Interventions for Suicide Survivors: A Review of the Literature

More documents

Recommendations

Info

344 Interventions for Suicide Survivors iors (e.g., exercise) showed better outcomes. changes in parents’ depression after partici- Gender differences were also observed, with pation. The comparison group consisted of mothers generally showing improvement in families contacted but assigned to the no- health and functioning, and fathers showing treatment condition. The results showed deterioration in PTSD symptoms and health significant decreases for children in the treatover the 5-year period. Importantly, Murphy ment group in depression and anxiety symp- also noted that participants reported that toms, although not in trauma or social ad- their greatest period of accommodation to justment scores. Unfortunately, there were the loss occurred in the third and fourth no significant changes in parent’s depression years after the death and not in the first year, scores, a result that the authors attribute to as is commonly assumed. the fact that the intervention was designed to Mitchell and Kim (2003) have recently educate parents about bereavement in chilreported on a debriefing intervention modi- dren, rather than directly affect parents’ own fied for early intervention with suicide survivors. In this study, 60 recently bereaved (one month or less) suicide survivors were ran- grief responses. domly assigned to either a single session de- RECOMMENDATIONS briefing group or to a treatment as usual group. Participants filled out measures of AND CONCLUSIONS perceived stress, complicated grief, depres- At this point, we can return to the sion, PTSD, general psychiatric symptoms, original goals of the article. These included and general quality of life at 4 and 12 weeks reviewing the current status of knowledge after the intervention. The treatment group about interventions for suicide survivors, and was found to be less distressed prior to the developing recommendations for future reintervention than the controls, and this was search on this topic. The literature on gen- found to be related to the closeness of the eral bereavement interventions suggests that kinship relationship to the deceased (controls many services may be of dubious value, at had closer kinship connections than treat- least as delivered in the research studies. ment group), and controlled by using change However, there is evidence that interventions scores rather than direct comparisons be- for high-risk populations, such as suicide sur- tween groups. There was also significant atvivors, may be more effective. The literature trition in follow-up participation, so that the also indicates that the design of interventions final results were based on an n of 27. Results may need to take into account gender differ- showed trends toward greater improvement ences, with men responding differently and/ in grief and perceived stress for the treatment or less positively than women to typical in- group at 4 weeks. Likewise, at 3 months the terventions. Lastly, bereavement studies sugtreatment group showed greater improvegest that many of the interventions are simment on general mental health and a trend ply of insufficient strength and duration to toward less perceived stress. Despite the make a measurable impact. This may be par- methodological issues, the results suggest a ticularly true for traumatic losses such as suimodest potential for a positive effect for an cide, where clinical experience and the self- early, CISM type intervention for survivors. reported needs of survivors strongly suggest Finally, Pfeffer et al. (2002) reported that brief interventions delivered early in the on a well-designed support group interven- mourning trajectory may be insufficient to tion for children who had experienced the address the magnitude of disruption engen- suicide of a parent or sibling. Although it was dered by a suicide (Murphy et al., 2003). For primarily an intervention with bereaved chil- a more extensive discussion of these concludren, the research is noted here because the sions, please see the recent review by Jordan intervention included a psychoeducational in- and Neimeyer (2003). tervention for parents which was assessed by The studies that have empirically eval-
Jordan and McMenamy 345 uated interventions specifically designed for surround the survivor. Other areas that may survivors are somewhat more promising, and show differences in the bereavement expe- also have similar implications for future re- rience include the impact of suicide on the search and clinical intervention. Most of the assumptive world of survivors and possible studies found at least some effect for the in- long-term “sleeper” effects, particularly for tervention and also report high levels of children who lose parents to suicide. participant satisfaction with the services. Un- There is also a lack of consensus about fortunately, the methodological rigor of the whether there is a universal pattern of re- studies has generally been weak, with many sponse among suicide survivors, or alternaresearchers failing to utilize random assigntively, a diversity of responses that are influment and appropriate comparison groups. enced by variables over and above the loss. Moreover, the studies that have employed This suggests the need for continuing rethe most careful research designs (Kovac & search into which factors tend to produce Range, 2000; Murphy et al., 1998; Pfeffer et which types of responses for which groups of al., 2002) also tended to find the least confir- survivors (Farberow, 2001). In addition, very mation that the interventions were success- little is known about the coping strategies ful. Hence, while there is anecdotal evidence that survivors develop on their own, and only and a general clinical impression that services slightly more about what types of formal and are helpful, we must conclude that the effi- informal assistance survivors receive from cacy of formal interventions for survivors has professional caregivers, family, friends, and yet to be scientifically established. The state others in their social network. Careful longiof our knowledge about how, when, and with tudinal research with a diverse, community- whom to intervene after a suicide is still quite based sample of survivors would greatly in- primitive, suggesting a pressing need for furcrease our understanding of the challenges ther research that addresses several key is- involved and the coping skills required after sues. We turn to this topic in the final section a suicide. It would also provide much needed of this article. information about the large number of survivors (quite likely the majority) who never Recommendations for Future Research attend organized support groups or receive professional assistance. Such research would The first need is for better information allow us to generate creative strategies for inabout the “natural” course of bereavement tervention that build on the natural coping after suicide. We have not yet definitively an- efforts that different types of survivors typiswered the question as to what, if any, differ- cally make and the support resources they ences exist between suicide bereavement and utilize. Differences in coping strategies based other types of losses (Clark, 2001). Mc- on gender, personality, and cultural differ- Intosh’s (1999) summary of the literature ences need to be studied and incorporated concluded that most suicide bereavement is into treatment planning. To summarize, it nonpathological, suggesting that whatever seems likely to us that the “one size fits all” differences exist between bereavement after approach to understanding and intervening suicide and other types of losses appear to with survivors which has been dominant disappear after the first 2 years. Jordan (2001) since the inception of modern suicidology has also reviewed this literature and reached needs considerable refinement (Ellenbogen a more complex conclusion, suggesting that & Gratton, 2001). while quantitative evidence for differences in Second, we need methodologically sound outcome has received only mixed support, studies of the efficacy and effectiveness of there appear to be important distinctions in formal interventions for survivors. Given the the thematic content of the grief experience present state of knowledge, we believe that it for many survivors, in addition to differences is generally premature to study comparative in social support and family processes that treatment interventions at this time. Since
Page 1 and 2: Suicide and Life-Threatening Behavi
Page 3 and 4: Jordan and McMenamy 339 surveyed co
Page 5 and 6: Jordan and McMenamy 341 men and wom
Page 7: Jordan and McMenamy 343 cult to dra
Page 11 and 12: Jordan and McMenamy 347 psychoeduca
Page 13: Jordan and McMenamy 349 concerns ab

Interventions for Suicide Survivors: A Review of the Literature

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?