Support received after bereavement by suicide and other sudden deaths: A cross-sectional UK study of 3432 young bereaved adults
Open accessAbstract
Objective: To test the hypothesis that people bereaved by suicide are less likely to receive formal or informal support than people bereaved by other causes of sudden death. Design: National cross-sectional study. Setting: Adults working or studying at any UK higher education institution (HEI) in 2010. Participants: A total of 3432 eligible respondents aged 18–40 years bereaved by the sudden death of a close friend or relative, sampled from approximately 659 572 bereaved and non-bereaved staff and students at 37 of 164 UK HEIs invited to participate. Exposures: Bereavement by suicide (n=614; 18%), by sudden unnatural causes (n=712; 21%) and by sudden natural causes (n=2106; 61%). Main outcome measures: Receipt of formal and informal support postbereavement; timing of valued support. Results: 21% (725/3432) of our sample of bereaved adults reported receiving no formal or informal bereavement support, with no evidence for group differences. People bereaved by suicide were less likely to have received informal support than those bereaved by sudden natural causes (adjusted OR (AOR)=0.79; 95% CI 0.64 to 0.98) or unnatural causes (AOR=0.74; 95% CI 0.58 to 0.96) but did not differ from either comparison group on receipt of formal support. People bereaved by suicide were less likely to have received immediate support (AOR=0.73; 95% CI 0.59 to 0.90) and more likely to report delayed receipt of support (AOR=1.33; 95% CI 1.08 to 1.64) than people bereaved by sudden natural causes. Associations were not modified by gender, or age bereaved, but became non-significant when adjusting for stigma. Conclusions: People bereaved by suicide are less likely to receive informal support than people bereaved by other causes of sudden death and are more likely to perceive delays in accessing any support. This is concerning given their higher risk of suicide attempt and the recommendations within suicide prevention strategies regarding their need for support. Study registration: http://www.ucl.ac.uk/psychiatry/bereavementstudy/
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Written from the paper’s full text.
TL;DR
In a UK cross-sectional survey of 3432 young bereaved adults, people bereaved by suicide were less likely to receive informal support and more likely to report delayed support than those bereaved by other sudden deaths, while 21% overall received no formal or informal support. The significant associations became non-significant after adjusting for perceived stigma.
Key findings
- 21% (725/3432) reported receiving no formal or informal bereavement support, with no evidence for group differences; 78% (2572/3432) received some support, and 85% (2173/2572) perceived some aspect as valuable.
- People bereaved by suicide were less likely to receive informal support than those bereaved by sudden natural causes (AOR=0.79; 95% CI 0.64 to 0.98) or sudden unnatural causes (AOR=0.74; 95% CI 0.58 to 0.96), but did not differ on formal support.
- People bereaved by suicide were less likely to receive immediate support within 1 week (AOR=0.73; 95% CI 0.59 to 0.90) and more likely to report delayed support beyond 6 months (AOR=1.33; 95% CI 1.08 to 1.64) than those bereaved by sudden natural causes.
- Among 210 respondents who had attempted suicide postbereavement, 67% (141/210) had not sought help for any postbereavement self-harm; the most common source among those who did seek help was a general practitioner (20%).
Methods
- National cross-sectional online survey in 2010 of UK higher education institution staff and students aged 18–40 bereaved by sudden death of a close friend or relative; 37 of 164 invited HEIs participated, accessing an estimated sampling frame of 659,572 people, with 3432 eligible respondents. Exposures were suicide (n=614; 18%), sudden unnatural causes (n=712; 21%), and sudden natural causes (n=2106; 61%).
- Outcomes included receipt of formal and informal support, no support, immediate support (<1 week), delayed support (>6 months), exclusive formal support, and help sought after postbereavement self-harm; perceived stigma was measured with the Grief Experience Questionnaire stigma subscale.
- Analysis used multivariable random effects logistic regression with HEI as a random effect, adjusted for eight prespecified confounders, comparing suicide bereavement with sudden natural causes and with sudden unnatural causes; interaction tests assessed gender and age at bereavement, plus sensitivity analyses.
Limitations
- Stated by the paper: selection bias from HEI sampling and pronounced male non-response bias limit generalisability beyond highly educated female groups; the limited age range restricts generalisability beyond young adults; no denominator meant no response rate could be presented; recall bias among those worst affected was possible; models did not account for pre-bereavement anxiety or other mental disorders; two secondary outcomes were underpowered due to group sizes <466; gender interaction tests had limited power, and gender-specific analyses were not possible due to low male numbers.
- Evident from the text: the cross-sectional observational design limits causal inference, and receipt of support may reflect perceived availability rather than preference or objective lack of help offered.
Model-written summary. Check it against the paper before relying on it.
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Cites
Statistics
Claims the paper makes
0 of 45 cited sources checked · 0 supported · 0 flagged
- Findingown data
The associations between suicide bereavement and support outcomes became non-significant when adjusting for perceived stigma.
“Associations were not modified by gender, or age bereaved, but became non-significant when adjusting for stigma.”
Quote in the paperSubstantial claim - Findingown data
People bereaved by suicide were less likely to have received informal support than people bereaved by sudden unnatural causes (AOR=0.74; 95% CI 0.58 to 0.96).
“People bereaved by suicide were less likely to have received informal support than those bereaved by sudden natural causes (adjusted OR (AOR)=0.79; 95% CI 0.64 to 0.98) or unnatural causes (AOR=0.74; 95% CI 0.58 to 0.96) but did not differ from either comparison group on receipt of formal support.”
Quote in the paperSubstantial claim - Findingown data
People bereaved by suicide were less likely to have received informal support than people bereaved by sudden natural causes (AOR=0.79; 95% CI 0.64 to 0.98).
“People bereaved by suicide were less likely to have received informal support than those bereaved by sudden natural causes (adjusted OR (AOR)=0.79; 95% CI 0.64 to 0.98) or unnatural causes (AOR=0.74; 95% CI 0.58 to 0.96) but did not differ from either comparison group on receipt of formal support.”
Quote in the paperSubstantial claim - Findingown data
People bereaved by suicide were less likely to have received immediate support (within 1 week) than people bereaved by sudden natural causes (AOR=0.73; 95% CI 0.59 to 0.90).
“People bereaved by suicide were less likely to have received immediate support (AOR=0.73; 95% CI 0.59 to 0.90) and more likely to report delayed receipt of support (AOR=1.33; 95% CI 1.08 to 1.64) than people bereaved by sudden natural causes.”
Quote in the paperSubstantial claim - Findingown data
People bereaved by suicide were more likely to report delayed receipt of support (beyond 6 months) than people bereaved by sudden natural causes (AOR=1.33; 95% CI 1.08 to 1.64).
“People bereaved by suicide were less likely to have received immediate support (AOR=0.73; 95% CI 0.59 to 0.90) and more likely to report delayed receipt of support (AOR=1.33; 95% CI 1.08 to 1.64) than people bereaved by sudden natural causes.”
