Grief as a relational process

Grief is not only an individual reaction to loss but a relational process embedded within social systems—most notably, the family [12]. The death of a family member affects the familial system, altering roles, responsibilities, communication patterns, and relationships. Gilbert [13], adopting a social constructionist perspective on grief, conceptualizes the family as a central “arena” of bereavement. She argues that although family members may share “the same loss,” they often do not experience “the same grief” due to differences in their relationships with the deceased, emotional expression, and coping strategies. This phenomenon, which she terms differential grief, can contribute to misunderstanding and emotional disconnection among family members.

Building on this perspective, Hayslip and Page [14], drawing from family psychology and systems theory, adopt a family systems framework that emphasizes the concept of multileveled embeddedness—the idea that grief unfolds within and across interrelated systems, including the family unit, broader social networks, and cultural or institutional contexts. From this view, families are dynamic systems whose communication patterns, roles and responsibilities (e.g., caregiving for relatives, raising children), intergenerational composition, and the specific circumstances of the death shape the grieving process. This framework underscores the crucial role of the family in how grief is expressed, processed, and supported across relational and societal contexts.

This relational lens is echoed in the revised Dual Process Model of coping with bereavement (DPM-R), proposed by Stroebe and Schut [15], which bridges individual-level and relational models of coping. The original model (DPM) [16] conceptualizes coping as an oscillation between loss-oriented processes, such as confronting the reality of the death and engaging in grief work, and restoration-oriented processes involving adaptation, role adjustment, and reestablishing everyday continuity [16,17]. In its revised form [15], the DPM-R incorporates both intra- and interpersonal dimensions within the family context. Stroebe and Schut emphasize that coping unfolds not only within individuals but also through the relational dynamics of the family. Coping, in this framework, is not merely “the sum” [15] of individual responses, but an emergent, interdependent process.

This shift toward relational understandings of bereavement is further advanced by Breen and colleagues [12], whose work is situated at the intersection of psychosocial bereavement research and public health, reflecting a transdisciplinary approach to grief in the family context. They argue that grief is “a family affair,” offering a research- and practice-oriented critique of individualistic paradigms in bereavement theory and research. The authors advocate for centering families in bereavement research and call for a conceptual integration of grief theory with family systems theory to better account for the relational and systemic nature of loss. Importantly, they argue that this perspective should inform not only research but also formal bereavement care, suggesting that family-oriented approaches may support adaptation and reduce adverse outcomes by addressing both individual and collective needs.

Social support and family bereavement

Although not conceptually foregrounded in these frameworks, social support is implicitly embedded in the relational dynamics they describe. Existing literature widely recognizes social support as a protective factor in bereavement, associated with reduced grief-related distress and improved emotional adjustment [18,19]. Conceptually, social support is a multifaceted phenomenon embedded in and exchanged through interpersonal relationships across families, partnerships, friendships, and communities [20,21]. Shumaker and Brownell [20] broadly define it as a set of resources that serve both health-sustaining and health-compensating (i.e., stress-related) functions. Such support may foster affiliation, connection, and a sense of security [20] and is commonly classified into emotional, instrumental, informational, and appraisal dimensions [22].

Empirical research suggests that social support in bereavement may operate through both a main effect—enhancing overall well-being [23]—and a stress-buffering effect—mitigating the psychological impact of grief-related stressors [19]. While professional or community-based support may be available, bereaved individuals most often rely on informal networks, particularly family, for emotional and practical support [24]. However, the extent to which this support is experienced as helpful varies widely and depends on how well it aligns with the bereaved person’s needs—particularly in terms of its timing, amount, function, and the relationships involved [25]. Emotional support, characterized by compassion and presence, is often perceived as most helpful [18]. When such support is absent or misaligned with the bereaved person’s needs, it can intensify grief-related distress [25]. Moreover, family relationships and dynamics themselves are affected by the loss, and support may be complicated by differing grief responses [15] or by interpersonal strain, which is often reported in the context of traumatic grief, such as suicide loss [18]. Thus, the family represents not only a key context in which grief is experienced, but also an important—yet complex and sometimes vulnerable—source of social support, especially in suicide bereavement, which is marked by distinct characteristics that can further challenge family relationships and the provision of support.

