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The Support Needs and Experiences of Suicidally Bereaved Family and Friends
Article in Death Studies · August 2010

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Death Studies
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The Support Needs and Experiences of Suicidally

Bereaved Family and Friends
Anne Wilson & Amy Marshall
To cite this article: Anne Wilson & Amy Marshall (2010) The Support Needs and
Experiences of Suicidally Bereaved Family and Friends, Death Studies, 34:7, 625-640, DOI:
10.1080/07481181003761567
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Download by: [UNIVERSITY OF ADELAIDE LIBRARIES] Date: 11 September 2017, At: 17:18
Death Studies, 34: 625–640, 2010
Copyright # Taylor & Francis Group, LLC
ISSN: 0748-1187 print=1091-7683 online
DOI: 10.1080/07481181003761567
THE SUPPORT NEEDS AND EXPERIENCES OF

SUICIDALLY BEREAVED FAMILY AND FRIENDS
Downloaded by [UNIVERSITY OF ADELAIDE LIBRARIES] at 17:18 11 September 2017
ANNE WILSON and AMY MARSHALL

Discipline of Nursing, School of Population Health and Clinical Practice,
The University of Adelaide, Adelaide, South Australia, Australia
This study aimed to identify what suicidally bereaved persons’, particularly close
relatives’ and loved ones’, perceptions of their need for support were and their
experiences of support directed at meeting those needs. A total of 166 persons
who were bereaved by suicide completed a questionnaire consisting of both closed
and open-ended questions. Overall, 94 % of participants indicated a need for help
to manage their grief, but only 44 % received help. Most participants indicated a
great or significant need for help. In addition, only 40 % of those who received
professional support felt satisfied with it. The authors concluded that there is
a significant gap between need for support and the quality and provision of
professional support services.
Suicide is recognized as one of the major issues facing health care

providers and mental health organizations worldwide. Each year
approximately 1 million people die from suicide around the world,
representing one death every 40 seconds (International Associ-
ation for Suicide Prevention, 2004). Suicide is a leading cause
of death, particularly in younger people. It is sobering that in
Australia, over 2,200 people every year are so deeply distressed
that they end up taking their lives (Australian Bureau of Statistics,
2007). Considering there are many others whose deaths by drugs
and single-person motor vehicle accidents may also be a form of
self-inflicted death (but cannot be confirmed as such), the extent
of the problem of suicide takes on considerable proportions.
The highest rates of suicide are among men, with peaks in
Received 23 April 2009; accepted 28 April 2009.

We acknowledge the contribution by Dr. Sheila Clark to the reported research study.
Address correspondence to Dr. Anne Wilson, Discipline of Nursing, School of Popu-
lation Health and Clinical Practice, The University of Adelaide, 5005 Adelaide, Australia.
E-mail: anne.wilson@adelaide.edu.au
625
626 A. Wilson and A. Marshall
30–34-year-old men, 40–44-year-old men, and the elderly (Australian

Bureau of Statistics, 2007; Parrish & Tunkle, 2005).
For every death, it is hypothesized that between 6 and 28
others are severely affected by grief (Knieper, 1999; Shneidman,
1972); therefore, taking the most conservative estimate, over
13,000 people suffer major grief from losing someone close through
suicide every year in Australia. Such an incidence poses serious

