Suicide is a major public health concern that affects some 3,500 individuals a year in Canada (1). According to the literature, each suicide affects an average of six people (2–4). Dealing with a loved one’s suicide can be extremely challenging for suicide-bereaved survivors (SBS), so much so that they may become more vulnerable to an array of problems (5). The situation can have an impact on the bereavement process, the development of somatic or mental health disorders and, ultimately, suicide risk (6–11). SBS often have difficulty seeking help because they may have lost confidence in the health and social services systems that failed their loved one, do not dare to consult, are isolated, or feel shame over what happened (6,8,12–15).
Bereavement programs do exist but SBS do not always access them. A proactive approach is often needed to offer help to these vulnerable individuals (16). Also, such offers must be repeated at intervals because individuals experience grief differently and may need support at different times (16,17). According to McKinnon and Chonody (2014), proactive help should be offered by first responders, coroners and other professionals that come into contact with SBS very early on. The absence of a formal process to connect SBS with support programs is in fact the principal unmet need of SBS (18).
While bereaved individuals know little about bereavement programs and how to access them, researchers know very little about the content and effectiveness of these programs (19). Some evidence of benefits has emerged from a few intervention studies (19–21). For example, Andriessen et al. (2019) carried out a systematic review of controlled studies to assess evidence of the effectiveness of interventions for SBS and simultaneously appraise research quality. Their results showed that interventions targeting support, therapy and education seemed to work best when they included the social environment of the bereaved and when the therapy sessions were led by professionals. In another systematic review, Linde et al. (2017) found that bereavement groups had positive effects on uncomplicated grief and that cognitive-behavioral programs had positive effects on individuals at risk for suicide. However, as pointed out by Andriessen et al. (2019) and Linde et al. (2017), the overall quality of research in the field of SBS postvention remains very weak so that what little evidence there is of the effectiveness of these interventions is neither strong nor reliable. For example, the results of a Canadian systematic review by Szumilas and Kutcher (2011) showed that only 16 of 49 studies of suicide postvention programs met their inclusion criteria regarding quality and evidence of effectiveness. Moreover, outcomes and measures varied widely from one study to another and most studies were conducted with women. To our surprise, none of the studies addressed interventions for individuals over the age of 65. Given the absence of any evidence-based suicide postvention program, further research is required into the exact form and structure of these programs. Furthermore, if these programs are proved ineffective, it could be because they were not based on the actual needs of bereaved adults to begin with. As shown by Wilson and Marshall (2010), less than half of individuals bereaved by suicide who expressed needing help with their grief process actually received help and only 40% of these were satisfied with the help received. In a study exploring the needs of SBS in Ontario (Canada), Gall, Henneberry, and Eyre (2014) described and compared the perspectives of SBS and of mental health workers and found that they complemented each other and helped identify best practices for SBS postvention. Pitman et al. (2018), too, demonstrated the importance of addressing support needs from the perspective of SBS. Finally, Séguin and Castelli-Dransart (2006) proposed that the help offered SBS follow a specific progression as a function of their needs: family support in the first weeks, support group if necessary, and therapy for difficult or pathological bereavement.
The above studies and findings argue in favor of approaching SBS needs proactively (16,18) and of developing specific programs to address these needs. The majority of SBS will not develop pathological bereavement or other problems. However, it is important to recognize those who do and to bear in mind that this may occur even 18 to 24 months post suicide. Moreover, it is reassuring to know that programs exist that have proved effective in situations of complicated bereavement (22,23).
In Quebec, suicide prevention centers often propose help in the form of support groups but SBS are not systematically referred to these centers. This is why it is important to assess social and health service needs and to understand why such needs go unmet. Grieving difficulties, service utilization, and unmet needs should be assessed systematically.
Against this background, we undertook an exploratory cross-sectional and retrospective mixed-methods study to describe the met and unmet needs of SBS two years after the event and to formulate specific suicide postvention recommendations over this two-year period.