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Suicide Bereavement and Grief Counseling

Counseling did not have a big impact in this unselected group of bereaved individuals.

Bereavement usually activates a painful state of acute grief. Complicated grief occurs when acute grief is prolonged by inconsolable separation distress, ineffective emotion regulation, or excessive avoidance of reminders of the loss. Bereavement after someone has died by suicide is assumed to be especially difficult.

These researchers randomized 75 suicide-bereaved families (143 individuals) to an intervention to prevent complicated grief or to usual care. Families were identified from coroners’ records of suicides. The intervention, which consisted of four 2-hour sessions, occurred 3 to 6 months after the death and included psychoeducation, assistance with emotional processing, and support for family interaction and problem solving.

The rate of help seeking (psychiatric, medical, or other) in the first year post-loss was somewhat higher in the intervention group than in the usual-care group (100% vs. 70%). However, scores on the complicated-grief measure at 13 months post-loss did not differ between the groups, with both showing modest decreases.

Comment: These results confirm the most replicated finding in the grief-intervention literature: Grief counseling for unselected groups of bereaved individuals is not efficacious. Sensitive support is always warranted in bereavement, but grief-focused therapy is needed only for the few patients (approximately 10%–20%) with clear evidence of complicated grief more than 6 months after the death.

The findings further underscore the fact that it is not the circumstances of the death (e.g., suicide) that render grief complicated, but rather factors that affect the trajectory of grief symptoms. Research data support a modest increase in complicated grief with suicide bereavement, although most suicide-bereaved individuals do not develop the condition.

— M. Katherine Shear, MD

Published in Journal Watch Psychiatry June 11, 2007

Citation(s):

de Groot M et al. Cognitive behaviour therapy to prevent complicated grief among relatives and spouses bereaved by suicide: Cluster randomised controlled trial. BMJ 2007 May 12; 334:994.

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