challenges for service providers, researchers, governments, and
policymakers in addressing the needs of those affected by such grief.
The death of a close relationship is one of the greatest of life’s
stresses (Holmes & Rahe, 1967) and the grieving process may last
several years (Zisook & Shuchter, 1986). Grief may affect indivi-
duals’ physical, emotional, cognitive, mental, social, and spiritual
well-being (Corr, 1999). Research suggests that people bereaved
through suicide are a group at particular risk of depression (Brent
et al., 1994; Valente & Saunders, 1993) and suicide (Roy, Nielsen,
Rylander, & Sarchiapone, 2000). One descriptive study demon-
strated high levels of complicated grief in bereaved people who
were close to the suicide deceased and suggests they are at risk
of developing physical and mental health problems (Mitchell,
Kim, Prigerson, & Mortimer-Stevens, 2004).
There is increasing recognition that people bereaved through
suicide grieve differently and have different needs from those
bereaved through other modes of death (Clark & Goldney,
2000). Some research suggests that the differences between people
bereaved through a suicide and others are largely characterized
by specific issues and themes that are not necessarily more
severe than other types of bereavement but rather more prominent
(de Groot, de Keijser, & Neeleman, 2006).
Some of the grief themes experienced by suicide survivors
include feelings of guilt; questions of why; feelings of stigma and
shame; blame of others or self; anger at the deceased, the medical
system, and the waste of the life of the deceased; a crisis of values;
and relief after a suicide has finally occurred following repeated
suicide threats (Parrish & Tunkle, 2005). In a systematic review
of suicide survivors’ grief reactions compared with survivors after
other modes of death, Sveen and Walby (2008) found little
variance between the groups for mental health measures but a
substantial degree of variance in the strength of grief measures,
particularly with rejection, shame and stigma, blaming, and social
Support Needs and Experiences of Suicidally Bereaved 627
support. All these issues require insight, specific knowledge, and

sensitivity from the supporting professional.
Social support is important in the bereavement period because
it has been identified as a major factor in reducing psychological
morbidity (Wilson & Clark, 2004). This also appears true for the
aftermath of suicide (Leenaars & Wenckstern, 1998). In a compara-
tive study of psychological reactions and help received by parents

bereaved through suicide, SIDS, and accident, Dyregrov,
Nordanger, and Dyregrov (2003) found that the parents of young
suicide and accident victims experienced more severe psychologi-
cal reactions compared to the SIDS group at 1 to 1.5 years post-
death. However, suicide-bereaved individuals frequently reported
insufficient social support (Cvinar, 2005; Sveen & Walby, 2008).
Our current knowledge of the needs of the suicide-bereaved
comes not only from clinical reviews (Knieper, 1999), but also
from the studies in this area that point to the need for early (in
the first week) and repeated offers of help for a minimum of one
year (Dyregrov, 2002; Provini, Everett, & Pfeffer, 2000). Bereaved
individuals need help from a professional with appropriate atti-
tudes and knowledge, including outreach in their home (Cvinar,
2005; Parrish & Tunkle, 2005). In addition, support by a bereaved
peer who may form a buddy type of relationship is also recognized
(Clark, 2001; Dyregrov, 2002). Various types of assistance are
required, including counseling, legal, and financial advice, and
practical assistance (Clark, 2001; Dyregrov 2002). Information
is vital and should include a directory of the different services
available, what types of help they provide, information about
the administrative issues to do with the death, including coroner
matters, and facts about the grieving process (Andriessen,
Delhaise, & Forceville, 2001; Clark, 2001; Dyregrov, 2002).
Many bereaved individuals report receiving no help at all.
This percentage ranges from 15% in Norway (Dyregrov, 2002) to
76% in New York (Provini et al., 2000). A mapping exercise of
supports for people bereaved through suicide in New Zealand
found appropriate services were ‘‘virtually non-existent’’ (Health
Innovations Management Services, 2004).
Bereavement programs overall are beneficial (Murphy et al.,
1998; Pfeffer, Jiang, Kakuma, Hwang, & Metsch, 2002; Woof &
Carter, 1997). But with a small body of research identifying that
many people bereaved by suicide are not getting such support,
for whatever reasons, it is becoming more pertinent than ever to

identify gaps between need and services. This article examines
the self-reported need for support by the suicide bereaved, and
their access to and experience with support services in South
Australia. These findings are part of a larger study examining
approaches to postvention for those bereaved through suicide from
the perspective of consumers, service providers, and organizations

