Primary prevention of complicated grief in the aftermath of suicides. Region-wide implementation of a brief, nurse-led, cognitive behavioural, family-oriented, primary care and evidence based approach

The ZON funded randomized trial Survivors at Risk is evaluating whether a specially developed, brief, nurse-delivered, family-focused preventive intervention along psycho-educative and cognitive behavioural principles, can reduce the medium-term (14 months') risk of mental problems in 1st - degree relatives bereaved by a suicide. The intervention caters for a largely unmet need of bereaved persons and their general practitioners who report high levels of satisfaction. Interim outcome analyses indicate that the intervention modifies the course of bereavement substantially with speedier resolution of complicated grief especially in men. Dysfunctional cognitions relating to the suicide are lower among those who received the intervention who also have lower levels of suicidal ideation themselves. Given calls for continuation of the intervention developed, and the absence of alternative regular offers of primary prevention aimed at this high risk group of mourners we propose a 42-month study to examine whether and how this intervention can be introduced structurally in the (primary) health care system as a primary prevention of psychiatric disorder. We will focus on obstacles to recruitment and detection of persons at risk, roles played by other parties like victim support, funeral agents and police, and on the possibilities of integrating the treatment package in the job description of primary care nurses (praktijkondersteunenden op HBO niveau).