When someone dies by suicide, those who lose this individual in their lives often face significant stress. These feelings can be inundating and are often accompanied by a sense of complicated grief and, at times, depression [1]. It is a tragic event that can generate negative emotions as well as many questions that may be left unanswered in the minds of these surviving individuals. In addition, this population of people bereaved by suicide is at an increased risk of suicidal behavior themselves [2]. Based on data that over 700,000 people die by suicide each year globally [3], and that for each suicide, there are from 6 family members to 135 community members considered to be bereaved or exposed, respectively [4,5], up to 94.5 million can be affected by suicide annually. Thus, many people affected by suicide loss each year are subsequently at increased risk of dying by suicide themselves.

There are commonalities between bereavement of suicide and other forms of death; however, some features of suicide bereavement are more pronounced, such as feelings of guilt, blame on self or others, or a longing for answers [6,7]. While all bereaved people may experience feelings of grief, loss, and depression, people bereaved by suicide specifically can begin to develop symptoms of posttraumatic stress disorder (PTSD) [8,9]. However, some individuals show signs of posttraumatic growth (PTG) more so than symptoms of PTSD. PTG is the personal improvement that occurs as a consequence of experiencing a traumatic or extremely challenging event or crisis. Literature has begun to show that, on average, PTG occurs more often than the development of pathological disorders following exposure to a traumatic event [10,11]. This is, of course, not to say that PTG is always the result of trauma, but rather, psychological suffering allows the opportunity for a person to grow and for new meaning to flourish in the face of trauma. An inverted U-shaped curve best describes the relationship between the developments of PTG—both too much and too little suffering are detrimental to the development of PTG [12,13]. This concept of PTG following a traumatic event [14] has since been applied to learning more about the bereavement experiences of individuals bereaved by suicide. Some authors have also used the phrase “personal growth” [15] or “stress-related growth” [16] in place of PTG. This study will use the terminology of PTG rather than personal growth or stress-related growth.

Determining a metric for PTG can be difficult as it is seen as both an ongoing process and a final result. However, the Posttraumatic Growth Inventory (PTGI) has been developed and shown to capture and highlight well many of the defining characteristics of PTG [10]. These characteristics are broken down into 5 domains: “greater appreciation of life and changed sense of priorities; warmer, more intimate relationships with others; a greater sense of personal strength; recognition of new possibilities or paths for one’s life; and spiritual development” [14]. It does not, however, fully account for all idiosyncratic differences that occur over time; in this regard, a more longitudinal approach for the measurement of such a complex construct (ie, PTG) could provide valuable insight [17].

For those who lose someone to suicide, there can be variables that affect their desire or willingness to seek both formal and informal help and work towards the development of PTG. Each of these variables can influence how well someone bereaved by suicide copes with and grows following their loss. For example, some individuals who have experienced suicide bereavement have reported that their primary support came from nonprofessional sources and that they were disappointed by their family and friends’ responses to their bereavement [18]. Suicide and the survivors’ grieving process can also be seen from a variety of perspectives depending on the culture from which someone comes, such as being seen as stigmatized, taboo, and isolating [19,20]. Along with these responses, some individuals have reported generally negative attitudes toward professional support systems, such as tactlessness and being unaligned in the grieving process [21]. Unfortunately, these detrimental experiences can be an additional stressor on top of what can already be a tragic and intense time of grieving. These factors could contribute to why up to 25% of people bereaved by suicide receive neither informal nor formal support [22]. Each of these variables (ie, poor support, stigmatization, tactless professional help, etc) can hinder PTG development.

This systematic review and meta-analysis is an update of a previous systematic review and meta-analysis conducted by Levi-Belz et al [23]. Our searches have found that the latter is the only one to ever be conducted on this topic. As their original review gathered data from literature before 2019, this review will include data found from searches between January 2019 and January 2024. This updated meta-analysis will synthesize data from both the original and updated reviews to search for any new or consistent trends. As some authors and databases call for a systematic review to be updated every 2 years [24], and with the paucity of understanding that exists on this subject, examining new literature, in conjunction with the previous review, could allow for a more in-depth understanding of which factors facilitate PTG in people bereaved by suicide. The aforementioned evidence suggests that PTG can and does occur following suicide bereavement; therefore, investigating further which factors might facilitate, as well as detract from, PTG development could greatly benefit people bereaved by suicide.

We have three primary aims with this review: (1) to investigate whether PTG can occur in the aftermath of a suicide loss, (2) to examine the sociodemographic and psychological correlates of PTG among people bereaved by suicide, and (3) to observe which factors facilitate PTG in the aftermath of suicide bereavement.

This updated systematic review and meta-analysis was funded in October 2023 and is currently underway. It is expected to have results in October 2024. A total of 21 studies are included in this review; this will be reported by a PRISMA flow diagram (Figure 1). These 21 studies are currently being analyzed. All data produced in this review is included in Multimedia Appendix 2. A meta-analysis will be conducted using the data from both the studies of this updated search as well as the studies from the original review’s search. Doing so will allow for any varying or static trends to be revealed. Moderating factors will be examined to determine which variables may influence PTG development in people bereaved by suicide. We aim to submit the full paper for publication in December 2024. The PRISMA-P checklist will be abided by to ensure a higher quality of research practices are followed (see Multimedia Appendix 3).

We hypothesize that interpersonal variables of self-disclosure and social support, as well as the loss-related factor of time since loss and the intrapersonal variable of resilience, will have a positive influence on PTG. A full discussion will further examine these key relationships and general findings identified in the Results section. These findings will then be discussed in relation to 3 research aims identified in this review. The discussion will also investigate the findings of this updated review in comparison with the findings of the original review. Any differences would be highlighted and expounded upon to discover which factors have changed. Overall, we anticipate that the moderating variables will have varying effects on PTG and will deliberate on any potential correlational relationships, as this could emphasize which specific factors are correlated to greater PTG facilitation.

Implications and strengths, future work, and subsequent research, which could build upon the findings of this updated review will be discussed. The limitations of this review will be considered as well, such as the quality of the journal articles included in this review. Similarly, we will discuss how this systematic review has chosen to exclude qualitative articles as well as gray literature and dissertations and the strengths and limitations that follow this decision. We will also examine the impact of using solely the NOS for quality assessment of studies. While the NOS is a widely recognized tool for assessing the risk of bias, it may not fully capture the complexities associated with PTG. PTG involves multidimensional psychological, social, and emotional processes, which may be influenced by a variety of factors not entirely accounted for by the NOS. As such, relying solely on the NOS may limit the ability to assess the nuanced methodological challenges present in studies of PTG. Future research may benefit from supplementing the NOS with other bias assessment tools or qualitative methodologies to provide a more comprehensive assessment of study quality and the contextual factors influencing PTG outcomes. This paper will be submitted for peer-reviewed publication. It will also be part of a thesis submitted to the University of Strathclyde.