(Wilson & Clark, 2005).
Method
An author-generated questionnaire asked demographics about the

respondent and decedent, need for help following the death,
satisfaction and helpfulness of the services received (if any), and
provided opportunity for suggestions for improving support. The
59 questions included both closed and open-ended formats.
The questionnaire was piloted prior to distribution.
Two different methods were used to engage participants in the
study. Firstly, a series of radio interviews and newspaper and inter-
net articles invited persons bereaved through suicide, whatever
their kinship and social relationship to the deceased, to register
by telephone and receive a postal questionnaire. People were
invited to participate in the research without benefit of treatment.
Announcements were made on ethnic radio programs in an
attempt to recruit people from non-English speaking backgrounds.
Secondly, bereavement support groups informed members of the
study through their newsletters and mailed questionnaires to all
on their mailing lists. An informational flier for bereaved volun-
teers was developed to accompany the questionnaire. These
processes resulted in 172 (48.7% of the 353 distributed) question-
naires being returned, of which 166 (47%) were sufficiently com-
plete to be included. This method allowed people other than
the immediate family, such as second-degree relatives, friends,
workmates, and colleagues, to participate in the study.
An advisory group was established to provide support and
advice to the research team, increase the understanding of key
issues related to the project, act as a point of reference for resolving
methodological issues, and assist in liaising with the community.
They included representatives from consumer groups, the cor-
oner’s office, psychiatry, Department of Human Services,
community mental health, and research. Approval to conduct

the study was received by The University of Adelaide Human
Research Ethics Committee.
Respondents were divided into three kinship groups: first-
degree relatives, second-degree relatives, and non-relatives.
The first-degree relatives group was at least four times larger than
any other group (n ¼ 142; 86.6%), and was mostly parents (n ¼ 57;
35%), with two thirds of these being mothers. The second-largest
sub-group was spouses and partners, including same-sex partners
(n ¼ 36; 22%). Other subgroups included siblings (n ¼ 26; 16%)
and children (n ¼ 13; 14%). Non-relatives were the second largest
group (n ¼ 13; 7.9%) and were mostly friends (n ¼ 9; 5%). The
smallest group was second-degree relatives (n ¼ 9; 5.5%) including
aunts=uncles, in-laws, and fiancés.
Respondents’ mean age was 49 years (mode ¼ 43, Mdn ¼ 50,
range ¼ 20–78), and 124 (75.6%) were women. Also, 97 (60%) were
married or in de facto relationships. In education, 78 (50%) had
university or higher degrees, 55 (35.3%) had left school without
further study, and a small percentage were either still studying or
had received trade or apprenticeship training. In work, 51 (31.3%)
were employed full time, 52 (31.9%) were employed part time, 49
(30%) were either involved in home duties or retired, and a few were
unemployed and students. According to cultural background, 118
(74.7%) identified as Australian background; 27 (17%) had English,
Irish, or Scottish backgrounds; and a few came from European,
Asian, South African, or Aboriginal=Afghan backgrounds. For
almost all participants, the main language spoken at home was Eng-
lish, which is consistent with the dominant cultural backgrounds.
The mean number of children in the family was 1.7 (mode ¼ 1;
range ¼ 1–4), and 55 (33.7%) had children under age 16 at home
at the time of the suicide. In socioeconomic status, 67 (41.9%) were
eligible for discounted health care and community services, but post-
codes indicated that 100 (61%) were from areas of high and
medium-high advantage (Australian Bureau of Statistics, 2003). Most
(152 or 90%) were from urban areas, mostly metropolitan Adelaide.
The mean time since the suicide was 5.8 years (mode ¼ 2
years, SD ¼ 7.94, range ¼ 1 month–62 years). Most (118 or
72.4%) of the deceased were men=boys, which is consistent with
national statistics (Australian Bureau of Statistics, 2007). Most of
the deceased (72 or 44.2%) were aged 16–24.
In cases where there had been more than one suicide, respon-
dents were requested to report on the most recent. Most (141 or
85%) had been bereaved once through suicide, but 24 (15%)
had lost two or more loved ones. Also, 23 (14%) had discovered
the suicide, and 55 (33.5%) had been present at the suicide site.
Results
Most participants (n ¼ 151, 95%) reported needing professional

