Relational and Institutional Disenfranchisement in Suicide Bereavement: A Qualitative Meta-Synthesis of Family Members' Experiences.

Abstract

Objectives: This study aims to synthesize qualitative evidence on the lived experiences and perceived support needs of suicide-bereaved family members, including extended relatives.

Methods: A qualitative systematic review and quote-based thematic meta-synthesis was conducted. Searches were undertaken in PubMed, Scopus, and Web of Science. Eligible studies were primary qualitative research published in English involving family members bereaved by suicide. Methodological quality was appraised using the JBI Critical Appraisal Checklist for Qualitative Research, and confidence in each synthesized finding was assessed using GRADE-CERQual. Verbatim participant quotations extracted from findings/results sections were analyzed using Braun and Clarke's thematic analysis, guided by Doka's disenfranchised grief as a sensitizing framework, with inductive coding for data not captured by the lens.

Results: Twenty-seven studies were included. Six cross-cutting themes described suicide bereavement as layered disenfranchisement: (1) stigma and anticipatory judgment prompting secrecy and withdrawal; (2) relational erasure through silence and loss of permission to name the deceased; (3) institutional non-recognition and lack of navigable postvention pathways; (4) moral injury and persistent culpability; (5) embodied, trauma-like distress and enduring existential suffering; and (6) legitimacy repair through peer support, compassionate witnessing, continuing bonds, and meaning-making. Synthesized support needs converged on stigma-competent and culturally safe care, permission-based communication, proactive coordinated pathways, trauma-informed long-term follow-up with attention to suicide risk, and accessible, tailored peer support.

Conclusion: Suicide bereavement among family members is frequently shaped by social, relational, and institutional disenfranchisement, with important implications for designing proactive, culturally safe, and longitudinal postvention that addresses both symptom burden and social-ecological barriers.