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Research

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

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39161.457431.55 (Published 10 May 2007) Cite this as: BMJ 2007;334:994
  1. Marieke de Groot, psychiatric nurse1,
  2. Jos de Keijser, clinical psychologist2,
  3. Jan Neeleman, professor of psychiatry3,
  4. Ad Kerkhof, professor of clinical psychology4,
  5. Willem Nolen, professor of psychiatry1,
  6. Huibert Burger, associate professor of epidemiology5
  1. 1Department of Social Psychiatry, University of Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands
  2. 2Mental Health Care Centre Friesland, Leeuwarden, Netherlands
  3. 3Department of Social Psychiatry, University of Groningen, and Julius Center for Health Sciences and Primary Care, University of Utrecht, Utrecht, Netherlands
  4. 4Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
  5. 5Departments of Social Psychiatry and Epidemiology, University of Groningen, Groningen, Netherlands
  1. Correspondent to: M de Groot m.h.de.groot{at}med.umcg.nl
  • Accepted 20 February 2007

Abstract

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.

Footnotes

  • We thank all the participants; the local coroners for reporting suicides, especially Jan Broer of the Groningen Municipal Health Service; the general practitioners for mediating; and Trudie Chalder, who contributed to the study design, the manual, and counsellors' training. We especially thank Riet de Haan for her efforts in family recruitment and all her support and Ten Have Publishing Company for editing and publishing the self help manual, which is now available for families bereaved by suicide in the Netherlands and Belgium.

  • Contributors: MdeG planned and coordinated the study, drafted and edited the self help manual, was responsible for data collection and management, worked out statistical analyses, interpreted results, drafted the manuscript, and is guarantor. JdeK advised in study design, measurement, treatment, and the content of the self help manual, trained and supervised the counsellors and interviewers, and assisted in the interpretation of the results. JN masterminded the study design and obtained funding. AK and WN critically reviewed the manuscript and approved the final draft. HB advised in statistical analyses, critically reviewed the manuscript, and approved the final draft.

  • Funding: ZonMW (Netherlands Organisation for Health Research and Development).

  • Competing interests: None declared.

  • Ethical approval: University Medical Center Groningen ethics committee.

  • Accepted 20 February 2007
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