SOPRoxi

Are empathy profiles and perceived social support associated with depressive and grief-related symptoms in suicide survivors?

OBJECTIVE

To investigate the link between empathy, perceived social support, and depressive and grieving symptoms in suicide survivors.

METHODS

Scores on the Beck Depression Inventory (BDI), Inventory of Complicated Grief (ICG), Prolonged Grief Disorder (PGD), Interpersonal Reactivity Index (IRI), and the Social Support section of the Interpersonal Questionnaire were collected from 265 survivors. Relations were tested via multivariate regression models.

RESULTS

Lower Perspective Taking (PT) was related with higher levels of BDI score, and higher Personal Distress (PD) was associated with higher BDI, ICG, and PGD scores. Higher levels of Social Support were related with higher BDI and ICG (but not PGD) scores.

CONCLUSION

Empathic PD and PT, and perceived social support are differently associated with depression and grief-related symptoms. Empathy-focused psychotherapies and empowerment of social support may reduce symptoms in suicide survivors.

Addressing psychological distress in people bereaved through suicide: From care to cure

To illustrate the main characteristics of the request for and choice of support by a population accessing a dedicated service for people bereaved through suicide.The participants were divided first according to their reason for requesting support and based on their choice of intervention, which were "caring" services (improve knowledge about suicide prevention, postvention and grief support) and "curing" services (psychotherapy, chat groups, and meditation retreats).The study was based on 539 participants, chiefly middle-aged women. Most had lost kin and the time since suicide ranged from 1day to 45 years. The main reasons for contacting the service were: seeking help for symptoms (42%), connecting with other suicide survivors (19%); 15% reported not knowing what to ask for. Among the participants, 30% participated in the "curing" interventions; they were slightly older and had more grief symptoms, some above the threshold for complicated grief. These participants had more often survived a child or partner and more frequently sought contact with other survivors or were more likely to be seeking help for symptoms.The presence on the web of a project specialized in the care of suicide survivors can provide a resource bringing them closer to curing their emotional pain.

Do interpersonal events buffer or worsen depressive and grief related symptoms in people bereaved through suicide?

Life events can heighten emotional suffering related to the loss of a close relative or friend by suicide, while supportive social relationships may promote coping. We investigated the impact of stressful events and perceived social support on depressive and grief symptoms in 378 help-seeking Italians bereaved through suicide. While we did not observe a significant effect of interpersonal stressors, perceived social support did have a buffering role on the intensity of depressive symptoms but not of grief-related suffering. Focusing on expanding and capitalizing on clients' perceived social networks could strengthen postvention programs. Further research on the role of interpersonal factors is needed.

Mindfulness-based weekend retreats for people bereaved by suicide (Panta Rhei): A pilot feasibility study

OBJECTIVES

This study investigates whether a programme of mindfulness-based weekend retreats (Panta Rhei) is able to improve mood states, mindfulness qualities, and self-compassion in family members and friends of suicide victims (suicide survivors).

DESIGN

Longitudinal prospective study.

METHODS

Sixty-one suicide survivors participated in a mindful-self-compassion retreat. The Five-Facet Mindfulness Questionnaire, the Profile of Mood States (POMS), and the Self-Compassion Scale were administered 4-6 days before and after the retreat.

RESULTS

A significant reduction in all dimensions of the POMS (except Vigor-Activity) and lower levels of overidentification were observed after the retreat.

CONCLUSIONS

Although further research is warranted, this study highlights the potential beneficial effect of brief mindfulness-based weekend retreats on the well-being of suicide survivors.

PRACTITIONER POINTS

Mindfulness-based weekend retreats seem to be effective in alleviating the psychological distress of suicide survivors in the short term. The benefit may depend on standard mindfulness practices and on more tailored interventions aimed at promoting acceptance of loss, forgiveness and rage management, and thus reducing rumination. Since there is no established treatment for this population, this type of intervention, which seems feasible and well accepted by participants, paves the way for future research in this area.

Stigma, grief and depressive symptoms in help-seeking people bereaved through suicide

BACKGROUND

The painful experience of mourning after suicide can be further complicated by the stigma surrounding suicide survival. We investigated how grief and depression influence the perception of stigma towards survivors in a sample of help-seeking persons bereaved through suicide.

METHODS

Cross-sectional design. Information on sociodemographic variables and responses to the Stigma of Suicide Survivor Scale, Beck Depression Inventory (BDI) and Inventory of Complicated Grief (ICG) was collected from 240 people bereaved through suicide who consecutively accessed an online support initiative.

RESULTS

Despite the strong correlation between ICG and BDI scores, the intensity of depressive but not of grief symptoms was related to perceived stigma towards survivors. Time since loss was also positively related to levels of perceived stigma against survivors. The links between depression and perceived stigma persisted after taking into account relationship with the deceased and other sociodemographic factors.

