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      Being pro-active in meeting the needs of suicide-bereaved survivors: results from a systematic audit in Montréal

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          Abstract

          Background

          Suicide is a major public health concern. In 2017, the suicide rate in Canada was 11 per 100,000 inhabitants. According to literature, 1 in 5 people have experienced a death by suicide during their lifetime. The aim of this study was to describe the met and unmet needs of suicide-bereaved survivors and to provide postvention recommendations.

          Methods

          Further to an exploratory mixed-method audit of 39 suicides that occurred in Montreal (Canada) in 2016, suicide-bereaved survivors ( n = 29) participated in semi-structured interviews and completed instruments to discuss and assess potential pathological grief, depression (PHQ-9), and anxiety (GAD-7), as well as health and social services utilization. A panel then reviewed each case and provided recommendations. The mean age of participants was 57.7 years and 23 were women.

          Results

          Although help was offered initially, in most cases by a health professional or service provider (16/29), 22 survivors would have liked to be contacted by telephone in the first 2 months post suicide. Four categories of individual unmet needs (medical/pharmacological, information, support, and outreach) and one collective unmet need (suicide pre/postvention training and delivery) emerged.

          Conclusions

          Although Quebec provincial services have been developed and offered to suicide-bereaved survivors in the past decade, many dwindled over time and none has been applied systematically. Recommendations for different stakeholders (Ministry of Health and Social Services, coroners, NGOs, and representatives of suicide-bereaved survivors) outlined in this study could be an interesting first step to help develop a suicide pre/postvention strategy.

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          Most cited references34

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          Long-term psychological distress of Bosnian war survivors: an 11-year follow-up of former displaced persons, returnees, and stayers

          Background Research on the long-term mental health consequences of war and displacement among civilians who live in post-conflict countries is rare. The aim of this study was to examine the developmental trajectories and predictors of general psychological distress in three samples of Bosnian war survivors over an 11-year period. Methods In 1998/99, about three years after the war in Bosnia and Herzegovina, a representative sample of 299 adult Sarajevo citizens was examined in three subsamples: individuals who had stayed in Sarajevo throughout the siege, individuals who had been internally displaced, and refugees who had returned. Of the 138 study participants who could be located 11 years later, 100 were re-assessed (71%) using the Brief Symptom Inventory. Results Over time, psychological symptoms and general psychological distress decreased in those survivors who had stayed and increased in returnees. Former displaced persons did not show any significant changes. After controlling for other factors, cumulative trauma exposure before and during the war predicted general psychological distress at baseline. Eleven years later, higher trauma exposure during and after the war, returnee status, and more current stressors were all associated with higher levels of general psychological distress. Conclusions Levels of psychological symptoms remained high in three subsamples of Bosnian war survivors. The differential symptom trajectories may correspond to distinct war experiences and contemporary stressors. Still, the cumulative effect of war traumata on mental distress persisted more than a decade after war and displacement, although the influence of current stressors seemed to increase over time. Electronic supplementary material The online version of this article (10.1186/s12888-018-1996-0) contains supplementary material, which is available to authorized users.
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            Effects of suicide bereavement on mental health and suicide risk

            Between 48 million and 500 million people are thought to experience suicide bereavement every year. Over the past decade, increased policy attention has been directed towards suicide bereavement, but with little evidence to describe the effect of exposure or to provide appropriate responses. We used a systematic approach to carry out a narrative review of studies of the effect of suicide bereavement on mortality, mental health, and social functioning, and compared them with effects from other bereavements. We found 57 studies that satisfied strict inclusion criteria. Results from these studies suggested that exposure to suicide of a close contact is associated with several negative health and social outcomes, depending on an individual's relationship to the deceased. These effects included an increased risk of suicide in partners bereaved by suicide, increased risk of required admission to psychiatric care for parents bereaved by the suicide of an offspring, increased risk of suicide in mothers bereaved by an adult child's suicide, and increased risk of depression in offspring bereaved by the suicide of a parent. Some evidence was shown for increased rejection and shame in people bereaved by suicide across a range of kinship groups when data were compared with reports of relatives bereaved by other violent deaths. Policy recommendations for support services after suicide bereavement heavily rely on the voluntary sector with little input from psychiatric services to address described risks. Policymakers should consider how to strengthen health and social care resources for people who have been bereaved by suicide to prevent avoidable mortality and distress.
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              Optimizing Treatment of Complicated Grief: A Randomized Clinical Trial.

              To our knowledge, this is the first placebo-controlled randomized clinical trial to evaluate the efficacy of antidepressant pharmacotherapy, with and without complicated grief psychotherapy, in the treatment of complicated grief.
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                Author and article information

                Contributors
                fabienne.ligier@cpn-laxou.com
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                10 October 2020
                10 October 2020
                2020
                : 20
                : 1534
                Affiliations
                [1 ]Centre Psychothérapique de Nancy, Pôle Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, 1 rue du Dr Archambault, F-54520 Laxou, France
                [2 ]GRID grid.29172.3f, ISNI 0000 0001 2194 6418, EA 4360 APEMAC, , Université de Lorraine, ; Vandoeuvre-lès-Nancy, France
                [3 ]GRID grid.86715.3d, ISNI 0000 0000 9064 6198, School of Nursing, Université de Sherbrooke, ; Longueuil, Canada
                [4 ]GRID grid.414210.2, ISNI 0000 0001 2321 7657, Centre de recherche de l’Institut Universitaire en Santé Mentale de Montréal, ; Montreal, Canada
                [5 ]GRID grid.459278.5, ISNI 0000 0004 4910 4652, CIUSSS de l’Est de l’Ile de Montréal, , CLSC St-Michel, ; Montreal, Canada
                [6 ]GRID grid.265705.3, ISNI 0000 0001 2112 1125, Department of Psychoeducation and Psychology, , Université du Québec en Outaouais, ; Gatineau, Canada
                [7 ]Centre intégré de santé et service social de l’Outaouais (CISSSO), Outaouais, Quebec, Canada
                [8 ]GRID grid.14848.31, ISNI 0000 0001 2292 3357, Department of Psychiatry, , Université de Montréal, ; Quebec, Canada
                Author information
                http://orcid.org/0000-0002-9324-5183
                Article
                9636
                10.1186/s12889-020-09636-y
                7547412
                33036601
                8bf45aa6-af00-4b96-9a37-c7300b4645a6
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 27 February 2020
                : 30 September 2020
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Public health
                bereaved,help seeking,needs,postvention,suicide
                Public health
                bereaved, help seeking, needs, postvention, suicide

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