Impact of suicide loss on families

Suicide bereavement is marked by unique emotional and relational challenges that differentiate it from other forms of loss. Jordan [26] identifies three dimensions in which these differences are most apparent: the thematic content of the grief, the social dynamics surrounding the bereaved, and the impact on family systems. SLS often face significant challenges in making sense of the circumstances surrounding the death, a process that can be accompanied by intense feelings of guilt, self-blame, anger, and abandonment [26]. These reactions are often compounded by the stigma that continues to surround suicide, which manifests in public perceptions of bereaved families as neglectful, dysfunctional, or responsible for the death [27,28]. SLS frequently perceive their communities as avoidant or judgmental, contributing to feelings of rejection, isolation, and social exclusion [29–31]. This public stigma is often internalized by SLS as self-stigma, reinforcing shame and social withdrawal in suicide bereavement [28,32]. Together, public and self-stigma pose significant barriers to self-disclosure, help-seeking, and access to social support— both within families and in the broader community [28,32,33]. As Jordan [26] notes, these challenges are often compounded by the emotional toll and mental health struggles of family members, along with communication barriers that can further strain familial relationships and hinder adaptive coping.

The third dimension, the impact on the family unit, remains relatively underexplored in the empirical literature. Jordan and colleagues [34] provided one of the earlier efforts to conceptualize how sudden and traumatic deaths can disrupt intra-family processes, highlighting patterns such as impaired communication and emotional withdrawal, especially in families where grief is not acknowledged or openly discussed. Their work, while based primarily on clinical observation and preliminary research, contributed foundational insights into systemic family responses to such losses. Building on this, a literature review by Cerel et al. [35] identified patterns of blame, secrecy, and emotional withdrawal that can emerge following a suicide, straining communication within bereaved families and social networks. More recent qualitative work by Creuzé et al. [36] expands this understanding, with participants describing suicide loss as “an extremely violent and traumatic event that shakes the family to the core.” Their findings revealed dynamics of taboo, inhibited emotional expression, and interpersonal conflict that can disrupt communication and erode family cohesion.

These experiences have important implications for both social support provision and mental health outcomes. Research indicates that SLS frequently report unmet support needs [37–39], which have been associated with greater psychosocial distress and an increased risk of suicidality [38]. Inadequate social support can deprive individuals of essential coping resources [18] and is linked to heightened psychosocial distress and mental health risks among SLS, including symptoms of suicidality and depression [38,40]. Levi-Belz and colleagues found that interpersonal factors such as thwarted belongingness are predictive of heightened suicidal ideation and complicated grief [41,42]. Conversely, secure attachment, through mechanisms such as self-disclosure and perceived social support, can foster posttraumatic growth among SLS [43], underscoring the value of social connectedness and relational security.

Research gaps and rationale

While research has shown that suicide loss profoundly impacts emotional and relational processes within families, there remains limited understanding of how family support is experienced. To date, no studies have explored in depth how family members support one another following the suicide of a family member. Existing literature has largely focused on individual psychological outcomes associated with perceived social support and on general support needs, with relatively little attention to the relational mechanisms that facilitate or hinder support within familial systems. This gap underscores the need for qualitative research that examines the lived experience of family support in suicide bereavement.

Study aim and contribution

The present study addresses these gaps by exploring how individuals bereaved by the suicide of a family member experience support within their families. Specifically, it investigates the characteristics and determinants of perceived family support.

In conducting this study, we did not impose an a priori definition of ‘family.’ Instead, we allowed participants to define for themselves what family meant in the context of their bereavement. This approach aligns with Breen and colleagues’ [12] conceptualization of family as “a web of relationships [...] that is individually experienced; may have legal, biological, and/or relational bases; and exists within social, temporal, and cultural contexts.” Such a perspective recognizes that family is not a uniform construct, but a system shaped by personal meaning and sociocultural context. Nevertheless, to ensure analytic focus on intra-family support dynamics, we applied an operational boundary: participants included in this analysis had experienced the suicide of someone with whom they shared a familial context—understood as a connection that they themselves identified as part of their family system.

