Objectives

Postvention aims at alleviating the aftereffects of trauma, especially in the survivors after a suicide (Shneidman 1968, quoted by Callahan 2000).
The curative or preventive efficiency of postventive actions was not yet demonstrated in support groups of bereaved people nor in colleges and high schools.

Methods

1, Evaluating the efficiency of survivors self-help support groups

As randomisation is not at hand, the following 22 questions ask what is felt to have changed, for instance one year after applying for a group and attending at least eight meetings.

The questions may be copied-pasted from this Page.
The interviewed will trace ++, + or nothing after each question.

How did you experience your evolution during the past months ?

• I can talk about it.
• I am less afraid of future.
• I am less ruminating the shock.
• I am less asking myself why.

• I am less afraid the blame is mine.
• I feel less depressed.
• I have agreed to consult a professional.
• I persevered taking the anti depressant medications, if prescribed.
• I am less tempted by alcohol, drugs, tranquillizers.
• I am no more planning to take my life.
• At home, there are no more firearms, drugs or material usable to kill oneself.

• I have changed my mind about what is important to me.
• I have learned to deal better with my problems.
• The meaning of life became clearer to me.
• Deep inside of me, I have grown up.

• I am less holding aloof.
• I am living more trustingly.
• Our couple escaped breaking off.
• I got rid of sick feeling when having happy times.
• I endeavour to make life pleasant around me.
• I am more caring and nice to others.
• I can help other bereaved persons.

Among the above mentioned evolutions, underline those for which
the most efficient help issued from your survivors group.

2, Evaluating the efficiency of postvention in schools

Randomising for postvention colleges and high schools stricken with suicides is possible, then interviewing the pupils one year after the suicides and eventually showing more depressions being diagnosed and well treated in pupils and in their families.

Most of the 22 questions are available. Specific other ones may be added:

• Were the pupils at risk identified?
• Were the pupils warned about what is found on suicide through the Internet?
• Were the journalists appropriately warned?
• For the pupils: due to the postvention, did your cohesion improve:
- a reduced interpersonal aggressiveness;
- being more able to discuss important topics;
- did a collective project start as a consequence of this suicide ?
• Were focus groups organised for other classes of the school?
• How did the personnel and pupils react to the question: In this school, is life pleasant?
• What answers to the 22 questions from the parents and siblings of the deceased, one year   after the suicide?

Discussion

1, Survivor groups

The self-help survivors groups were acknowledged as efficient by those who attended for over 15 years in Northern America and they are encouraged by scientific associations.
A more systematic evaluation is needed, but would not reply to the main objection of some professionals in the absence of whom these groups are meeting.

Regarding other criteria than suicides or attempts, questionnaires were built for evaluating post-traumatic distress or bereavement: the GEQ used by Callahan 200 and the HGRC built by Nancy Hogan 2001.
The post-traumatic distress (Freud 1917, Farberow 1967) is the priority after suicide (Sheskin 1976, Farberow 1987). The efficiency of debriefing was admitted by Joseph 1993, Kenardy 1996 and questioned by Deahl 1994, Raphael 1995. These evaluations focused exceedingly on psychiatric disturbances.

Even if the questionnaires related to trauma or bereavement (reviewed by Neimeyer and Hogan 2001) met the psychometric requirements,
their use for evaluating therapies seems questionable.

The medical concepts of constancy, specificity
and of the unequal value of symptoms for evaluating therapies are unknown to theses questionnaires.
Their items have an equal weight, are so numerous and are aggregated in such a way that the useful differences have few chances of significantly emerging.

At present time, demonstrating an efficiency is more needed than explaining a mechanism. Thus, the feeling of a failure of postvention expressed by Callahan 2000 may be temporary until new tools are used.

2, Schools