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Over two-thirds of suicide loss survivors, those who have lost a loved one to suicide, seek individual therapy following their loss. However, nothing is known about what survivors find helpful about therapy or how therapy impacts their grief. An online survey was conducted June 2012-March 2013 with a convenience sample of 197 survivors primarily from the USA and Australia to develop a better understanding of treatment seeking loss survivors and their experiences in therapy. Questions explored the experience of the suicide death, the therapy received after the loss, and insights about improving therapy for loss survivors. Participants were generally positive about their therapy experiences. However, respondents endorsed symptoms of PTSD, though many did not report a formal diagnosis from a provider, suggesting a discrepancy that could lead to inadequate treatment of symptoms. The findings provide an understanding of treatment seeking loss survivors, along with implications for therapists treating this population.

Objective: Suicide has been identified as a major public health issue. Exposure to suicide (i.e., knowing someone who died by suicide) is far more pervasive than previously considered and might be associated with significant adverse outcomes. As suicide becomes more commonly discussed in the public arena, a compelling need exists to determine who is exposed to suicide and how this exposure affects those left behind. This study estimated the proportion of the population exposed to suicide and delineated factors that predict significant psychiatric and psychosocial morbidity following that exposure., Methods: A dual-frame random-digit-dial survey was conducted on a sample of 1,736 U.S. adults in the Commonwealth of Kentucky. Depression and anxiety were compared in suicide-exposed and suicide-unexposed individuals. Relationships were examined between psychiatric outcomes and perceptions of closeness to the decedent., Results: Forty-eight percent of weighted participants (n=816/1,687) reported lifetime exposure to suicide. Current depression and anxiety symptoms were higher in suicide-exposed than in suicide-unexposed individuals. Suicide-exposed individuals were twice as likely as suicide-unexposed individuals to have diagnosable depression and almost twice as likely to have diagnosable anxiety. Suicide-exposed individuals were more likely than suicide-unexposed individuals to report suicide ideation (9% vs. 5%). Closeness to the decedent increased the odds of depression and anxiety and almost quadrupled the odds of posttraumatic stress disorder., Conclusion: Exposure to suicide is pervasive and occurs beyond family; as such, it is imperative to identify those with perceived closeness to the decedent. This hidden cohort of suicide-exposed people is at elevated risk for psychopathology and suicidal ideation.

When a person goes missing, those left behind mourn an ambiguous loss where grief can be disenfranchised. Different to bereavement following death, hope figures into this experience as a missing person has the potential to return. This review explores hope for families of missing people. Lived experience of ambiguous loss was deconstructed to reveal responses punctuated by hope, which had practical and psychological implications for those learning to live with an unresolved absence. Future lines of enquiry must address the dearth of research exploring the role of hope, unresolved grief, and its clinical implications when a person is missing.

Objective: This paper aims to contribute to the development of a more sustainable Australian rural community mental health workforce by comparing the findings from a literature search investigating impacting factors on retention with the experiences of community mental health service managers running services in rural Australia., Design: Semi-structured interviews., Setting: Public health sector, rural New South Wales., Participants: Five community mental health managers, running services in rural Australia., Main Outcome Measures: Interviews were undertaken as a pilot for a broader qualitative study investigating factors influencing the decision to stay or leave among community mental health professionals working in rural positions. The purpose of undertaking this pilot study was to test for validity and relevance of the retention phenomena and help inform the research design for the main study., Results: Three key retention focussed themes were identified: (i) Staffing is a persistent challenge; (ii) Small remote towns pose the biggest challenge; and (iii) The decision to stay or leave is complex and multifactorial., Conclusions: The findings of this pilot study support previous research and contribute to the understanding of influences on retention among health professionals working in rural community mental health services. Importantly, those who have worked for several years in rural positions hold important information through which to explore factors that impact retention in rural and remote regions., (© 2015 National Rural Health Alliance Inc.)

