyses indicated that suicide survivors, compared against the other groups, experienced more frequent feelings of rejection, responsibility, "unique" reactions, and more total grief reactions. Trends indicating increased levels of shame and perceived stigmatization were also evident. Aggregate factors of death "naturalness" and "expectedness" showed less influence than mode of death in influencing grief. Overall, results support previous clinical and research findings and intuitive logic in demonstrating that the grief experienced by suicide survivors includes elements that are less frequently seen in the case of nonsuicidal deaths.     

Predictors and correlates of bereavement in suicide support group participants

A sample of 210 survivors of suicide, all participants in suicide support groups, was studied. Associations between demographic factors, circumstances surrounding the suicide, and overall levels of grief (using the Grief Experience Questionnaire) were calculated. Results showed that seeing the body at the scene of the death was the most significant predictor of high levels of distress, and support from family and friends was the strongest protective factor. Time since the death (for women) and attendance at Alcoholics Anonymous meetings (for those participating in nonsuicide support groups) were also significantly related to level of grief. For men, a moderate level of participation in other support groups, as compared with none, was associated with higher levels of grief. All other variables were not significant. Results suggest that a model that combines posttraumatic reactions and grief is most appropriate for the aftermath of suicide.     

The suicide survivor's grief and recovery

While official estimates report approximately 30,000 completed suicides each year, some researchers claim the numbers range much higher. Each suicide has severe and prolonged effects on the family members and friends left behind. Those left behind, the survivors of the suicide, tend to experience a very complicated form of bereavement. This is due to the combination of the sudden shock, the unanswered question of "why," and possibly the trauma of discovering or witnessing the suicide. Survivors' grief reactions can become even more exacerbated by inappropriate responses from the community to the suicide. A mental health professional can help the survivor through this difficult grieving process by direct and indirect means.