Effectiveness of grief counselling to prevent complicated grief among families bereaved by suicide

A grief counselling programme for families bereaved by suicide does not reduce grief or depression, but may help to prevent perceptions of blame among close relatives and spouses, finds a study published on bmj.com.

Up to 15 per cent of bereaved people develop complicated grief, characterised by symptoms such as purposelessness, subjective sense of detachment, yearning, disbelief, and bitterness related to the death. It is also associated with long term psychiatric illness and suicidal ideation.

Relatives of people who have killed themselves may have particularly difficult grief reactions and studies have suggested that cognitive behavioural therapy is useful for the treatment of complicated grief.

So researchers in the Netherlands examined the effectiveness of a cognitive behaviour grief counselling programme to prevent complicated grief among families bereaved by suicide.

The study involved 122 first degree relatives and spouses of 70 people who had committed suicide between 1 September 1999 and 1 January 2002. Thirty-nine families (68 participants) were allocated to four sessions with a trained psychiatric nurse counsellor, while 31 families (54 participants) received usual care. The counselling sessions took place three to six months after the suicide.

Thirteen months after the event, self-reported grief was measured and the presence of depression, suicidal ideation, and perceptions of being to blame for the suicide were recorded.

Counselling had no beneficial effect on complicated grief, suicidal ideation or depression. However, after adjusting for several factors, the researchers did see a trend towards reduced perceptions of being to blame and fewer maladaptive grief reactions in the counselling group compared to the usual care group.

The authors suggest that having a chance in counselling to inform relatives of the psychiatric context in which suicide usually occurs, and reflect on and acknowledge their loved one's difficulties before the suicide, may have helped relatives to realise that they did nothing wrong.

http://www.bmj.com