“Guardians of Memory”: Psychosocial Barriers to Mental Health Care for Mothers Bereaved by Suicide

1. Introduction

Suicide is the fourth leading cause of death among people aged 15–29 [1]. The death of a child or young person by suicide is one of the most traumatic and devastating experiences for the surviving family and friends [2,3]. Evidence suggests that suicide-exposed family members are more likely to have psychological, mental and physical health problems, including an increased risk of hospitalization for psychiatric care, relative to the general population. Related vulnerability [4,5,6], including depression, self-harm, suicide thoughts, and death by suicide, are more prevalent among partners and parents of the deceased [4,7].

Furthermore, those who have lost a loved one to suicide are 80% more likely to leave their job or their academic studies than those who have lost a loved one to sudden death from natural cause [6]. This illustrates the impact of suicide on the bereaved survivors at both educational and occupational level, severely affecting their functioning. Other data underline shame, rage, and existential challenges experienced by suicide-bereaved parents [8]. Additionally, quantitative research comparing scores on grieving dimensions has shown that suicide-bereaved parents report higher stigma scores than other bereaved parent groups [9].

Despite the enduring suffering, suicide-bereaved parents are more likely to receive less help from family and friends, and experience delays in receiving formal support than those who have lost a loved one to any other types of unexpected death [9,10,11]. Qualitative data from United Kingdom [12], Australia [13], and African-American communities [14], highlight that stigma is a major obstacle in seeking formal help and getting appropriate support during suicide bereavement. Pitman et al. [6] critically demonstrated cultural differences in how stigma is perceived following sudden deaths, with stigma and self-blame being linked to complicated grieving processes and ineffective recovery of the bereaved. Similarly, the support needs of suicide-bereaved parents may not be generic either, even within the same cultural community [6]. Thus, a deeper comprehension of how the death of a child or a young person by suicide has inflicted mothers’ needs and attitudes towards seeking help in particular may support interventions aimed at promoting effective gender-specific help-seeking, evidence-based person-centered care, and updating relevant mental health services.

At the same time, research has often overlooked mothers’ perspectives, grouping them together with fathers or with more general samples of “bereaved parents” [15]. Yet, mothers are frequently positioned as primary caregivers and held responsible for supporting the needs of the rest of the family, as well as maintaining family cohesion [16]. Subsequently, they may face heightened stigma, self-blame, and social judgment when a child dies by suicide, as well as unique pressures to support surviving family members [2]. Thus, their experiences, needs, and barriers to support deserve focused exploration.

The Republic of Cyprus (RC) is small Eastern Mediterranean country, characterized by a sociocultural setting shaped by deep family ties, an honor culture and religious traditions [17]. According to Christian Orthodox Christianity, which is the prevailing religion in the RC [17], suicide is frequently viewed as a moral and religious offence [18,19]. Thus, the stigma around suicide remains severe, frequently leading to silence and secrecy within families and communities [19]. Subsequently, suicide-bereaved individuals are most of the times reluctant to seek support to avoid further stigmatization [20], while access to specialized grieving services is also limited in the RC. As a result, informal family support network is the most common form of grieving support “service” in the RC [19].

These cultural and systemic issues strongly influence how suicide-bereaved mothers grieve and seek support [21], emphasizing the significance of assessing their needs in this particular socio-cultural context, as well as the dynamic between them and formal support services [22]. Nevertheless, most existing data are quantitative, providing a broad understanding of the impact of suicide on bereaved survivors but leaving key questions about mothers’ specific needs unexplored [23]. While there is an existing body of work [24,25,26,27], further research is still needed to explore exclusively bereaved mothers’ living experiences in diverge sociocultural contexts, especially in the Southern Europe and Eastern Mediterranean, such as the RC, where both gender- and stigma- related issues are culturally specific [28].

In particular, there are only limited studies on the needs of suicide-bereaved mothers outside of central European cultures [29,30]. Subsequently, the dynamic surrounding the consequences of a child’s suicide on bereaved mothers, remains unclear in these contexts [8]. Overall, a deeper understanding of the interplay between suicide-bereaved mothers’ needs and their social context may advance supportive psycho-therapeutic interventions in mental healthcare services towards this vulnerable group.