This exploration contributes new insights to inform postvention strategies that strengthen familial support systems and foster both personal and relational coping after suicide loss.

Ethics statement

The study was approved by the Ethics Commission at Ulm University (application number: 374/18) and conducted in accordance with the Declaration of Helsinki. Participants were informed about the study’s aims, procedures, and potential risks during a preliminary educational phone call and via written materials. All participants provided written informed consent prior to participation and data processing. Participants also received information on available mental health and bereavement support services.

Study design and setting

This study is part of DE-LOSS, a mixed-methods project conducted in Germany between 2021 and 2024 that investigates experiences and determinants of social support following suicide loss. As part of this project, we employed a qualitative interview design to explore subjective perceptions, meanings, and the interpersonal and social dynamics of social support following suicide loss. The present analysis focuses specifically on how SLS experience support within their families following the suicide of a shared family member. To ensure methodological transparency and rigor, we adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) [44].

Recruitment and sample selection

The recruitment period for this study was from 17/01/2022–31/03/2022. Participants were recruited via multiple channels, including newspaper advertisements in southern Germany and outreach to national SLS support groups. These advertisements outlined the study’s purpose, procedures, compensation, and contact details. A total of 106 individuals expressed interest by contacting the research team via telephone, email, or an online form. Interested individuals then participated in telephone screenings conducted by an experienced qualitative researcher (FM) to confirm eligibility and clarify the study process. These conversations also served to address any concerns and ensure informed participation.

Eligibility criteria were as follows: (1) age 18 or older, to ensure legal capacity to consent; (2) fluency in German, to enable in-depth qualitative interviewing and ensure data quality by supporting participant comfort and nuanced self-expression; (3) the suicide loss of someone significant to them, defined as ‘someone important to you and your life,’ to allow for inclusive and participant-driven definitions of relational closeness; (4) age 14 or older at the time of the loss, as the study focused on adult and late adolescent experiences of social support; and (5) a minimum self-rated emotional distress score of 3 on a 5-point scale (1 = not at all; 5 = extremely), to include individuals who perceived themselves as emotionally impacted by the loss, affected by grief, and potentially in need of support.

A purposive sampling strategy was initially used to ensure diversity across participant characteristics such as gender, age, relationship to the deceased, and use of formal support services. We aimed for a sample size of 20 participants, which was deemed methodologically appropriate and practically feasible, based on prior experience with qualitative research on emotionally complex and deeply personal topics. Participants who did not take part in an interview were pre-registered for a follow-up online survey conducted within the broader DE-LOSS project.

Of the 20 interviews conducted, five were excluded from this analysis. Based on the study’s focus on intra-family support dynamics, we included only participants who had experienced the suicide of someone with whom they shared a familial context. Three interviews were excluded on this basis, as they involved losses of a partner or close friend whose death was not experienced as part of a shared family dynamic—for example, a 23-year-old participant who had lost his partner, with whom his family had minimal contact. Additionally, two interviews involving assisted suicide were excluded due to the distinct contextual considerations associated with those cases [45]. The excluded interviews informed related publications within the DE-LOSS project, addressing non-familial social support [29] and the experiences of individuals involved in assisted suicide [46]. These exclusions were made during data analysis, as the specific thematic focus on intra-family support emerged inductively rather than being predetermined. Accordingly, the final analytic sample of 15 participants represents a thematically relevant subsample of the purposively recruited group. No additional interviews were conducted, because data collection for the qualitative sub-study had already concluded. The final sample size remains in line with prior qualitative studies on suicide bereavement (e.g., [36]) and was sufficient to explore a diverse range of perspectives within the study’s defined scope.

Sample

The final sample comprised 15 participants (self-reported gender: 9 female, 6 male) who had experienced the suicide of a family member. All participants described the bereavement context analyzed here as embedded within a family of origin and/or legally recognized kinship system. Participants ranged in age from 23 to 64 years (M = 47.13, Md = 48), and their average age at the time of loss was 39.35 years (range: 14–63; Md = 42). The deceased comprised four parents, three siblings, five children, two spouses, and one grandparent. One participant reported multiple familial suicide losses (uncle, godfather, and father). The mean age of the deceased was 44.12 years (range: 15–83; Md = 43). Table 1 provides a summary of participant demographics and loss-related characteristics.