help, but only 71 (44%) received it. On needing help, 47 (29.4%)
reported great need, 48 (30.1%) significant need, 38 (23.8%) some
need, 18 (11.2%) small need, and 9 (5.6%) no need (where
1 ¼ great, 2 ¼ significant, 3 ¼ some, 4 ¼ small, and 5 ¼ none;
M ¼ 2.34, SD ¼ 1.18). First-degree relatives had the greatest degree
of need, as 56% indicated a great or significant degree of need
(M ¼ 2.22, SD ¼ 1.18), as shown in Table 1. There was a significant
overall effect of kinship on the degree of need, with first-degree
relatives having a significantly higher degree of need than
second-degree relatives and non-relatives, F(2,157) ¼ 7.70, p < .01.
An independent samples t test indicated that those who most
needed help received it, t(155) ¼ 4.43, p < .001. A significant
relationship was also found between receiving help and being
present at the site of the suicide, v2 (1, n ¼ 166) ¼ 4.07, p < .05,
presumably because of the help provided by the on-site crisis
services. An independent samples t test between need and gender
of respondent indicated that men reported a higher level of need
than women, t(158) ¼ 2.03, p < .05, but no relationship was
found between need and having children under 16 at home at
TABLE 1 Perceptions of Need by Kinship Group
First-degree Second-degree Non-relative

Level of need
(n ¼ 160) No. % No. % No. %
Great 46 28.8 0 0.0 1 0.6

Significant 44 27.5 2 1.3 2 1.3
Some 27 16.9 6 3.8 5 3.1
Small 13 8.1 1 0.6 4 2.5
None 8 5.0 0 0.0 1 0.6
Total 138 86.3 9 5.6 13 8.1
the time of the death, t(157) ¼ .62, p > .05, or between need and
discovering the suicide t(158) ¼ 1.26, p > .05.
Respondents believed that professional assistance was
required for considerable time following the death, as shown in
Table 2. Overall, 35 (27%) indicated they required support for at
least 12 months and a further 25 (19%) for at least 2 years. On
an open-ended question, 23 (17.4%) stated that support should

be for as long as required.
On professional support, 77 (46.2%) received counseling from
at least one of four professional groups: psychiatrists, psychologists,
nurses, and other counselors. In addition, participants consulted
general practitioners (n ¼ 71; 42.8%), as well as funeral parlor
directors, support groups, religious institutions, police, telephone
counseling services, mental health services, and legal services.
Respondents indicated there were services they would have
liked to have received but did not, as shown in Table 3. Help from
a support group (n ¼ 59; 35.5%) and counseling (n ¼ 55; 33.1%)
topped the list, but crisis teams (n ¼ 32; 19.3%), mental health ser-
vices (n ¼ 24; 14.5%), telephone counseling (n ¼ 20; 12.0%) and
legal advice (n ¼ 17; 10.2%) were also needed. The greatest dis-
crepancy between help received and help needed was with regard
to crisis teams which were desired by almost 20% (n ¼ 32) of part-
icipants yet only received by 2% (n ¼ 4).
Analysis of participants’ satisfaction with the help they
received showed that only 53 (40%) of respondents reported a
great or significant degree of satisfaction with professional services,
TABLE 2 Length of Time Help Is Needed
Length of time (n ¼ 132) No. %
At least 1 month 10 7.6

At least 2 months 6 4.5
At least 2 years 25 18.9
At least 5 years 3 2.3
As long as neededa 23 17.4
Total 132 100.0
a
Participant-nominated item.
TABLE 3 Sources of and Satisfaction with Professional Help
Who got help Who desired help

(n ¼ 166) (n ¼ 166)
Professional help source No. % No. %
Counsellors 77 46.5 55 33.1

