title: The Stigma of Suicide Survivorship and Related Consequences-A Systematic Review.
abstract: BACKGROUND
  considerable proportion of the population experiences major life disruptions after losing a loved one to suicide. Social stigma attached to suicide survivors adds to complications occurring in the course of suicide bereavement. Despite its known risks, stigma related to suicide survivors has been sparsely investigated.
  
  
  METHODS
  We conducted a systematic literature search in PubMed, Web of Science, PsycInfo and PsyArticles, of studies indexed up through August 2015. Articles were eligible for inclusion if they addressed experiences of stigma in suicide survivors, compared them to other bereavement populations, or investigated stigmatizing attitudes within the public. The search was restricted to English-language studies.
  
  
  RESULTS
  25 records matched inclusion criteria. Study designs were heterogeneous, making comparisons difficult. Results demonstrated that suicide survivors experience stigma in the form of shame, blame, and avoidance. Suicide survivors showed higher levels of stigma than natural death survivors. Stigma was linked to concealment of the death, social withdrawal, reduced psychological and somatic functioning, and grief difficulties. Only one study investigated stigmatizing attitudes towards suicide survivors among the general population.
  
  
  CONCLUSIONS
  Internal and external validity of the studies was restricted by a lack of valid measures and selection bias.
  
  
  CONCLUSIONS
  More methodologically sound research is needed to understand the impact of stigma on suicide survivors' grief trajectories and to separate it from other grief aspects. Clinicians and grief-counselors as well as the public should be educated about the persistent stigma experienced by suicide survivors.
authors.affiliation: Department of Psychosomatic Medicine, University of Leipzig, Leipzig, Germany.
authors.forename: Franz
authors.initials: F
authors.lastname: Hanschmidt
authors.affiliation: Department of Psychosomatic Medicine, University of Leipzig, Leipzig, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Lehnig
authors.affiliation: Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
authors.forename: Steffi G
authors.initials: SG
authors.lastname: Riedel-Heller
authors.affiliation: Department of Psychosomatic Medicine, University of Leipzig, Leipzig, Germany.
authors.forename: Anette
authors.initials: A
authors.lastname: Kersting