Within this framework, the present study constituted a secondary exploration of data on the living experience of Greek-speaking suicide bereaved mothers in the RC, aiming to gain a deeper insight into their expressed needs following the suicide of their child, with particular focus on the difficulties they face in receiving formal support. Given the persistent stigma surrounding suicide in Eastern Mediterranean and Southern European societies, such as the RC, mothers bereaved by suicide may face unique psychosocial barriers to accessing mental health care [2,21]. These barriers may not only be shaped by cultural silence and societal judgment related to suicide, but also by a healthcare system that may inadequately respond to their gendered and grief-specific needs [31]. Indeed, previous research suggests that fathers and mothers may grieve in different ways, which indicates the need for differentiated therapeutic approaches [32]. This underscores the importance of generating data that can inform the development of targeted interventions specifically addressing the emotional needs of bereaved mothers. In light of these challenges, this study is expected to contribute to understanding how bereaved mothers navigate loss outside of formal therapeutic settings, shedding light on the self-management strategies they develop and the institutional gaps they encounter. This knowledge is essential for informing the development of responsive, stigma-sensitive mental health care services tailored to women across the lifespan. Thus, this new insight is expected to inform how suicide-bereaved mothers may be supported in formal mental healthcare services based on their self-perceived needs after the loss of their child.

2. Materials and Methods

2.1. Study Design

An inductive, secondary content analysis of data collected primarily by Zavrou et al. [2] was employed. Specifically, a new research question was articulated for the purpose of the present study, and a new analysis was conducted to the raw data to go beyond the original study by Zavrou et al. [2]. In more detail, the focus of the previously published study by Zavrou et al. [2] was on the exploration of the living experience of suicide bereaved parents, with focus on their interpretations concerning their child's suicide, its aftereffects and their coping strategies. The present new research question emerged from gaps in understanding the specific needs of suicide-bereaved mothers and the difficulties they face in receiving formal support; thus, a relevant research question was framed and a secondary to the primarily data analysis was employed [33].

Qualitative secondary analysis was applied herein as the most appropriate methodological approach, as it enabled further efficient use of already available resources while generating new substantive insights [33,34,35]. This approach also reduced the burden on both participants and researchers, a benefit particularly important in studies of sensitive topics and/or hard-to-reach communities, such as suicide-bereaved mothers, where primary data collection poses significant challenges [35,36]. The present secondary analysis was done openly to let new insights emerge from the data itself as it is defined by the inductive method [37,38].

Reporting of the current findings followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist (please see Supplementary Table S1).

2.2. Aim & Objectives

The aim of this study was to assess the experiences of Greek-speaking mothers in the RC whose child died by suicide, with focus on a) their interpretations about their needs, b) the difficulties they face in receiving formal support.

2.3. Participants and Recruitment

There is no formal suicide registry in the Republic of Cyprus (RC) to provide identifying information on who have died by suicide or of their surviving relatives. As a result, the researchers could not directly access the target population. Nor are there support or self-help groups for parents who have lost a child to suicide in public or private mental health services or by non-governmental organizations in the RC.

To address these challenges, a formal communication strategy was developed to inform both public and private mental health providers about the study’s objectives and methods. This approach aimed to reach the entire target population and recruit as many participants as possible. As a result, participants were partially recruited through the mental health services used by suicide-bereaved mothers or the deceased. Due to the absence of a formal registry of families affected by suicide, it was not possible to estimate the size of this community accurately.

To attract volunteers from diverse backgrounds, the study was also advertised through media outlets, at pertinent scientific meetings and on social media platforms, e.g., Facebook and Twitter, with postings directed at groups and pages concerned with mental health services and medical topics. Participants were encouraged to share information about the study within their own networks. This open call, along with a snowball sampling technique, effectively broadened the purposive sampling pool of eligible individuals.

Participants either contacted the research team directly to express their interest (via phone) or allowed the researcher to contact them using the information they provided, depending on how they learned about the study.

2.4. Data Collection

Data was collected (July 2017-August 2019) by RZ and MK.

