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Table 1 Effectiveness of suicide bereavement interventions: Summary of studies

From: Effectiveness of interventions for people bereaved through suicide: a systematic review of controlled studies of grief, psychosocial and suicide-related outcomes

Author (year)/Location Eligibility criteria Sample size Age (M, SD, range) Male/female Time since bereavement/Relationship to the deceased Type of intervention/Setting Characteristics of intervention Duration/Frequency of contact Outcome/Instrument/Timepoints Main results
Battle (1984) USA [33] Intervention: suicide loss, help-seeking from a crisis centre
Control:
i) Non-help-seeking suicide survivors (non-group control group),
ii) patients from the centre (patient control group).
Intervention N = 36
Non-group bereaved control group N = 13
Patients control group N = 31
Range 14–66 years
M = 38
Control groups: not reported
22% /78%
Control groups: not reported
8 days – 11 years
M = 2 months
Group
Suicide prevention/crisis intervention service
Support group with educational component
non-help seeking survivors, and patients
Combination of non-directive and directive leadership
Facilitated by clinicians
1.5 h weekly sessions in first 4 months, followed by 2-weekly 1.5 h sessions
69% attend less than 10 sessions
97% attends max 14 sessions.
Psychosocial functioning incl. Problems, feelings, goals (self-constructed questions)
Pre/post intervention
Participants are more emotional (more distress, pain, happiness, pleasure) than non-group controls); suicidal pain 50% vs 0%; perfect happiness: 67% vs 1%; more solutions to their problems than controls.
Control patients also experienced strong emotions.
Psychodynamic insights in the survivors and the suicides.
No p values reported.
Constantino & Bricker (1996) USA [34] Widows whose spouse died by suicide Intervention N = 16
Control N = 16
M = 43 Majority is female
More men in intervention group than in control
Not reported Group
Setting not reported
Bereavement Group Postvention (BGP), i.e. group psycho therapy
vs
Social Group Postvention (SGP), e.g., socialization, recreation
Directive
vs
non-directive leadership
Facilitated by trained mental health nurses
1.5 h weekly sessions, 8 weeks Depression (BDI)
Distress (BSI)
Social adjustment (SAS)
Grief (GEI)
Pre/post intervention
Reduction in depression and distress in both BGP and SGP groups (both p < .05).
Improvement in social adjustment in SGP group only (p = .003).
Grief aspects: despair, rumination and depersonalization decreased in both BGP and SGP groups (all p < .05); anger/hostility and guilt decreased in BGP only (p < .05).
Constantino et al. (2001) USA [35] Widows whose spouse died by suicide
Aged 18+
English speaking
N = 47
(Originally N = 60, 30 + 30)
Range 24–70 yrs. Male/female  10/37,
21%/78%
1–27 months
M = 10.91, SD = 8.65
40% less than 6 months
Widows
Group
Setting not reported
Bereavement Group Postvention (BGP), i.e. group psycho therapy
vs
Social Group Postvention (SGP), e.g., socialization, recreation
Facilitated by trained mental health nurses
1.5 h weekly sessions, 8 sessions Depression (BDI)
Distress (BSI)
Grief (GEI)
Social adjustment (SAS)
Pre/post intervention, 6-month, 12-month follow-up
N.s. differences between BGP and SGP groups on outcome variables at four timepoints.
Analysis of both groups BGP and SGP combined:
significant decrease in depression (p =. 0001), total distress (p = .0001), grief symptoms (all p < .05), except for anger/hostility and social isolation, and increase in total social adjustment (p = .0001) over the four time points.
