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Pulling Together – The Protective Role of Belongingness for Depression, Suicidal Ideation and Behavior Among Suicide-Bereaved Individuals

Published Online:https://doi.org/10.1027/0227-5910/a000784

Abstract.Background: While belongingness has frequently been investigated in the general population as an antidote to experiencing depression, suicidal thoughts, and suicidal behavior, it has rarely been evaluated as a protective factor among individuals bereaved by suicide. Aims: We examined whether perceived belongingness could moderate the differences between suicide-bereaved, suicide-exposed, and nonexposed respondents regarding depression, suicide ideation, and suicide attempts. Method: We conducted an online survey of the adult Israeli population (N = 806), with 203 suicide-bereaved, 266 suicide-exposed, and 377 nonexposed respondents. Participants completed several questionnaires tapping depression and suicidality as well as perceived belongingness levels. Results: Individuals bereaved by suicide reported the highest levels of depression, suicide ideation, and suicide attempts in comparison with suicide-exposed and nonexposed individuals. However, belongingness was found to moderate these distinctions concerning suicide ideation and suicide attempts. Limitations: Belongingness was assessed by only a single question, and the online survey suffered from a relatively high nonresponse rate. Conclusion: Our results suggest that belongingness may act as a potent antidote to the adverse mental health consequences among individuals bereaved by suicide. Clinicians should accord adequate attention to fostering social connectedness among their clients bereaved by suicide.

References

  • Andriessen, K., Krysinska, K., Kõlves, K., & Reavley, N. (2019). Suicide postvention service models and guidelines 2014–2019: A systematic review. Frontiers in Psychology, 10, 2677. 10.3389/fpsyg.2019.02677 First citation in articleCrossref MedlineGoogle Scholar

  • Andriessen, K., Rahman, B., Draper, B., Dudley, M., & Mitchell, P. B. (2017). Prevalence of exposure to suicide: A meta-analysis of population-based studies. Journal of Psychiatric Research, 88, 113–120. 10.1016/j.jpsychires.2017.01.017 First citation in articleCrossref MedlineGoogle Scholar

  • Arabyat, R. M., & Raisch, D. W. (2019). Relationships between social/emotional support and quality of life, depression and disability in patients with chronic obstructive pulmonary disease: An analysis based on propensity score matching. Annals of Behavioral Medicine, 53(10), 918–927. 10.1093/abm/kaz002 First citation in articleCrossref MedlineGoogle Scholar

  • Australian Institute for Suicide Research Prevention. (2017). Postvention Australia guidelines: A resource for organisations and individuals providing services to people bereaved by suicide. https://www.griffith.edu.au/—data/assets/pdf_file/0038/359696/Postvention_WEB.pdf First citation in articleGoogle Scholar

  • Bakst, S. S., Braun, T., Zucker, I., Amitai, Z., & Shohat, T. (2015). The accuracy of suicide statistics: Are true suicide deaths misclassified? Social Psychiatry and Psychiatric Epidemiology, 51(1), 115–123. 10.1007/s00127-015-1119-x First citation in articleCrossref MedlineGoogle Scholar

  • Baumeister, R. F., & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117(3), 497–529. 10.1037//0033-2909.117.3.497 First citation in articleCrossref MedlineGoogle Scholar

  • Berman, A. L. (2011). Estimating the population of survivors of suicide: Seeking an evidence base. Suicide and Life-Threatening Behavior, 41(1), 110–116. 10.1111/j.1943-278x.2010.00009.x First citation in articleCrossref MedlineGoogle Scholar

  • Calhoun, L. G., & Tedeschi, R. G. (2006). Expert companions: Posttraumatic growth in clinical practice. In L. G. CalhounR. G. Tedeschi (Eds.), Handbook of posttraumatic growth: Research & practice (pp. 291–310). Lawrence Erlbaum Associates. First citation in articleGoogle Scholar

  • Carrera, S. G., & Wei, M. (2017). Thwarted belongingness, perceived burdensomeness, and depression among Asian Americans: A longitudinal study of interpersonal shame as a mediator and perfectionistic family discrepancy as a moderator. Journal of Counseling Psychology, 64(3), 280–291. 10.1037/cou0000199 First citation in articleCrossref MedlineGoogle Scholar

