Laura Hofmann

Background: Suicide bereavement refers to the grief experienced by individuals who have lost a close contact to suicide. It is often characterized by intense emotional distress, feelings of guilt, stigma, and social isolation, and may increase the risk of mental health problems and suicidal behavior. As research on suicide bereavement and postvention continues to expand globally, there is a growing need to map its development systematically and identify key trends. Aims: This study aimed to describe patterns in published literature on suicide bereavement and postvention through a global bibliometric analysis. Method: Systematic searches in eight databases (Web of Science; Scopus; CINAHL; PsycINFO; MEDLINE; Embase; Emcare; APA PsycArticles) yielded 49,386 references. After deduplication and screening, 1,072 articles published between 1953 and 2025 were included. Eligible peer-reviewed publications included empirical research, evidence syntheses (systematic reviews, scoping reviews, meta-analyses) and nonempirical publications (such as opinion pieces, and personal experiences). There were no restrictions on language, location, or year of publication. Results: The 1,072 eligible publications demonstrated a steady increase in suicide bereavement/postvention publications annually. 95% of publications were by first authors from high-income countries, while 1.3% of first authors were from lower-middle-income and low-income countries. Most studies were empirical and followed a quantitative or qualitative design, primarily cross-sectional, increasing over the years, while nonempirical publications declined. We identified few longitudinal or interventional studies. Populations sampled most frequently were working-age adults, with few studies focused on older adults. Limitations: The results provide little information about the methodological quality of the included studies. Some full texts could not be found and were unavailable for data extraction. Conclusion: The research gaps identified suggest that future studies should focus on underrepresented populations as well as on high-quality intervention studies to address adverse outcomes among suicide loss survivors.

Unfinished business in bereavement is associated with symptoms of prolonged grief, grief-related distress and poorer adjustment to the loss. To date, no study has examined unfinished business exclusively in suicide loss survivors. The aim of this study is to address this gap by exploring unfinished business and its impact on psychopathological symptoms in individuals bereaved by suicide loss. A total of 127 suicide bereaved individuals completed a questionnaire that assessed unfinished business (UBBS), symptoms of prolonged grief (TGI-SR+), symptoms of (complex) post-traumatic stress (ITQ), depression (PHQ-9), and guilt (GEQ). Significant positive correlations were found between unfinished business and all assessed outcomes. Unfinished business as well as unresolved conflicts and unfulfilled wishes were significant predictors for symptoms of PGD, PTSD, cPTSD, depression and guilt. Including unfinished business in clinical interventions could be an essential component in the care of suicide loss survivors.

Background: Physician-assisted suicide (PAS) is increasingly being legalized in a growing number of countries and is the focus of societal and ethical debates. However, there is limited knowledge regarding the perception and acceptance of PAS across different physical and mental health conditions. This study aimed to explore emotional responses, understanding, and willingness to support individuals with the wish for PAS. Methods: Participants from the general German population (N = 512) were presented with four case vignettes of PAS depicting individuals in an online study: one with cancer, one with depression, one with schizophrenia, and one healthy individual. Participants were asked to evaluate the emotional reactions elicited by the desire for PAS, the extent of their understanding of this wish, and their willingness to support each individual. Results: The study revealed significant differences in reactions to the case vignettes. Pro-social emotions were lowest and anger highest when considering the healthy individual. Participants demonstrated the greatest understanding and highest willingness to support the individual with cancer, while the least understanding and support were observed for the healthy person. Conclusions: The differential levels of support for PAS across various conditions underscore the complex interplay between societal values, perceived quality of life, and ethical considerations, particularly when mental health is involved.

Background: Men have a significantly higher risk of dying by suicide than women and at the same time are less likely to make use of psychosocial support services. Therefore, informal caregivers who care for a person at risk play a significant role. This study aims to highlight the distress and support needs of informal caregivers for men in suicidal crises. Methods: N = 15 participants who lost a man to suicide in the last 3–12 months were interviewed using psychological autopsy interviews. The interviews were analyzed using a comprehensive category system while following a deductive-inductive approach. Results: The majority of participants reported experiencing significant stress as well as anxiety about leaving the affected men unsupervised. Only four participants indicated that they openly discussed their stress with their social environment, and just two sought professional support. Notably, only two caregivers anticipated the possibility of suicide. There was also little professional support for caregivers, resulting in participants using internet resources to inform themselves about suicidal ideation and behavior. Conclusion: These findings highlight the significant stress and burden experienced by informal caregivers in suicide prevention for men. Lack of open communication and insufficient access to support exacerbate the emotional burden on caregivers. These results highlight the need for accessible resources and assistance to better support both caregivers and the individuals they care for. Trial registration: German Clinical Trials Register, DRKS00030758, Registered on 11.11.2022.

