The effectiveness of family-based cognitive-behavior grief therapy to prevent complicated grief in relatives of suicide victims: the mediating role of suicide ideation

Grief interventions are more effective for high risk individuals. The presence of suicide ideation following suicide bereavement was examined to determine whether it indicates a high risk status. Using data from a randomized controlled trial (n = 122) on the effectiveness of cognitive-behavior therapy, the effect of suicide ideation on the effectiveness of grief therapy on the bereavement outcome at 13 months post loss was examined. Results show that suicide ideators more often have a history of mental disorder and suicidal behavior than non-ideators, and suicide ideation indicates a high risk for adverse bereavement outcome. Grief therapy likely reduces the risk of maladaptive grief reactions among suicide ideators. Therefore, suicide ideators may benefit from grief therapy following a loss through suicide.     

Complicated grief and suicidal ideation in adult survivors of suicide

While the prevalence of complicated grief has been demonstrated to be elevated in survivors of suicide, the association between complicated grief and suicidal ideation among adult survivors of suicide has not been explored. The purpose of the present study is to examine the association between complicated grief and suicidal ideation in suicide survivors. The Inventory of Complicated Grief and the Beck Depression Inventory were administered to 60 adult survivors within 1 month of a death by suicide of a family member or significant other. Complicated grief was associated with a 9.68 (CI: 1.036, 90.417) times greater likelihood of suicidal ideation after controlling for depression, suggesting that syndromal complicated grief heightens vulnerability to suicidal ideation. Clinicians may provide more comprehensive assessments by recognizing the possibility of suicidal ideation in those with complicated grief.     

The epidemiology of suicide and attempted suicide

Since more than one century suicides have been registered in national statistics of death causes. They thus furnish one of the few parameters of psychiatrically relevant behaviour by means of which trends, cohort, age-group and period effects can be studied over longer periods. Since the second half of last century, the suicide rates for Swiss males--similar to those found in England and Wales--show a decrease in consecutive birth cohorts up to males born in the decade 1930-1940, and a continued decline in the total trend until about World War II. From then on the suicide rates of males in consecutive birth cohorts have been slowly increasing in the majority of European and North American countries--but not so in Sweden. Opposite to this, the predominantly low rates for females display little change. Further to the considerable differences between nations and the predominance of suicides committed by females in some Asian countries and Cuba, the changes indicate the significance of cultural and economic environmental factors. Typical period effects are mainly the result of changes in conception and conditions of life. In attempted suicide they proceed in a more sensitive and more rapid way and are about ten times higher. Such a period effect showing increases by about 300% in younger age-groups followed by a decline, attaining its peak about 1976, was ascertained in large cities of the Federal Republic of Germany. By the example of the effects of a television serial, the study of causal processes turning collective environmental factors into individual suicidal behaviour, proved that regularities are effective in learning by a process of modelling. Besides, the epidemiological data give essential hints how to treat suicidal behaviour.     

The syndrome of traumatic grief

Traumatic grief is a common and debilitating syndrome whose clinical presentation is well recognized but whose diagnostic criteria have only recently been delineated. Though it shares features with major depressive disorder, adjustment disorder, and posttraumatic stress disorder, none of these subsume the criteria set for traumatic grief, and the diagnostic overlap is limited in community samples. Furthermore, diagnosis of traumatic grief appears to have prognostic value for clinical course and treatment response among bereaved individuals. In the absence of empirically supported treatments of pathological grief, a new, manualized treatment for traumatic grief symptoms has been developed and is currently undergoing testing in a randomized controlled trial. The conceptual basis for Traumatic Grief Treatment (TGT) is presented, the structure of the treatment is outlined, and the primary clinical strategies employed are described.     

The hidden grief of abortion

This article explores the possibility of dealing with grief reaction when counseling a woman who has undergone an abortion. It first defines what is meant by a grief reaction in this context, then proposes a model for understanding various degrees of grief reaction, and finally examines some of the factors which determine the severity of a grief reaction in the case of abortion.     

Unresolved grief

This paper has reviewed the literature on bereavement and, with particular emphasis on the authors' own work, describes three syndromes which seem to be related to the nonresolution of distinct phases of the grief process. The possibility of unresolved grief should receive a high index of suspicion for the patient with otherwise unexplainable depression, chronic illness behavior, or symptoms similar to those of a deceased relative or friend. When any of these syndromes are identified, it is useful to ask the patient who he has lost, how he has lost them, how he felt about the loss, whether he felt that he grieved, whether he still cries or feels the need to cry, and whether he has adjusted. The answer to these questions--both verbal and nonverbal--will help identify unresolved grief, when present, and may be a guide to specific interventions. On the other hand, our studies have suggested that unresolved grief is a somewhat overly simplistic concept. Most, if not all, people never totally resolve their grief; significant aspects of the bereavement process go on for years after the loss, even in otherwise normal patients. For some, identification syndromes continue. Others may continue to feel the presence of the deceased or have daily visions of him or her. Still others may feel pain, anger, and guilt for years after the death. It is still unclear at what point and to what degree these behaviors and symptoms become medical or psychiatric concerns and become pathological or predispose to serious medical, psychological, or social complications. Investigations into these unreported areas have been initiated and, we trust, will lead to clinically useful answers.     

The Reasons to Go On Living Project: stories of recovery after a suicide attempt

Qualitative research in suicidology has become increasingly common in the literature. Lakeman and FitzGerald (2008) conducted a review of qualitative works specifically on suicide and recovery. Five interconnected themes—suffering/psychache, struggle, connection, turning points, and suicide and coping—were identified. The Reasons to Go On Living Project (RTGOL) project was a web-based narrative research project that sought to understand the transition from making a suicide attempt to choosing life. This article reports the findings of a secondary analysis of the narratives. By using Lakeman and FitzGerald’s themes as a starting point, one hundred and thirteen submissions were thematically analyzed using a deductive approach. The findings are mostly consistent with the interconnected themes identified by Lakeman and FitzGerald. Moreover, subthemes were identified to better reflect the lived experience of the participants. Clinical and research implications of this project will be discussed.     

Anticipatory grief: The search for destiny

This paper explores the dynamics between a woman dying of cancer, the man she lived with for 37 years, and the clinician who worked with them during the final months of the woman's life. Psychoanalytic perspectives on transformational and transitional object-seeking as natural processes which aid the internalization of attachment to the one who is approaching death, the creation of a primary maternal preoccupation in the caretaker, the hospice as a holding environment, and the search for destiny as a metaphor for the work of anticipatory grief are integrated with the case-material.Presented at the American Academy of Religion Annual Meeting,Person, Culture and Religion Pre-session, November, 1991.     

The paradoxical nature of the grief experience

This paper develops the thesis that the grief experience attendant to loss by death is a natural phenomenon and that language has been used to obscure its nature as a process. The paradoxical nature of the grief experience refers to an expanded appreciation of its nature which can include a consideration of the survivor's own joy at being alive. A feeling of joy can occur consequent to allowing the more intense grief pain to be exposed and shared. Frequent references from playwrights and other well-known authors herein support the universal recognition of the above. The author has found these thoughtful individuals to constitute an important intellectual network for himself through the years.This paper was originally presented at the International Conference on the Occasion of the Tenth Anniversary of the Department of Basic Psychoanalytic Research and Family Therapy, University of Heidelberg, West Germany, May 17, 1985.Appreciation is expressed to Betty Byfield Paul, L.I.C.S.W., Counseling Associates, Lexington, Massachusetts, for consultation and editorial review.