Table 1.

Study Characteristics and results

Study ID	Setting	Study design	Participants	Comparison	Outcome(s)	Results	Limitations of the study
Cerel et al., 1999 [34]	Ohio, United States	Cohort study Follow-up: 1, 6, 13 and 25 months after the death	N = 26 children bereaved by suicide of parent, from 15 families	N = 322 children bereaved by non-suicide death of parent (reasons other than suicide or homicide)	BAMO, an unvalidated scale measuring somatisation disorder Health/Sickness Questionnaire School and Physician Rating Forms	No significant difference in scores of somatisation between suicide and non-suicide bereaved. Suicide-bereaved children visited doctor less frequently but missed significantly more days of school than non-suicide-bereaved children	Small sample size for suicide-bereaved children. No confounding factors were controlled for. Type 1 error is increased due to multiple testing of the data
Cleiren et al., 1994 [37]	Leiden, The Netherlands	Cohort study Follow-up: 4 and 14 months after death	N = 91 first-degree relatives and spouses bereaved by suicide	N = 93 first-degree relatives and spouses bereaved by traffic accident N = 125 people bereaved by the illness of first-degree relative	General wellbeing questionnaire measuring physical health and somatic complaints (measure not described)	No differences were found for somatic complaints between the different modes of death groups (no p-value given). Mode of death was not significantly associated with physical health complaints	Some of the scales used are not validated. No confounding factors were controlled for. 10% loss to follow-up which may introduce attrition bias
Erlangsen et al., 2017 [35]	Denmark	Longitudinal cohort study Follow-up: 1980–2014	N = 15,607 suicide-bereaved spouses	N = 788,778 spouses bereaved by non-suicide death	Diagnosis of cancers, diabetes, sleep disorders, cardiovascular and chronic lower respiratory tract diseases, liver cirrhosis, and spinal disc herniation	Suicide-bereaved had lower risk of diagnoses of cancer, diabetes, cardiovascular and chronic lower respiratory tract disorders. They were less likely to take sick leave	Only people who were in a formal union or who were living together were included. While analyses was adjusted for some covariates, unmeasured confounders may be an issue
Fang et al., 2011 [44]	Sweden	Historic cohort study Follow-up: 1990–2004	N = 102 parents bereaved by suicide of child	N = 124 parents bereaved by non-suicide death of child N = 334 and n = 297 parents bereaved by non-cancer and cancer death of child N = 46 and n = 251 parents bereaved by an infection-related or any other cause of death of child	A diagnosis of infection-related cancer using ICD codes	The risk ratio was higher for suicide-bereaved than for non-suicide bereaved but this didn’t reach statistical significance; confidence intervals greatly overlapped	Some potential confounders were not accounted for due to the registry-based nature of the study
Farberow et al., 1992 [22]	Three counties in California	Cohort study Follow-up: 2, 6, 12 and 30 months after the death	N = 108 suicide-bereaved aged ≥55 years	N = 199 people aged ≥ 55 years bereaved by natural death N = 144 people aged ≥55 years not experiencing any death or divorce of spouse	The somatisation subscale of the Brief Symptom Inventory (BSI)	Suicide-bereaved and naturally bereaved spouses did not differ significantly on the somatisation subscale. All of the mean scores of the scales, including somatisation, decreased over the 2.5 year period	There appears to be loss to follow-up in each group which may indicate the presence of attrition bias
Grad and Zavasnik, 1999 [39]	Slovenia	Cohort study Follow-up: 2 and 12–14 months after the death	N = 30 suicide-bereaved spouses	N = 23 spouses bereaved by road traffic accident N = 20 spouses bereaved by terminal illness	Slovenia Bereavement Scale (SBS) has 46 items, representing several categories, including physical health	There were no statistically significant differences (no data presented) between the bereaved groups on the physical health measures contained within the SBS	Small sample size and no confounding factors controlled for. First assessment was conducted 2 months post-death when acute grief is likely to be present
Kennedy et al., 2014 [45]	Sweden	Historical cohort study Follow-up: 1961–2006	N = 19,535 offspring ≤18 years and n = 12,137 ≥ 18 years who lost a parent to suicide	N = 42,796 offspring ≤18 years and n = 136,786 ≥ 18 years bereaved by parental cancer death N = 52,592 offspring ≤18 years and n = 178,393 ≥ 18 years bereaved by parental non-cancer death N = 25,772 offspring ≤18 years and n = 18,566 ≥ 18 years bereaved by parental non-suicide death	Diagnosis of first malignant cancer before the age of 40 in the Cancer Register	The effect of suicide bereavement more than doubled the risk of human papillomavirus-related cancers before the age of 40, compared to those bereaved by non-suicide deaths. However, this finding was not statistically significant	No information on individual confounding factors including alcohol consumption and smoking