Background: Suicide bereavement increases the probability of adverse outcomes related to grief, social functioning, mental health, and suicidal behavior. While more support for individuals bereaved by suicide has become available, the evidence regarding its effectiveness is not straightforward. The literature suggests that identifying best-practice components is key in designing effective postvention interventions. Aims: This metareview aims to identify components of suicide bereavement interventions perceived to be effective by suicide-bereaved people. Method: The review adhered to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Systematic searches in Medline, PsycINFO, Embase, Emcare, EBM Reviews, Scopus, and Web of Science identified 11 eligible systematic reviews published between 2008 and 2023. The methodological quality was assessed using the Measurement Tool to Assess Systematic Reviews (AMSTAR-2) (PROSPERO registration CRD42023458300). Results: Our narrative synthesis reported the components perceived to be effective in relation to structure and content of interventions, facilitators, and modality (peer, group, community, online). Limitations: The quality of the included reviews varied considerably, and not all reviews reported on perceived effectiveness of interventions’ components. Meta-analysis of findings was not possible due to study heterogeneity. Conclusion: The findings provide crucial information for researchers, service providers, and policymakers to enhance the provision of evidence-based support for people bereaved by suicide.

Men at risk for suicide are a challenging population group to reach with suicide prevention strategies. Gatekeepers hold a pivotal role in the prevention of male suicide, yet effective intervention requires them to have a level of knowledge and strategies to provide support. This study aimed to examine the efficacy of an online gatekeeper program for gatekeepers in male suicide prevention, assessing knowledge, perceived preparedness, self-efficacy, and psychopathological symptoms of gatekeepers. Eighty-four participants were randomized to either the intervention (n = 43) or the waitlist control group (n = 41). The intervention comprised four modules providing knowledge and strategies for addressing men in suicidal crises. Outcomes included depression (PHQ-9), distress (PSS-10), burden (BAS), involvement (IEQ), as well as gatekeeper outcomes and knowledge. Completer analyses revealed significant improvement of depressive symptoms (d = 0.39) and an increase in gatekeeper outcomes (d = 0.58 to d = 0.84) and knowledge (d = 0.62) from baseline to post-assessment. The effects were maintained for 3 months. No significant effects could be found for burden, distress, and involvement. The findings indicate that a brief gatekeeper program can serve as a valuable resource. Future research should focus on examining the mental health of gatekeepers themselves and its long-term effects on intervention behavior. German Clinical Trials Register, DRKS00030758, registered on 05.12.2022.

Background: Physician-assisted suicide (PAS) and voluntary euthanasia remain highly debated topics in society, drawing attention due to their ethical, legal, and emotional complexities. Within this debate, the loss of a loved one through suicide may shape the attitudes of survivors, resulting in more or less favorable attitudes towards this topic. Aims: This study aims to explore and compare the attitudes towards PAS and voluntary euthanasia in a population of suicide loss survivors and the general population, while also considering socio-demographic factors. Methods: A total of 529 participants, 168 of whom were survivors of suicide loss, completed an online questionnaire on their attitudes (NOBAS) and opinions (open response format) towards PAS and voluntary euthanasia, as well as regarding their legalization in Germany. The analysis consisted of both quantitative and qualitative components. Results: The entire sample showed positive attitudes towards PAS and voluntary euthanasia in terminally ill persons. Participants were more divided in their attitudes towards PAS in the case of a mental health disorder. Individuals without experienced suicide loss were more liberal regarding legalization in Germany and were more likely to understand the wish for PAS. Survivors of suicide loss were mainly concerned about the consequences for relatives. However, differences between both groups are small. Discussion: The experience of a loss by suicide influences attitudes towards PAS and voluntary euthanasia. Both groups showed an accepting attitude towards PAS and voluntary euthanasia, but also expressed concerns and fears regarding easy accessibility and consequences for grieving relatives.

Suicide-bereaved individuals are often confronted with profound grief reactions and have an increased risk for mental health disorders. Little is known about the development of complex post-traumatic stress disorder (CPTSD) following a loss by suicide. This paper aims to assess the prevalence of CPTSD, PTSD, prolonged grief disorder (PGD), and depression as well as to identify sociodemographic and loss-related factors regarding their development. A total of 161 suicide loss survivors (91.3% female) completed a questionnaire, which collected symptoms of grief (TGI-SR+), PTSD, CPTSD (ITQ), and depression (PHQ-D). In total, 12.4% met the diagnosis for CPTSD, 5.0% for PTSD. A total of 22.0% fulfilled the diagnosis for PGD. 41.6% showed at least moderate symptoms of depression. Pearson's correlation showed that time since loss was negatively associated with PG and PTSD symptoms, kinship to the deceased was associated with PG severity. The sample scored high on all disturbances in self-organization (DSO) symptom clusters typical for CPTSD. A focus on symptoms of CPTSD may be a necessary component in the care of survivors of suicide loss.

Men show a significantly higher suicide rate, are less often recognized as persons at risk, and are more difficult to reach for suicide prevention interventions. Warning signs and deterioration in mental health are often not recognized by their surroundings. This study aims to retrospectively analyze the behavior and communication of men before a suicide, how relatives noticed changes, and how the interaction was perceived. N = 15 individuals who lost a close male relative to suicide were interviewed using psychological autopsy interviews. The interviews were evaluated following a deductive–inductive approach while using a comprehensive category system. The majority of men showed changes in behavior before the suicide, especially social withdrawal, irritability, and generally a deterioration in mental health. In fact, men did communicate their suicidal thoughts before they died through suicide, but mainly indirectly. While only one-third of the deceased made preparations before suicide, the majority of relatives noticed a deterioration in the mental health of the individual as well as increased alcohol and substance use. Men show signs of suicide, which are little recognized by their surroundings. Suicide prevention interventions should be adapted more to the needs of men.