Wirksamkeit von Interventionen für Hinterbliebene nach einem Suizid: ein Systematischer Review

Zusammenfassung

Hintergrund Suizidhinterbliebene weisen ein erhöhtes Risiko für psychische und somatische Folgeerkrankungen auf. Dennoch gibt es nur eine geringe Anzahl an Interventionen, welche sich spezifisch an diese Betroffenengruppe richten. Der systematische Review bewertet die Wirksamkeit von Interventionen, die speziell für jugendliche und erwachsene Suizidhinterbliebene entwickelt wurden.

Methodik Es wurden ausschließlich randomisierte kontrollierte Studien (k = 6) mit insgesamt N = 473 Teilnehmenden eingeschlossen.

Ergebnisse Für die Interventionsgruppen ließen sich bei den gruppeninternen Unterschieden kleine bis mittlere Effektstärken feststellen, es wurden jedoch keine signifikanten Unterschiede zwischen den Vergleichsgruppen gefunden.

Schlussfolgerungen Interventionen für Suizidhinterbliebene zeigten eine Reduzierung des psychischen Belastungserlebens auf, dennoch konnte dieser Effekt nicht in einem kontrollierten Design bestätigt werden. Das heißt, es liegt derzeit keine Evidenz dafür vor, dass eine Intervention nach dem Suizid einer nahestehenden Person wirksamer ist als keine oder eine unspezifische Intervention. Insgesamt gibt es bisher nur wenige qualitativ hochwertige Studien und dieser Umstand weist auf einen hohen Forschungsbedarf hin.

Abstract

Background Suicide bereavement is a significant risk factor for psychological and somatic disorders. However, to date there exists only a limited number of suicide bereavement interventions, and little is known about their efficacy.

Methods A computerized search in databases such as PsychINFO, PubMed, Medline was conducted. Randomized controlled trials (RCTs) that compared an intervention for suicide bereaved to a control condition were included after a quality assessment of two independent researchers. In total, six studies with N = 473 participants were included. Cohen’s d was used to calculate the effect sizes.

Results The results indicated small to medium effect sizes for within-group differences for the main outcomes in the intervention condition, while no significant between-group differences were revealed.

Conclusions Interventions for suicide bereavement can reduce mental health symptoms, however the results do not appear robust between group comparisons. Thus, it could not be demonstrated that an intervention following the suicide of a close relative is more effective than no intervention or an unspecific intervention. Future research should focus on high-quality intervention studies.

