Interpersonal predictors of suicide ideation and complicated-grief trajectories among suicide bereaved individuals: A four-year longitudinal study

Background: Survivors of suicide loss (suicide survivors) are recognized as an at-risk population for several psychiatric complications, including complicated grief (CG) and suicide ideation (SI). Recent studies have emphasized the contribution of interpersonal factors, such as thwarted belongingness and perceived burdensomeness, on distress and suicidality. However, no longitudinal study has examined the predictive values of these interpersonal factors on CG and SI trajectories among suicide survivors to date. In this 42-month prospective design study, we examined interpersonal variables as predictors of CG and SI over time. Method: Participants were 152 suicide survivors, aged 18-70, who completed questionnaires tapping thwarted belongingness, perceived burdensomeness, CG, and SI at index measurement (T1) and again after 18 months (T2) and 40 months (T3). Results: The integrated model showed that thwarted belongingness and perceived burdensomeness predicted SI and CG levels over time, both directly and indirectly. Thwarted belongingness was found to have a high predictive value on SI levels, whereas perceived burdensomeness was predictive of CG levels. Limitations: The voluntary nature of the participants; self-report measures; lack of pre-suicide-loss assessment. Conclusion: The study's findings highlight the critical role of interpersonal factors in facilitating CG and SI among suicide survivors. Those with higher levels of thwarted belongingness and perceived burdensomeness presented increased prospects of both SI and CG. Theoretical implications relating to healing processes are discussed, as well as focused clinical recommendations, including psychoeducational interventions for addressing PB and TB among suicide survivors.