De Groot et al. (2007) The Netherlands [41] First-degree relatives or spouses bereaved by suicide
Aged 15+
Intervention N = 68, 39 families
Control N = 54,
31 families
Intervention M = 43, SD = 13.7
Control M = 43, SD = 13.5
Intervention Male/female 28/40, 41%/59%
Control Male/female 12/42, 22%/78%
3–6 months after suicide
Spouse (31%)
Parent (31%)
Child (16%)
In-laws (4%)
Group / family
Participant’s home
Family-based cognitive behaviour counselling programme
vs treatment as usual
Facilitated by trained psychiatric nurses
2 h, 2- -3 weekly sessions, 4 sessions Grief (ITG, TRGR2L)
Depression (CES-D)
Suicidal ideation (PSI)
Guilt and self-blame (self-constructed questions)
Baseline, 13-month follow-up
N.s. effect of intervention on complicated grief, depression, and suicidal ideation.
A trend towards
feeling less being to blame (p = .01) and fewer maladaptive grief reactions (p = .056).
De Groot et al. (2010) The Netherlands [42] First-degree relatives or spouses bereaved by suicide
Suicide < 8 weeks
Aged 15+
Total N = 122
Intervention N = 68, 39 families
Control N = 54,
31 families
Intervention M = 43, SD = 13.7
Control M = 43, SD = 13.5
Intervention Male/female 28/40, 41%/59%
Control Male/female 12/42, 22%/78%
3–6 months after suicide
Spouse (31%)
Parent (31%)
Child (16%)
In-laws (4%)
Group / family
Participant’s home
Family-based cognitive behaviour counselling programme
vs treatment as usual
Facilitated by trained psychiatric nurses
2 h, 2–3 weekly sessions, 4 sessions Grief (ITG, TRGR2L)
Depression (CES-D)
Suicidal ideation (PSI)
Guilt and self-blame (self-constructed questions)
Clinical assessment (SCAN2.1)
Baseline, 13-month follow-up
Participant with suicidal ideation compared with non-ideators:
N.s. decrease of complicated grief in suicide ideators
Reduction in maladaptive grief reactions (p = .03) and risk of suicidal ideation (p = .03) among ideators.
Farberow (1992) USA [36] Loss by suicide
Aged 18+
Intervention N = 60
Control N = 22
Range 18–60+ Intervention Male/female 18/42, 30%/70%
Control
5/17, 23%/77%
Less than 3 to 24+ months
77% between 6 and 8 months after death
Sibling (35%)
Child (23%)
Parent (20%)
Spouse (13%)
Sweathearts and other
Group
Suicide prevention centre
Bereavement group with therapeutic and educational aspects
vs refusers, dropouts
Quasi-experimental design
Facilitated by mental health professional and trained peer
1.5 h weekly sessions, 8 sessions, followed by open monthly sessions Health, impact of loss, coping, major changes, feelings (self-constructed questions)
After suicide (T1), pre/post intervention (T2/T3)
Intervention group: decreased scores from T1 to T2 to T3.
Control group: decreased scores from T1 to T2; only in anxiety for T2 to T3.
Intervention group at T3 significant higher on depression and puzzlement compared to Control group.
No p values reported.
Hazell & Lewin (1993) Australia [43] Students selected by school staff on basis of close friendship with deceased student Intervention N = 63
Control N = 63
School A: M = 15.1
School B: M = 14.4
Not reported Within 7 days after suicide
Fellow students of same school
Group
School setting
Group counselling and information
vs no counselling
Facilitated by child psychiatrist or trainee psychiatrist with assistance of senior school staff
1.5 h session
One session
Behaviour (YSR)
Risk behaviour (RBQ)
Suicidal ideation/behaviour
Drug/alcohol use
8 months after suicide
N.s. differences between intervention and control group on internalizing, externalizing, depression, risk behaviour, suicidal ideation/behaviour or drug/alcohol use.
