BMJ  2007;334:994 (12 May), doi:10.1136/bmj.39161.457431.55 (published 20 April 2007)

Research

Cognitive behaviour therapy to prevent complicated grief among relatives and spouses bereaved by suicide: cluster randomised controlled trial

¹ Department of Social Psychiatry, University of Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands, ² Mental Health Care Centre Friesland, Leeuwarden, Netherlands, ³ Department of Social Psychiatry, University of Groningen, and Julius Center for Health Sciences and Primary Care, University of Utrecht, Utrecht, Netherlands, ⁴ Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, Netherlands, ⁵ Departments of Social Psychiatry and Epidemiology, University of Groningen, Groningen, Netherlands

Objective To examine the effectiveness of a family based grief counselling programme to prevent complicated grief among first degree relatives and spouses of someone who had committed suicide.

Design Cluster randomised controlled trial with follow-up at 13 months after the suicide.

Setting General practices in the Netherlands.

Participants 122 first degree relatives and spouses of 70 people who committed suicide; 39 families (68 participants) were allocated to intervention, 31 families (54 participants) to control.

Intervention A family based, cognitive behaviour counselling programme of four sessions with a trained psychiatric nurse counsellor between three to six months after the suicide. Control participants received usual care.

Main outcome measures Self report complicated grief. Secondary outcomes were the presence of maladaptive grief reactions, depression, suicidal ideation, and perceptions of being to blame for the suicide.

Results The intervention was not associated with a reduction in complicated grief (mean difference –0.61, 95% confidence interval –6.05 to 4.83; P=0.82). Secondary outcomes were not affected either. When adjusted for baseline inequalities, the intervention reduced the risk of perceptions of being to blame (odds ratio 0.18, 0.05 to 0.67; P=0.01) and maladaptive grief reactions (0.39, 0.15 to 1.01; P=0.06).

Conclusions A cognitive behaviour grief counselling programme for families bereaved by suicide did not reduce the risk of complicated grief or suicidal ideation or the level of depression. The programme may help to prevent maladaptive grief reactions and perceptions of blame among first degree relatives and spouses.

Trial registration Current Controlled Trials ISRCTN66473618 [controlled-trials.com] .

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Complicated grief after bereavement

Keith Hawton
BMJ 2007 334: 962-963. [Extract] [Full Text] [PDF]

Helping people bereaved by suicide

Keith Hawton and Sue Simkin
BMJ 2003 327: 177-178. [Extract] [Full Text] [PDF]

Statistics Notes: Analysing controlled trials with baseline and follow up measurements

Andrew J Vickers and Douglas G Altman
BMJ 2001 323: 1123-1124. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• McDaid, C., Trowman, R., Golder, S., Hawton, K., Sowden, A. (2008). Interventions for people bereaved through suicide: systematic review. Br. J. Psychiatry 193: 438-443 [Abstract] [Full text]  
• Hawton, K., Simkin, S., Rees, S. (2008). Help is at hand for people bereaved by suicide and other traumatic death. Psychiatr. Bull. 32: 309-311 [Full text]  
• (2007). Suicide Bereavement and Grief Counseling. JWatch Psychiatry 2007: 1-1 [Full text]  
• Hawton, K. (2007). Complicated grief after bereavement. BMJ 334: 962-963 [Full text]  

Rapid Responses:

Read all Rapid Responses

Cognitive behaviour therapy (CBT) and Comlicated grief

Imran Mushtaq, et al.
bmj.com, 12 May 2007 [Full text]

CBT to prevent complicated grief - methodological issues

Caroline S Flood
bmj.com, 1 Jun 2007 [Full text]

Online poll

Find out more >>