Context: Rural Australians experience poorer health and poorer access to health care services than their urban counterparts, and there is a chronic shortage of health professionals in rural and remote Australia. Strategies designed to reduce this rural-urban divide include fly-in fly-out (FIFO) and drive-in drive-out (DIDO) services. The aim of this article is to examine the opportunities and challenges involved in these forms of service delivery. This article reviews recent literature relating to FIFO and DIDO healthcare services and discusses their benefits and potential disadvantages for rural Australia, and for health practitioners., Issues: FIFO and DIDO have short-term benefits for rural Australians seeking healthcare services in terms of increasing equity and accessibility to services and reducing the need to travel long distances for health care. However, significant disadvantages need to be considered in the longer term. There is a potential for burnout among health professionals who travel long distances and work long hours, often without adequate peer support or supervision, in order to deliver these services. A further disadvantage, particularly in the use of visiting medical practitioners to provide generalist services, is the lack of development of a sufficiently well-resourced local primary healthcare system in small rural communities., Lessons Learned: Given the potential negative consequences for both health professionals and rural Australians, the authors caution against the increasing use of FIFO and DIDO services, without the concurrent development of well-resourced, funded and staffed primary healthcare services in rural and remote communities.

The idea that scholarly writing is an integral part of academic and clinical work is not new; however, increasing expectations that health professionals contribute to research output through publication, regardless of level of employment or experience, creates anxiety and dissonance for many novice and sometimes not-so-novice writers. Publications and the impact of scholarly work have become the key indicators not only of the performance of individual health academics, but also of health disciplines and universities more broadly. In Australia, as in many other countries, publications as the measure of research impact and outputs are expected in professional disciplines, universities and schools. Research impact is assessed and rated against other institutions and used as a means of allocating scarce research funding. Publishing has become a matter of professional reputation and sustainability. This paper reports on a project designed to enhance publication rates across health disciplines based at a rural university, where many staff members combine academic work with ongoing clinical roles. Without deliberate and focused support to enhance skills and confidence in writing it was unlikely that these academics and clinical staff members would be able to develop the kind of track record required for a successful academic career or promotion. This paper outlines the development, delivery and outcomes of this university-funded project, which drew on evidence in the literature to increase the publication rates across two Schools (Health and Medicine) at a rural university.

In light of prevailing confusion over the meaning of the term "suicide survivor," we propose a more exact terminology for designating different levels of impact on those left behind by suicide, ranging on a continuum from those exposed to suicide through those who are affected by it and finally to those who are bereaved by suicide in the short- or long-term, as a function of their loss of a close emotional attachment through this tragic form of loss. We briefly note the possible utility of this terminological specificity in promoting more clearly targeted research and intervention efforts, and call for closer investigation of various categories of "survivorship" in future studies., (© 2014 The American Association of Suicidology.)

The complex family environments in which a suicide death had previously occurred were explored in a qualitative study of narratives of suicide-bereaved participants. The participants searched for reasons why the suicide occurred in their family. Family patterning stories and the context of the environment in which the suicide death occurred provided an additional depth of meaning into the relational aspects of the family. Fractured families emerged as an important theme. Shared in the narratives were stories of conditions within the family that may have contributed to vulnerability towards persistent negative feelings about their lives, their family, and their future. The study also identifies the strengths of family culture that led to resilience in the suicide bereaved. These stories highlight the importance of support for those bereaved by the suicide of a close family member and the issues that places people in vulnerable situations that perhaps may explain the increased risk of suicide for those bereaved family members.

Objective: Suicide bereavement research can help facilitate greater understanding of the impact of suicide and potential risks for others. As there is limited research on the experience of young people who lose a friend to suicide, the aim of this exploratory study was to consider specific psychological factors for such bereaved young people., Methods: Ten young people who had experienced the suicide death of a friend completed self-report measures to assess levels of depression, anxiety, coping and prolonged grief., Results: Participants reported increased levels of stress, depression, reduced coping capacity and prolonged grief symptoms that have continued considerably beyond the death of their friend., Conclusions: Psychological distress for young people bereaved by a friend's suicide is of concern given the developmental changes and life transitions associated with this age group. Implications include the significant health and wellbeing challenges associated with suicide bereavement for young people. The outcomes support a more proactive response from mental health and support services.

