Dr Hilary Causer

People bereaved by suicide are affected psychologically and physically and may be at greater risk of taking their own lives. Whilst researchers have explored the impact of suicide on family members and friends, the area of colleague suicide has been neglected and postvention guidance for supporting surviving colleagues is often poorly developed. This critical integrative review explored the impact of colleague suicide on surviving co-workers and reviewed postvention guidance for workplaces. Systematic searches found 17 articles that met the inclusion criteria. Articles were appraised for quality and extracted data were analysed using a thematic network method. Article quality was moderate. Two global themes were developed: impact of a colleague suicide comprised themes of ‘suicide loss in the workplace’; ‘professional identities and workplace roles’; ‘perceptions of professional uniqueness’; and ‘professional abandonment and silencing’. Postvention following a colleague suicide comprised ‘individualised responses’; ‘the dual function of stigma’; and ‘complex pressure on managers’. A unifying global network ‘after a colleague suicide’ describes the relationships between all themes. A series of disconnects between existing postvention guidance and the needs of impacted workers are discussed. This review demonstrates the need for robust, systemic postvention for colleagues impacted by the complex issue of colleague suicide.

Wider networks of people are affected by a suicide death than originally thought, including those whose job-role brings them into contact with a death by suicide of another person. The impact of student suicide within United Kingdom (UK) Higher Education Institutions (HEIs) is unexplored and the experiences of staff members remain unknown. It is not known whether staff members have specific postvention needs following a student death by suicide. Any postvention support currently offered to staff members within UK HEIs lacks a context-specific evidence base. This study asked ‘How is a student suicide experienced by staff members within a UK HEI and what are the features of that experience?’ Staff members from diverse job-roles in two UK HEIs responded to a qualitative survey (n = 19) and participated in semi-structured interviews (n = 10). Data were transcribed and subjected to a constructivist grounded theory analysis. Participants’ experiences informed the development of a core category: ’Bearing witness’, which encompassed six further categories: ’Responding to a student suicide’; ’Experiencing a student suicide’; ’Needs and fears’; ’Experiences of support’; ’Human stories’; and ’Cultural stories’. The resulting grounded theory demonstrates how participants’ perceptions of impact are informed by their experiences of undertaking tasks following a student suicide within the community of their HEI. Processes of constructing perceptions of closeness to the student who died are evident amongst participants who did not know the student prior to their death. Tailored postvention support is required to respond to the range and complexity of HEI staff needs following a student death by suicide.

Purpose

To systematically review and synthesise the qualitative literature on experiences that challenge self-identity following traumatic brain injury (TBI).

Method

Four electronic databases were searched systematically for qualitative research published between 1965 and August 2017, investigating subjective experiences of identity change following TBI. Papers which met the inclusion criteria were evaluated using the Critical Skills Appraisal Programme (CASP) tool and synthesised using guidelines by Thomas and Harden (2008).

Results

Of the 1965 papers retrieved, 36 met inclusion and quality criteria. Synthesis resulted in six themes: (1) awareness of change in physical, cognitive, emotional and social functioning; (2) autobiographical memory loss; (3) responses of other people that highlight change; (4) loss of autonomy; (5) comparing old me and new me–loss of valued roles and activities; (6) social rejection and stigma.

Conclusions

An in-depth understanding of the experiences that challenge self-identity after TBI can inform rehabilitation to support individuals to negotiate these processes with less distress and more successfully.

Recent research has highlighted that the number of people impacted by a death by suicide is far greater than previously estimated and includes wider networks beyond close family members. It is important to understand the ways in which suicide impacts different groups within these wider networks so that safe and appropriate postvention support can be developed and delivered. A systematic review in the form of a qualitative research synthesis was undertaken with the aim of addressing the question ‘what are the features of the experiences of workers in health, education or social care roles following the death by suicide of a client, patient, student or service user?’ The analysis developed three categories of themes, ‘Horror, shock and trauma’, ‘Scrutiny, judgement and blame’, and ‘Support, learning and living with’. The mechanisms of absolution and incrimination were perceived to impact upon practitioners’ experiences within social and cultural contexts. Practitioners need to feel prepared for the potential impacts of a suicide and should be offered targeted postvention support to help them in processing their responses and in developing narratives that enable continued safe practice. Postvention responses need to be contextualised socially, culturally and organisationally so that they are sensitive to individual need.

The purpose of this chapter is to: - explore the experiences of professional workers who are exposed to a death by suicide because of their job role - report the experiences and needs of staff at two UK universities following a student death by suicide - provide guidance in resonding to staff needs following a student death by suicide.

The suicide rate among health professionals is 24% higher than the national average, with figures showing that 430 practitioners took their lives in the four years from 2011 to 2015 (Office for National Statistics (ONS), 2017). This article outlines the need for evidence based postvention guidance so that the NHS can support staff members who are affected by a colleague death by suicide.

This guidance has been developed with the input of NHS staff who have been affected by a colleague death by suicide, andstaff who have provided support to those who are affected. Fifty-one NHS staff members across a wide range of job rolesand levels of seniority shared their experiences and insight in one-to-one interviews with researchers from the University of Surrey. Additionally, 68 stakeholders – including policy makers, senior leaders, front-line staff, union and third-sector employees and academics – attended a workshop in which they reviewed and commented on recommendations that had been developed from the interview data. The evidence gathered from these twosources underpins this guidance. 
(14) (PDF) Postvention guidance: Supporting NHS staff after the death by suicide of a colleague. Available from: https://www.researchgate.net/publication/372676883_Postvention_guidance_Supporting_NHS_staff_after_the_death_by_suicide_of_a_colleague [accessed Nov 01 2023].

