Competence-building in adolescents, Part II: Community intervention for survivors of peer suicide

Responding to Suicide in School Communities: An Examination of Postvention Guidance from Expert Recommendations and Empirical Studies

PURPOSE OF REVIEW

We review the published literature on a school's response after a student dies by suicide ("postvention"). We examine published recommendations based on expert guidance and empirical studies that have evaluated postvention measures.

RECENT FINDINGS

Experts recommend careful communication with family, staff, and students that adheres to published suicide reporting guidelines. Experts also emphasize the importance of identifying and supporting high-risk students. Few robust, controlled studies have identified effective postvention measures. Effective measures tended to occur in group settings (e.g., group therapy), focus on improving grief symptoms, and involve mental health professionals. Postvention has not been robustly studied in the school context. Expert recommendations and a few evidence-backed studies provide the frame for a coherent, school-based postvention response. Further research is needed to strengthen and expand our collective understanding of effective postvention measures in the school context as youth suicide attempts continue to rise.

Community Based Support for People at Risk for Suicide and Those Who Care for them - Areas for Improvement

To systematically review the quality of evidence regarding the effectiveness of supports for people affected by suicide. EMBASE, MEDLINE, and PsychINFO were searched for evaluations of community-based supports for people affected by suicide. Outcomes included suicide-related behavior, depression, grief, quality of life, caring ability, and qualitative experiences. Fifteen studies evaluated 15 supports of various modalities. Study quality was generally poor; most studies examined bereaved individuals with mixed findings. Few reduced suicide-related behavior, half improved depression, and grief, while studies of caring ability, quality of life, or qualitative experiences reported positive effects. Supports associated with better outcomes connected peers with similar experiences, were provided over a period of months, and involved veteran rather than novice facilitators. Supports for people affected by suicide may be effective for improving suicide-related behavior, psychological adjustment, quality of life and caregiving, but require further evaluation.

Suicide Postvention Service Models and Guidelines 2014-2019: A Systematic Review

Background: Suicide bereavement can have a lasting and devastating psychosocial impact on the bereaved individuals and communities. Many countries, such as Australia, have included postvention, i.e., concerted suicide bereavement support, in their suicide prevention policies. While little is known of the effectiveness of postvention, this review aimed to investigate what is known of the effects of postvention service delivery models and the components that may contribute to the effectiveness.

Method: Systematic review and quality assessment of peer reviewed literature (Medline, PsycINFO, Embase, EBM Reviews) and gray literature and guidelines published since 2014.

Results: Eight studies and 12 guidelines were included, with little evidence of effectiveness. Still, providing support according to the level of grief, involvement of trained volunteers/peers, and focusing the interventions on the grief, seem promising components of effective postvention.

Conclusions: Adopting a public health approach to postvention can allow to tailor the service delivery to needs of the bereaved individuals and to align postvention with suicide prevention programs.

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

BACKGROUND

Suicide bereavement is a risk factor for adverse outcomes related to grief, social functioning, mental health and suicidal behaviour. Consequently, suicide bereavement support (i.e., postvention) has been identified as an important suicide prevention strategy. However, little is known about its effectiveness. To redress this gap, this review aimed to assess the evidence of effectiveness of interventions for people bereaved by suicide, and appraise the quality of the research in this field.

METHODS

We conducted a systematic review according to PRISMA guidelines. Searches of peer-reviewed literature in Medline, PsycINFO, Embase and EBM Reviews identified 12 papers reporting on 11 relevant studies conducted between 1984 and 2018.

RESULTS

Across studies, there was a wide variety of intervention modalities, study populations, control groups, and grief, psychosocial and suicide-related outcome measures. Overall, the quality of studies was weak. While there was some evidence of the effectiveness of interventions for uncomplicated grief, evidence of the effectiveness of complicated grief interventions was lacking. Based on this scant evidence, interventions which seem to show promise include supportive, therapeutic and educational approaches, involve the social environment of the bereaved, and comprise a series of sessions led by trained facilitators.

CONCLUSIONS

There is a clear need for additional methodologically sound studies in this area. Specifically, selection procedures, sample sizes, randomization, and the use of appropriate measures are crucial. As people bereaved by suicide are at-risk of adverse grief, mental ill-health and suicidal behaviour, further research across the life-span is essential to prevent grief and mental health ramifications.

Post-suicide intervention programs: a systematic review

OBJECTIVE

The purposes of this study were: 1) to determine the effectiveness of suicide postvention programs on suicide attempts and suicide as well as grief symptoms, mental distress, and mental health broadly defined; and 2) to investigate their cost-effectiveness.

METHODS

Computerized database searches (PubMed, PsycINFO, Cinahl, Cochrane Database, Crisis and Suicide & Life-Threatening Behavior) were performed in September 2009 to obtain evaluations of suicide postvention programs and in February 2010 (Centre for Research and Dissemination Database, Cochrane Database of Systematic Reviews, PubMed, PsycINFO, and Cinahl) to obtain cost-effectiveness analyses of bereavement programs. Hand searches of relevant articles and reviews were also conducted. Publications were included in the analysis if they described an evaluation/cost-effectiveness analysis of a suicide postvention program, provided data, and were published in English-language peer-reviewed journals. There was no restriction on publication date. Studies were excluded if they were narrative systematic reviews or dissertations or if they described a postvention program but provided no evaluation. Because very few cost-effectiveness analyses were identified, articles describing "costs" of bereavement programs were also included. Studies were evaluated for quality using Centres for Evidence-Based Medicine Levels of Evidence, and for program effectiveness using Office of Justice Programs "What Works Repository" Analytic Framework.

RESULTS

Of the 49 studies of suicide postvention programs retrieved, 16 met inclusion criteria for evaluation of study quality and evidence of effectiveness. Three target populations for postvention programs were identified: school-based, family-focused, and community-based. No protective effect of any postvention program could be determined for number of suicide deaths or suicide attempts from the available studies. Few positive effects of school-based postvention programs were found. One study reported negative effects of a suicide postvention. Gatekeeper training for proactive postvention was effective in increasing knowledge pertaining to crisis intervention among school personnel. Outreach at the scene of suicide was found to be helpful in encouraging survivors to attend a support group at a crisis centre and seek help in dealing with their loss. Contact with a counseling postvention for familial survivors (spouses, parents, children) of suicide generally helped reduce psychological distress in the short term. There was no statistical analysis of community-based suicide postvention programs; however media guidelines for reporting of suicide and suicide attempts have been adopted by mental health organizations in numerous countries. No analyses of cost-effectiveness of suicide postvention programs were found.

CONCLUSION

Recommendations to provide guidance to policy-makers, administrators and clinicians are presented and directions for future research are outlined.