A systematic review of studies describing the influence of informal social support on psychological wellbeing in people bereaved by sudden or violent causes of death

Abstract

Aims Whilst any type of bereavement can be traumatic, bereavement through violent or sudden causes is associated with more severe negative health and wellbeing outcomes compared to other types of loss. Social support has been found to have a positive impact on wellbeing after traumatic events in general. However, this association appears to be less consistently demonstrated in studies that focus on bereavement, and the literature in this area has not yet been systematically reviewed. This study aimed to review the international literature to examine systematically whether there is an association between informal social support from family and friends after bereavement through sudden and/or violent causes and post-bereavement wellbeing. Methods We conducted a systematic search for quantitative studies that tested for an association between social support and any outcome related to wellbeing after a sudden and/or violent loss. Included studies were assessed for risk of bias, and findings were reported using the approach of narrative synthesis. The review was pre-registered on Prospero (registration number CRD42018093704). Results We identified 16 papers that met inclusion criteria, all of which we assessed as having generally low or moderate risk of bias. 15 different wellbeing outcomes were measured across all studies. We found consistent evidence for an inverse association between social support and symptoms/presence of depression, predominantly consistent evidence for an inverse association between social support and symptoms/presence of post-traumatic stress disorder (PTSD), and conflicting evidence for an inverse association between social support and symptoms/presence of complicated grief. Conclusions Our systematic review identified evidence to suggest that social support after sudden or violent bereavement is associated with a reduced severity of depressive and PTSD symptoms. Further longitudinal research is needed to explore potential causality in this relationship, widening the focus from common mental disorders to include other mental illnesses, wellbeing outcomes, and suicide-related outcomes after bereavement. There is also a need for consensus on the conceptualisation and measurement of social support. Our findings imply that interventions to improve access to and quality of social support may reduce the burden of mental illness after bereavement, and may therefore be worth investing in.

Factors associated with higher levels of grief and support needs among people bereaved during the pandemic: Results from a national online survey

“…and protects against poor psychological outcomes(Juth et al, 2015, Mason et al, 2020, especially after traumatic deaths(Scott et al, 2020). Our findings support this body of research and highlight the challenges of bereavement during a time of huge disruptions to social networks.…”

“…The protective effects of social support, and the poor outcomes associated with loneliness, are increasingly recognised (Prohaska et al ., 2020, Wang et al ., 2018). Bereavement increases the risk of loneliness (Fried et al ., 2015), while social support enables grieving people to cope (Harrop et al ., 2020b) and protects against poor psychological outcomes (Juth et al ., 2015, Mason et al ., 2020), especially after traumatic deaths (Scott et al ., 2020). Our findings support this body of research and highlight the challenges of bereavement during a time of huge disruptions to social networks.…”

Anxiety, resilience and local conditions: A cross‐cultural investigation in the time of Covid‐19

“…The limits on meeting with others reduced people's capacity to mobilise social support. Social support has been shown to be an important contributor to well‐being in many different populations and in many different circumstances—for example, systematic reviews and meta‐analyses have found an association between social support and well‐being in adolescents (Chu et al, 2010), Chinese older adults (Chen et al, 2012), and among those bereaved by sudden or violent death (Scott et al, 2020). Social support has been proposed to have a direct effect on well‐being, but also to have a particularly important role to play at times of greater stress (Alnazly et al, 2021)—the stress‐buffering approach (Cohen & Wills, 1985), which might be particularly relevant at such a time as a pandemic.…”

Are empathy profiles and perceived social support associated with depressive and grief‐related symptoms in suicide survivors?

“…Hence, empathy is an interpersonal phenomenon, where an individual consciously shares (and, in some cases, even experiences as his/her own) common feelings with another person, fostering their expression rather than passing judgment (Norman, 1967). Social support, combining a sense of belonging and the sense of having someone to count on, consists of the help provided to the individual by his/her social network, as well as formal help obtained from professionals and non‐professionals (Scott et al, 2020). In other groups of bereaved people, it has been shown, albeit with some inconsistencies, that social and instrumental support from network members contributes to adjustment and diminished loneliness after a loss, through different mechanisms (Stroebe et al, 1996; Sullivan & Infurna, 2020; van Baarsen, 2002).…”