Kovac & Range (2000) USA [37] Undergraduate students who had a close person die by suicide in the past 2 years and were upset by the death Total N = 42
Intervention N = 20
Control N = 22
N = 30 completed follow-up tests
Range 18–46
M = 23.98
SD = 7.34
Intervention M = 23.16, SD = 6.99
Control M = 25, SD = 7.98
Male/female 9/33, 21%/79%
Intervention 5/14, 26%/74%
Control 3/18, 14%/86%
Intervention M = 13.26 months, SD = 9.32
Control M = 11.95, SD = 6.54
Not reported
Individual
Experimental/laboratory setting
Writing task: profound, death-related writing vs trivial writing
Facilitated by researchers
15 min sessions, 4 sessions over 2 weeks Grief (GRQ, GEQ)
Impact of grief (IES)
Essay evaluation form
Experiment follow-up form
Pre/post-test (6 weeks)
Reduction in impact of grief (p < .05), and general GRQ grief levels (p < .05) in intervention and control group.
Suicide-specific grief GEQ more reduced in intervention than control group (p < .05).
No difference in self-reported health visits between groups.
Pfeffer et al. (2002) USA [38] Families where child’s parent or sibling died by suicide
Children aged 6–15
No psychiatric disorders
Total N = 75 children, 52 families
Intervention N = 39, 27 fam
Control N = 36, 25 fam
Intervention M = 9.6, SD = 2.9
Control M = 11.4, SD = 3.5
Male/female
Intervention 16/23, 41%/59%
Control 12/24, 33%/67%
Within a year after death
Siblings (11/39), children (28/39) and parents
Group / family
Clinical setting
Manual based bereavement group intervention for children grouped by age
Psycho-educational, support group for parents
No treatment control
Facilitated by trained psychologists
1.5 h weekly sessions
10 sessions
Children: Posttraumatic stress symptoms (CPTSRI)
Depression (CDI)
Anxiety (RCMAS)
Social adjustment (SAICA)
Parents: depression (BDI)
Pre/post intervention (12 weeks)
Children:
Significantly greater reduction in anxiety and depressive symptoms in intervention vs. control group (p ≤ .01). N.s. differences in posttraumatic stress or social adjustment.
Parents:
N.s. differences in depression between groups.
Sandor et al. (1994) USA [39] Members of a church-related youth group Intervention N = 15
Control n = 19
Intervention Range 14–17, M = 15.73
Control range 14–18, M = 16.37
Intervention Male/female 5/15, 33%/67%r
Control Male/female 6/13, 32%/68%
A few days after the death
Relationship: peer group
Group
Church youth group
Supportive community intervention; Survivor Group (SG) vs Comparison Group (CG; no intervention)
Quasi experimental design
Facilitated by church youth group leaders
3 meetings: 2 h open session with youth and parents, after two days one closed psycho-educational session with youth, a day later a memorial service in church Problem solving (APSA)
Self-perception (HSP)
Self-efficacy (SES)
Baseline (T1), 2 months after suicide (T2), 2-month follow-up (T3)
Greater self-efficacy at T2 and T3 compared to T1 in SG vs. CG group (p < .01).
Greater social acceptance and job competence at T2 in SG vs. CG (p < .05), but not at T3.
SG vs CG group not compared on problem-solving appraisal, scholastic competence, and global self-worth.
Wittouck et al. (2014) Belgium [44] Suicide of a significant other 3–24 months before participation
Aged 18+
Dutch speaking
Intervention N = 47
Control N = 36
Intervention M = 49.3, SD = 13.8
Control M = 47.6, SD = 12.8
Intervention male/female 9/38, 19%/81%
Control 11/25, 31%/69%
Intervention 9.8 months, SD = 5.7
Control M = 12.4, SD = 6.3
Deceased: child (n = 20; 42%), partner (n = 12, 25%), parent (n = 1, 2%), sibling (n = 8, 17%), other (n = 6, 13%)
Group / family
Participant’s home
Cognitive-behavioral therapy-based psycho-educational intervention
vs
no treatment
Facilitated by clinical psychologist
2 h sessions, 4 sessions
Frequency not reported
Depression BDI-II)
Hopelessness (BHS)
Grief (CGQ, ITG)
Coping (UCL)
Baseline, 8 (months
N.s. decrease in depression, hopelessness and grief in intervention vs. control group.