2.4.1. Sampling Method

Once participants to be provided to the researchers written informed consent to participate in the study, the primary author assessed their alignment with the following inclusion criteria: (a) being a mother of a son or a daughter who died by suicide; (b) fully understanding the study's purpose and procedures; (c) having the ability to reflect on the personal experience of the loss, and d) to communicate these experiences to the researchers. There was no specific inclusion criterion regarding the time passed since the son’s/daughter’s suicide. There were no exclusion criteria. Participants were recruited through various ways: six individuals were referred through a member of their treatment team, two were recruited through social media, and the remaining two found out about the research through their peers.

2.4.2. Sample Size

During the concurrent analysis and data collection, the sample size was determined to be 10 participants, based on theoretical and data saturation criteria. Specifically, data analysis suggested that the recruitment of new participants was complete when no new themes emerged. At that point, all recruitment of participants stopped at that point. Due to the fact that everyone who reached out to the researchers met the inclusion criteria, they were included in the final sample which resulted in a response rate of 100%. All participants completed the study without dropouts.

2.4.3. Process

The first author performed semi-structured, in-person interviews. For each participant, two interviews were conducted, each lasting one to three hours, were performed of three to six months apart for each participant. The second interview aimed to confirm and refine the information gathered in the first interview. Additionally, it allowed to clarify any unclear topics arise when analyzing the initial interview data. Interviews were not limited by time and only participants and researchers were present. Most of the interviews were conducted at home, by the will of the participants, and no one else was present during the process. The focus of the interviews was on the participants’ insights and their needs. Thus, they were encouraged to discuss their feelings and perceptions about the suicide, and subsequent needs.

The interview guide used for data collection has been previously published by Zavrou et al.[2].

At the first interview, participants’ demographic information along with details about the child's suicide was collected. This information was documented on a data sheet, as shown in Table I. A total of ten biological mothers whose sons or daughters had died by suicide were identified and recruited. The participants’ ages ranged from 45 to 63 years, and the length of bereavement varied between 3 and 19 years.

2.5. Data Analysis

To gain a comprehensive understanding each interview was read multiple times, and was then individually analyzed by each researcher (RZ, AK, and MK). Aiming to identify initial codes in accordance with the study's research objectives, the researchers highlighted participants' insights on a) their needs surviving their child’s suicide (emotions, feelings, thoughts and behaviors) described as expectations, obstacles/ barriers or eliminations in fulfilling everyday goals or function, and b) difficulties in accessing formal support, described as (unmet) expectations, obstacles, barriers or eliminations in relation to mental healthcare professionals/services. Special focus was given on participants interpretations about their interactions with healthcare clinicians/ systems.

Descriptive definitions for primary codes, sub-categories and categories were developed to establish criteria for data selection. Consequently, initial groups of constructs were developed, employing an inductive method rather than adhering to any specific theoretical framework. The levels of abstraction were identified to reflect additional relevant codes, sub-categories and categories. Analyzing each interview, codes, sub-categories and categories were revised, maintaining an active process of subsuming earlier categories and creating new ones [39]. The researchers conferred about their interpretations of the data to determine overarching themes, which were then described and summarized using the "one sheet of paper" method [40].

The research team determined that a sub-category and a category appearing in eighty percent of the transcripts would be deemed saturated [41]. This approach not only validated the themes included in the findings but also subtly suggested issues for further research that were rarely addressed in the first or second interviews.

Munhall nine criteria for research were used to assess the rigor of the study [37,42] (Supplementary Table S2). This comprehensive approach ensured that the findings were both credible and reliable, providing a robust framework for understanding the living experiences of bereaved mothers.

2.6. Researchers' Positionality

At the time of the research, the RZ was a doctoral student in nursing with clinical experience in conducting brief suicide assessments in an inpatient psychiatric hospital. She had mastered the interviewing technique under the guidance and supervision of MK, an associate professor in mental health nursing. The data analysis team included RZ, MK and AK. MK is trained in advanced clinical and qualitative research and experienced in interview analysis. AK is a clinical psychologist with extended experience in parents’ bereavement support and qualitative data analysis.