LIMITATIONS

The main study limitations are the cross-sectional design, reliance on self-report measures, and the self-selection of the sample of people bereaved through suicide, seeking help through a website. Social support was not measured and the sample included a large proportion of women.

CONCLUSIONS

Specific interventions designed for persons bereaved by suicide should consider that psychological distress and mourning are qualitatively different reactions to a suicide loss. The relationship among perceived stigma, depressive suffering and time elapsed since the suicide loss suggests the usefulness of closely investigating the experience of stigma in all people bereaved through suicide with depressive symptoms, even long after the event.

Rorschach Assessment in Suicide Survivors: Focus on Suicidal Ideation

Background: The study of Suicidal ideation (SI) in people bereaved through suicide (Suicide Survivors, SSs) could be hampered by the person's willingness to admit it, or by their limited awareness of it. Our main hypothesis is that SI is common in these people, especially if they are parents or children of the victim. For its potential in shedding light on specific unconscious processes, Rorschach test was chosen for our investigation, for the first time in SSs literature. Rorschach suicide ideation and selected variables were further analyzed to better delineate their psychological profile. Method: Rorschach according to Exner's Comprehensive System was administered to 21 people bereaved through suicide presenting as outpatients at SOPROXI Project Service-Padova Mental Health Center- and 23 healthy controls. Beck Depression Inventory (BDI) was routinely administered to SSs and considered in the study. Results: T-tests showed significantly higher mean SI score (S-Con) as it emerged from the Rorschach test S-Con scores in SSs compared to control participants. SI found only weak correlation with the BDI item in which SSs can explicitly state the desire for their death. Within-group analysis revealed higher S-Con mean scores in bereaved children and parents of the victim compared to other kind of kinships. Morbid content (MOR) has been fund as the most characterizing variable in SSs' S-Con in terms of effect size, followed by a low number of responses with an ordinary form (X +%). Human movements (M), Special Scores related to thought slippage (ALOG, FABCOM2, INCOM2, and CONTAM) and poor human representations (PHR) have been shown to be more significantly present in SSs compared controls. Discussion: Psychodynamic interpretations of our results are provided. Clinical practice should consider Rorschach as one of eligible tools of investigation on this field.

Stigma and psychological distress in suicide survivors

BACKGROUND

Suicide bereavement is frequently related to clinically significant psychological distress and affected by stigma. This study was designed to evaluate the relationship between psychological distress by psychopathological domains and stigma, in a sample of individuals bereaved by suicide (suicide survivors).

METHODS

The data were collected between January 2012 and December 2014 and included information on sociodemographic variables (gender, age, marital status and education level) and responses to the Stigma of Suicide Survivor scale (STOSSS) and the Brief Symptom Inventory (BSI). One hundred and fifty-five suicide survivors completed the evaluation and were included in the study.

RESULTS

Levels of psychological distress in suicide survivors, as measured by BSI, were positively related to levels of perceived stigma toward suicide survivors, as measured by STOSSS. The association was not affected by age and gender, or by marital status, education level, days from suicide or a personal history of suicide attempt. Participants with higher scores on almost all subscales of the BSI, particularly the interpersonal sensitivity and paranoid ideation subscales, reported the highest levels of perceived stigma toward suicide survivors.

CONCLUSION

Levels of distress in subjects bereaved by the suicide of a relative or friend were positively associated with levels of perceived stigma toward suicide survivors. Specific interventions dedicated to the bereavement of suicide survivors might help to alleviate not only psychological distress but also stigma towards loss by suicide.

Psychological Distress Increases Perceived Stigma Toward Attempted Suicide Among Those With a History of Past Attempted Suicide

People who suffer from mental illness have high self-stigmatizing attitudes. This study aims to test the effect of psychopathological distress on stigma toward attempted suicide in a population of suicide attempters. Data were collected through an interview and 2 questionnaires (90-item Symptom Checklist; Stigma of Suicide Attempt scale) administered to 67 patients hospitalized after an attempted suicide. Participants with a history of past attempted suicide had higher scores on the Stigma of Suicide Attempt scale (t58.9 = -2.51, p = 0.014). Higher levels of psychological distress were related to greater perceived stigma only in individuals with a history of past attempted suicide (standardized coefficient = 0.37; t = 2.36; p = 0.024; R2 = 14%; adjusted R2 = 11.5%). A previous experience of attempted suicide is related to greater self-stigmatizing attitudes toward suicidal behavior. Among those who have previously attempted suicide in particular, psychopathological distress may significantly contribute to increase the perception of stigma.

Bereavement after the suicide of a significant other

CONTEXT

It is estimated that approximately one in four people know someone who has taken their own life and that one suicide death leaves six or more suicide survivors.

AIMS

The aim of this paper was to review the literature regarding the association between suicide and bereavement, focusing also on the supportive and therapeutic resources available for survivors.

MATERIALS AND METHODS

Careful MedLine and PsycINFO searches for the period 1980-2013.

