In talking about suicide, it is very important to understand its huge impact: it is a significant public health problem, causing an estimated 700,000 deaths annually, making it the seventeenth leading cause of death worldwide. It impacts not only doctors and medical staff but obviously also relatives and caregivers of those who committed suicide. In this last perspective, we have chosen to search for articles specifically focused on suicide survivors.
Here there are two reading suggestions that we decided to summarize and comment on for you: “Prolonged Grief Symptoms among Suicide-Loss Survivors: The Contribution of Intrapersonal and Interpersonal Characteristics” and “Stigma, Grief and Depressive Symptoms in Help-Seeking People Bereaved through Suicide”, because they seemed to be giving a very new contribution and an innovative point of view on the topic, even though they have been published 5 years apart.
Suicide-loss survivors (SLSs) have unique characteristics that increase their risk of developing prolonged grief symptoms (PGS). According to cumulative evidence, PGS represent a bereavement-specific diagnosis that comprises part of the clinical syndrome of prolonged grief disorder (PGD), a condition recently supplemented to the International Classification of Diseases, 11th Revision (ICD-11). PGD is now included for the first time in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) in the chapter on trauma and stressor-related disorders.
The core element of PGD is intense longing or craving for the deceased or engaging in thoughts or memories of them. Other symptoms include intense emotional pain related to the death, feeling that part of oneself has been lost, difficulty accepting the death, avoiding cues that might trigger thoughts of the deceased and difficulty engaging in social or other activities following the loss. According to the DSM-5 criteria, symptoms should persist for at least 12 months after a loss, whereas ICD diagnostic criteria anticipate symptoms persisting for more than 6 months after the loss.
The aim of this study is to examine the role of intrapersonal characteristics (such as guilt and depression) and Interpersonal characteristics (such as thwarted belongingness (TB), perceived burdensomeness (PB) and self-disclosure (SD)) and the impact of their co-occurrences as potential factors contributing to PGS after suicide loss; in order to facilitate the design of preventive interventions for individuals at increased risk and establish therapeutic measures targeting elements contributing to the onset and severity of PGS.
Study participants were 152 SLSs (80.4% women) 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 the time since suicide and the participant’s age at the time of suicide, were also examined.
Authors evidenced that guilt and depression are critical contributors to the level of PGS among SLSs. Furthermore, they found that interpersonal variables (PB, TB, SD) contributed to PGS beyond intrapersonal, sociodemographic, and loss-related factors. Thus, these results suggest that SLSs’ devastating feelings of lack of belonging, isolation, being a burden to their surroundings, and difficulty disclosing intimate feelings and thoughts may contribute to PGS. This study’s main finding is that PB levels significantly moderate the contribution of guilt to PGS. Thus, it can be inferred from these results that perceived burdensomeness plays a significant role in facilitating PGS among SLSs, especially in those experiencing guilt.
This study has important theoretical and practical implications which could be useful in clinical practice in managing SLSs and SLS relatives searching for help. Concerning the practical implications, it suggests interpersonal variables may serve as buffers against grief complications, particularly among SLSs suffering from painful guilt. Therefore, healthcare professionals, and all the people surrounding the SLS, should monitor the social involvement of the SLS and the extent of social support they receive because it appears that disclosing intimate feelings and thoughts may protect against PGD by enhancing a sense of belonging, relieving harmful cognitions and reducing guilt. Offering primary psychoeducational interventions could help SLSs gain support and get a new perspective on themselves and on the suicide event. In addition, psychotherapy protocols aiming to help people understand their relationships with others may benefit individuals with high TB and PB levels. For example, interpersonal psychotherapy (IPT), which aims to improve interpersonal skills, especially self-disclosure, may prove effective for SLSs. Moreover, psychosocial therapies focusing on activating social support and reducing maladaptive cognitions may benefit SLSs. Another possible treatment may be group therapy, which can help SLSs in sharing and disclosing their feelings of guilt, modifying the meaning of the suicide event, normalizing the grief experience of suicide, and, most importantly, providing them with a sense of belonging. Finally, it appears that there is potential in mindfulness-based interventions as well, as they seem to promote self-compassion, which has been shown to positively impact feelings such as TB and PB and cope with unpleasant emotions such as guilt.
We chose to write about this study because we found it very interesting, complete, useful and extremely recent. In fact, it is very well explained what PGD is, especially since it was only recently added to the DSM-5-TR, and what intrapersonal and interpersonal characteristics include. It also gives an overview of the background knowledge related to suicide and personal factors that can be helpful, especially for those new to the field.
In conclusion, we advise reading this study because it highlights the importance of social and community factors in preventing PGD among suicide-loss survivors. It illustrates the practical implications and suggests that the resilience factors of a sense of belonging and self-disclosure may help SLSs to effectively cope with PGS.
References:
Levi-Belz Y, Ben-Yaish T. Prolonged Grief Symptoms among Suicide-Loss Survivors: The Contribution of Intrapersonal and Interpersonal Characteristics. Int J Environ Res Public Health. 2022 Aug 24;19(17):10545. doi: 10.3390/ijerph191710545. PMID: 36078261; PMCID: PMC9518413.
EPA Section of Suicidology and Suicide Prevention 