GP 71 42.8 11 6.6
Funeral parlor 48 28.9 8 4.8
Support group 47 28.3 59 35.5
Religious institution 33 19.9 7 4.2
Police 27 16.3 12 7.2
Mental health services 24 14.5 24 14.5
Telephone counselling 19 11.4 20 12.0
Hospital 15 9.0 6 3.6
Legal services 11 6.6 17 10.2
Crisis team 4 2.4 32 19.3
Other services 8 4.8 8 4.8
Satisfied with professional help

received (n ¼ 134) F %
Great degree 21 15.7

Significant degree 32 23.9
Some degree 28 20.9
Small degree 18 13.4
Not at all 35 26.1
46 (34.3%) felt some or small satisfaction, and 35 (26.1%) were not

satisfied at all (where 1 ¼ great, 2 ¼ significant, 3 ¼ some, 4 ¼ small,
and 5 ¼ none; M ¼ 3.10, SD ¼ 1.43). Over half of the respondents
(n ¼ 65; 53.7%) found contact with services to be helpful compared
with a third of respondents (n ¼ 42; 34.7%) who indicated they
found contact with services to be unhelpful.
Written comments explaining what aspect of professional
support was unsatisfactory indicated lack of appropriate training
(n ¼ 30; 18.1%) as well as attitudes of the service provider (n ¼ 12;
7.2%) were most frequent. Examples included comments such as,
‘‘Some seemed fearful of my grief, e.g., [sic] GP wanted to give
me sleeping tablets and said ‘Don’t start crying I don’t know how
to help you’ ’’; ‘‘Church seemed uneducated about suicide and its
impact. Appeared too busy to listen; appeared to be judgmental
and quick to draw inaccurate conclusion; very insensitive to
family needs’’; and ‘‘I found on several occasions that professionals

who had not themselves lost a loved one through suicide, to be
quite damaging to me.’’ Also, 8 respondents listed lack of immedi-
ate and on-going follow-up services. Other reasons for dissatis-
faction were in difficulties accessing help—for example, ‘‘I
wanted support from a professional but when we went we got the
royal run around. Now I just want to leave things where they are.
I get upset and don’t want to stir things up inside’’—and dissatis-
faction with the quality of particular services such as financial
advice and children’s support.
On a partially closed question, the most common barriers that
hindered receiving or accessing help were a lack of available infor-
mation (n ¼ 42; 25.3%), lack of awareness of services (n ¼ 39;
23.5%), help not offered (n ¼ 38; 22.9%), thinking no one could
help (n ¼ 31; 18.7%), distance (n ¼ 25; 15.1%), and cost (n ¼ 24;
14.5%). Other comments about barriers to receiving or accessing
help included, ‘‘I am still on a waiting list for counseling through
(named) mental health services it has been 2 years’’; ‘‘Three
children to care for. I was pregnant at the time of his death’’;
and ‘‘Never having experienced a suicide in the family I did not
know that I needed some help. It’s only after you come out of
the grief that you realize you needed help.’’
Overall, 68 (41%) participants indicated they attended a grief
support group, as shown in Table 4. For most, the group was run
by volunteers (n ¼ 54; 79.4%) with other groups run by govern-
ment (n ¼ 7; 10.3%) or non-government (e.g., Church) organiza-
tions (n ¼ 7; 10.3%). The perceived benefit was generally positive
with the majority reporting at least a small degree of benefit
(n ¼ 68; 97.1%), and only two respondents (2.9%) found no benefit
from the support groups (where 1 ¼ great degree, 2 ¼ significant
degree, 3 ¼ some degree, 4 ¼ small degree, and 5 ¼ none;
M ¼ 2.43, SD ¼ 1.19).
On non-professional support, most respondents (n ¼ 150;
94.9%) received help from non-professionals including friends
(n ¼ 135); families (n ¼ 134); colleagues (n ¼ 78); neighbors
(n ¼ 59); religious institutions (n ¼ 35); clubs, teams, and social
groups (n ¼ 28); and schools and educational facilities (n ¼ 25).
The types of support received were of an emotional, social,
practical and financial nature, and frequently involved a complex
combination of all.
TABLE 4 Support Group and Other Non-Professional Help Received: Rates

and Satisfaction
Support groups No. % Satisfaction with groups No. %
Bereaved through suicide 35 66.0 Great degree 20 28.6

