Name of Innovative Program:
Complicated Grief in Survivors of Suicide: An Evaluation of Complicated Grief Group Therapy
Caring Connections: A Hope and Comfort in Grief Program University of Utah College of Nursing
Name of Innovative Program Lead:
Katherine P. Supiano
E-mail Address of Innovative Program Lead:
An estimated 38,000 persons commit suicide in the US every year, and for every completed suicide, four to six family members or friends are impacted. While the lives of all suicide survivors are forever affected by the death, those survivors with chronic and ineffective mourning known as complicated grief (CG) represent a subset of survivors for whom traditional support groups are therapeutically insufficient. Among suicide survivors, untreated CG may increase risk of suicide. We propose to evaluate complicated grief group therapy (CGGT) for suicide survivors with CG. CGGT is based on Shears’ complicated grief therapy for individuals and designed to generate a shared experience for grief experienced as apart from the normal grief process. It reduces the isolation that is a consequence of avoidance behavior and constricted social supports and provides an opportunity to give, as well as receive, support.This study will use Community-Based Participatory Research to engage suicide survivors and those who care for them to refine the group therapy intervention. Utah’s reported rate of 17.1 suicide deaths/100,000 persons places the State at 10th in the nation in rate of suicide. This unfortunate, but real need positions the proposed study in an important location to accomplish change.
Creativity and Innovation:
This study represents an innovative application of complicated grief group therapy (CGGT) developed by the research team and found to be efficacious in other populations to address the critical need for targeted therapeutic interventions for suicide survivors with CG. The research setting is Caring Connections: A Hope and Comfort in Grief Program, the highly regarded grief support program affiliated with the University of Utah College of Nursing, and the location of the original CGGT study. The study will use Community-Based Participatory Research (CBPR) and will elicit the counsel of community agency partners as well as suicide survivors who participated in prior research and requested a continued role in advising the research team. Partners include the Utah chapters of the American Foundation for Suicide Prevention and National Alliance on Mental Illness, Hill Air Force Base Wingman Advocates, group facilitators, former study participants who are suicide survivors and their supportive others.
This project relies on a shared leadership model in the spirit of Community-Based Participatory Research, a "collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community, has the aim of combining knowledge with action and achieving social change to improve health outcomes and eliminate health disparities (WK Kellogg Foundation).” This partnership represents a commitment of time and talent by all parties and we expect the research advisory team to be sustained beyond the duration of this study. The shared leadership model will build on the strength of existing relationships and proceed with open communication, respect and equality. The community partners will contribute expertise in developing culturally sensitive approaches to the intervention, recruitment and retention, to feasibility and access, and to translation and dissemination.
The physical space and intellectual environment at University of Utah are exceptionally well suited to the performance of this study. With University and College commitment to developing early career investigators, Dr. Supiano will have the support she needs to complete this research study and continue to apply for future funding. Additionally, this study will seamlessly integrate into the facilities available at the College of Nursing. The University of Utah provides research support at both the College of Nursing and university levels. A grants coordinator, research associate, four member statistical staff, and a research affinity group provide support for both pre- and post-award grant management.Dr. Supiano is an active member of several national organizations that encourage collaboration and multi-site investigations. Many of our community partners are active in their national organizations and are committed to advocating for ongoing support and broader capacity-building across support settings for survivors of suicide.
The rigor of the study design maximizes the potential for both refinement and replicability of the CGGT intervention. If pilot study findings demonstrate that complicated grief group therapy reduces complicated grief in affected survivors of suicide, we will apply for Federal research funding to conduct a randomized clinical trial, leading to a manualized, replicable intervention that is scalable and suitable for dissemination into the clinical practice arena. This is consistent with the “knowledge to action” framework proposed by the Centers for Disease Control and Prevention encouraging timely research translation to evidence-based models of care.
Our proposal uses an innovative application of CBPR to develop and evaluate psychosocial outcomes for suicide survivors participating in CGGT, while maintaining scientific rigor. The outcome variable will be complicated grief group therapy (CGGT). We will evaluate treatment response, measured as change in scores on the Prolonged Grief Disorder Scale (PG-13) and the Brief Grief Questionnaire (BGQ). Participants will also be evaluated for depression with the Quick Inventory of Depressive Symptomatology (QIDS); for anxiety with the Generalized Anxiety Disorder Scale (GAD-7); and for suicidality with the Columbia Suicide Severity Rating Scale (C-SSRS). These five psychosocial variables will be assessed at four intervals: pretest, group midpoint (8 weeks), posttest (16 weeks) and at 6 week follow-up. Additional analyses will be conducted on anxiety and depression scores, and on demographic variables.