Schlüsselwörter

Suizid - Hinterbliebene - Trauerintervention - Wirksamkeit - Suizidprävention

Keywords

suicide - bereavement - intervention - efficacy - suicide prevention

Publication History

Article published online:
20 July 2020

• Literatur

• 1 Department Statistisches Bundesamt. Statistiken zu Selbstmord und Sterbehilfe. 2019. https://de.statista.com/themen/40/selbstmord/ abgerufen am 03.06.2020
• 2 Shneidman E, Cain A. Survivors of suicide. Springfield (IL): Charles C Thomas; 1972
• 3 Cerel J, Brown MM, Maple M. et al. How many people are exposed to suicide? Not six. Suicide and Life-Threatening Behavior 2019; 49: 529-534
• 4 Andriessen K, Rahman B, Draper B. et al. Prevalence of exposure to suicide: A meta-analysis of population-based studies. J Psychiatr Res 2017; 88: 113-120 doi:10.1016/j.jpsychires.2017.01.017
• 5 Diekstra RF. Suicide and the attempted suicide: An international perspective. Acta Psychiatrica Scandinavica 1989; 80: 1-24
• 6 Rynearson E, Schut H, Stroebe M. Complicated grief: Scientific foundations for health care professionals. London: Routledge; 2013: 278-292
• 7 Agerbo E. Risk of suicide and spouse’s psychiatric illness or suicide: nested case-control study. BMJ (Clinical research ed) 2003; 327: 1025-1026 doi:10.1136/bmj.327.7422.1025
• 8 Agerbo E. Midlife suicide risk, partner’s psychiatric illness, spouse and child bereavement by suicide or other modes of death: A gender specific study. Journal of Epidemiology and Community Health 2005; 59: 407-412 doi:10.1136/jech.2004.024950
• 9 Brent DA. Selective serotonin reuptake inhibitors and suicidality: a guide for the perplexed. Canadian journal of psychiatry Revue canadienne de psychiatrie 2009; 54: 72-74; discussion 75 doi:10.1177/070674370905400202
• 10 Sveen CA, Walby FA. Suicide survivors’ mental health and grief reactions: a systematic review of controlled studies. Suicide Life Threat Behav 2008; 38: 13-29 doi:10.1521/suli.2008.38.1.13
• 11 Kersting A, Brahler E, Glaesmer H. et al. Prevalence of complicated grief in a representative population-based sample. Journal of affective disorders 2011; 131: 339-343 doi:10.1016/j.jad.2010.11.032
• 12 Erlangsen A, Runeson B, Bolton JM. et al. Association Between Spousal Suicide and Mental, Physical, and Social Health Outcomes: A Longitudinal and Nationwide Register-Based Study. JAMA psychiatry 2017; 74: 456-464 doi:10.1001/jamapsychiatry.2017.0226
• 13 Wilcox HC, Mittendorfer-Rutz E, Kjeldgård L. et al. Functional impairment due to bereavement after the death of adolescent or young adult offspring in a national population study of 1,051,515 parents. Social Psychiatry and Psychiatric Epidemiology: The International Journal for Research in Social and Genetic Epidemiology and Mental Health Services 2015; 50: 1249-1256 doi:10.1007/s00127-014-0997-7
• 14 Rostila M, Saarela J, Kawachi I. Suicide following the death of a sibling: a nationwide follow-up study from Sweden. BMJ open 2013; 3: e002618 doi:10.1136/bmjopen-2013-002618
• 15 Rostila M, Saarela J, Kawachi I. “The psychological skeleton in the closet”: mortality after a sibling’s suicide. Social psychiatry and psychiatric epidemiology 2013;
• 16 Guldin M-B, Li J, Pedersen HS. et al. Incidence of suicide among persons who had a parent who died during their childhood: A population-based cohort study. JAMA psychiatry 2015; 72: 1227-1234 doi:10.1001/jamapsychiatry.2015.2094
• 17 Pitman AL, Hunt IM, McDonnell SJ. et al. Support for relatives bereaved by psychiatric patient suicide: National confidential inquiry into suicide and homicide findings. Psychiatric Services 2017; 68: 337-344 doi:10.1176/appi.ps.201600004
• 18 Andriessen K, Krysinska K, Hill NTM. et al. Effectiveness of interventions for people bereaved through suicide: a systematic review of controlled studies of grief, psychosocial and suicide-related outcomes. BMC psychiatry 2019; 19: 1-15 doi:10.1186/s12888-019-2020-z
• 19 Journot-Reverbel K, Raynaud J-P, Bui E. et al. Support groups for children and adolescents bereaved by suicide: Lots of interventions, little evidence. Psychiatry research 2017; 250: 253-255 doi:10.1016/j.psychres.2017.01.077
• 20 Linde K, Treml J, Steinig J. et al. Grief interventions for people bereaved by suicide: A systematic review. PLoS One 2017; 12 doi:10.1371/journal.pone.0179496
• 21 McDaid C, Trowman R, Golder S. et al. Interventions for people bereaved through suicide: Systematic review. The British Journal of Psychiatry 2008; 193: 438-443 doi:10.1192/bjp.bp.107.040824