Southern Fleurieu suicide 8 15.1 Significant degree 18 25.7
bereavement group
Funeral parlor 4 7.5 Some degree 16 22.9

Church 2 3.8 Small degree 14 20.0
Family 1 1.9 Not at all 2 2.9
Other 3 5.7
Satisfaction with other

Other non-professional non-professional
help (n ¼ 166) No. % help (n ¼ 150) No. %
Friends 135 81.3 Great degree 60 40.0

Family 134 80.7 Significant degree 49 32.7
Colleagues 78 47.0 Some degree 33 22.0
Neighbors 59 35.5 Small degree 7 4.7
Religious groups 35 21.1 Not at all 1 0.7
Club=Team=Social group 28 16.9
School=Education facility 25 15.1
Other 5 3.0
Most respondents (n ¼ 150; 99.3%) were satisfied with the

help received (where 1 ¼ great degree, 2 ¼ significant degree,
3 ¼ some degree, 4 ¼ small degree, and 5 ¼ none; M ¼ 1.93,
SD ¼ .93), and half (n ¼ 73; 52.9%) reported no need for further
non-professional support. However, 65 (46.4%) indicated they
would have liked to have received assistance from a variety of
non-professionals, including family (n ¼ 21; 15.2%), religious
personnel (n ¼ 15; 10.9%), friends (n ¼ 9; 6.5%), educational
institutions (n ¼ 5; 3.6%), and neighbors (n ¼ 4; 3%).
Discussion
Among 166 mostly middle-aged adults in Australia, a substantial

majority of people bereaved by suicide felt some degree of
need for professional help, but less than half actually received
any professional help. This finding is consistent with other research
that has indicated that suicide survivors receive inadequate levels
of support (Cvinar, 2005; Dyregrov, 2002; Jordan, 2001; Provini

et al., 2000; Sveen & Walby, 2008). This research is the only one
of its type in Australia, and an advisory group of persons represent-
ing the service sector and bereaved people were consulted
throughout. One of the most salient features of this research was
the uptake of the report by the state mental health services for
consideration in health policy.

In addition to receiving less help than they need, most
indicated little or no satisfaction with the professional help they
received or indicated that they received unhelpful support. This
finding is also consistent with other research (Andriessen et al.,
2001; Clark, 2001; Harwood, Hawton, Hope, & Jacoby, 2002;
van Dongen, 1993). With previous research indicating that bad
or inadequate support can actually be harmful (Kneiper, 1999), it
is concerning that this study found that both the amount of help
available was poor and the quality of professional bereavement
support provided was unsatisfactory and damaging. Some experts
recommend professionals to be more proactive in offering
bereaved relatives possibilities to talk to them, and extend offers
of support repeatedly (Schmid, Mehlsteibl, Cording, Wolfersdorf, &
Spiessl, 2008). Present results are consistent with this recommen-
dation. The need for appropriate bereavement programs,
improved staff education and support, and increased availability
of bereavement resources cannot be overlooked.
In contrast to negative experiences with professional support,
present participants reported receiving and being satisfied with
non-professional support. Although most non-professional support
was from family and social groups (e.g., friends, colleagues,
religious institutions), over 40% of present adults attended a grief
support group. They rated these support groups to be of great
benefit. Other research has shown that grief support groups
are beneficial (Murphy et al., 1998; Woof & Carter, 1997), and
this study complements such findings with evidence that suicide
survivors themselves find such support groups beneficial. Unlike
previous research, this study explored a wide range of non-
professional support like community support, revealing that
these services are perceived by suicide survivors as critical to their
recovery.
Research suggests that those who were close to the deceased
are at risk of developing complicated grief, a distinctive psychiatric
disorder that occurs in response to a significant loss through death