Quote in the paperSubstantial claim
- Findingown data
People bereaved by suicide did not differ from people bereaved by sudden natural causes or sudden unnatural causes on receipt of formal support.
“People bereaved by suicide were less likely to have received informal support than those bereaved by sudden natural causes (adjusted OR (AOR)=0.79; 95% CI 0.64 to 0.98) or unnatural causes (AOR=0.74; 95% CI 0.58 to 0.96) but did not differ from either comparison group on receipt of formal support.”
Quote in the paperSubstantial claim - Findingown data
The associations between suicide bereavement and support outcomes were not modified by gender.
“Associations were not modified by gender, or age bereaved, but became non-significant when adjusting for stigma.”
Quote in the paperNot a substantial claim - Findingown data
The associations between suicide bereavement and support outcomes were not modified by age bereaved.
“Associations were not modified by gender, or age bereaved, but became non-significant when adjusting for stigma.”
Quote in the paperNot a substantial claim - Findingown data
Overall, 78% (2572/3432) of the sample reported receiving some form of support after the loss.
“Overall, 78% (2572/3432) of the sample reported receiving some form of support after the loss, whether informal (51%), formal (14%) or both (35%), and 85% (2173/2572) perceived some aspect of it to have been valuable.”
Quote in the paperSubstantial claim - Findingown data
85% (2173/2572) of those receiving support perceived some aspect of it to have been valuable.
“Overall, 78% (2572/3432) of the sample reported receiving some form of support after the loss, whether informal (51%), formal (14%) or both (35%), and 85% (2173/2572) perceived some aspect of it to have been valuable.”
Quote in the paperNot a substantial claim - Findingown data
Self-help was used by 10% of the sample.
“Self-help was used by 10% (table 2).”
Quote in the paperNot a substantial claim - Findingown data
The most endorsed sources of formal support were funeral directors (14%) and health professionals (13%).
“The most endorsed source of informal support was family and friends (64%) and of formal support were funeral directors (14%) and health professionals (13%).”
Quote in the paperNot a substantial claim - Findingown data
The most endorsed source of informal support was family and friends (64%).
“The most endorsed source of informal support was family and friends (64%) and of formal support were funeral directors (14%) and health professionals (13%).”
Quote in the paperNot a substantial claim - Findingown data
Two-fifths (42%; 1438/3432) had received valuable support within a week of the loss.
“Two-fifths (42%; 1438/3432) had received valuable support within a week of the loss.”
Quote in the paperSubstantial claim - Findingown data
Overall, 20% of the sample received no support at all, excluding the 20 individuals who specified that they had chosen to handle the bereavement alone.
“Overall, 20% of the sample received no support at all, excluding the 20 individuals who specified that they had chosen to handle the bereavement alone.”
Quote in the paperNot a substantial claim - Findingown data
Two-thirds of the suicide-bereaved group receive no formal support.
“two-thirds of a group featuring so prominently in UK suicide prevention strategies receive no formal support”
Quote in the paperSubstantial claim - Findingown data
Interaction tests showed no evidence that childhood versus adult bereavement modified any of the associations identified.
“Interaction tests showed no evidence that gender, or childhood versus adult bereavement, modified any of the associations identified.”
Quote in the paperNot a substantial claim - Findingown data
People bereaved by suicide were significantly less likely to have received informal support.
“People bereaved by suicide were significantly less likely to have received informal support”
Quote in the paperSubstantial claim - Findingown data
One in four people bereaved by suicide in this national sample had received no formal or informal support after their loss.
“One in four people bereaved by suicide in this national sample had received no formal or informal support after their loss”
- Also stated in: § Conclusions · plain
“and that a quarter receive no support at all.”
Quote in the paperSubstantial claim - Also stated in: § Conclusions · plain
- Findingown data
Overall 6% of the sample reported having attempted suicide since the bereavement.
“Overall 6% reported having attempted suicide since the bereavement”
Quote in the paperNot a substantial claim - Findingown data
In sensitivity analyses simulating predicted non-response biases, the association between bereavement by sudden unnatural causes and use of formal bereavement support became non-significant.
“apart from the association between bereavement by sudden unnatural causes and use of formal bereavement support, which became non-significant.”
Quote in the paperNot a substantial claim - Findingown data
After adding perceived stigma to models, all four significant associations of suicide bereavement with support outcomes became non-significant.
“After adding perceived stigma to models, all four significant associations of suicide bereavement with support outcomes became non-significant”
Quote in the paperSubstantial claim - Findingnone given
This group was distinct from the 1% who stated that they preferred to cope without assistance.
“This group was distinct from the 1% who stated that they preferred to cope without assistance.”
Quote in the paperSubstantial claim - Findingown data
People bereaved by suicide were more likely to describe delays in receiving any formal or informal support.
“and more likely to describe delays in receiving any formal or informal support.”
Quote in the paperSubstantial claim - Findingown data
There were no other group differences on this or any other secondary outcome.
“There were no other group differences on this or any other secondary outcome.”
Quote in the paperNot a substantial claim - Findingown data
People bereaved by suicide were significantly less likely to receive informal support than those bereaved by sudden unnatural causes (AOR=0.74; 95% CI 0.58 to 0.96).
“and those bereaved by unnatural causes (table 4; AOR=0.74; 95% CI 0.58 to 0.96)”
Quote in the paperSubstantial claim - Findingown data
There were no other group differences on the outcome of formal bereavement support.
“but there were no other group differences on this outcome.”
Quote in the paperNot a substantial claim - Findingown data
Of those who attempted suicide postbereavement, 67% (141/210) had not sought help for any episode of self-harm occurring postbereavement.
“of which 67% (141/210) had not sought help for any episode of self-harm occurring postbereavement”
Quote in the paperNot a substantial claim - Findingown data
People bereaved by suicide were significantly less likely to receive informal support than those bereaved by sudden natural causes (AOR=0.79; 95% CI 0.64 to 0.98).
“People bereaved by suicide were significantly less likely to receive informal support than those bereaved by sudden natural causes (table 3; adjusted OR (AOR)=0.79; 95% CI 0.64 to 0.98)”
Quote in the paperSubstantial claim - Findingown data
Among those who had sought help for postbereavement self-harm, the most common source was a general practitioner (20%).
“In those who had sought help, the most common source was a general practitioner (20%).”
Quote in the paperNot a substantial claim - Findingown data
Compared with people bereaved by sudden natural causes, people bereaved by suicide were significantly more likely to report delayed receipt of support (AOR=1.33; 95% CI 1.08 to 1.64).
“and significantly more likely to report delayed receipt of support (AOR=1.33; 95% CI 1.08 to 1.64)”
- Also stated in: § Conclusions · boosted
“manifested in delayed receipt of support”
Quote in the paperSubstantial claim - Also stated in: § Conclusions · boosted
- Findingown data
In that analysis, the association of suicide bereavement with delayed receipt of valuable support became non-significant.
