Supporting the mental health of adults bereaved by suicide : A systematic review of protective factors
Résumé
Background. Exposure to the death by suicide of a loved one is a traumatic event that has been associated with poor mental health outcomes. Specifically, those bereaved by suicide have a higher risk of depression, post-traumatic stress disorder, prolonged grief disorder and suicidal behavior. Thus, understanding the characteristics and mechanisms that promote mental health in suicide-loss survivors (SLS) is essential to developing appropriate interventions and support for this vulnerable population. We therefore sought to systematically synthesize the evidence on protective factors in adults bereaved by suicide. Method. Following guidelines for systematic reviews, searches were performed using PubMed, PsycINFO, Web of Science, Embase and Scopus by two independent reviewers using the same criteria and search procedures. This study has been registered on Prospero. Findings. The literature search yielded 2166 articles. After screening, 31 articles fulfilled the inclusion criteria and were retrieved for review, including 4 longitudinal, 17 cross-sectional and 10 qualitative studies. Results revealed several interpersonal (social support received and provided, self-disclosure), intrapersonal (sense of belonging, secure attachment, self-forgiveness, problem-focused coping, meaning-making activity, spirituality) and sociodemographic (age of deceased and bereaved, marital status) factors that can prevent the development of mental disorders in SLS. Discussion. Despite the major impact of suicide on loved ones, a range of factors are able to support the mental health of the bereaved throughout their difficult journey. Like risk factors, they must be understood from a biopsychosocial perspective, as they involve multiple and intersecting individual, interpersonal and sociodemographic characteristics. However, the majority of included studies were cross-sectional, limiting the ability to make causal inferences between protective factors and psychological outcomes. In addition, some of the cohort studies included were from the same survey and therefore involved the same participants, limiting the scope of their results. Most studies also involved limited sample sizes. So, to better identify the constituent elements and underlying mechanisms of resilience in SLS, further large longitudinal studies are needed. Conclusion. This review contributes to improve our understanding of determinants of SLS mental health. Futhermore, it provides information on factors that should be targeted for effective support