(Mitchell et al., 2004). Although little is known about how close the
relationship of the deceased and survivor needs to be for compli-
cated grief to occur, the findings of this study suggest that first-
degree relatives had greater support needs than second-degree
relatives and non-relatives. Similarly, Mitchell et al. (2004) found
that closely related survivors of suicide had higher levels of compli-

cated grief and could be at risk of developing comorbid problems
in the future. Nevertheless, it is important to note that, although
the group was small in this sample, the needs of non-relatives
are still high. Most (n ¼ 8; 62%) indicated at least some need for
professional help. Although this proportion is not as high for this
group as for first-degree and second-degree relatives (n ¼ 117,
85%, and n ¼ 8,89%, respectively), it is still a substantial proportion
given that few support services, and little research, are directed at
this group.
It is questionable whether service planning and review is
undertaken with information from those who most need it, as
shown by the discrepancy between the type of help received and
the type of help needed. As the large majority of the study sample
was of a Caucasian culture, further research could examine the
types of help preferred by those of other cultures. Though we
already know that grief is a universal phenomenon and reactions
to it are socially constructed and patterned, some studies have
found that cultural groups mourn differently (Koffman, Donaldson,
Hotopf, & Higginson, 2005).
Any conclusions from this study should be taken in context
due to the nature of the sample and also of the retrospective nature
of the research. The sample was self-selected and the respondents
may have had particular personal agendas in wishing to participate,
which is not uncommon in research. The return rate of 47% indi-
cated yet another layer of selection of the sample. The researcher’s
research diary noted several telephone calls from bereaved people
wishing to participate but finding the questionnaire too laborious
or emotionally traumatic for their current state of mind. Written
comments in some completed questionnaires also indicated the
difficulty for participants and one specified that the respondent
was having someone help with answering the questions. However
there were many other comments, including that participating in
the study had been helpful to their healing and provided something
constructive from the death of their loved one as well as endeavor-

ing to help others who became bereaved through suicide.
The demographics indicate that there are several features
of this sample that may not be representative of the general
population bereaved through suicide. That most participants were
women is consistent with trends in self-selection of samples in
bereavement research and with the gender differences in suicide.

The high percentage of respondents who had completed university
or higher education is consistent with the methods used in the
selection of the sample, that is, newspaper, Internet and profile
of the radio stations hosting the programs. The fact that 40% were
health care cardholders despite a large number living in medium-
high socioeconomic areas is interesting. The question arises as to
whether a suicide changes the financial status of families and if
so, to what extent. It may indicate that this is a disadvantaged
group and financial considerations are important for servicing
those bereaved through suicide. More research is necessary to clar-
ify the reasons. Two-thirds of participants had no more children at
home after the death, and a third were not working outside the
home, both of which are risk factors for severe psychological reac-
tions (Dyregrov et al., 2003). High proportions of the participants
also had other well-recognized risk factors, such as being bereaved
parents and having deceased of a young age. Some subgroups were
not sufficiently sampled, such as people from non-English speaking
backgrounds, migrant populations, young people, the elderly and
second-degree relatives and non-relatives. No attempt was made
to find the opinions of rural and remote residents (although this
sample contains a few) and the views of children themselves.
Further, research needs to be done to find the specific needs of
men, gays, lesbians, and other special groups.
The retrospective nature of the reported research is an impor-
tant consideration, especially as the mean length of time since the
death was 5 years. A factor that may affect the accuracy of recall is
the high level of distress experienced over the period of time that is
the subject of this study. One further consideration is the mental
state of participants at the time of completing the questionnaire.
From the written comments and phone calls recorded in the
research journal, many were clearly distressed, either because of
the extant severity of their grief or because of the distress caused
by revisiting their grief experiences.
There is a significant gap between the perceived need for