“apart from the association of suicide bereavement with one secondary outcome (delayed receipt of valuable support), which became non-significant”
Quote in the paperNot a substantial claim - Findingown data
Compared with people bereaved by sudden natural causes, people bereaved by suicide were significantly less likely to receive immediate support (AOR=0.73; 95% CI 0.59 to 0.90).
“Compared with people bereaved by sudden natural mortality causes, people bereaved by suicide were significantly less likely to receive immediate support (table 3; AOR=0.73; 95% CI 0.59 to 0.90)”
Quote in the paperSubstantial claim - Findingown data
Interaction tests showed no evidence that gender modified any of the associations identified.
“Interaction tests showed no evidence that gender, or childhood versus adult bereavement, modified any of the associations identified.”
Quote in the paperNot a substantial claim - Findingown data
The inequities were manifested in a lesser likelihood of receiving support from family and friends.
“and a lesser likelihood of receiving support from family and friends.”
Quote in the paperSubstantial claim - Findingown data
After adding perceived stigma to models, the association between bereavement by sudden unnatural causes and use of formal bereavement support became non-significant.
“as did the association between bereavement by sudden unnatural causes and use of formal bereavement support.”
Quote in the paperSubstantial claim - Findingown data
The study demonstrated clear inequities in the support received by people bereaved by the suicide of a close contact.
“Our study demonstrated clear inequities in the support received by people bereaved by the suicide of a close contact”
Quote in the paperSubstantial claim - Findingown data
In an analysis comparing suicide bereavement to all non-suicide sudden bereavements, associations were similar in magnitude and direction.
“In an analysis comparing suicide bereavement to all non-suicide sudden bereavements, we found similar associations in terms of magnitude and direction”
Quote in the paperSubstantial claim - Findingown data
People bereaved by sudden unnatural causes were significantly more likely to receive formal bereavement support than those bereaved by sudden natural causes (AOR=1.28; 95% CI 1.05 to 1.56).
“People bereaved by sudden unnatural causes were significantly more likely to receive formal bereavement support than those bereaved by sudden natural causes (table 3; AOR=1.28; 95% CI 1.05 to 1.56)”
Quote in the paperSubstantial claim - Premisecitation
People bereaved by suicide tend to avoid seeking help.
“The next challenges are the paucity of trial evidence for effective interventions7 and the tendency of people bereaved by suicide to avoid seeking help8 9 despite expressing clear unmet needs.10”
Quote in the paperSubstantial claim0 of 2 sources checked - Interpretationown data
People bereaved by suicide are less likely to receive informal support than people bereaved by other causes of sudden death.
“People bereaved by suicide are less likely to receive informal support than people bereaved by other causes of sudden death and are more likely to perceive delays in accessing any support.”
Quote in the paperSubstantial claim - Premisecitation
There is a paucity of trial evidence for effective interventions for people bereaved by suicide.
“The next challenges are the paucity of trial evidence for effective interventions7 and the tendency of people bereaved by suicide to avoid seeking help8 9 despite expressing clear unmet needs.10”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [7] source
Not checked in the free run.
- Interpretationown data
People bereaved by suicide are more likely to perceive delays in accessing any support.
“People bereaved by suicide are less likely to receive informal support than people bereaved by other causes of sudden death and are more likely to perceive delays in accessing any support.”
Quote in the paperSubstantial claim - Study design and conductcitation
Conducting a national cross-sectional survey of young adults working or studying at UK HEIs avoided the biases associated with recruiting a help-seeking sample.
“We conducted a national cross-sectional survey of young adults working or studying at UK higher education institutions (HEIs), avoiding the biases associated with recruiting a help-seeking sample.24”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [24] Pitman, 2015, The use of internet-mediated cross-sectional studies in mental health research, BJPscyh Advances source
Not checked in the free run.
- Premisecitation
Informal support is known to be valued after suicide bereavement.
“Registry-based studies describe health service use18–21 but not informal support, a resource known to be valued after suicide bereavement.10”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [10] source
Not checked in the free run.
- Study design and conductcitation
The sample size calculation indicated that at least 466 participants were required in any one group (two-tailed analysis; 90% power).
“We based our sample size calculation on the primary outcome for a separate study investigating the association between suicide bereavement and suicide attempt,2 indicating that at least 466 participants were required in any one group (two-tailed analysis; 90% power).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [2] source
Not checked in the free run.
- Premisecitation
Young adults have priority status within UK suicide prevention strategies.
“We focused on young adults given concerns about their vulnerabilities to suicide,22 their tendency to avoid accessing mental health services23 and their priority status within UK suicide prevention strategies.4–6”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [4] Department of Health. Preventing suicide in England: a cross-government outcomes strategy to save lives, 17680. 2012:1–57.
Not checked in the free run.
- cites [5] Department of Health Social Services and Public Safety. Protect Life - A Shared Vision. The Northern Ireland suicide prevention strategy 2012-2014, 2012.
Not checked in the free run.
- cites [6] Welsh Government. Talk to me 2 - Suicide and self harm prevention strategy for Wales 2015-2020, 2015.
Not checked in the free run.
- Premisecitation
Young adults tend to avoid accessing mental health services.
“We focused on young adults given concerns about their vulnerabilities to suicide,22 their tendency to avoid accessing mental health services23 and their priority status within UK suicide prevention strategies.4–6”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [23] source
Not checked in the free run.
- Premisecitation
People bereaved by suicide express clear unmet needs.
“The next challenges are the paucity of trial evidence for effective interventions7 and the tendency of people bereaved by suicide to avoid seeking help8 9 despite expressing clear unmet needs.10”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [10] source
Not checked in the free run.
- Premisecitation
Registry-based studies describe health service use but not informal support.
“Registry-based studies describe health service use18–21 but not informal support, a resource known to be valued after suicide bereavement.10”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [18] Bolton, 2013, Parents bereaved by offspring suicide: a population-based longitudinal case-control study, JAMA Psychiatry source
Not checked in the free run.
- cites [19] Kuramoto, 2013, Time to hospitalization for suicide attempt by the timing of parental suicide during offspring early development, JAMA Psychiatry source
Not checked in the free run.
- cites [20] source
Not checked in the free run.
- cites [21] source
Not checked in the free run.
- Premisecitation
Young adults have vulnerabilities to suicide.
“We focused on young adults given concerns about their vulnerabilities to suicide,22 their tendency to avoid accessing mental health services23 and their priority status within UK suicide prevention strategies.4–6”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [22] source
Not checked in the free run.
- Study design and conductown data
There were no statistically significant group differences by bereavement exposure in relation to gender, age, ethnicity, socioeconomic status, personality disorder screen or perceived level of social support.
“There were no statistically significant group differences by bereavement exposure in relation to gender, age, ethnicity, socioeconomic status, personality disorder screen33 or perceived level of social support.”
Quote in the paperNot a substantial claim - Study design and conductnone given
Results were robust to sensitivity analysis.