2.7. Ethical Issues

The study's procedures and confidentiality policies were explained to the participants both verbally and in writing via informed consent documents. Specifically, the research team provided to participants an information sheet detailing the study’s objectives and methodology, confidentiality, informed consent procedures, and the voluntary nature of participation, in accordance with Cypriot human research ethics regulations. Additionally, the researcher offered to discuss the study design over the phone with each participant. Written consent was obtained from all participants prior to their involvement in the study. Participants were clearly assured that no identifiable information would be disclosed at any stage of the investigation. All interviews were recorded with the participants' consent. At each stage, participants agreed to continue to the subsequent phases of the study.

Additionally, each participant was provided with a list of all public mental health resources and information about the team's affiliated clinicians who could offer support if needed. The participants described their interviewing process as therapeutic, which alleviated our concerns regarding participant well-being.

Given the emotionally sensitive nature of interviewing mothers bereaved by suicide, ethical considerations extended beyond participant care to include the well-being of the research team. The primary researcher received regular supervision from MK, a senior mental health nurse and experienced academic with extensive expertise in providing trauma-informed support. This supervision provided an essential space for clinical reflection, emotional processing, and guidance throughout the data collection and analysis phases. Additionally, the research team had access to mental health nursing professionals who were available to offer psychological support if any member experienced distress. These measures were implemented to safeguard researcher mental health and maintain ethical rigor in conducting emotionally demanding qualitative interviews.

All methods used in this study adhered to the Helsinki Declaration of 1975, as amended in 2024, and followed the ethical guidelines of the applicable national and institutional committees on human experimentation. The National Bioethics Committee of the state where the study was conducted approved the research protocol. Given that all demographic information collected and displayed comes from a population of 1,000,000, it is impossible to pinpoint any individual participant.

3. Results

The core of the participants' needs was reflected in their “persistent effort for protection”. This encompassed three interconnected domains: (1) shielding themselves from stigma, social judgment, and emotional disintegration; (2) safeguarding the psychological well-being and cohesion of surviving family members; and (3) preserving the posthumous dignity and memory of their deceased child. Rather than seeking formal support, participants overwhelmingly turned away from mental health services, citing a lack of empathy, cultural misunderstanding, and fear of being further stigmatized. Furthermore, the participating mothers described numerous self-management strategies to alleviate themselves from the impact of loss on them, which were developed independently of clinical support. Mental health professionals were often perceived as inadequate or even harmful, reinforcing the participants’ drive toward self-reliance and autonomy in bereavement

In more detail, the participants narratives revolved about their need to protect themselves and their child’s memory from stigma and negative sentiments surrounding the suicide. They described their need to protect their own personal dignity and public image from being perceived as inappropriate mothers. By revealing their deep need to overcome inappropriate societal attitudes and ensure that their child's existence was not forgotten and remembered positively, they described various actions taken toward this goal. Most importantly, they expressed a willingness to destigmatize their situation and positively transform their societal image through activism and community service.

Furthermore, the participants underlined their effort to protect surviving family members, especially the siblings of the deceased, from the psycho-social impact of the suicide, and to support them in moving forward with their life. This need also perceived as a strong motivation to protect their own well-being, including their mental and physical health, and return to normality. Ultimately, the participants derived motivation from the need to create a positive legacy, fostering a sense of purpose in their grief while enhancing remembrance and challenging societal perceptions of suicide.

The generic categories and sub-categories identified in the study, as outlined in Table II, are detailed below:

3.1. Category 1: Need for Self-Protection and Being Accepted

3.1.1. Need to Make Sense of the Event and Get Meaningful Answers

The experience of their child’s death by suicide left participants in a profound pain and sadness, increasing their internal longing to derive meaning from the event and find meaning in numerous unanswered questions, particularly "why." They grappled with questions like "Why did he/she do this?" and "What led to this?" When answers remained elusive, the participants had to construct their own interpretations of the suicide, often blaming themselves, or attributing the cause to external factors, such as a breakup or the child’s potential neurobiological disorders: "Sometimes I feel a big ‘why'’ [..] maybe it's our fault that me and his dad broke up."(P5). This search for meaning frequently entrapped in a suffering-centered cycle in our search for meaning, thereby prolonging our emotional pain and grief: "Sometimes I think about finding his close friends to tell me, but then I wonder if it will really make me feel any better?"(P10).