support of those bereaved by suicide and the provision and quality
of support services. This poses a significant challenge for service
providers in particular, as well as other health professionals,
researchers, governments, and policymakers. To bridge this gap
between need and provision, changes to perceptions and practice
need to occur. As such, we make the following recommendations

for the South Australian context: First, provide an appropriate
and immediate crisis response team that is consistently highly
skilled in the issues of suicide postvention, including a trained vol-
unteer as a ‘‘been there’’ other person at the suicide site and to give
ongoing support to the newly bereaved (buddy system similar to the
SIDS and international models), and offer clean-up services for the
suicide site to prevent further distress to the family and relatives.
Second, establish clearly defined pathways to care including a
home visiting service following the suicide; co-ordinate services
for the bereaved from the time of the suicide and continuing long
term; provide a flexible, co-ordinated approach to service delivery
that acknowledges what the bereaved suffers; provide easy access to
practitioners trained in suicide bereavement such as general practi-
tioners and counselors; and identify referral pathways for individual
needs. Third, strengthen support groups by providing resources
such as co-facilitation by professionals; train facilitators and support
volunteers in specific issues of suicide grief, group management
skills, crisis intervention, pathways, etc.; and grant core funding to
enable support groups to offer an expanded range of services cover-
ing 24 hours, 7 days a week. Fourth, provide a free 24-hour tele-
phone support service staffed by experts and bereaved volunteers.
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THE SUPPORT NEEDS AND EXPERIENCES OF

ANNE WILSON and AMY MARSHALL

Suicide is recognized as one of the major issues facing health care

Received 23 April 2009; accepted 28 April 2009.

30–34-year-old men, 40–44-year-old men, and the elderly (Australian

suicide every year in Australia. Such an incidence poses serious

support. All these issues require insight, specific knowledge, and

tive study of psychological reactions and help received by parents

for whatever reasons, it is becoming more pertinent than ever to

the perspective of consumers, service providers, and organizations

An author-generated questionnaire asked demographics about the

community mental health, and research. Approval to conduct

Most participants (n ¼ 151, 95%) reported needing professional

TABLE 1 Perceptions of Need by Kinship Group

First-degree Second-degree Non-relative

Great 46 28.8 0 0.0 1 0.6

an open-ended question, 23 (17.4%) stated that support should

TABLE 2 Length of Time Help Is Needed

Length of time (n ¼ 132) No. %

At least 1 month 10 7.6

TABLE 3 Sources of and Satisfaction with Professional Help

Who got help Who desired help

Professional help source No. % No. %

Counsellors 77 46.5 55 33.1

Satisfied with professional help

Great degree 21 15.7

46 (34.3%) felt some or small satisfaction, and 35 (26.1%) were not

family needs’’; and ‘‘I found on several occasions that professionals

TABLE 4 Support Group and Other Non-Professional Help Received: Rates

Support groups No. % Satisfaction with groups No. %

Bereaved through suicide 35 66.0 Great degree 20 28.6

Funeral parlor 4 7.5 Some degree 16 22.9

Satisfaction with other

Friends 135 81.3 Great degree 60 40.0

Most respondents (n ¼ 150; 99.3%) were satisfied with the

Among 166 mostly middle-aged adults in Australia, a substantial

of support (Cvinar, 2005; Dyregrov, 2002; Jordan, 2001; Provini

consideration in health policy.

disorder that occurs in response to a significant loss through death

that closely related survivors of suicide had higher levels of compli-

constructive from the death of their loved one as well as endeavor-

bereavement research and with the gender differences in suicide.

There is a significant gap between the perceived need for

need to occur. As such, we make the following recommendations

Andriessen, K., Delhaise, T., & Forceville, G. (2001). De quelle(s) aides=assistance(s)

In K. Hawton & K. van Heeringen (Eds.), International Handbook of Suicide and