Abstract:

Suicide exposure refers to exposure to others’ suicidal behaviors. Suicide exposure can cause psychological trauma to suicide bereaved, first responders to suicide incidents, and mental health professionals who previously served the deceased. t may also worsen symptoms in individuals with pre-existing mental disorders or suicide risk, and increase the likelihood of suicide contagion among adolescents and young adults. Thus, it is essential for professionals and researchers to identify vulnerable individuals following exposure, provide appropriate postvention support, and prevent further contagion. Nevertheless, researchers in China’s mainland have given insufficient attention to suicide exposure and postvention. This paper reviewed existing research on the definition and classification of suicide exposure, summarized vulnerable populations and their negative psychological responses along with potential mechanisms, and examined postvention approaches, guidelines, and their effectiveness, limitations.

In this review, suicide exposure was redefined as “being exposed to suicidal behaviors (including both completed suicide and attempted suicide) of a real or virtual person, while having awareness of basic information such as who, when and where, the method and outcome of suicide”. Meanwhile, suicide affected individual refers to people who experiences short- or long-term psychological distress as a result of suicide exposure. The types of suicide exposure include direct versus indirect exposure, exposure to completed suicide versus attempted suicide, exposure to suicide by close versus non-close others, and real-world versus virtual exposure. Four groups are particularly vulnerable to suicide exposure: suicide bereaved individuals face complex challenges in meaning-making and responsibility attribution, with core experiences of guilt, self-blame, blaming others, and feelings of being blamed; adolescents and young adults are highly susceptible to peer suicidal behaviors, particular attention should be given to multiple suicide exposure in their social networks and social media; individuals with pre-existing mental disorders or suicide risk may respond pathologically to suicide exposure, which may worsen clinical symptoms and prompt a reassessment of suicidal intentions based on others’ suicide outcomes, affecting their suicide decision-making; for those exposed occupationally, direct exposure can cause psychological trauma and negatively impact both their professional competence and overall workforce stability.

We found that studies on impact mechanisms primarily focused on trauma/grief maintenance among suicide bereaved individuals and suicide contagion mechanisms. Core experiences of suicide bereaved individuals (guilt and blame), along with shame and perceived stigma, showed significant positive correlations with Prolonged Grief Disorder, PTSD, depression, and suicidal ideation. Several theoretical frameworks have been applied to explain suicide contagion: the Contagion model, Symbolic Interactionist Theory (SIT), Social Cognitive Theory (SCT), the Interpersonal Theory of Suicide (IPTS), and the Integrated Motivational-Volitional Model (IMV). Both SIT and SCT emphasized the critical role of “identification”. For instance, individuals with mentalization deficits may fail to differentiate their own psychological states from those of others, resulting in pathological or projective identification with the suicidal individual. This can trigger intense emotional reactions or imitative suicidal behavior. Furthermore, suicide exposure can increase the accessibility of suicidal ideation, acquired capability, and suicidal imagery.

A substantial body of postvention research focused on individuals bereaved by suicide. Common approaches include peer support groups, CBT-based groups, community-led initiatives, and online resource provision. The most effective mechanism of these interventions lies in facilitating supportive connections for individuals bereaved by suicide, allowing them to experience a sense of understanding and belonging within an empathetic community. Nevertheless, current approaches showed limited sustainability in maintaining long-term therapeutic benefits. For broader exposed populations, some Suicide Postvention Guidelines and Suicide Cluster Response Frameworks have been developed based on crisis intervention models and expert consensus. These guidelines generally recommend adopting the Public Health Model, implementing tiered interventions according to individuals’ level of impact: universal strategies such as social support and psychoeducation for all affected individuals; selective strategies including counseling, peer support, and mutual aid groups for those mildly impacted; and indicated strategies such as psychiatric treatment or psychotherapy referrals for those experiencing significant distress and/or mental disorders. Despite their clinical utility and practical relevance, these guidelines face numerous implementation barriers and lack sufficient evidence regarding their effectiveness.

Overall, suicide exposure research focused predominantly on suicide bereaved individuals and lacks robust classification systems and risk prediction models for broader affected populations. Previous discussions of suicide contagion mechanisms relied heavily on theoretical inference with limited high-quality empirical evidence. Similarly, postvention efforts primarily targeted suicide bereaved individuals, focusing on interpersonal support and psychoeducational approaches. Professional evidence-based postventions delivered by mental health practitioners remain scarce, and postventions for non-bereaved suicide exposed individuals are largely overlooked. Future research should prioritize non-bereaved suicide exposed individuals and update existing survey instruments and methodologies. Interdisciplinary approaches—such as qualitative studies, longitudinal designs, and big data analytics enhanced by artificial intelligence—are needed to investigate psychological reactions and trajectories following exposure. Additionally, theoretical research on suicide contagion mechanisms requires strengthening, along with developing classification criteria and risk prediction models for vulnerable subgroups. It is also critical to design tailored postvention strategies for different exposure profiles. These advancements will not only enrich postvention research but also improve clinical practices in contagion prevention, ultimately helping the public and relevant stakeholders understand and respond to suicide incidents more effectively.

Key words: suicide exposure, suicide bereaved, negative impacts, suicide contagion, suicide postvention