Prolonged Grief Symptoms among Suicide-Loss Survivors: The Contribution of Intrapersonal and Interpersonal Characteristics

Abstract

Background: Suicide-loss survivors (SLSs) are a population with unique characteristics that place them at increased risk for developing grief complications and painful feelings of guilt that may impact their supportive social environment. However, no studies to date have examined the role of intrapersonal and interpersonal variables that may contribute to prolonged grief symptoms (PGS) as outlined by the new DSM-5 criteria. The present study aimed to extend knowledge regarding the role of interpersonal variables, such as perceived burdensomeness, thwarted belongingness, and self-disclosure, in determining the impact of guilt on the development of PGS among SLSs. Method: This study is part of a longitudinal study, though, in this study, we used a cross-sectional examination of the recently completed fourth measurement. Study participants included 152 SLSs aged 22 to 76 who completed questionnaires measuring guilt, depression, perceived burdensomeness, thwarted belongingness, self-disclosure, and PGS using the Prolonged Grief–Revised Inventory. Participants’ demographics and loss-related characteristics, such as time since suicide and participant’s age at the time of suicide, were examined. Results: Confirming the hypotheses, intrapersonal variables (i.e., guilt and depression), as well as interpersonal variables (i.e., perceived burdensomeness, thwarted belongingness, and self-disclosure), contributed significantly to PGS beyond sociodemographic and loss-related factors. Perceived burdensomeness significantly moderated the contribution of guilt to PGS: for participants with high burdensomeness levels, guilt contributed to PGS more strongly than for participants with low burdensomeness. Conclusion: Guilt is an important contributor to PGS among SLSs, and perceived burdensomeness plays a critical role in moderating this contribution. In light of these findings, it can be suggested that SLSs with high levels of guilt should receive special attention and may benefit from therapeutic interventions focusing on reducing maladaptive cognitions that elicit intense guilt or perceived burden.

Shame, depression, and complicated grief among suicide loss-survivors: the moderating role of self-disclosure

“…Moreover, self-disclosure can carry the benefit of decreasing SLSs’ psychological difficulties, such as depression and suicide ideation (Van Orden et al, 2010 ). In recent studies, ii was found that experiences such as belongingness serve as a factor that diminishes CG levels (Levi-Belz & Aisenberg, 2021 ) and depression (Levi-Belz & Ben-Yaish, 2022 ) in the aftermath of suicide loss. Thus, grief and depression levels may also be related to the nature of SLSs’ interpersonal engagement.…”

“…In some studies (e.g. Levi-Belz & Ben-Yaish, 2022 ; Shu-Liang et al, 2020 ), self-disclosure was found to be related to higher levels of perceived social support and belongingness, which have been recognised as factors that may contribute to SLSs’ recovery from their suicide loss (Levi-Belz & Aisenberg, 2021 ). Thus, self-disclosing emotional aspects of traumatic events to others may facilitate changes in loneliness and social support, as well as craft new ways of thinking about oneself and the suicide event (Levi-Belz, 2015 ), thus easing the harsh feelings of shame and its ramifications (Levi-Belz & Gilo, 2020 ).…”

Depression and Suicide Ideation among Suicide-Loss Survivors: A Six-Year Longitudinal Study

“…Such relationships may amplify the oppressive experience of blame and shame, which characterize many SLSs (e.g., Refs. [ 5 , 47 ]) and hinder their recovery from depressive symptoms. The more acute grieving process of SLSs with high TB [ 10 ] may also play a role in the association between low social relationships and depression, promoting lasting symptoms of depression for the high TB group.…”

“…The more acute grieving process of SLSs with high TB [ 10 ] may also play a role in the association between low social relationships and depression, promoting lasting symptoms of depression for the high TB group. On the other hand, a higher sense of belongingness, viewed as one of the fundamental human psychological needs [ 48 ], may function as a buffer against the stigma and shame experienced by SLSs [ 5 , 47 ] and, as a result, shield SLSs from mental pain and even depression.…”

What Do We Know about Suicide Bereavement, and What We Can Do to Help Suicide-Loss Survivors?

“…Research has revealed that suicide-loss survivors present higher levels of depression, and suicidal ideation and behavior [ 6 , 7 ] than other bereaved individuals. Moreover, those bereaved by suicide can experience adverse grief reactions such as prolonged grief disorder symptoms [ 8 , 9 ] which can persist even several years following the loss.…”