This document provides information and resources for supporting those who have lost someone to suicide ("survivors"). It discusses common survivor experiences like shock, intense emotions, questioning why it happened, and feelings of guilt. It also outlines reactions to traumatic experiences like distressing thoughts/images, avoidance, and hypervigilance. The document notes signs that warrant professional referral such as loss of emotional control, depression/trauma lasting weeks, and inability to function. Finally, it discusses survivors' needs like help validating their loss, managing triggers, retelling the story, and adjusting to changes, as well as the risk of suicidal thoughts among survivors.

1. Suicide Grief Support Primer
TABLE OF CONTENTS
2 - How to Listen and Respond
3 - Common Survivor Experiences
4 - Reactions to Trauma
5 - Indicators for Professional Referral
6 - Survivors' Needs after the Crisis
7 - Survivors and Suicide Risk
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Based on: Hobfoll, S.E., Watson, P., Bell, C.C., Bryant, R.A., Brymer, M.J., Friedman, M.J., … Ursano. (2007). Five
essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry. 70(4), 283–
315.
How to Listen and Respond
(See http://bit.ly/afterasuicide.)

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Common Survivor Experiences
● Shock, feeling numb (from surviving a traumatic experience)
● Intense emotions (anger, irritability, shame, abandonment, sorrow)
● Distress over the question "Why?" (blame, continuously and
painfully thinking about the death, denying that the cause is suicide)
● Guilt ("What did I do to cause this?" "I should have done more to
prevent it.")
● Negative judgments or actions from other people because the death
was a suicide
● Weakened support systems (people uncertain how to react to
suicide, stressful family relations, social isolation)
● Relief (the death relieves family's difficulties, ends deceased's pain)
Note: Not all survivors experience all or any of these reactions.
Adapted from: Jordan, J. R., & McIntosh, J. L. (2011). Is suicide bereavement different? A framework for rethinking the
question. In J. R. Jordan & J. L. McIntosh (Eds.), Grief after Suicide: Understanding the consequences and caring for
the survivors (pp. 19-42). New York: Routledge. [Please also see this book review.]

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● Having distressing thoughts or images while awake or dreaming
● Feeling like the experience is happening all over again (a flashback)
● Avoiding talking, thinking, or having feelings about the event
● Avoiding reminders (triggers) of the event (people, places, and things
connected to what happened)
● Reacting to (or being triggered by) reminders of or feelings about the
event (troubling thoughts or images, emotional or physical distress)
● Being "on the lookout" for danger, startling easily, being jumpy
(hypervigilance)
● Having restricted emotions (e.g., feeling numb)
● Feeling detached or estranged from others (e.g., social withdrawal)
● Losing interest in usually pleasurable activities
● Having difficulty falling or staying asleep, problems concentrating or
paying attention
Reactions to Traumatic Experience
Adapted from: Brymer, M., Jacobs, A., Layne, C., Pynoos, R., Ruzek, J., Steinberg, A., Vernberg, E., & Watson,
P., (2006). Psychological First Aid: Field operations guide (2nd ed.). National Child Traumatic Stress Network, Los
Angeles & Durham, N.C.; National Center for PTSD, White River Junction, Vermont, 131–133.

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Adapted from: SAVE. (2011). After a suicide: Coping with your grief. [Wallet card] Minneapolis, Minn.
● Repeatedly experiencing loss of emotional control
● Feeling depressed or traumatized (see "Reactions,"
Page 4) for weeks with little or no relief
● Coping by using alcohol, drugs, or other risky or
unhealthy means
● Having difficulty functioning in essential ways for days
at a time (not taking care of personal hygiene, daily
necessities, basic responsibilities
Note: These can be "normal" in traumatic grief, and
decision making about seeking professional help should be
guided by the severity and duration of symptoms.
Seek Professional Help: If a person is ...

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Survivors' Needs after the Crisis
● Help affirming or validating their sense of loss, especially through
nonjudgmental listening and behavior
● Help anticipating emotional triggers and decreasing the intensity
of reactions to trauma that disrupt daily functioning
● Help facing their grief in “doses” (instead of constantly) and
finding ways to “take a break” from intense grief
● Help retelling the story of the death in a way that is safe and that
shows compassion both for the deceased and for the survivor
● Help finding effective ways to manage changes in family
dynamics and social relations -- and practicing what to say in
particular situations
● Help exploring their continuing relationship with the deceased
● Help with activities to remember and honor the deceased
● Help returning to daily functions and looking toward the future
● Help identifying and engaging in culturally familiar and supportive
sources of assistance for coping with their grief
Adapted from: Jordan, J.R. (2011). Principles of grief counseling with adult survivors. In J.R. Jordan & J.L. McIntosh
(Eds.), Grief after Suicide: Understanding the consequences and caring for the survivors (pp. 179–223). New York:
Routledge. [Please also see this book review.].

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It is important to remember that ...
● As a group, survivors are at a
statistically higher risk of
suicide.
● It is not uncommon for people
who have lost a loved one to
suicide to think about wanting to
die, so it is vital to ask directly
and clearly if a person might
take action on such thoughts.
● A survivor's wish to die might
be for various reasons, for
instance
oTo escape from the pain of loss
oTo join the loved one in death
oBecause of feeling unable or
undeserving to live