Momen et al., 2013 [26]	Denmark and Sweden	Population-based cohort study Follow-up for Denmark/ Sweden: 1968–2007/1973–2006	N = <66 suicide-bereaved (exact number unavailable from authors)	N = 1217 children bereaved by unexpected deaths, other than accident, suicide or the violence death of their relative	A diagnosis of childhood cancers using ICD codes	The adjusted hazard ratio was higher for suicide-bereaved children than children bereaved by other causes of death. However this association did not reach statistical significance	Small numbers of suicide- bereaved may not make these findings generalisable to other suicide-bereaved family members
Séguin et al., 1995 [31]	Quebec City, Montreal	Cohort study Follow-up: First interview M = 5.8 months after the death Second interview M = 9 months after the death	N = 30 parents who lost a son aged 18 to 35 years to suicide	N = 30 parents who lost a son aged 18 to 35 years by a car accident	Physical disorders were measured using items taken from Quebec’s 1987 Health Survey	Suicide-bereaved had more physical illnesses and consulted health professionals more frequently than accident survivors	Some important confounding factors including gender and age of the deceased not controlled for. High rate of attrition bias
Weinberg et al., 2013 [46]	United States	Prospective longitudinal controlled study Follow-up: 5 years	N = 45 offspring bereaved by suicide of a parent	N = 27 offspring bereaved by accidental death of a parent N = 51 offspring bereaved by sudden natural death of a parent	BMI was the outcome studied, by measuring the weight and height of offspring objectively	There were no differences in the BMI categories of offspring bereaved by suicide, accident and sudden natural death	Some participants recruited via advertising. Possible attrition bias as participants lost to follow-up more likely to be bereaved than those retained in the study
Wilcox et al., 2015 [47]	Sweden	Prospective cohort study Follow-up: 3 years	N = 537 parents bereaved by suicide of an offspring	N = 716 parents bereaved by accidental death of offspring N = 549 parents bereaved by natural death of offspring	Diagnosis-specific sickness absence exceeding 30 days due to somatic diagnoses	No statistically significant differences in the risk of somatic diagnosis between suicide-bereaved, accident-bereaved and naturally bereaved parents	Sickness absence due to specific somatic diagnoses were only included if they exceeded 30 days
Barrett and Scott, 1990 [36]	North Dakota and Minnesota, United States	Cross-sectional study	N = 14 suicide-bereaved spouses	N = 15 accident-bereaved spouses N = 15 unanticipated natural death bereaved N = 13 bereaved by theexpected natural death of spouse	Grief Experiences Questionnaire (GEQ): somatic reactions subscale	No significant differences in mean scores of somatic reactions for suicide-bereaved and non-suicide bereaved	Small sample size of suicide and non-suicide bereaved
De Groot et al., 2006 [30]	Northern Provinces in The Netherlands	Cross-sectional study	N = 153 first-degree suicide-bereaved relatives and spouses	N = 70 first-degree relatives and spouses bereaved by natural causes	RAND-36 used to assess general health, with nine subscales	Suicide-bereaved functioned less well in terms of pain and general health than naturally-bereaved	Possibility of selection bias due to difficulty in recruiting family members bereaved by natural death
Demi and Miles, 1988 [38]	United States	Cross-sectional study	N = 59 (15 fathers and 44 mothers) parents whose children died by suicide	N = 61 (13 fathers and 48 mothers) whose children died as a result of an accident or a chronic disease	Hopkins Symptom Checklist (HSCL) Health problems measured using the Bereavement Health Assessment Scale (BHAS)	No difference on the 5 subscales of the HSCL (somatisation, obsessive-compulsive, interpersonal sensitivity, depression, anxiety) or across physical health outcomes between the 2 groups	Bereaved parents may not be representative as they were recruited from self-help groups
Dyregrov et al., 2003 [33]	Norway	Cross-sectional study	N = 128 suicide-bereaved parents	N = 68 accident-bereaved parents N = 36 SIDS-bereaved parents	General Health Questionnaire (GHQ-28): somatic symptoms	SIDS-bereaved parents experienced significantly fewer problems on GHQ than suicide and accident-bereaved	Control group was heterogenous (violent and non-violent deaths)