We argue that with increased rates of suicide among health workers, and given the specific cultural and professional contexts, narratives and behaviours that shape health workers experiences, that context specific, evidence-based, postvention guidance is required within the NHS to support staff who are affected by, or who offer support following, a colleague death by suicide. 

In​ the ​UK, ​90% ​of ​nurses ​are ​female, ​a​ figure ​replicated​ at​ the ​global ​level.​ A​ significant​ proportion​ are​ also​ from​ the​ global​ ethnic​ majority (NMC, 2023; ONS, 2019).​ Notably,​the ​risk ​of ​suicide ​among ​female ​nurses ​is ​23% ​higher ​compared ​to​ women ​in ​other ​occupational​ groups ​(NCISH,​2020). ​Despite ​this ​significant ​finding,​ our​ understanding​ of ​this ​phenomenon ​remains ​limited, ​in ​part​ due ​to ​how​ we ​interpret​ suicide ​in ​certain ​contexts. ​This ​has ​clear ​implications ​for ​potential​ solutions. 
 

Suicide is a leading cause of death. NHS workers, especially female nurses, have heightened vulnerability. Being impacted by a colleague’s suicide can lead to increased suicidality. Postvention refers to support following a suicide. We investigated current, available postvention for NHS workers following a colleague’s suicide and the experiences of staff who deliver it (“supporters”). Twenty-two supporters were interviewed, and data were analyzed using classic grounded theory. The theory of negotiating postvention situations was developed. Supporters must negotiate enabling and disabling elements that form a “postvention situation” and impact behaviors and postvention efficacy. Postvention delivery is emotionally burdensome. Supporters need support, which they do not always receive. Postvention can lead to learning, which can better inform future postvention. The extent to which NHS workers can effectively support colleagues will depend on their postvention situation. As such, work must be done to enable supporters to offer effective postvention in the future. 

In this paper, we introduce a novel method for the synthesis of qualitative data and co-production in the development of evidence-based guidelines. The call for evidence-based practice in healthcare settings has been dominated by a focus on patient groups, overlooking the need for robust guidelines to inform the delivery of support or developmental interventions for staff members. We propose an eight-step method that brings together primary and secondary qualitative data with co-produced data. Data is synthesised at two of the eight stages. This method generates robust findings and recommendations which are well suited to informing written guidelines. We present our experience of implementing this method in the development of postvention guidelines for the support of National Health Service (NHS) staff following the death by suicide of a colleague. This worked example illustrates the application of the method to the generation of evidence-based, co-produced practice guidelines. We discuss the application of qualitative data and co-production in the development of fit for purpose guidelines, and the lack of transparent reporting of methods in existing guidelines. We recommend that guidelines should be underpinned by empirical evidence and developed in consultation with stakeholders and end-users, including those who will implement and those who will receive treatment or intervention. For transparency and to inform end-users, we conclude that written guidelines should always detail the methods employed in their production.

Health-workers are more likely to die by suicide than their counterparts in other occupational groups. The suicide of a staff member can be widely felt by colleagues, leading to complex emotional and cognitive responses. Exposure to suicide heightens the risk of dying by suicide. We investigated the impact of a colleague suicide on National Health Service (NHS) staff. Twenty-nine staff were interviewed; all participants were white British, and so not representative of the ethnic make-up of the NHS. Data were analyzed using grounded theory methods. A theory, “filling in the gaps” was developed. Staff experiences gave rise to needs that were not always met. Staff endeavored to “fill in the gaps” in support; however, sometimes fell through those gaps. Organizational and professional contexts shaped their experiences and responses. Recommendations include skilled and targeted support and compassion for affected staff. Cultural change is needed to challenge suicide stigma and unhelpful narratives.

Background: Suicide bereavement increases the probability of adverse outcomes related to grief, social functioning, mental health, and suicidal behavior. While more support for individuals bereaved by suicide has become available, the evidence regarding its effectiveness is not straightforward. The literature suggests that identifying best-practice components is key in designing effective postvention interventions. Aims: This metareview aims to identify components of suicide bereavement interventions perceived to be effective by suicide-bereaved people. Method: The review adhered to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Systematic searches in Medline, PsycINFO, Embase, Emcare, EBM Reviews, Scopus, and Web of Science identified 11 eligible systematic reviews published between 2008 and 2023. The methodological quality was assessed using the Measurement Tool to Assess Systematic Reviews (AMSTAR-2) (PROSPERO registration CRD42023458300). Results: Our narrative synthesis reported the components perceived to be effective in relation to structure and content of interventions, facilitators, and modality (peer, group, community, online). Limitations: The quality of the included reviews varied considerably, and not all reviews reported on perceived effectiveness of interventions’ components. Meta-analysis of findings was not possible due to study heterogeneity. Conclusion: The findings provide crucial information for researchers, service providers, and policymakers to enhance the provision of evidence-based support for people bereaved by suicide.