3.1.2. Need to Externalize Emotions Within an Empathic Context

Most of the participants described a strong need to express intense negative emotions such as sorrow, pain, and grief to protect their mental and physical health. However, externalizing these emotions and discussing their distress openly was perceived as a substantial challenge. Indeed, when they did manage to open up, it typically occurred in moments of privacy: "When I was alone, I was crying. I had to cry to myself, too. I shouldn't have kept it all inside because I was about to explode."(P3). Their reluctance to share their feelings and thoughts with others stemmed from a lack of empathy in their social network and among healthcare professionals: “The psychologist was staring at me, as if I were an alien” (P1)”. However, the participants consistently emphasized their need for empathetic understanding mainly from peers, rather than from friends or healthcare personnel, highlighting their need for acceptance of their traumatic experiences and feelings in a safe and supportive context: “[…] mothers who have lost a child, it’s important to cry, to laugh, to listen, and to be heard. Don’t keep everything to yourself. Spend time with others who have experienced similar losses—they can understand what you’re going through. I believe this can be helpful.” (P5).

3.1.3. Need for Social Withdrawal and Self-Isolation

Many participants expressed a need to withdraw from the social network: "I shut myself up at home. Whoever wants to, I said, should come to my house and see me. I had nowhere to go."(P9). Sometimes, this was participants’ personal choice: “[…] I don't go outside. I don't have the desire or the motivation I had before the incident."(P11). Some other times this was the result of social stigmatization following their child’s suicide: "Why are you grieving for her? She was a drug addict! It’s better that she’s gone[…] So, I stopped talking to others or hanging around with them." (P7). In that case, the participants sought to shield themselves and be protected from negative comments and the lack of understanding and empathic support from others, including healthcare professionals, as well. They described how social stigma made them feel sad, disappointed, and guilty, with society often portraying suicide-bereaved mothers as inadequate, suggesting that their actions contributed to their child's death. This societal criticism deepened the participants’ grief and led them to isolate themselves:” "I used to go out […] and when I heard them saying, 'instead of helping her son, they let him hang himself,' I stopped going out." (P1)

3.1.4. Need for Self-Reliance, Autonomy and Independence Through the Bereavement Process

Participants emphasized their need for self-reliance and autonomy during the bereavement process: "[…] this is way you always need to be yourself and stand on your own two feet […] you don’t want that kind of ‘coddling’" (P1). Relying on others during bereavement was often perceived as a threat to their self-respect and personal autonomy. This need to protect their independence was reinforced by experiences of disempowering attitudes within their social support network or from healthcare personnel. It also reflected the participants’ need to grieve in a personal way, avoiding potential harm from judgment, intrusiveness, or inappropriate responses from others: “I struggled with this for 6-7 months until I managed to do psychotherapy on my own; talked to myself, and got back on my feet. I didn't take any sedative, nor did I see a doctor." (P3). Overall, the lack of empathic support, coupled with the need to protect their self-respect and autonomy, compelled participants to rely on personal strengths as a way for self-protection against further emotional distress. These responses reflected how participants’ perceptions on healthcare professionals and stigma surrounding suicide shape bereaved participants’ disengagement from healthcare systems, despite their intense psychological needs.

The need for independence was also accompanied with participants’ need for privacy and the protection of their personal life. Indeed, participants struggled to protect and secure their privacy, as well as their personal approach to managing the impact of their child’s suicide: "I'm not even obliged to justify myself to anyone. Each house knows how it goes. Whether I'm going to drink coffee or sit by the sea is something that only concerns me."(P8). Consequently, participants clearly described their feelings that their way of life and attitudes were inherently their own, and that they were not accountable to anyone else, as only they truly understood their own experiences and struggles. Nevertheless, this need for autonomy and self-governance was crucial for their emotional well-being and personal recovery.