RESULTS

The review of the literature indicates that emotional turmoil in suicide survivors may last a long time and, in some cases, may end with their own suicide.

CONCLUSION

Future research should evaluate the efficacy of professional treatments and of support groups targeting suicide survivors.

PRACTICE IMPLICATIONS

It is crucial to understand the bereavement process after the suicide of a significant other in order to provide proper care, reduce stigma, and improve the outcomes of related psychiatric conditions.

Stigma of Suicide Attempt (STOSA) scale and Stigma of Suicide and Suicide Survivor (STOSASS) scale: two new assessment tools

This study aimed at validating two new assessment tools, the Stigma of Suicide Attempt (STOSA) scale and the Stigma of Suicide and Suicide Survivor (STOSASS) scale. The Devaluation-Discrimination scale of Link et al. was translated into Italian and adapted to measure stigma towards suicidal behavior. Both scales were administered to a mixed sample including members of the general population (n=282), patients with a mental disorder (n=113), suicide attempters (n=57) and people who had lost a significant other to suicide (n=75). Reliability of the scales was good in terms of both internal coherence and test-retest stability. Factor analysis produced an acceptable solution for the STOSA-scale. Items were distributed into two factors, one grouping items to measure supportive, respectful and caring attitudes, the other factor grouping items oriented towards stigmatizing attitudes and beliefs. The clinical populations were more inclined towards stigmatization of suicide than were people from the general population, who might be less aware of the stigma attached to suicide. The two scales may be helpful to quantify stigma at individual level in order to provide targeted supportive interventions, and at population level to measure changes in the beliefs and attitudes of the general population.

Psychiatrists' emotional reactions to patient suicidal behavior

BACKGROUND

Psychopathology is a risk factor for suicidal behavior. It is likely that psychiatrists will have to deal with an attempted or completed suicide by a patient at some point in their careers. The goal of this study was to assess psychiatrists' emotional reactions to patients' suicidal behavior.

METHODS

Data were collected using a questionnaire that was administered to psychiatrists after a completed or attempted suicide by one of their patients.

RESULTS

Thirty-four psychiatrists participated in the study and reported on 62 attempted suicides and 11 completed suicides. All of the participants reported at least one emotion following the event. After an attempted suicide, trainees were more likely than consultants to experience psychological pain, guilt, self-doubt, and frustration. Being a trainee was also associated with psychological pain, guilt, fear, self-doubt, and frustration in regression analysis. Shock, disbelief, fear, self-doubt, and embarrassment were associated with completed rather than attempted suicides.

CONCLUSIONS

Attempted and completed suicides have a significant impact on psychiatrists. The impact of an attempted suicide is usually less severe. The patterns of reaction differ between consultant and trainee psychiatrists.

Involving patients who attempt suicide in suicide prevention: a focus groups study

The aim of this study is to gain insight into the individual experiences of patients who attempt suicide in order to better understand the reasons for and emotions behind a suicide attempt, thus also gaining insight, through the patients' own input, into the risk and protective factors which might influence possible repeat attempts and the attitude towards the assistance they receive. Two focus groups were conducted involving 17 participants, all hospitalized at the time of research for attempting suicide. The patients proved themselves competent, even expert in indicating reasons for, risk factors of and prevention strategies for suicide. The main findings suggest that the relational factor represents a key point both as a trigger for the suicide attempt and for promoting the communication of the intent or for preventing a repeat suicide attempt, as interpersonal relationships and an empathic environment were, in essence, what was perceived as therapeutic and protective and enabled the expression of thoughts and self-understanding. Accordingly psychotherapy, non-specific relationship 'monitoring' after discharge and tutored self-help groups have been suggested. Feasibility and implementing methods as well as the role of the nurse for such interventions were discussed.

Attitudes toward suicide: the effect of suicide death in the family

There have been few reports on the effect of suicide death on family members' attitudes toward suicide. In order to estimate the extent to which suicide death affects attitudes toward suicide among family members of suicides, data of 264 informants from a case-control psychological autopsy study were analyzed. The results showed that there were no significant differences in attitudes toward suicide, measured by the General Social Survey's (GSS) four questions, between informants of suicides and informants of living controls, between family members of suicides and family members of living controls, or between family members of suicides and non-family members of suicides. Our findings did not support the hypothesis that suicide death affects the attitudes toward suicide in suicides' family members. However, some factors were found to be related to the pro-suicide attitudes measured by the four questions included in the GSS.

Can Postvention Be Prevention?

Background. There has been recent interest in postvention activities which involve provision of support to family members and others affected by a suicide death. Aims. To review the current status of postvention support, including definitions used and the objectives and effectiveness of support activities for people bereaved by suicide. Methods. Selected controlled studies of support activities and programs are reviewed with narrative comment. Results. Not applicable. Conclusions. Effective postvention support can be viewed as contributing toward suicide prevention among those people who are bereaved by suicide. Further development of support programs is needed.