“Results were robust to sensitivity analysis”
Quote in the paperNot a substantial claim - Study design and conductown data
Gender-specific analyses were not possible due to the low numbers of men responding.
“it would have been desirable to have conducted gender-specific analyses, but this was not possible due to the low numbers of men responding.”
Quote in the paperNot a substantial claim - Premisecitation
People bereaved by suicide's avoidance of help-seeking is likely linked to stigmatising societal beliefs about suicide as a failure of problem solving.
“This avoidance is likely to be linked to stigmatising societal beliefs about suicide as a failure of problem solving.9”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] source
Not checked in the free run.
- Study design and conductreasoning
The possibility of selection bias through sampling from HEIs limits generalisability beyond highly educated female groups.
“The possibility of selection bias through sampling from HEIs and the pronounced male non-response bias limit generalisability beyond highly educated female groups.”
Quote in the paperNot a substantial claim - Interpretationcitation
The findings represent gaps in support rather than a rejection or avoidance of help.
“This suggests that our findings represent gaps in support rather than a rejection or avoidance of help.”
Quote in the paperSubstantial claim- Rests on an assumption: Receipt of support is a function of what is perceived to be available.
- Study design and conductnone given
This national sample represents the largest and most comprehensive survey of support received by people bereaved by a close contact's sudden death.
“This national sample represents the largest and most comprehensive survey of support received by people bereaved by a close contact’s sudden death.”
Quote in the paperNot a substantial claim - Interpretationcitation
The quarter of the suicide-bereaved sample who received no support represents failed implementation of UK suicide prevention strategies.
“The quarter of our suicide-bereaved sample who received no support represents failed implementation of UK suicide prevention strategies.4–6”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [4] Department of Health. Preventing suicide in England: a cross-government outcomes strategy to save lives, 17680. 2012:1–57.
Not checked in the free run.
- cites [5] Department of Health Social Services and Public Safety. Protect Life - A Shared Vision. The Northern Ireland suicide prevention strategy 2012-2014, 2012.
Not checked in the free run.
- cites [6] Welsh Government. Talk to me 2 - Suicide and self harm prevention strategy for Wales 2015-2020, 2015.
Not checked in the free run.
- Study design and conductnone given
Use of a precise sampling frame allowed the authors to be clear about the limits of generalisability.
“use of a precise sampling frame allowed us to be clear about the limits of generalisability.”
Quote in the paperNot a substantial claim - Study design and conductown data
The multivariable models did not account for pre-bereavement anxiety or other mental disorders.
“but did not account for pre-bereavement anxiety or other mental disorders.”
Quote in the paperNot a substantial claim - Premisecitation
People bereaved by suicide have a higher risk of suicide attempt.
“given their higher risk of suicide attempt2”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [2] source
Not checked in the free run.
- Study design and conductnone given
The limited age-range sampled restricts generalisability beyond young adults.
“The limited age-range sampled restricts generalisability beyond young adults.”
Quote in the paperNot a substantial claim - Interpretationreasoning
The results of this study may only be generalisable to young bereaved women and the more highly educated.
“Given the age range sampled and the possibility of selection bias (favouring higher social classes) and male non-response bias, the results of this study may only be generalisable to young bereaved women and the more highly educated.”
Quote in the paperSubstantial claim - Study design and conductreasoning
The pronounced male non-response bias limits generalisability beyond highly educated female groups.
“The possibility of selection bias through sampling from HEIs and the pronounced male non-response bias limit generalisability beyond highly educated female groups.”
Quote in the paperNot a substantial claim - Study design and conductown data
Models for two secondary outcomes (exclusive use of formal support; help seeking for attempted suicide postbereavement) lacked sufficient power due to group sizes <466.
“Models for two secondary outcomes (exclusive use of formal support; help seeking for attempted suicide postbereavement) lacked sufficient power due to group sizes <466”
Quote in the paperNot a substantial claim - Interpretationown data
Reduced receipt of informal support was attributable to suicide bereavement rather than unnatural losses more widely.
“we were able to ascertain that reduced receipt of informal support was attributable to suicide bereavement rather than unnatural losses more widely.”
Quote in the paperSubstantial claim - Study design and conductnone given
Interaction tests for gender had limited statistical power.
“Despite testing for an interaction with gender, we acknowledge such tests’ limited statistical power.”
Quote in the paperNot a substantial claim
- May combine two claims. 14
- Classified as probably not a substantial claim. 28
- The quote only partly states this claim. 1
May combine two claims.
Findingown dataIn the sample of 3432 young bereaved adults, 21% (725/3432) reported receiving no formal or informal bereavement support, with no evidence for group differences by bereavement exposure.
“21% (725/3432) of our sample of bereaved adults reported receiving no formal or informal bereavement support, with no evidence for group differences.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataThe sample was primarily female, white and related to the deceased by blood.
“The sample was primarily female, white and related to the deceased by blood (table 1).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataOf those receiving support, 51% received informal only, 14% formal only, and 35% both formal and informal.
“Overall, 78% (2572/3432) of the sample reported receiving some form of support after the loss, whether informal (51%), formal (14%) or both (35%), and 85% (2173/2572) perceived some aspect of it to have been valuable.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataOne quarter (24%; 824/3432) reported that they had been most affected in the first week after the loss, but a third (38%; 1274/3432) endorsed over 6 months after the loss, with no evidence for group differences.
“One quarter (24%; 824/3432) reported that they had been most affected in the first week after the loss, but a third (38%; 1274/3432) endorsed over 6 months after the loss, with no evidence for group differences.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataThe mean time elapsed since bereavement was 4.9 years (SD=5.3; range=1 day-30 years), with no significant group differences.
“The mean time elapsed since bereavement was 4.9 years (SD=5.3; range=1 day–30 years), with no significant group differences.”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
Findingown dataIn sensitivity analyses simulating predicted non-response biases, the magnitude and direction of significant associations between suicide bereavement and outcomes were unchanged.
“In sensitivity analyses simulating predicted non-response biases, the magnitude and direction of significant associations between suicide bereavement and outcomes were unchanged”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationBereavement by suicide is associated with an increased probability of suicide attempt in close contacts.
“Empirical research now supports an association between bereavement by suicide and a range of negative health outcomes, including an increased probability of suicide1 and of suicide attempt in close contacts.2”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2] source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationUS and UK suicide prevention strategies recommend providing support for people bereaved by suicide.
“US and UK suicide prevention strategies recommend providing support for people bereaved by suicide,3–6 but the extent of implementation is unknown.”
Quote in the paperNot a substantial claim0 of 4 sources checked- cites [3] US Department of Health and Human Services (HHS) Office of the Surgeon General and National Action Alliance for Suicide Prevention. National Strategy for Suicide Prevention: Goals and Objectives for Action. Washington, DC: BMJ Publishing Group, 2012.
Not checked in the free run.
- cites [4] Department of Health. Preventing suicide in England: a cross-government outcomes strategy to save lives, 17680. 2012:1–57.
