Group intervention for children bereaved by the suicide of a relative
Abstract
Objective This study evaluated efficacy of a manual-based bereavement group intervention for children who suffered suicide of a parent or sibling.Method Seventy-five families (102 children) were screened from medical examiners' lists of suicide victims. Fifty-two families (75 children) were eligible and assigned in alternating order to receive (27 families, 39 children) or not to receive (25 families, 36 children) the intervention. Intervention efficacy was evaluated as change in children's symptoms of anxiety, depression, posttraumatic stress, social adjustment, and parents' depressive symptoms from initial to outcome assessments.Results Changes in anxiety and depressive symptoms were significantly greater among children who received the intervention than in those who did not. A greater dropout of children assigned not to receive (75%) than to receive (18%) intervention led to an imbalance in retention of intervention and nonintervention participants.Conclusions A bereavement group intervention focusing on reactions to death and suicide and strengthening coping skills can lessen distress of children bereaved after parental or sibling suicide. Such intervention may prevent future morbidities.
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It seems beneficial to deliver interventions over time (e.g., over 8-10 weeks) or to use manuals or guidelines for the intervention.
“Also, it seems beneficial to deliver interventions over time (e.g., over 8–10 weeks) (Farberow, 1992; Pfeffer et al., 2002) or to use manuals or guidelines for the intervention (Kovac and Range, 2000; Pfeffer et al., 2002; Supiano et al., 2017; Zisook et al., 2018).”
From Suicide Postvention Service Models and Guidelines 2014–2019: A Systematic Review (2019) · cites this paper as Pfeffer et al., 2002
Together these studies suggest that social support in the community, and a professionally led support group or therapy group program for adults and for children might be helpful.
“Together these studies suggest that social support in the community (Sandor et al., 1994), and a professionally led (with involvement of trained volunteers) support group or therapy group program for adults (Farberow, 1992) and for children (Pfeffer et al., 2002) might be helpful.”
From Suicide Postvention Service Models and Guidelines 2014–2019: A Systematic Review (2019) · cites this paper as Pfeffer et al., 2002
Pfeffer et al. (2002) suggested that psychoeducation of parents contributed to the effect of the intervention for bereaved children, as it enabled them to better support their children.
“Pfeffer et al. (2002) suggested that psychoeducation of parents contributed to the effect of the intervention for bereaved children, as it enabled them to better support their children.”
From Suicide Postvention Service Models and Guidelines 2014–2019: A Systematic Review (2019) · cites this paper as Pfeffer et al., 2002
A psychoeducational component for parents may have contributed to the positive effects.
“A psychoeducational component for parents may have contributed to the positive effects.”
From Suicide Postvention Service Models and Guidelines 2014–2019: A Systematic Review (2019) · cites this paper as Pfeffer et al., 2002
A 10-week psychologist-facilitated group therapy program for children reduced anxiety and depression but not posttraumatic stress or social adjustment at 12-weeks follow-up.
“Regarding psychosocial outcomes, the previous review (Andriessen et al., 2019) found that a 10-week psychologist-facilitated group therapy program for children reduced anxiety and depression but not posttraumatic stress of social adjustment at 12-weeks follow-up (Pfeffer et al., 2002).”
From Suicide Postvention Service Models and Guidelines 2014–2019: A Systematic Review (2019) · cites this paper as Pfeffer et al., 2002
Three studies evaluated family-oriented interventions, and two examined individual interventions.
“Three studies evaluated family-oriented interventions [38, 41, 42, 44], and two examined individual interventions [37, 40].”
Most studies involved interventions that targeted adult populations, but three tested interventions aimed at children or adolescents.
“Most studies involved interventions that targeted adult populations, but three tested interventions aimed at children or adolescents [38, 39, 43].”
Five studies had a passive control group (no intervention).
“Five studies had a passive control group (i.e., no intervention) [36, 38, 39, 43, 44].”
Several studies involved manualised interventions.
“Several studies involved manualised interventions [37, 38, 40–42].”
Eight of the 11 studies were conducted in the USA.
“Eight studies were conducted in the USA [33–40].”
The overall study quality was weak: nine studies received a total rating of 'weak'; the other two were rated 'moderate'.
“The overall study quality was weak: nine studies received a total rating of ‘weak’; the other two [37, 38] were rated ‘moderate’.”
Pfeffer et al. demonstrated that a 10-week psychologist-facilitated group therapy program for children reduced anxiety and depression but not post-traumatic stress or social adjustment at 12-weeks follow-up.
“Pfeffer et al. [38] demonstrated that a 10-week psychologist-facilitated group therapy program for children reduced anxiety and depression but not post-traumatic stress of social adjustment at 12-weeks follow-up.”
All reviewed studies reported on effectiveness of interventions in terms of various psychosocial outcomes, such as depression and/or anxiety, posttraumatic stress, distress and social adjustment, self-efficacy, problem solving, and substance use.
“All reviewed studies reported on effectiveness of interventions in terms of various psychosocial outcomes, such as depression and/or anxiety [e.g., 34, 38], posttraumatic stress [38], distress and social adjustment [34], self-efficacy [39], problem solving [33], and substance use [43].”
Particular interventions were related to particular positive outcomes, e.g., a group therapy for children, CBT-based psycho-educational intervention, and group psychotherapy for widows, found significant reductions in depression.
“Particular interventions were related to particular positive outcomes, e.g., a group therapy for children [38], CBT-based psycho-educational intervention [44], and group psychotherapy for widows [34], found significant reductions in depression.”
Involving parents or the wider community may contribute to the effectiveness.
“Involving parents [38], or the wider community [39] may contribute to the effectiveness.”
Both effective interventions with a passive control group were provided by trained facilitators and included supportive, therapeutic and educational aspects.
“Both interventions were provided by trained facilitators (trained volunteer and clinician, and clinicians only, respectively), and included supportive, therapeutic and educational aspects.”
Of the interventions with a passive control group, effective interventions were delivered over time (eight and 10 weeks respectively).
“Of the interventions with a passive control group, effective interventions [36, 38] were delivered over time (eight and 10 weeks respectively).”
The use of manuals or guidelines may help guiding the intervention.
“The use of manuals or guidelines may help guiding the intervention [37, 38, 40–42].”
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- Authors
- PFEFFER, C. R., JIANG, H., KAKUMA, T., HWANG, J., & METSCH, M.
- Affiliations
- Cornell University (US)
- Corresponding author
- PFEFFER, CYNTHIA R.
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2002-05
- Volume
- 41
- Issue
- 5
- Pages
- 505-513
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W1988030132
- Cited by
- 152
- References
- 34
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 5 · 2023: 6 · 2022: 6 · 2021: 5 · 2020: 4 · 2019: 6 · 2018: 4 · 2017: 5 · 2016: 4 · 2015: 9 · 2014: 6 · 2013: 4 · 2012: 8
- FWCI
- 8.41
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
- Keywords
- suicide bereavement, group intervention, parental suicide, anxiety symptoms, depressive symptoms, post-traumatic stress, social adaptation, parental depressive symptoms, coping strategies, intervention dropout, intervention retention
- MeSH terms
- Adaptation, Psychological, Adolescent, Bereavement, Child, Family, Female, Humans, Male, Personality Assessment, Psychotherapy, Group, Suicide, Outcome Assessment, Health Care
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