Grief after Suicide: Effect of the Local Outreach to Suicide Survivors (LOSS) Program in Singapore

Background: The Local Outreach to Suicide Survivors (LOSS) program, a grief support postvention that provides individual and group counseling and support services to those who have lost a loved one to suicide. This program launched in 2006 by Samaritans of Singapore (SOS) is the only suicide postvention and specialist counseling service in Singapore. In 2020, Singapore’s suicide rate increased by a 13% compared to the suicide deaths in 2019 (SOS, 2021). Amidst psychological distress and social isolation brought by the COVID-19 pandemic, suicide behavior has been the nation’s highest court since 2012. This pilot study aims to evaluate the first suicide postvention program in Singapore and its impact on suicide survivors of sudden death or loss.

Methods: The study used a mixed-methods design to facilitate the triangulation and integration of qualitative and quantitative data. Data was collected through pre-and post-test surveys and semi-structured interviews as a means of gaining a rich understanding of participants’ grief experiences, impact of the suicide death, social adjustment, psychosocial well-being, and overall experiences with LOSS. Purposeful sampling was used to identify recent suicide survivors who had lost a loved one within the past 6 months to suicide seeking bereavement services from SOS. A total of 6 suicide survivors participated in the study. All participants were Chinese, and the average age was 45 years old. The average duration for counseling and services from the LOSS program was around 8 months.

The questionnaire consisted of demographics, the Grief Experiences Inventory Questions (Barrett & Scott, 1989), the Impact of Event Scale Revised (Weiss, 2007), and the Social Adjustment Scale (Weissman et al., 2001). Pre-and post-test scores were analyzed using paired-samples t-tests, and thematic analysis was utilized for the interview data.

Results: The findings showed the top three dimensions of grief were “search for explanation”, “guilt”, and “unique reactions”. There was a significant difference in the Impact of Event (IES) scores between pre-intervention (M=38.17) and post-intervention (M=20.17; t(10)=3.12, p=0.010), indicating the survivors’ post-traumatic stress after the loss was reduced after the LOSS program. All participants expressed benefitting from the individual counseling and support group, especially the chance to connect with other survivors. Besides emotional reactions of grief, survivors reported somatic symptoms like trouble with sleep and difficulty concentrating. Increased sleep and ability to do household chores were indicative of “feeling better” for them.

Conclusions/Implications: Based on these findings, the current study highlights that social workers can administer assessment tools that measure grief and trauma since suicide survivors may try to settle practical matters first and focus only on the improvement of their somatic symptoms. With regard to practical matters, suicide and life insurance may be a complicated topic for survivors to understand and navigate on their own. Thus, a guidebook for survivors on the practical issues after a suicide death may be beneficial. Furthermore, exposure to suicide death, particularly a close family member, is a risk for suicidal ideation so social workers should continue to monitor for suicidal ideation in survivors as well.