Decrease in intensity of grief, depression, passive coping style, social support seeking and behavioural expression of (negative) feelings in intervention group only (all p < .05).
Zisook et al. (2018) USA [40] People bereaved by suicide SB), accident, homicide (A/H), and natural causes (NC) with ≥30 ITG score
Exclusion: Being suicidal, other psychiatric disorders except depression, other treatments
Total N = 395
SB
N = 58
A/H N = 74
NC N = 263
SB
Medication N = 14
Placebo N = 17
CGT + Medication N = 17
CGT + Placebo N = 13
Range 18–95
SB M = 47.2, SD = 14.1
A/H M = 51.6, SD = 14.8
NC
N = 54.6, SD = 14.2
Male/female
SB
10/48, 17%/82%
A/H 18/56, 24%/76%
NC 59/204, 22%/78%
Time since death
SB
M = 3.9 yrs.
SD = 4.6
A/H
M = 6.6
SD = 9.1
NC
4.3
SD = 7.1
SB deceased is a partner 18 (31%), parent 7 (12%), child 19 (33%), other 14 (24%)
Individual
Clinical setting
Manual-based structured Complicated Grief Therapy (CGT)
Therapists, including social workers, psychiatrists, psychologists
Antidepressant medication (citalopram)with individual follow-up
Facilitated by Trained researcher
CGT: 16 sessions over 20 weeks
Medication: 12-week with 2–4 weekly visits until week 20
Grief (CG-CGI-I, GRAQ, ICG, SCI-CG, TBAQ)
Suicidal ideation (C-SSRS-R)
Work/social adjustment (WSAS)
Lower improvement on clinician-rated CG-CGI-I in SB vs. A/H and NC groups (p < 0.5).
N.s. differences on other measures of grief, suicidal ideation or work/social adjustment between SB, A/H and NC groups.
Low rates of post treatment active suicidal ideation in SB, A/H and NC groups.
  1. APSA: Adolescent Problem Solving Appraisal [60]; BDI: Beck Depression Inventory [48]; BHS: Beck Hopelessness Scale [61]; BSI: Brief Symptom Inventory [50]; CDI: Children’s Depression Inventory [62]; CES-D: Center for Epidemiological Studies Depression Scale [49]; CG-CGI-I: Complicated Grief Clinical Global Impressions Scale – Improvement [63]; CPTSRI: Childhood Posttraumatic Stress Reaction Index [64]; C-SSRS-r: Columbia Suicide Severity Rating Scale – Revised [52]; GCQ: Grief Cognitions Questionnaire [46]; GEI: Grief Experience Inventory [47]; GEQ: Grief Experience Questionnaire [65]; GRAQ: Grief-Related Avoidance Questionnaire [66]; GRQ: Grief Recovery Questions [57]; IES: Impact of Event Scale [67]; ITG: Inventory of Traumatic Grief [68]; PSI: Paykel’s Suicidality Items [69]; RBQ: Risk Behavior Questionnaire [70]; RCMAS: Revised Children’s Manifest Anxiety Scale [71]; SAICA: Social Adjustment Inventory for Children and Adolescents [72]; SAS: Social Adjustment Scale [51]; SCAN 2.1: Schedules for Clinical Assessment in Neuropsychiatry [73]; SCI-CG: Structured Clinical Interview for Complicated Grief [74]; SES: Self Efficacy Scale [75]; SPP: Self-Perception Profile for Adolescents [76]; TBQ: Typical Beliefs Questionnaire [77]; TRGR2L: Traumatic Grief Evaluation of Response to Loss [45]; UCL: Utrecht Coping List [78]; WSAS: Work and Social Adjustment Scale [79]; YSR: Youth Self Report Child Behavior Checklist [80]