• 22 Sakinofsky I. The Aftermath of Suicide: Managing Survivors’ Bereavement. Canadian Journal of Psychiatry 2007; 52: 129S-136S
• 23 Szumilas M, Kutcher S. Post-suicide Intervention Programs: A Systematic Review. Canadian Journal of Public Health-Revue Canadienne De Sante Publique 2011; 102: 18-29
• 24 Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010; 340: c332 doi:10.1136/bmj.c332
• 25 Cohen J. The effect size index: d. Statistical power analysis for the behavioral sciences 1988; 2: 284-288
• 26 Morris SB. Estimating Effect Sizes From Pretest-Posttest-Control Group Designs. Organizational Research Methods 2007; 11: 364-386 doi:10.1177/1094428106291059
• 27 Hedges LV, Olkin I. Statistical methods for meta-analysis. Academic press; 2014
• 28 Constantino R, Bricker P. Nursing postvention for spousal survivors of suicide. Issues Ment Health Nurs 1996; 17: 131-152 doi:10.3109/01612849609035002
• 29 Constantino R, Sekula LK, Rubinstein EN. Group intervention for widowed survivors of suicide. Suicide and Life-Threatening Behavior 2001; 31: 428-441 doi:10.1521/suli.31.4.428.22044
• 30 de Groot M, de Keijser J, Neeleman J. et al. Cognitive behaviour therapy to prevent complicated grief among relatives and spouses bereaved by suicide: cluster randomised controlled trial. BMJ: British Medical Journal (International Edition) 2007; 334: 994-996 doi:10.1136/bmj.39161.457431.55
• 31 de Groot M, Neeleman J, van der Meer K. et al. The effectiveness of family-based cognitive-behavior grief therapy to prevent complicated grief in relatives of suicide victims: The mediating role of suicide ideation. Suicide and Life-Threatening Behavior 2010; 40: 425-437 doi:10.1521/suli.2010.40.5.425
• 32 Kovac SH, Range LM. Writing projects: Lessening undergraduatesʼ unique suicidal bereavement. Suicide and Life-Threatening Behavior 2000; 30: 50-60 doi:10.1111/j.1943-278X.2000.tb01064.x
• 33 Zisook S, Shear MK, Reynolds CF. et al. Treatment of Complicated Grief in Survivors of Suicide Loss: A HEAL Report. Journal of Clinical Psychiatry 2018; 79 doi:10.4088/JCP.17m11592
• 34 Wittouck C, Autreve V, Portzky G. et al. A CBT-Based Psychoeducational Intervention for Suicide Survivors A Cluster Randomized Controlled Study. Crisis-the Journal of Crisis Intervention and Suicide Prevention 2014; 35: 193-201 doi:10.1027/0227-5910/a000252
• 35 Supiano KP, Haynes LB, Pond V. The transformation of the meaning of death in complicated grief group therapy for survivors of suicide: A treatment process analysis using the meaning of loss codebook. Death studies 2017; 41: 553-561 doi:10.1080/07481187.2017.1320339
• 36 Yalom ID. The theory and practice of group psychotherapy. Basic Books (AZ); 1995
• 37 Boelen PA, Van Den Hout MA, Van Den Bout J. A cognitive‐behavioral conceptualization of complicated grief. Clinical Psychology: Science and Practice 2006; 13: 109-128
• 38 Iso-Ahola SE. The social psychology of leisure and recreation. William C Brown Pub; 1980
• 39 Barrett TW, Scott TB. Suicide bereavement and recovery patterns compared with nonsuicide bereavement patterns. Suicide and Life-Threatening Behavior 1990; 20: 1-15
• 40 Wittouck C, Van Autreve S, De Jaegere E. et al. The prevention and treatment of complicated grief: a meta-analysis. Clinical psychology review 2011; 31: 69-78
• 41 Beck AT, Steer RA, Brown GK. Beck depression inventory-II. San Antonio 1996; 78: 490-498
• 42 Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Applied psychological measurement 1977; 1: 385-401
• 43 Sanders CM, Mauger PA, Strong PE. A manual for the Grief Experience Inventory. Palo Alto, CA: Consulting Psychologists Press; 1985
• 44 Barrett TW, Scott TB. Development of the grief experience questionnaire. Suicide and Life-Threatening Behavior 1989; 19: 201-215
• 45 Prigerson HO, Jacobs SC. Traumatic grief as a distinct disorder: A rationale, consensus criteria, and a preliminary empirical test. In: Stroebe MS, Hansson RO, Stroebe W, Schut H. eds. Handbook of bereavement research: Consequences, coping, and care. American Psychological Association; 2001: 613-645
• 46 Horowitz M, Wilner N, Alvarez W. Impact of Event Scale: a measure of subjective stress. Psychosomatic medicine 1979; 41: 209-218 doi:10.1097/00006842-197905000-00004
• 47 Beck AT, Weissman A, Lester D. et al. The measurement of pessimism: the hopelessness scale. Journal of consulting and clinical psychology 1974; 42: 861