Supporting the Mental Health of Adults Bereaved by Suicide: A Systematic Integrative Review of Protective Factors

OBJECTIVE: Suicide bereavement is associated with elevated risks of depression, posttraumatic stress disorder, prolonged grief disorder, and suicidality, yet evidence on protective factors remains fragmented. This systematic review aimed to synthesize protective processes associated with adaptation among suicide-bereaved adults. METHOD: Following PRISMA guidelines, a systematic search of PubMed, PsycINFO, Embase, Web of Science, and Scopus was conducted (Prospero registration number: CRD42024549348). Two independent reviewers screened the identified records, using identical procedures and criteria. Of 2,700 records screened through January 2026, 43 studies met inclusion criteria, including 4 longitudinal, 18 cross-sectional, and 21 qualitative studies. Findings were synthesized within a biopsychosocial framework. RESULTS: Fifteen protective factors were identified across biological/contextual, psychological/intrapersonal, and social/interpersonal domains. Interpersonal factors showed the most consistent protective associations: Higher perceived social support, belongingness, and self-disclosure were linked to lower depressive symptoms and fewer grief-related difficulties and, in some adjusted models, to lower suicidal ideation. Intrapersonal factors, including self-forgiveness, coping styles, and meaning-related processes, were also associated with better outcomes, although findings were more heterogeneous. Biological and contextual factors were less frequently examined. Qualitative evidence highlighted relationally safe support, disclosure, meaning-making, and continuing bonds as recurrent processes supporting adaptation. CONCLUSIONS: Protective processes after suicide loss appear to cluster around three interrelated functions: restoring social safety and belonging, reducing negative self-evaluative processes, and supporting narrative integration of the loss. These functions represent promising targets for postvention, although further longitudinal and mechanism-focused research is needed.