  • Cerel, J., Brown, M. M., Maple, M., Singleton, M., Venne, J., Moore, M., & Flaherty, C. (2019). How many people are exposed to suicide? Not six. Suicide and Life-Threatening Behavior, 49(2), 529–534. 10.1111/sltb.12450 First citation in articleCrossref MedlineGoogle Scholar

  • Cerel, J., Jordan, J. R., & Duberstein, P. R. (2008). The impact of suicide on the family. Crisis, 29(1), 38–44. 10.1027/0227-5910.29.1.38 First citation in articleLinkGoogle Scholar

  • Cerel, J., Maple, M., van de Venne, J., Brown, M., Moore, M., & Flaherty, C. (2017). Suicide exposure in the population: Perceptions of impact and closeness. Suicide and Life-Threatening Behavior, 47(6), 696–708. 10.1111/sltb.12333 First citation in articleCrossref MedlineGoogle Scholar

  • Cerel, J., McIntosh, J. L., Neimeyer, R. A., Maple, M., & Marshall, D. (2014). The continuum of “survivorship”: Definitional issues in the aftermath of suicide. Suicide and Life-Threatening Behavior, 44(6), 591–600. 10.1111/sltb.12093 First citation in articleCrossref MedlineGoogle Scholar

  • Choenarom, C., Williams, R. A., & Hagerty, B. M. (2005). The role of sense of belonging and social support on stress and depression in individuals with depression. Archives of Psychiatric Nursing, 19(1), 18–29. 10.1016/j.apnu.2004.11.003 First citation in articleCrossref MedlineGoogle Scholar

  • Chu, C., Buchman-Schmitt, J. M., Stanley, I. H., Hom, M. A., Tucker, R. P., Hagan, C. R., Rogers, M. L., Podlogar, M. C., Chiurliza, B., Ringer, F. B., Michaels, M. S., Chiurliza, B., RingerF. B., MichaelsM. S., Patros, C. H. G., & Joiner, T. E. (2017). The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research. Psychological Bulletin, 143(12), 1313, 1345. 10.1037/bul0000123 First citation in articleCrossref MedlineGoogle Scholar

  • Cockshaw, W. D., & Shochet, I. (2010). The link between belongingness and depressive symptoms: An exploration in the workplace interpersonal context. Australian Psychologist, 45(4), 283–289. 10.1080/00050061003752418 First citation in articleCrossrefGoogle Scholar

  • Cukrowicz, K. C., Jahn, D. R., Graham, R. D., Poindexter, E. K., & Williams, R. B. (2013). Suicide risk in older adults: Evaluating models of risk and predicting excess zeros in a primary care sample. Journal of Abnormal Psychology, 122(4), 1021–1030. 10.1037/a0034953 First citation in articleCrossref MedlineGoogle Scholar

  • Cvinar, J. G. (2005). Do suicide survivors suffer social stigma: A review of the literature. Perspectives in Psychiatric Care, 41(1), 14–21. 10.1111/j.0031-5990.2005.00004.x First citation in articleCrossref MedlineGoogle Scholar

  • Feigelman, W., & Cerel, J. (2020). Feelings of blameworthiness and their associations with the grieving process in suicide mourning. Frontiers in Psychology, 11, 610–619. 10.3389/fpsyg.2020.00610 First citation in articleCrossref MedlineGoogle Scholar

  • Feigelman, W., Cerel, J., McIntosh, J. L., Brent, D., & Gutin, N. (2018). Suicide exposures and bereavement among American adults: Evidence from the 2016 General Social Survey. Journal of Affective Disorders, 227, 1–6. 10.1016/j.jad.2017.09.056 First citation in articleCrossref MedlineGoogle Scholar

  • Feigelman, W., Gorman, B. S., & Jordan, J. R. (2009). Stigmatization and suicide bereavement. Death Studies, 33(7), 591–608. 10.1080/07481180902979973 First citation in articleCrossref MedlineGoogle Scholar