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Table 1. Participant demographics and loss-related characteristics.

https://doi.org/10.1371/journal.pone.0334964.t001

Data collection

All participants completed a brief demographic questionnaire assessing age, gender, religious belief, migration background, education, employment, living situation, and suicide loss characteristics. Interview data were collected using a semi-structured, problem-centered interview format [47]. This approach ensured alignment with the study’s core themes while allowing flexibility to explore personally meaningful or unforeseen topics. The interview guide was developed through a comprehensive literature review on experiences of suicide bereavement and social support theory, and refined in consultation with academic peers and a participatory advisory board of SLS and postvention experts. This collaborative process ensured both scientific validity and relevance to lived experience.

The guide covered themes such as perceived social support and responses from both close and extended social networks, as well as unmet support needs. Each theme was introduced with narrative-generating prompts (e.g., “Can you tell me about...”), followed by optional follow-up questions to enhance depth and nuance. An overview of the interview guide, including theme summaries and narrative prompts, is provided in S1 Table (found in the Supporting information).

Interviews were conducted between 01/03/2022 and 04/05/2022 via secure online video conferencing due to COVID-19 restrictions. Written informed consent was obtained in advance and reconfirmed verbally before starting the audio recording. Interviews lasted between 48 and 93 minutes and were audio-recorded in full. Participants received €30 compensation and were provided with information about relevant psychosocial support services. Brief rapport-building and debriefing sessions were conducted before and after each interview. Participants were free to skip questions, pause, or end the session at any point, though none chose to do so. At the conclusion, participants were invited to share any final thoughts and reminded that they could contact the research team with any further reflections or concerns.

Data analysis

Audio recordings were transcribed and pseudonymized, with identifying details such as names and locations removed. Data were analyzed using Kuckartz and Rädiker’s [48] Qualitative Content Analysis, a systematic, multi-step approach that combines deductive and inductive coding. The coding system was developed collaboratively through a discursive-communicative process to ensure coding quality and validate interpretation. All analyses were conducted using MAXQDA 2022, a software tool for qualitative data analysis.

First, the research team (FM, NO) conducted an initial exploration of the data, reading transcripts to familiarize themselves with the material and reflect on potential biases. FM documented reflexive memos throughout the study to examine assumptions, preconceptions, and the influence of the interviewer’s position. These reflections were discussed within the research team and the participatory advisory board to enhance analytic transparency and strengthen the interpersonal validity of interpretations.

FM compiled individual case summaries, noting key themes for further analysis. An initial coding system was developed by FM based on the interview guide and thematic observations, with clearly defined category and code descriptions. The coding system was structured hierarchically, with each category comprising multiple codes, which were later refined into subcodes. NO reviewed the system for clarity and accuracy. FM then applied the initial coding system across all transcripts. To ensure consistency, NO conducted structured reliability checks by reviewing multiple segments within each code. The number of segments reviewed varied according to the volume of material assigned to each code, ensuring representation across both high-frequency and low-frequency codes.

In the second phase, the team conducted cross-case analysis, applying primarily inductive subcoding within each main category. FM and NO independently refined segments of the data and jointly reviewed emerging subcodes to resolve discrepancies and ensure shared interpretation. FM further consolidated the coding structure by merging or clarifying overlapping subcodes, using concept maps to visualize thematic relationships. All refinements were documented in code memos, including definitions and illustrative text excerpts. The finalized coding system was reviewed in a qualitative research workshop with academic colleagues for additional feedback. No further changes were required. FM then applied the final system across the full dataset.

The final phase involved in-depth analysis of key categories, guided by analytic questions derived from the study’s central research aims. FM compiled and interpreted text passages from each category, and emerging findings were reviewed in research team meetings and validation workshops with colleagues and the participatory advisory board. These discussions informed interpretation, clarified conceptual distinctions, and supported refinement of both structural and textual presentation of results.

