Effectiveness of suicide postvention service models and guidelines

What's the issue?

Suicide prevention is recognised as a public health priority in Australia. Research estimates that for each suicide, approximately 135 community members are impacted. Exposure to suicide can place people at an increased risk of suicide and mental health concerns.

Suicide postvention refers to coordinated activities that support those bereaved by suicide. Postvention can help individuals, families and communities understand grief caused by a suicide death and support them through other challenges such as coronial inquests, legal proceedings and media presenting the suicide. Suicide postvention activities are considered an important component of public health approaches to suicide prevention.

Despite the potential benefit of postvention activities, limited reviews have been undertaken examining the effectiveness of postvention models.

The authors of this scoping review aimed to determine which suicide postvention service models and guidelines have been shown to be effective in reducing distress in family, friends and communities following a suicide.

What was done?

The scoping review was undertaken in July 2024. The review explored both peer-reviewed studies and grey literature.

The authors used a definition of postvention taken from previous research stating that a suicide postvention service model is a coordinated approach to providing support to people impacted by the death of a family member, friend or person in a network (such as a school, nursing home, workplace, etc.) through suicide.¹ This definition extends to targeted interventions, suicide bereavement support programs, and postvention guidelines.

The researchers used a search strategy based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR) guidelines. Five databases were searched.

The search strategy included examining peer-reviewed postvention focused studies from Australia, the UK, the US, Canada, New Zealand, and Western Europe.

Studies were included if they were available in English language and published since 2014. Qualitative, quantitative and mixed methods research with original data were all included. The authors also searched for relevant studies from the citation lists of studies selected for the review.

Grey literature was included in the search. Grey literature sources were included if: 1) they reported on people bereaved by suicide; 2) the study applied quantitative, qualitative or mixed methods; 3) they reported original data about the effect and impact of the postvention service or program, and 4) had been published since 2014.

Authors assessed the peer-reviewed studies and grey literature to help determine quality of evidence for the effectiveness of postvention models.

What was found?

The authors identified 19 peer-reviewed studies, and 14 guidelines from the grey literature eligible for inclusion in the study.

Most studies focused on postvention service models for adults, and two studies involving young people as part of a school-based postvention service model. Across all studies, participants were predominantly female, including in school-based studies. Family members were the most common participants in the postvention studies.

The review found that:

• There was limited evidence of the effectiveness of postvention service models and guidelines particularly for groups disproportionately impacted by suicide such as Aboriginal and Torres Strait Islander people.
• Some of the research indicated effectiveness of postvention models included certain postvention components, like involving trained peers in support groups, workplace training programs, psychoeducation, informal social support, peer support, mutual recognition and experience sharing, and arts-based interventions.
• Studies and grey literature sources being determined as low quality were mostly due to the lack of intervention and control groups in the studies. Participant selection methods for the studies, and other confounding factors also weakened the level of evidence of the studies.
• Only two of the studies in the review used randomised designs to test effectiveness of the postvention service model.

Of the 14 grey literature postvention models included in the review, the indicators demonstrating effectiveness of the postvention service model was mixed.

Some studies focused on mental health outcomes after engaging with the postvention model such as a person’s focus on mindfulness, their resilience, and level of anxiety.

Ten of the grey literature sources measured suicidality and grief, and nine focused on emotional impacts experienced resulting from the suicide.

Why are the findings important?

Postvention is seen as an integral component of a suicide prevention approaches in Australia. It is important to understand what the evidence tells us about the effectiveness of different postvention models so that the approaches we select as postvention service models are effective.

It is difficult to evaluate postvention service models without some biases such as select participant groups as most people engaged in postvention service models have been impacted by suicide.

More research is encouraged to evaluate the effectiveness of postvention service models for population groups disproportionately impacted by suicide such as LGBTIQA+, Aboriginal and Torres Strait Islander people, and young people.