  • Granato, S. L., Smith, P. N., & Selwyn, C. N. (2015). Acquired capability and masculine gender norm adherence: Potential pathways to higher rates of male suicide. Psychology of Men & Masculinity, 16(3), 246–253. 10.1037/a0038181 First citation in articleCrossrefGoogle Scholar

  • Hedegaard, H., Curtin, S. C., & Warner, M. (2020). Increase in suicide mortality in the United States, 1999–2018. NCHS Data Brief, No. 362, April 2020. https://www.cdc.gov/nchs/data/databriefs/db362-h.pdf First citation in articleGoogle Scholar

  • Horesh, N., Levi, Y., & Apter, A. (2012). Medically serious versus non-serious suicide attempts: Relationships of lethality and intent to clinical and interpersonal characteristics. Journal of Affective Disorders, 136(3), 286–293. 10.1016/j.jad.2011.11.035 First citation in articleCrossref MedlineGoogle Scholar

  • Joiner, T. E (2007). Why people die by suicide. Harvard University Press. First citation in articleCrossrefGoogle Scholar

  • Joiner, T. E., Jr., Hollar, D., & Orden, K. V. (2006). On Buckeyes, Gators, Super Bowl Sunday, and the Miracle on Ice: “Pulling together” is associated with lower suicide rates. Journal of Social and Clinical Psychology, 25(2), 179–195. 10.1521/jscp.2006.25.2.179 First citation in articleCrossrefGoogle Scholar

  • Joiner, T. E., Jr., & Van Orden, K. A. (2008). The interpersonal–psychological theory of suicidal behavior indicates specific and crucial psychotherapeutic targets. International Journal of Cognitive Therapy, 1(1), 80–89. 10.1521/ijct.2008.1.1.80 First citation in articleCrossrefGoogle Scholar

  • Jordan, J. R. (2001). Is suicide bereavement different? A reassessment of the literature. Suicide and Life-Threatening Behavior, 31(1), 91–102. 10.1521/suli.31.1.91.21310 First citation in articleCrossref MedlineGoogle Scholar

  • Jordan, J. R. & McIntosh, J. L. (Eds.). (2011). Grief after suicide: Understanding the consequences and caring for the survivors. Routledge. First citation in articleCrossrefGoogle Scholar

  • Kramer, J., Boon, B., Schotanus-Dijkstra, M., van Ballegooijen, W., Kerkhof, A., & van der Poel, A. (2015). The mental health of visitors of web-based support forums for bereaved by suicide. Crisis, 36(1), 38–45. 10.1027/0227-5910/a000281 First citation in articleLinkGoogle Scholar

  • Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B. W., Berry, J. T., & Mokdad, A. H. (2009). The PHQ-8 as a measure of current depression in the general population. Journal of Affective Disorders, 114(1–3), 163–173. 10.1016/j.jad.2008.06.026 First citation in articleCrossref MedlineGoogle Scholar

  • Levi-Belz, Y. (2015). Stress-related growth among suicide survivors: The role of interpersonal and cognitive factors. Archives of Suicide Research, 19(3), 305–320. 10.1080/13811118.2014.957452 First citation in articleCrossref MedlineGoogle Scholar

  • Levi-Belz, Y. (2016). To share or not to share? The contribution of self-disclosure to stress-related growth among suicide survivors. Death Studies, 40(7), 405–413. 10.1080/07481187.2016.1160164 First citation in articleCrossref MedlineGoogle Scholar

  • Levi-Belz, Y. (2019). With a little help from my friends: A follow-up study on the contribution of interpersonal characteristics to posttraumatic growth among suicide-loss survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 11(8), 895–904. 10.1037/tra0000456 First citation in articleCrossref MedlineGoogle Scholar

  • Levi, Y., Horesh, N., Fischel, T., Treves, I., Or, E., & Apter, A. (2008). Mental pain and its communication in medically serious suicide attempts: An “impossible situation. Journal of Affective Disorders, 111(2–3), 244–250. 10.1016/j.jad.2008.02.022 First citation in articleCrossref MedlineGoogle Scholar