Not checked in the free run.
- cites [5] Department of Health Social Services and Public Safety. Protect Life - A Shared Vision. The Northern Ireland suicide prevention strategy 2012-2014, 2012.
Not checked in the free run.
- cites [6] Welsh Government. Talk to me 2 - Suicide and self harm prevention strategy for Wales 2015-2020, 2015.
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationBereavement by suicide is associated with an increased probability of suicide.
“Empirical research now supports an association between bereavement by suicide and a range of negative health outcomes, including an increased probability of suicide1 and of suicide attempt in close contacts.2”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationPast suicidal ideation, suicide attempt and non-suicidal self-harm were described using standardised measures from the Adult Psychiatric Morbidity Survey.
“We described past suicidal ideation, suicide attempt and non-suicidal self-harm using standardised measures from the Adult Psychiatric Morbidity Survey,25 which distinguishes suicide attempt from non-suicidal self-harm on the basis of intent.26”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [25] McManus S , Meltzer H , Brugha T , et al . Adult psychiatric morbidity in England, 2007. Results of a household survey. Leeds: BMJ Publishing Group, 2009:1–141.
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe sampling frame accessed was an estimated 659 572 staff and students.
“This accessed an estimated sampling frame of 659 572 staff and students.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationFormal and informal support classifications were derived from similar British and international studies of service use.
“Formal and informal support classifications were derived from similar British23 and international studies of service use.29”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationDepression was measured using the Composite International Diagnostic Interview screen for lifetime depression.
“Depression was measured using the Composite International Diagnostic Interview screen for lifetime depression,27 qualified as above.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [27] source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataMissing data for model covariates and outcomes were less than 7% for covariates and less than 4% for outcomes.
“Missing data for model covariates and outcomes were less than 7% for covariates and less than 4% for outcomes.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataOf 659 572 invited, 5085 responded, 91% consented, and 68% fulfilled eligibility criteria.
“Of the 659 572 bereaved and non-bereaved people invited to take part, 5085 people responded to the questionnaire by clicking on the survey link. Of these, 91% (n=4630) consented to participate and 68% (n=3432) fulfilled eligibility criteria (figure 1).”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationUS surveys of support after suicide bereavement have tended to be small and localised or involve help-seeking samples.
“US surveys have tended to be small and localised14–16 or involve help-seeking samples.17”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [14] Farberow, 1992, The role of social supports in the bereavement process of surviving spouses of suicide and natural deaths, Suicide Life Threat Behav source
Not checked in the free run.
- cites [15] Séguin, 1995, Parental bereavement after suicide and accident: a comparative study, Suicide Life Threat Behav source
Not checked in the free run.
- cites [16] source
Not checked in the free run.
- cites [17] source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe study was approved by the UCL Research Ethics Committee in 2010 (ref: 1975/002).
“The study was approved by the University College London (UCL) Research Ethics Committee in 2010 (ref: 1975/002).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe thresholds for immediate and delayed support were agreed on the basis of clinical judgement and the published literature.
“These thresholds were agreed on the basis of clinical judgement and the published literature.31”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [31] source
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductreasoningEarly childhood bereavements (before age 10) were excluded to minimise recall bias.
“Early childhood bereavements (before age 10) were excluded to minimise recall bias.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenAll participants provided online informed consent.
“All participants provided online informed consent.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataA priori sensitivity analyses were conducted to assess the impact of simulating predicted non-response biases, excluding 918 respondents from the 10 HEIs that had modified the protocol recruitment method.
“Finally, we conducted a priori sensitivity analyses to assess the impact of simulating predicted non-response biases, excluding 918 respondents from the 10 HEIs that had modified the protocol recruitment method.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataIn 2010, 37 of 164 invited UK HEIs participated, with a higher response (40%) from Russell Group universities.
“Over 20% (37/164) agreed, with a higher response (40%) from those classified as the more prestigious Russell Group universities.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductreasoningThe denominator of bereaved people could not be ascertained using survey methods or routine data, so the proportion of bereaved people who responded could not be accurately measured.
“As the denominator of bereaved people could not be ascertained using survey methods or routine data, there was no accurate way of measuring the proportion of bereaved people who responded.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationPerceived stigma was measured using the stigma subscale of the Grief Experience Questionnaire.
“Perceived stigma, the subjective awareness of others’ stigmatising attitudes, was measured using the stigma subscale of the Grief Experience Questionnaire.28”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [28] source
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductreasoningMultivariable models included eight prespecified confounding variables identified from existing literature and clinical judgement.
“Our multivariable models included eight prespecified confounding variables identified from existing literature and clinical judgement: age, gender, socioeconomic status, preloss depression, preloss suicidal and non-suicidal self-harm, other family history of suicide (excluding index suicide bereavement), time since bereavement and kinship to the deceased.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningHEI was used as a random effect to take account of clustering effects at the institutional level.
“We used HEI as random effect to take account of clustering effects at the institutional level.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductnone givenSurveying the age range 18-40 minimised the potential for memory decay and narrowed period effects.
“Surveying this age range also minimised the potential for memory decay and narrowed period effects.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductcitationSelf-help was considered a separate category due to problematic formal/informal categorisation in relation to bereavement support.
“Self-help was considered a separate category due to problematic formal/informal categorisation in relation to bereavement support.30”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [30] source
Not checked in the free run.
May combine two claims.
PremisecitationHigh levels of stigma relative to other bereaved groups may reduce both willingness to seek help and friends' or relatives' readiness to offer support.
“High levels of stigma relative to other bereaved groups11 may reduce both willingness to seek help and friends’ or relatives’ readiness to offer support.9 12”
Quote in the paperSubstantial claim0 of 3 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Study design and conductnone givenIt was possible that those worst affected had biased recall of support received and its value.
“It was possible that those worst affected had biased recall of support received and its value.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationGender differences in help-seeking for mental illness exist, particularly in relation to informal support.
“Given gender differences in help-seeking for mental illness,22 particularly in relation to informal support,23”
Quote in the paperNot a substantial claim0 of 2 sources checkedMay combine two claims.
PremisecitationSurveys of the perceived needs of people bereaved by suicide indicate clear unmet needs for social networks to respond proactively and empathically and for professionals to offer immediate outreach.
“surveys of the perceived needs of people bereaved by suicide indicate clear unmet needs for social networks to respond proactively and empathically and for professionals to offer immediate outreach.10”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [10] source
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationAdverse outcomes and needs for support apply regardless of kinship.
“recognising that adverse outcomes and needs for support apply regardless of kinship.2”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2] source
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
Study design and conductnone givenThe study captured use of a wide range of formal and informal support sources and the time taken to access valued support.
“We captured use of a wide range of formal and informal support sources and the time taken to access valued support.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe multivariable models included pre-bereavement depression as a potential confounding variable.
“Our multivariable models included pre-bereavement depression as a potential confounding variable”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningThe cross-sectional, observational nature of these data limits causal inference.