This manuscript presents findings from one category of the coding system—family support—which comprises 199 coded segments and emerged as a conceptually rich domain warranting in-depth analysis. Within this category, five codes were identified and further refined into 18 subcodes. These codes were grouped into two overarching themes that served to organize the material conceptually (see Table 2). In the following sections, each theme is presented with illustrative quotes drawn from participant interviews. All participant quotes are identified by their assigned code, followed by gender, age at the time of interview, and the deceased’s relationship to the participant (e.g., P01/ female, 38, grandfather).

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Table 2. Coding system for the category of family support.

https://doi.org/10.1371/journal.pone.0334964.t002

Original quotes were translated from German to English by the research team through an iterative, collaborative process involving multiple rounds of translation, rephrasing, and refinement to preserve semantic accuracy and ensure the intended meaning was conveyed in the English context.

Contextual factors of family support

This theme explores the broader emotional and relational contexts that shaped the availability and quality of family support after a suicide loss. Participants described how family members’ grief reactions, changes in relationships, and the division of support roles and resources within the family influenced whether support was perceived as helpful or insufficient.

Characteristics of family support

This theme explores participants’ experiences of both supportive and unsupportive interactions within their families following the suicide. While many described meaningful emotional support and mutual care, others recounted experiences of disappointment, unmet needs, or relational strain.

Facilitators of supportive family processes

Family cohesion emerged as a crucial factor in sustaining support, fostering stability and shared grieving. Participants described physical closeness and maintaining everyday routines as ways to promote emotional connection and mutual responsiveness. These findings align with studies conducted in France by Creuzé et al. [36] and in the United Kingdom by Pitman et al. [38], which highlight how “the family itself” [36] can serve as both an active and latent source of support—the latter providing reassurance that support remains available even when not actively sought. Building on Levi-Belz’s [49] work in Israel on perceived belonging and posttraumatic growth, our findings suggest that family cohesion fosters inclusive environments that facilitate equitable access to emotional support within families.

Open discussions about guilt and responsibility helped SLS alleviate these emotions and foster cohesion through shared experiences. This aligns with Shumaker and Brownell’s [20] conceptualization of social support, which emphasizes self-disclosure and active listening as key relational processes in creating a supportive environment. Eisma et al. [50] similarly describe emotional expression as an “adaptive counterpart” to suppression, facilitating cognitive processing in bereavement. Furthermore, research has identified self-disclosure in suicide bereavement as a protective factor against complicated grief [42,51] and a facilitator of personal and posttraumatic growth [43,52], referring to positive psychological changes following the loss.

Another key finding was the importance of shared reflections on the circumstances of the death in helping families develop a more self-compassionate and destigmatized understanding of the suicide. In line with research by Jordan [2], participants described how discussing the deceased’s mental health history and personal challenges helped reframe the suicide as a complex outcome, rather than a failure of the family to prevent it. This finding reflects the broader role of meaning reconstruction in grief, aligning with the constructivist grief framework proposed by Gillies and Neimeyer [53], which identifies sense-making as a crucial coping mechanism in traumatic losses. Prior studies have shown that sense-making enables SLS to construct a narrative that is both personally “bearable” [2] and “socially acceptable” [54], thereby reducing suicide-related stigma. Castelli-Dransart [54], in a Swiss study, found that SLS who reject reductive or moralizing interpretations of suicide often come to understand their loss in ways that support personal growth and reengagement with life. Our findings echo this process, as participants who engaged in collective sense-making by considering systemic explanations reported not only gaining acceptance and relief from self-blame but also experiencing improved emotional connection within the family. Supporting this, U.S.-based studies by Currier et al. [55] and Rozalski et al. [56] identify sense-making as a key protective factor in bereavement after violent deaths, including suicide, mediating the impact of such losses on complicated grief symptomatology.