  • Levi-Belz, Y., & Gamliel, E. (2020). Effect of relative versus absolute quantitative messages regarding suicide on the perceived severity of the phenomenon. OMEGA – Journal of Death and Dying, 81(4), 592–606. 10.1177/0030222818791715 First citation in articleCrossref MedlineGoogle Scholar

  • Levi-Belz, Y., & Gilo, T. (2020). Emotional distress among suicide survivors: The moderating role of self-forgiveness. Frontiers in Psychiatry, 11, 341. 10.3389/fpsyt.2020.00341 First citation in articleCrossref MedlineGoogle Scholar

  • Levi‐Belz, Y., Gvion, Y., Horesh, N., & Apter, A. (2013). Attachment patterns in medically serious suicide attempts: The mediating role of self‐disclosure and loneliness. Suicide and Life‐Threatening Behavior, 43(5), 511–522. 10.1111/sltb.12035 First citation in articleCrossref MedlineGoogle Scholar

  • Levi-Belz, Y., Gvion, Y., Horesh, N., Fischel, T., Treves, I., Or, E., Stein-Reisner, O., Weiser, M., David, H. S., & Apter, A. (2014). Mental pain, communication difficulties, and medically serious suicide attempts: A case-control study. Archives of Suicide Research, 18(1), 74–87. 10.1080/13811118.2013.809041 First citation in articleCrossref MedlineGoogle Scholar

  • Lev-Ari, L., & Levi-Belz, Y. (2019). Interpersonal theory dimensions facilitate posttraumatic growth among suicide-loss survivors: An attachment perspective. Death Studies, 43(9), 582–590. 10.1080/07481187.2018.1504351 First citation in articleCrossref MedlineGoogle Scholar

  • Levi-Belz, Y., & Lev-Ari, L. (2019a). Is there anybody out there? Attachment style and interpersonal facilitators as protective factors against complicated grief among suicide-loss survivors. The Journal of Nervous and Mental Disease, 207(3), 131–136. 10.1097/NMD.0000000000000940 First citation in articleCrossref MedlineGoogle Scholar

  • Levi-Belz, Y., & Lev-Ari, L. (2019b). Attachment styles and posttraumatic growth among suicide-loss survivors: The mediating role of interpersonal factors. Crisis, 40(3), 186–195. 10.1027/0227-5910/a000550 First citation in articleLinkGoogle Scholar

  • Levi-Belz, Y., & Lev-Ari, L. (2019c). “Let's talk about it”: The moderating role of self-disclosure on complicated grief over time among suicide survivors. International Journal of Environmental Research and Public Health, 16(19), 3740–3753. 10.3390/ijerph16193740 First citation in articleCrossref MedlineGoogle Scholar

  • Lieblich, A. (1997). The POW wife: Another perspective on heroism. Women's Studies International Forum, 20(5–6), 621–630. 10.1016/s0277-5395(97)00056-3 First citation in articleCrossrefGoogle Scholar

  • Maple, M., & Sanford, R. (2020). Suicide exposure and impact within a non-representative Australian community sample. Death Studies, 44(6), 329–337. 10.1080/07481187.2018.1554609 First citation in articleCrossref MedlineGoogle Scholar

  • Mishra, S. K., Srivastava, M., Tiwary, N. K., & Kumar, A. (2018). Prevalence of depression and anxiety among children in rural and suburban areas of Eastern Uttar Pradesh: A cross-sectional study. Journal of Family Medicine and Primary Care, 7(1), 21. 10.4103/jfmpc.jfmpc_248_17 First citation in articleCrossref MedlineGoogle Scholar

  • Mitchell, A. M., Kim, Y., Prigerson, H. G., & Mortimer-Stephens, M. (2004). Complicated grief in survivors of suicide. Crisis, 25(1), 12–18. 10.1027/0227-5910.25.1.12 First citation in articleLinkGoogle Scholar

  • Oexle, N., Feigelman, W., & Sheehan, L. (2020). Perceived suicide stigma, secrecy about suicide loss and mental health outcomes. Death Studies, 44(4), 248–255. 10.1080/07481187.2018.1539052 First citation in articleCrossref MedlineGoogle Scholar