“The cross-sectional, observational nature of these data limits causal inference.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
No British study has provided an overview of the range of support received by people bereaved by suicide.
“No British study has provided an overview of the range of support received by people bereaved by suicide.”
The paper relies on this without support.
For service planning purposes, population-based studies describing the prevalence and correlates of support received by people bereaved by suicide are lacking.
“For service planning purposes, we lack population-based studies describing the prevalence and correlates of support received by people bereaved by suicide.”
The authors state this as an assumption.
The majority of non-responders were non-bereaved.
“assume that the majority of non-responders were non-bereaved”
The paper relies on this without support.
Receipt of support is a function of what is perceived to be available.
“as receipt of support is a function of what is perceived to be available.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
People bereaved by suicide may experience more feelings of abandonment, rejection, shame, struggles with meaning-making and 'why'-questions, and less social support.
“They may also experience more feelings of abandonment, rejection, shame, struggles with meaning-making and ‘why’-questions, and less social support [8, 9].”
From Effectiveness of interventions for people bereaved through suicide: a systematic review of controlled studies of grief, psychosocial and suicide-related outcomes (2019) · cites this paper as [9]
The Abstract Results and Conclusions report that people bereaved by suicide were less likely to receive informal support than people bereaved by other sudden deaths. The paper does not report greater feelings of abandonment, rejection or shame, or more struggles with meaning-making and ‘why’-questions. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOne in four people bereaved by suicide receive no support after the death.
“Quantitative survey work shows that one in four people bereaved by suicide receive no support after the death [20].”
From Support Needs and Experiences of People Bereaved by Suicide: Qualitative Findings from a Cross-Sectional British Study of Bereaved Young Adults (2018) · cites this paper as [20]
People bereaved by suicide are significantly less likely to receive informal support after the loss than those bereaved by other causes of sudden death and significantly more likely to experience delays in receiving any support.
“They are also significantly less likely to receive informal support after the loss than those bereaved by other causes of sudden death and significantly more likely to experience delays in receiving any support [20].”
From Support Needs and Experiences of People Bereaved by Suicide: Qualitative Findings from a Cross-Sectional British Study of Bereaved Young Adults (2018) · cites this paper as [20]
The findings of this study complement the quantitative findings from the same dataset of a lower likelihood of receiving informal support after suicide and delays in receiving support compared with people bereaved by other sudden deaths.
“The findings of this study complement the quantitative findings from this same dataset of a lower likelihood of receiving informal support after suicide and delays in receiving support compared with people bereaved by other sudden deaths [20].”
From Support Needs and Experiences of People Bereaved by Suicide: Qualitative Findings from a Cross-Sectional British Study of Bereaved Young Adults (2018) · cites this paper as [20]
Together this evidence suggests that poor mental health outcomes after suicide bereavement may be related to experiences of lack of support, whether due to self-stigma or others' ineptness in judging and meeting their needs.
“Together this evidence suggests that poor mental health outcomes after suicide bereavement may be related to experiences of lack of support, whether due to self-stigma [20] or others’ ineptness in judging and meeting their needs [19].”
From Support Needs and Experiences of People Bereaved by Suicide: Qualitative Findings from a Cross-Sectional British Study of Bereaved Young Adults (2018) · cites this paper as [20]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Suicide-group family-history percentage is understated
MinorThe 53 respondents are 8.63% of the 614-person suicide-bereavement group, which rounds to 9% rather than 7%.
Reported 7 · recomputed 8.631922
“| Yes | 123 (6) | 41 (6) | 53 (7) | 217 (6) | 0.071 |”
Reported overall support percentage does not match its fraction
Minor2572 of 3432 respondents is 74.94%, or 75% rounded, not 78%. Table 1 also reports 75% for this count.
Reported 78 · recomputed 74.941725
“Overall, 78% (2572/3432) of the sample reported receiving some form of support after the loss”
Percentage most affected after six months is overstated
Minor1274 of 3432 respondents is 37.12%, which rounds to 37%, not 38%.
Reported 38 · recomputed 37.121212
“a third (38%; 1274/3432) endorsed over 6 months after the loss”
Unadjusted no-support confidence interval conflicts with its p-value
MinorThe reported unadjusted 95% confidence interval for the odds ratio includes 1, whereas its p-value of 0.010 indicates evidence against an odds ratio of 1 at the 5% level.
“1.46 (0.95 to 1.52)”
“| 0.010 | 1.46 (1.09 to 1.95)”
School or college support counts do not add to their total
MinorThe exposure-group counts are 2, 0 and 0, but the total is reported as 1.
Reported 1 · recomputed 2
“| School/college teaching staff | 2 (2) | 0 (0) | 0 (0) | 1 (<1) |”
Worst-stage counts do not add to the reported total
MinorThe three exposure-group counts for being most affected within a week add to 864, not the reported total of 824.
Reported 824 · recomputed 864
“| Within a week | 560 (25) | 156 (22) | 148 (24) | 824 (24) | 0.112 |”
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“922 Informal only 796 (51) 286 (51) 220 (50) 1302 (51) Both formal and informal 560 (36) 196 (35) 153 (35) 909 (35) Point at which any valuable support received after loss (n (%)) Within a day 623 (30) 234 (33) 150 (24) 1007 (29) 0.”
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Cited by
Sorted by citations
Andriessen, K., Krysinska, K., Hill, N. T. M., Reifels, L., Robinson, J., Reavley, N., & Pirkis, J. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2020-z · Cited by 172 · see citing works
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Self-citationWeb-Based Bereavement Care: A Systematic Review and Meta-Analysis
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“People bereaved by suicide are also susceptible to physical illnesses, possibly due to the levels of stress or an unhealthy lifestyle (e.g., poor diet, smoking) (Erlangsen and Pitman, 2017; Erlangsen et al., 2017; Spillane et al., 2018).”