Barriers and gaps in family support

A central challenge to mutual family support was differences in grieving and coping styles. Participants who preferred to express their grief verbally often felt emotionally distant from family members who adopted more inward-oriented coping or avoidant strategies. The absence of shared or complementary coping styles within families frequently led to a perceived lack of support. These dynamics may reflect a normative bias toward verbal expressions of grief, as participants often perceived inward-oriented coping as problematic, and more reserved family members as avoidant. This finding echoes Gilbert’s [13] concept of differential grief, which emphasizes that differences in grieving styles can lead to misunderstanding and strain within families. Similarly, Breen and O’Connor [57], in an Australian study, found that disparities in emotional expression and memory-sharing may contribute to familial tension and estrangement following sudden loss.

Parental coping strategies significantly shaped family support dynamics. Parents often adopted protective buffering [58], a coping strategy in which individuals conceal their emotions in order to shield others from distress. This approach inhibited open dialogue and limited mutual support. Parents frequently described the tension of grieving their own loss while maintaining emotional availability and protection for their children, often feeling unequipped to assess and meet their children’s needs. As one mother shared, without external support, tending to her own needs while caring for her children felt nearly impossible. These findings align with Wray et al.’s [59] systematic review, which highlights that while caregiving can provide meaning, it often limits parents’ capacity to process their own grief. Paradoxically, protective buffering may ultimately increase distress for both the individual employing this strategy and those they seek to protect [15,59,60]. Alvis et al. [61] found that avoidant parental coping correlates with maladaptive grief in bereaved children and adolescents, suggesting that such behaviors may be modeled and internalized through social learning. This risk may be particularly pronounced in suicide bereavement, where stigma [30] and cultural taboos [62] further discourage open discussions about the loss.

Family support was also shaped by pre-existing relational dynamics. Some participants described how emotional distance and communication barriers persisted or intensified after the loss, aligning with Hayslip and Page’s [14] family systems approach, which emphasizes that pre-existing relational patterns persist in family grief dynamics. Research suggests that family communication styles, such as conversation-orientation versus conformity-orientation [63], play an important role in how families adapt to the death of a family member [14]. In our study, adolescents and young adults (aged 14–21 at the time of their loss) were especially affected by parental distance, which contributed to feelings of abandonment and self-blame. These findings echo Alvis et al.’s work [61,64], which highlights how parental grief expression and communication styles shape key caregiving “domains,” such as protection, reciprocity, and guided learning, that influence adolescent bereavement outcomes [64]. Without developmentally appropriate bereavement support, young people may become particularly susceptible to shame, maladaptive coping, and adverse mental health outcomes [65,66]. This risk may be amplified in suicide bereavement, where grief is compounded by “circumstance-related distress” [66].

Tensions around suicide disclosure further restricted mutual support. Participants who sought open acknowledgment of the suicide—within or beyond the family—expressed frustration with family members who avoided or appeared to deny the suicide. These dynamics contributed to relational strain and emotional distancing. Similarly, Azorina et al., in a UK-based study, describe how suicide can become “the elephant in the room” [67]—an unspoken subject that nonetheless shapes family interactions. Conflicting perspectives on disclosure underscore how the context of a loss—including its personal impact and the meanings attributed to it—shapes family bereavement [14]. As reflected in participants’ accounts and supported by previous research, non-disclosure may be rooted in suicide-related stigma, including shame, fear of judgment, and cultural or religious beliefs [28,67–69]. Although silence and non-disclosure can serve as protective coping strategies, they may also compound isolation and hinder access to social support networks [30,32].

The role of extended family

Our study highlights the critical role of extended family members in providing both emotional and practical support, particularly in the immediate aftermath of suicide loss. One key mechanism that emerged is what we term the proxy support effect, whereby extended family members’ support for children also indirectly supports parents. By assuming caregiving responsibilities and engaging children in shared activities, relatives provided parents with time and emotional space for personal grief work [16]. This support also helped alleviate parental concerns about the emotional burden their grief might place on their children. These findings align with Walsh’s family resilience framework [70], which conceptualizes resilience as a systemic, relational process rather than an individual one. In line with this framework, our study reinforces the stabilizing and supportive role of “cooperative parenting/caregiving teams” [70]—often embodied by extended family members.