Kitson, 2000 [41]	Two Midwestern counties in United States	Cross-sectional study	N = 85 suicide- bereaved widows	N = 56 homicide-bereaved widows N = 135 accident-bereaved widows N = 167 sudden death bereaved widows N = 106 long-term illness bereaved widows	The somatisation subscale of the Brief Symptom Inventory (BSI)	No differences between the 5 bereaved groups on somaticism	Control group contained both bereavement from violent and non-violent deaths which may have introduced selection bias
McNiel et al., 1988 [42]	United States	Cross-sectional study	N = 13 widows bereaved by the suicide death of their husband	N = 13 widows bereaved by the accidental death of their husband	General Health Questionnaire (GHQ): somatic complaints subscale	No significant differences in the mean scores of suicide and accident-bereaved	Very small sample size and no confounding factors were adjusted for
Miyabayashi and Yasuda, 2007 [32]	Japan	Cross-sectional study	N = 21 suicide-bereaved adults	N = 23 accident-bereaved adults N = 9 adults bereaved by acute illness N = 74 adults bereaved by shorter illness N = 88 adults bereaved by longer illness	General Health Questionnaire (GHQ), including somatic symptoms	No group differences were found for somatic symptoms. Multiple comparison tests indicated that those bereaved by suicide had poorer general heath than those bereaved by a longer illness (p < 0.05)	Selection bias may be present as participants recruited from self-help group. Response bias may be present due to the small sample of suicide-bereaved and those bereaved by acute illness. Some important confounders were not controlled for
Pfeffer et al., 2000 [24]	United States	Cross-sectional study	N = 11 families (made up of 16 children) where a parent died by suicide	N = 57 families (made up of 64 children) where a parent died from cancer	Child Behaviour Checklist (CBCL) has a subscale for somatic complaints	Mean scores of somatic complaints did not significantly differ between children bereaved by the cancer death of a parent and the suicide death of a parent	Some participants recruited via advertising which could lead to response bias. Very small sample of suicide-bereaved which will not be generalisable
Reed and Greenwald, 1991 [43]	United States	Cross-sectional study	N = 85 suicide-bereaved relatives and spouses	N = 96 accident-bereaved relatives and spouses	Measure for somatic complaints with 6-items	No significant differences in somatic complaints between the two groups	Use of unvalidated measures throughout the study
Xu and Li, 2014 [23]	China	Cross-sectional study	N = 92 immediate family members (parents, siblings, children, spouses) bereaved by suicide	N = 64 immediate family members (parents, siblings, children, spouses) bereaved by accidental death	The Symptom Checklist-90-Revised (SCL-90-R) has nine subscales, including somatisation	No significant differences were found on the score of somatisation between the suicide-bereaved group and the accidental death group	May not be generalisable to wider bereaved group as findings may be culturally specific
Bolton et al., 2013 [19]	Manitoba, Canada	Longitudinal case-control study	N = 1415 parents of children that died by suicide	N = 1132 parents of children who died in an motor vehicle crash N = 1415 non-bereaved parents	Physical health disorders based on ICD 9 and 10 codes Outpatient physician visits for physical health and hospitalisation for physical illnesses	Two years pre and post-death, suicide-bereaved parents had significantly higher rates of CVD COPD, hypertension, diabetes, and outpatient physician visits for physical illnesses compared to motor-vehicle bereaved parents	Prevalence of physical disorders were examined two years pre-death and two years post-death. This time may not be sufficient for the development of certain physical health problems
Harwood et al., 2002 [40]	England	Case-control study	N = 46 adults bereaved by the suicide of an older adult	N = 46 adults bereaved by the natural death of an older adult	Grief Experiences Questionnaire (GEQ): somatic reactions subscale	No significant difference on somatic reactions for suicide-bereaved and naturally-bereaved	Small sample size may have increased the risk of type II error
Huang et al., 2013 [20]	Sweden	Nested case-control study	N = 792 parents bereaved by the suicide of a child	N = 1451 bereaved by non-self-inflicted death of child N = 1066 bereaved by cancer of child N = 2814 bereaved by non-cancer death of child	Pancreatic cancer, identified by the Swedish Cancer Register	It appears that suicide-bereaved have a higher risk of cancer but this finding is not statistically significant when compared with non-suicide bereaved	Unmeasured potential confounders for pancreatic cancer, including smoking and BMI could not be controlled for.