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Self-citationPitman, A., Rantell, K. R., Marston, L., King, M., & Osborn, D. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14030286 · Cited by 62 · see citing works
Self-citationSpillane, A., Larkin, C., Corcoran, P. E., Matvienko‐Sikar, K., & Arensman, E. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-014707 · Cited by 58 · see citing works
Azorina, V., Morant, N. J., Nesse, H., Stevenson, F. A., Osborn, D., King, M., & Pitman, A. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16101801 · Cited by 59 · see citing works
Self-citationPitman, A., Nesse, H., Morant, N., Azorina, V., Stevenson, F., King, M., & Osborn, D. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1560-3 · Cited by 54 · see citing works
Self-citationPerceived Social Support and Mental Health After Suicide Loss
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Suicide bereavement in the UK : Descriptive findings from a national survey
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Self-citationSpillane, A., Matvienko‐Sikar, K., Larkin, C., Corcoran, P. E., & Arensman, E. (2019) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2018.1563430 · Cited by 35 · see citing works
COVID-19 Suicide Survivors—A Hidden Grieving Population
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Suicide stigma measures: A scoping review
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Use of Alcohol and Unprescribed Drugs after Suicide Bereavement: Qualitative Study
Eng, J., Drabwell, L., Stevenson, F. A., King, M., Osborn, D., & Pitman, A. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16214093 · Cited by 25 · see citing works
Self-citationBereavement support in the UK – a rapid evidence assessment
Hewison, A., Zafar, S., & Efstathiou, N. (2020) · Bereavement Care · doi:10.1080/02682621.2020.1728086 · Cited by 25 · see citing works
Addressing suicide risk in partners and relatives bereaved by suicide
Pitman, A. (2018) · The British Journal of Psychiatry · doi:10.1192/bjp.2017.46 · Cited by 24 · see citing works
Family Patterns and Suicidal and Violent Behavior among Adolescent Girls—Genogram Analysis
Sitnik‐Warchulska, K., & Izydorczyk, B. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15102067 · Cited by 23 · see citing works
Older Adults’ Conduct of Everyday Life After Bereavement by Suicide: A Qualitative Study
Hybholt, L., Berring, L. L., Erlangsen, A., Fleischer, E., Toftegaard, J., Kristensen, E., Toftegaard, V., Havn, J., & Buus, N. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01131 · Cited by 23 · see citing works
Kučukalić, S., & Kučukalić, A. (2017) · PubMed · Cited by 22 · see citing works
Drabwell, L., Eng, J., Stevenson, F. A., King, M., Osborn, D., & Pitman, A. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17030677 · Cited by 18 · see citing works
Self-citationPitman, A., Logeswaran, Y., McDonald, K. C., Cerel, J., Lewis, G., & Erlangsen, A. (2023) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796023000653 · Cited by 15 · see citing works
Self-citationSupportive and non-supportive social experiences following suicide loss: a qualitative study
Marek, F., & Oexle, N. (2024) · BMC Public Health · doi:10.1186/s12889-024-18545-3 · Cited by 15 · see citing works
Suicide postvention for staff and students on university campuses: a scoping review
Allie, S.-L. N., Bantjes, J. R., & Andriessen, K. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-068730 · Cited by 14 · see citing works
Watson, C., Cutrer‐Párraga, E. A., Heath, M. A., Miller, E. E., Young, T. A., & Wilson, S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182111384 · Cited by 13 · see citing works
Adshead, C., & Runacres, J. (2022) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228211070152 · Cited by 12 · see citing works
Exploring the mental well-being of higher educational institutions students: a bibliometric analysis
Rautela, S., Sharma, A., & Panackal, N. (2024) · Cogent Education · doi:10.1080/2331186x.2024.2343522 · Cited by 11 · see citing works
Galway, K., Forbes, T. L., Mallon, S. D., Santin, O., Best, P., Neff, J., Leavey, G., & Pitman, A. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16224561 · Cited by 10 · see citing works
Self-citationSocial Reactions After Disclosing Suicide Loss Among Women
Mayer, L., Puschner, N., Votruba, N., Rüsch, N., & Oexle, N. (2022) · Crisis · doi:10.1027/0227-5910/a000871 · Cited by 13 · see citing works
Towards an Evidence-Based Model of Workplace Postvention
Clements, A., Nicholas, A., Martin, K., & Young, S. M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20010142 · Cited by 10 · see citing works
Coping Styles Utilized during Suicide and Sudden Death Bereavement in the First Six Months
Mathieu, S. L., Todor, R., Leo, D. D., & Kõlves, K. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192214709 · Cited by 15 · see citing works
Rodway, C., Ibrahim, S. A., Tham, S.-G., Turnbull, P., Kapur, N., & Appleby, L. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.12.063 · Cited by 8 · see citing works
Addressing psychological distress in people bereaved through suicide: From care to cure
Scocco, P., Idotta, C., Totaro, S., & Preti, A. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.113869 · Cited by 9 · see citing works
Erlangsen, A., Fleischer, E., Gunnell, D., & Nordentoft, M. (2021) · Archives of Suicide Research · doi:10.1080/13811118.2021.1903636 · Cited by 8 · see citing works
To Blame or Not to Blame: the Role of Belief in Free Will in Substance Use and Suicide Stigma
Ozkok, H., Tatar, B. H., Ayyıldız, T. N., Eskin, M., Erdem, G., & Turan, B. (2022) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-022-00755-8 · Cited by 6 · see citing works
Encina, E. P., Rodante, D., Agrest, M., Tapia‐Muñoz, T., Vidal-Zamora, I., Ardila-Gómez, S. E., Alvarado, R., Leiderman, E. A., & Reavley, N. J. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05417-0 · Cited by 8 · see citing works
Grief and Prolonged Grief Disorder
(2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934 · Cited by 6 · see citing works
Suicide bereavement support: a literature review.
Griffin, E., & McMahon, E. M. (2019) · HRB National Drugs Library (Health Research Board) · Cited by 5 · see citing works
A cross-sectional examination of sudden-death bereavement in university students
Bhaskaran, J., Afifi, T. O., Sareen, J., Vincent, N., & Bolton, J. M. (2021) · Journal of American College Health · doi:10.1080/07448481.2021.1947298 · Cited by 5 · see citing works
Family support after a family member’s suicide: A qualitative exploration
Marek, F., & Oexle, N. (2025) · PLoS ONE · doi:10.1371/journal.pone.0334964 · Cited by 8 · see citing works
When a Child Dies by Suicide: An Interpretative Phenomenological Analysis Study
Black, V., & Heo, S. (2023) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228231194213 · Cited by 6 · see citing works
Whittaker, S., Rasmussen, S. A., Cogan, N. A., Tse, D. C. K., Martin, B., Andriessen, K., Shiramizu, V. K. M., Krysinska, K. E., & Levi‐Belz, Y. (2025) · JMIR Research Protocols · doi:10.2196/64615 · Cited by 5 · see citing works
Bélanger, S. M., Hauge, L. J., Reneflot, A., Øien-Ødegaard, C., Christiansen, S. G., Magnus, P. M., & Stene‐Larsen, K. (2024) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-023-02607-9 · Cited by 4 · see citing works