While extended family networks can provide a valuable combination of practical assistance and emotional support in the intimate home environment [59,70], some participants reported unmet expectations or disappointment with the level of proactive engagement received from relatives. Additionally, our findings reveal stigma-related barriers within these extended family networks. In some cases, moralizing responses to the suicide or judgmental remarks about the deceased led SLS to sever ties with extended family members. This highlights that stigma in suicide bereavement extends beyond direct blame toward the bereaved to include vicarious stigma [71]—distress experienced when others express negative attitudes toward the deceased. When others respond with blame toward the deceased rather than empathy toward the bereaved, SLS may feel their grief is invalidated—a phenomenon known as disenfranchised grief [72], in which grief is not sufficiently acknowledged or validated by one’s social environment.

Limitations

While this study offers new insights into family support after suicide bereavement, several methodological and interpretive limitations merit consideration. As is typical in qualitative research, the sample was non-representative and not designed to support statistical generalization. Rather, the aim was to explore diverse, in-depth perspectives on family support in the context of suicide bereavement. Although 20 interviews were originally conducted, five were excluded from the present analysis based on an inductively developed focus on intra-family support. While the final sample of 15 participants aligns with qualitative standards and provides a broad range of insights, this post hoc narrowing may have reduced the diversity of perspectives represented in this particular analysis.

The recruitment strategy, which utilized support groups and public calls, may have engaged individuals more comfortable articulating their personal bereavement experience, potentially due to their access to both formal and informal support. In contrast, those experiencing greater distress, stigma, or social withdrawal may have been less likely to participate. As a result, the sample may underrepresent experiences marked by relational distance, conflict, or disenfranchised grief—both within and beyond the family system. In addition, the sample was geographically and demographically specific, consisting predominantly of highly educated, non-migrant participants from Germany. These factors limit the transferability of findings to other sociocultural contexts. Future research should aim to include SLS from culturally marginalized and structurally underrepresented groups to explore the diversity of familial grief and support experiences across cultures and social classes.

Because we interviewed individuals rather than family units, the study focused on personal narratives. As a result, family dynamics, such as conflicting perceptions or misunderstandings, may have remained partially obscured. For instance, while participants often described avoidance and non-disclosure in others, they rarely framed their own behaviors as avoidant, perhaps due to social desirability, limited self-awareness, or sample bias. Future studies could employ dyadic or family interviews to triangulate perspectives, offering insight into how family coping and support are interactively constructed and experienced.

This analysis drew from a broader qualitative interview study that explored social support in suicide bereavement across multiple relational and cultural domains, including family, friends, and extended networks. While this broad scope allowed a wide range of themes to emerge, it may have limited deeper analytic focus on the specific determinants and mechanisms of family support. A more narrowly focused, theory-driven approach could yield greater specificity regarding family coping and support processes. At the same time, the inductive emergence of family themes across diverse, exploratively generated narratives may underscore their centrality in suicide bereavement.

Although gender emerged as a salient factor—particularly in caregiving, emotional expression, and support provision—the study was not designed to systematically examine gender-specific experiences of family support. Future research would benefit from applying gender-sensitive frameworks to explore how roles and expectations shape suicide bereavement and support across generations and cultural contexts.

Finally, as interviews were conducted in German and translated into English for publication, some linguistic nuances may have been lost, despite the research team’s bilingual fluency. This limitation applies particularly to idiomatic and regionally specific language, which may not translate directly or fully.

These limitations reflect opportunities for future inquiry—especially through research designs that are systemic, culturally inclusive, and theory-generative.

Toward an integrative framework for family support in suicide bereavement

Situated within existing theoretical and empirical research, our findings highlight that family support in suicide bereavement is not a static resource but a dynamic process shaped by personal, relational, systemic, and sociocultural factors. At the personal level, differential grief contributed to emotional distance, whereas self-disclosure fostered connection. Relationally, family cohesion facilitated supportive interactions, while protective buffering, emotional distance, and parental disengagement reinforced silence and isolation. Systemically, caregiving responsibilities provided stability but also imposed emotional constraints, especially for grieving parents. Extended family offered practical and emotional support, though its impact depended on attitudes toward suicide and levels of proactive engagement. At the sociocultural level, suicide stigma influenced disclosure and open communication, whereas shared sense-making emerged as a counterweight, enabling families to challenge internalized stigma.