Background: There is little empirical evidence regarding lifetime exposure to suicide or identification of those impacted by suicide deaths. Studies previously conducted used only convenience samples., Aims: To determine the prevalence of suicide exposure in the community and those affected by suicide deaths., Methods: A random digit dial sample of 302 adults., Results: 64% of the sample knew someone who had attempted or died by suicide, and 40% knew someone who died by suicide. No demographic variables differentiated exposed versus unexposed, indicating that exposure to suicide cuts across demographics. Almost 20% said they were a "survivor" and had been significantly affected by a suicide death. Demographic variables did not differentiate groups. The relationship to the decedent was not related to self-identified survivor status; what did differentiate those individuals impacted by the death from those who did not was their perception of their relationship with the decedent., Conclusions: Kinship proximity and relationship category to the deceased appeared to be unrelated to survivor status, but perceived psychological closeness to the deceased showed a robust association with self-identified survivor status. We need an expanded definition of "suicide survivor" to account for the profound impact of suicide in the community.

Background: While the research literature exploring suicide bereavement has expanded in recent years, this has been primarily quantitative and has focused more on the bereavement experience of parents and siblings. The bereavement experience of young people affected through the suicide death of a friend remains under-conceptualized and not well understood., Aims: To develop an understanding of the experiences of young people bereaved by the suicide of a friend., Method: Ten young people participated in a pilot study with in-depth interviews to explore their suicide bereavement experiences. Narrative inquiry methodology was utilized to analyze the qualitative data., Results: The findings indicated multiple grief experiences caused by suicide. Four themes reported are meaning making, feeling guilt, risky coping behavior, and relating to friends following suicide loss., Conclusions: Implications include the need for increased awareness that friends of young people who die by suicide may have significant health and well-being challenges associated with bereavement, and that friends in these circumstances may not readily present at services for assistance.

Background: While high-quality and ethically sound research is needed to better understand and respond to the needs of those bereaved by suicide, there is a concern that ethical boards internationally raise unreasonable objections to research with those bereaved by suicide., Aims: This pilot study was conducted to examine the issues faced by suicide bereavement and postvention researchers while obtaining ethical board approval., Method: Suicide bereavement and postvention researchers from four continents were surveyed on their experiences of responding to ethical board challenges to research proposals and requests to amend their research as a result of ethical board concerns., Results: While ethical boards differ in their response to suicide bereavement research, eight of 19 researchers surveyed indicated they had had proposals challenged, with two of these eight researchers reporting having to make major changes to their proposals as a result. The researchers provided examples of how they responded to those concerns about perceived risks of their research by ethical board members., Conclusions: There are strict guidelines regarding the treatment of research study participants, and ethical boards must ensure the proposed research procedures adhere to these guidelines. Yet, in the field of suicide bereavement research it would appear that some ethical boards place restrictions or raise concerns about research being conducted in an absence of sound knowledge about the safety of such research. This ultimately may influence the design of research being conducted. Such influence in turn shapes the data generated from the research and thus what is published in the literature. It is both timely and imperative for ethical board members to be well educated on what the risks of those who are bereaved by suicide may be prior to making recommendations on research project designs.

The current paper reports findings from a qualitative research project that aimed to explore parents' experiences following the suicide death of their young adult child. Twenty-two Australian parents told of the suicide death of their son or daughter during the data collection period (2003 to late 2004). One narrative theme drawn from the interview data is reported here: the way in which suicide-bereaved parents feel unable to talk about their child's life and death, their experience of suicide and their resultant bereavement. Parents reported being silenced by others and silencing themselves in relation to talking about their bereavement. Parents' private stories are used to explain the difficulties they faced given the contemporary social and cultural context of grief and suicide. Then follows an examination of the impact these difficulties had on their ongoing grief narrative and availability of social support. Implications for health and social care intervention are presented to assist in better preparing support workers in their interactions with parents bereaved in this manner.

Suicide deaths are often viewed as sudden and unexpected. Research examining bereavement responses to suicide are generally set within this conceptual framework. Twenty-two parents were interviewed about their bereavement experience following the suicide death of a young adult son or daughter. Data analyzed using narrative methods revealed the concept of preparedness. Three distinct preparedness narratives were identified, termed turbulent-relief, tragedy, and reflective plots. The data presented here highlights the way in which these different situations influence the resultant grief. Understanding preparedness for suicide assists in explaining the variety of grief responses in parents bereaved in this manner.