Sayer, N. A., Nelson, D. B., Gradus, J. L., Sripada, R. K., Murdoch, M., Teo, A. R., Orazem, R. J., & Cerel, J. (2023) · JMIR Research Protocols · doi:10.2196/51324 · Cited by 3 · see citing works
Experiences of families bereaved by opioid-related death
Hicks, D. L., Pasman, E., O’Shay, S., Kcomt, L., & Resko, S. M. (2024) · Journal of Social Work Practice in the Addictions · doi:10.1080/1533256x.2024.2351369 · Cited by 3 · see citing works
Exploring Social Dynamics in Suicide Bereavement
Pérez, S., Layrón, J. E., Neimeyer, R. A., & Salom, R. (2025) · Crisis · doi:10.1027/0227-5910/a001010 · Cited by 3 · see citing works
Pitman, A., Stevenson, F. A., & Osborn, D. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192013245 · Cited by 4 · see citing works
Self-citationChapter 7. Treatment of Prolonged Grief Disorder
Skritskaya, N. A., Charney, M. E., Simon, N. M., & Shear, M. K. (2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934.lg07 · Cited by 3 · see citing works
Posttraumatic Growth Following Suicide Bereavement: An Updated Systematic Review and Meta-Analysis
Whittaker, S., Rasmussen, S. A., Cogan, N. A., Tse, D. C. K., Martin, B., Andriessen, K., Shiramizu, V. K. M., Krysinska, K. E., & Levi‐Belz, Y. (2025) · Journal of Loss and Trauma · doi:10.1080/15325024.2025.2586763 · Cited by 3 · see citing works
Exploring experiences of supports for suicide bereavement in Ireland: protocol for a national survey
O’Connell, S., Ruane‐McAteer, E., Daly, C., O’Connor, C., Tuomey, F., McDonnell, L., Arensman, E., Andriessen, K., & Griffin, E. (2021) · HRB Open Research · doi:10.12688/hrbopenres.13437.1 · Cited by 2 · see citing works
Balt, E., Heesen, K., Popma, A., Gilissen, R., Mérelle, S. Y. M., & Creemers, D. H. M. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1256229 · Cited by 2 · see citing works
Ethnic Minority Groups’ Experiences of Suicide Bereavement: A Qualitative Exploratory Study
Rivart, P., Wainwright, V., Flynn, S., Hunt, I. M., Shaw, J., Smith, S., McGale, B., & McDonnell, S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182211860 · Cited by 1 · see citing works
Utilization of Postvention Supports: A National Cross-Sectional Survey of Adults Bereaved by Suicide
Griffin, E., O’Connell, S., Andriessen, K., Khan, A., O’Brien, C., Daly, C., Tuomey, F., & Arensman, E. (2025) · Archives of Suicide Research · doi:10.1080/13811118.2025.2552953 · Cited by 1 · see citing works
Exploring experiences of supports for suicide bereavement in Ireland: protocol for a national survey
O’Connell, S., Ruane‐McAteer, E., Daly, C., O’Connor, C., Tuomey, F., McDonnell, L., Arensman, E., Andriessen, K., & Griffin, E. (2022) · HRB Open Research · doi:10.12688/hrbopenres.13437.2 · Cited by 1 · see citing works
Chapter 2. Bereavement, Grief, and Prolonged Grief Disorder in Children and Adolescents
Cozza, S. J., & Ogle, C. M. (2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934.lg02 · Cited by 1 · see citing works
Cozza, S. J., & Fisher, J. E. (2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934.lg01 · Cited by 1 · see citing works
Chapter 4. Defining and Diagnosing Prolonged Grief Disorder
Maciejewski, P. K., & Prigerson, H. G. (2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934.lg04 · Cited by 1 · see citing works
Influence of Early Responder Interactions on Support-Seeking Behaviors of Suicide Loss Survivors
Duval, B., Peterson, E., McCauley, J., & Berkowitz, L. (2025) · Crisis · doi:10.1027/0227-5910/a000988 · Cited by 1 · see citing works
Whittaker, S., Rasmussen, S. A., Cogan, N. A., Tse, D. C. K., Martin, B., Andriessen, K., Shiramizu, V. K. M., Krysinska, K. E., & Levi‐Belz, Y. (2024) · doi:10.31234/osf.io/w8bh6 · Cited by 1 · see citing works
Appendix B. Structured Clinical Interview for Prolonged Grief Disorder
Prigerson, H. G., Viola, M., Lichtenthal, W. G., Rogers, M., Derry, H. M., She, W. J., Gordon-Elliott, J. S., & Maciejewski, P. K. (2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934.bm02 · Cited by 1 · see citing works
Rybyk, L. A., Sandal, O., Гончаренко, К. С., Manziy, O., Podilchak, O., Andreichuk, S., & Păduraru, M. E. (2021) · Wiadomości Lekarskie · doi:10.36740/wlek202111109
Narváez, M. T., & Martínez‐Taboas, A. (2022) · Revista Puertorriqueña de Psicología · doi:10.55611/reps.3302.06
Zur Bedeutsamkeit sozialer Unterstützung nach Verlust durch Suizid
Marek, F., & Oexle, N. (2023) · Psychiatrische Praxis · doi:10.1055/a-2024-5659
Andriessen, K., Krysinska, K. E., Kõlves, K., & Reavley, N. J. (2019) · doi:10.57022/txtp7812
Abrantes, M. L., & Pitman, A. (2023) · Current Research in Behavioral Sciences · doi:10.1016/j.crbeha.2023.100126
Self-citationPsychological Help for Family after Suicide
Borisonik, E. V. (2023) · Counseling Psychology and Psychotherapy · doi:10.17759/cpp.2023310205
Krefjandi lífsreynsla og flókin sorg: Að lifa af sjálfsvíg dóttur eða sonar
Björnsdóttir, E. Á., Sigurdardottir, S. L., & Halldórsdóttir, S. (2024) · Tímarit hjúkrunarfræðinga · doi:10.33112/th.100.1.1
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Chapter 5. Clinically Relevant Correlates of Prolonged Grief Disorder
Maciejewski, P. K., & Prigerson, H. G. (2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934.lg05
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(2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934.bm01
Chapter 3. Clinical Management of Bereaved Patients With and Without Prolonged Grief Disorder
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Chapter 6. Epidemiology of Prolonged Grief Disorder
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Postvention Following Bereavement by Suicide
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Psychische Gesundheit und Postvention von Suizidhinterbliebenen
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- Authors
- Pitman, A. L., Rantell, K., Moran, P., Sireling, L., Marston, L., King, M., & Osborn, D.
- Affiliations
- St Pancras Hospital (GB)
- UCL Queen Square Institute of Neurology (GB)
- University of Bristol (GB)
- Independent medico-legal practice, London, UK
- University College London (GB)
- Corresponding author
- Pitman, Alexandra L
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2017-05
- Volume
- 7
- Issue
- 5
- Pages
- e014487
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC5729987
- OpenAlex
- W2617155687
- Semantic Scholar
- 60f21f3642ad88adde7b16b838bf3e48668b7407
- Cited by
- 89
- References
- 36
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 7 · 2023: 25 · 2022: 11 · 2021: 9 · 2020: 6 · 2019: 10 · 2018: 6 · 2017: 4
- FWCI
- 8.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMJ Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion, cc-by)
- Explore Bristol Research (submittedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Medical Research Council
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Keywords
- sudden death, informal support, formal support, bereavement support, stigma, young adults, suicide prevention, gender differences, age differences, British universities
- MeSH terms
- Help-Seeking Behavior, Adolescent, Adult, Bereavement, Cross-Sectional Studies, Death, Sudden, Female, Humans, London, Male, Surveys and Questionnaires, Sex Factors, Social Class, Social Support, Suicide, Young Adult, Social Stigma
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