These findings underscore the need for multilevel, integrative frameworks that situate grief and support within family systems and broader sociocultural contexts. This aligns with Breen and colleagues’ [12] call to bridge family systems theory and grief models to better capture the complexity of bereavement within relational environments. Building on this, we propose advancing a conceptual approach that integrates systemic and relational grief models, social support theory, and stigma frameworks. The following section outlines theoretical approaches that may be useful to integrate or expand upon to more fully reflect the interdependent nature of support in suicide-bereaved families. Advancing theory in this area is essential for identifying support barriers, understanding bereavement determinants, and informing effective, family-centered interventions for SLS.

Grief models such as the DPM-R [15] and Hayslip and Page’s family systems framework [14] underscore the interdependent nature of grief within families, acknowledging how coping styles, communication patterns, generational roles, and demographic factors influence how bereavement is experienced. Complementary theoretical approaches to social support—drawing on relational sociology [73], symbolic interactionism [74], network theory [21], and communication theory [75]—offer lenses for examining how support is constructed, interpreted, and sustained within families. These perspectives move beyond transactional models of social support to account for the social embeddedness, communicative, and subjective dimensions of support, making them especially relevant for understanding how family members interpret and respond to each other’s grief after suicide loss.

Suicide bereavement is further shaped by cultural narratives and the stigma of suicide. Research shows that both public and internalized stigma contribute to psychological distress and can limit access to support [32,52,76,77]. Our findings underscore the family as a key context in which stigma is confronted and managed, shaping how grief is experienced, expressed, and supported. Corrigan, Sheehan, and colleagues [27,28] have developed the most structured conceptualization of family stigma in this context, combining social-cognitive theory with empirical research on lived experience. Building on their work, future research should refine the concept of family stigma in suicide bereavement to encompass not only sociocultural but also interpersonal and systemic dimensions. This includes exploring how stigma, silence, and shame manifest across generations, are embedded in family roles and dynamics, and are shaped by shifting societal discourses around suicide and mental health.

Qualitative and reconstructive approaches like Constructivist Grounded Theory (CGT) [78] offer a strong methodological foundation for advancing theory in suicide bereavement research. While primarily inductive, CGT incorporates theoretical reasoning and iterative coding, allowing researchers to develop and refine conceptual frameworks grounded in participants’ lived experience. This is particularly important in the context of suicide loss, where relational and sociocultural influences are difficult to capture through standardized approaches. By exploring how SLS construct grief, support, and stigma within family and social systems, CGT helps bridge the gap between subjective experience and theoretical advancement.

A key contribution of this study is the finding that social support functions as a co-constructed, relational process within bereaved families. While often framed as a facilitator of coping [20] or a protective buffer against distress [79], our findings suggest that support is continuously shaped by individual grieving styles and interpersonal coping dynamics. Although earlier work, including that by Shumaker and Brownell [20], has acknowledged the bidirectionality between coping and social support, noting that it “interfaces with almost every coping strategy mentioned in the stress literature,” its theoretical integration into grief models remains underdeveloped. The DPM-R [15] provides a useful foundation for addressing this gap, describing an oscillation between loss- and restoration-oriented coping that reflects patterns observed in our data. While social support is implicitly embedded in the model, it is not explicitly theorized as a relevant mechanism within bereaved families. Our data illustrate that social support both shapes and is shaped by this oscillation, as family members navigate different forms of coping while also taking on varying support roles—providing, receiving, and often engaging in both simultaneously, thereby co-constructing support within the family. However, these interactions are not always complementary. Mismatched coping and support needs can lead to emotional disconnection or limit the perceived availability and quality of support. Stroebe and Schut acknowledge such tensions, noting that incompatibilities in coping may amplify grief-related distress [15], but the role of social support remains peripheral in their model. We argue that explicitly integrating social support into the DPM-R would enhance its conceptual and practical relevance—particularly for designing systemic, family-centered interventions that are responsive to the relational dynamics of bereavement, including but not limited to suicide loss.