  • Peters, K., Cunningham, C., Murphy, G., & Jackson, D. (2016). “People look down on you when you tell them how he died”: Qualitative insights into stigma as experienced by suicide survivors. International Journal of Mental Health Nursing, 25(3), 251–257. 10.1111/inm.12210 First citation in articleCrossref MedlineGoogle Scholar

  • Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891. 10.3758/BRM.40.3.879 First citation in articleCrossref MedlineGoogle Scholar

  • Scharer, J. L., & Hibberd, R. (2019). Meaning differentiates depression and grief among suicide survivors. Death Studies, 44(8), 469–477. 10.1080/07481187.2019.1586791 First citation in articleCrossref MedlineGoogle Scholar

  • Scocco, P., Zerbinati, L., Preti, A., Ferrari, A., & Totaro, S. (2019). Mindfulness-based weekend retreats for people bereaved by suicide (Panta Rhei): A pilot feasibility study. Psychology and Psychotherapy: Theory, Research and Practice, 92(2), 39–56. 10.1111/papt.12175 First citation in articleCrossref MedlineGoogle Scholar

  • Silva, C., Hagan, C. R., Rogers, M. L., Chiurliza, B., Podlogar, M. C., Hom, M. A., Tzoneva, M., Lim, I. C., & Joiner, T. E. (2017). Evidence for the propositions of the interpersonal theory of suicide among a military sample. Journal of Clinical Psychology, 73(6), 669–680. 10.1002/jclp.22347 First citation in articleCrossref MedlineGoogle Scholar

  • Stanley, I. H., Hom, M. A., Chu, C., Dougherty, S. P., Gallyer, A. J., Spencer-Thomas, S., Shelef, L., Fruchter, E., Comtois, K. A., Gutierrez, P. M., Sachs-Ericsson, N. J., Joiner, T. E., & Sachs-Ericsson, N. (2019). Perceptions of belongingness and social support attenuate PTSD symptom severity among firefighters: A multistudy investigation. Psychological Services, 16(4), 543–555. 10.1037/ser0000240 First citation in articleCrossref MedlineGoogle Scholar

  • Stewart, S. M., Eaddy, M., Horton, S. E., Hughes, J., & Kennard, B. (2017). The validity of the interpersonal theory of suicide in adolescence: A review. Journal of Clinical Child & Adolescent Psychology, 46(3), 437–449. 1080/15374416.2015.1020542 First citation in articleCrossref MedlineGoogle Scholar

  • Stroebe, W., Schut, H., & Stroebe, M. S. (2005). Grief work, disclosure and counseling: Do they help the bereaved?. Clinical Psychology Review, 25(4), 395–414. 10.1016/j.cpr.2005.01.004 First citation in articleCrossref MedlineGoogle Scholar

  • Sveen, C.-A., & Walby, F. A. (2008). Suicide survivors' mental health and grief reactions: A systematic review of controlled studies. Suicide and Life-Threatening Behavior, 38(1), 13–29. 10.1521/suli.2008.38.1.13 First citation in articleCrossref MedlineGoogle Scholar

  • Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E., Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600. 10.1037/a0018697 First citation in articleCrossref MedlineGoogle Scholar

  • Vanderwerker, L. C., & Prigerson, H. G. (2004). Social support and technological connectedness as protective factors in bereavement. Journal of Loss and Trauma, 9(1), 45–57. 10.1080/15325020490255304 First citation in articleCrossrefGoogle Scholar

  • Wittouck, C., Van Autreve, S., Portzky, G., & van Heeringen, K. (2014). A CBT-based psychoeducational intervention for suicide survivors: A cluster randomized controlled study. Crisis, 35(3), 193–201. 10.1027/0227-5910/a000252 First citation in articleLinkGoogle Scholar

  • World Health Organization. (2017). Depression and other common mental disorders: Global health estimates. First citation in articleGoogle Scholar

  • Young, I. T., Iglewicz, A., Glorioso, D., Lanouette, N., Seay, K., Ilapakurti, M., & Zisook, S. (2012). Suicide bereavement and complicated grief. Dialogues in Clinical Neuroscience, 14(2), 177–186. 10.31887/DCNS.2012.14.2/iyoung First citation in articleCrossref MedlineGoogle Scholar