3.1.5. Need to Physically and Mentally Escape

Building on the previous findings, participants expressed a need to escape from their daily routines, thoughts, and memories of the suicide event. Overwhelmed by these thoughts and their strong need for recovery, they often withdrew from their social environment. This retreat was not solely for personal management; it was also a response to inadequate approaches by menta health clinicians as mentioned earlier: “[…] the psychologist was crying, devastated by my experience of my child’s suicide, along with the death of my husband. I never visited her again […].”(P1). Inappropriate responses from healthcare professionals further contributed to participants’ disengagement from healthcare systems, despite their penetrating psychological and mental needs. To cope, participants employed different strategies that allowed them to disassociate the event from their minds. They experienced rejuvenation and a brief respite in travel, nature walks, or playing chess. These activities provided the need to distract themselves and comforting connection with their emotions and manage their emotional burden from their grief: " […] You want, let's say, a condition where you can escape your own bad memories. To do pleasant things [...] I preferred to be away from home, and away from the city, even away from the country, to stay far away" (P1).

3.2. Category 2: Need to Ensure a Safe, Protective Environment for the Surviving Family Members

3.2.1. Need to Protect Other Members

Most participants reported engaging in protective behaviors toward other family members, such as spouses, surviving siblings, or grandchildren. They expressed a profound need to support them and understand their needs, which fostered the creation of a safe environment, free from the negative emotions and circumstances surrounding the suicide: “We try not to show our pain […] what we go through, we go through it on our own, so our children won’t notice and feel sad […]”(P11).

As a result, mothers often refrained from mentioning the suicide and avoided externalizing their feelings to other family members. This approach was primarily aimed at supporting the surviving siblings, thereby creating a protected environment, shielded from the tragedy of suicide. By doing so, they sought to protect their family members from the emotional burden and prevent further distress within the family. The following quote clearly illustrates how the mothers actively suppressed their grief in the presence of surviving children, prioritizing their emotional well-being: “I don't show my (surviving) children how I feel when I‘m alone, thinking about the suicide. When I’m with my (surviving) children I am a different person. I don't want to make them feel sad.” (P9).

3.2.2. Need to Protect Family Cohesion

Participants’ need to protect family cohesion emerged as a continuation of their deeper need to protect the surviving family members from the devastating and disruptive impact of suicide. Fear of potential fragmentation and loss of solidarity, both as a family unit and as individuals, was evident in their narratives. Special emphasis was placed on the surviving siblings, as participants made concrete, concerted efforts to ensure that they were not negatively impacted or influenced towards future suicidal behavior, similar to that of the deceased sibling. This protective attitude underscored their determination to promote the well-being and mental health of the entire family, aiming to prevent further tragedy and maintain a supportive, cohesive environment: "I wanted the remaining (surviving) family close to me. I felt a very strong need to be near them [..] to do things for them and support them " (P3).

Overall, the participants’ expressions reflected their need to support and strengthen their family in the wake of the tragedy following their child’s suicide, with central needs being their desire for protection, emotional shielding, and maintaining family unity.

Above all, the participants need to protect the surviving members of the family and its unity was also perceived as a strong motivation to protect their own well-being, including their mental and physical health, and return to normality: “[…] I kept telling myself, ‘You are just fine’ […] I had to support the whole family [...] This made me very strong […].” (P3)

3.3. Category 3: Need to Protect the Posthumous Reputation of the Deceased

3.3.1. Need to Release Their Child from the Stigma and Themselves from the Guilt Related to the Suicide

Mothers often aimed to protect their child's memory from the stigma associated with suicide, particularly the perception of an insidious personality. They expressed a desperate need to ensure that their child's existence and memory were not forgotten, and most importantly, that their child was remembered positively. By keeping photographs at home, saving personal properties, and only using the present tense to talk about their child, they achieved this: “When I see his things, they bring me closer to him. I have many of his clothes in the closet, and his younger brother wears them too, so he isn’t forgotten.” (P11).

Additionally, what provided the participants with the strength to continue with their lives was the hope that they could help others in need in the future, for example, through charitable activities in memory of their child. In this way, they created a lasting, positive legacy associated with their child's name. By doing this, they strove to keep their child's memory alive, while leaving behind something positive with their actions as a means to liberate their child from the negative social appraisal associated with the suicide. Subsequently, after their child's death, participants endeavored in every possible way to protect their child's memory and liberate them from the stigma of the suicide. Through these actions, they not only honored their child's memory but also found a way to cope with their grief and contribute positively to their communities, promoting a positive image for their child as well: “[…] this is what gives me the strength to live and do things [...] I want to live to do things in memory of my child.”(P2).

Overall, the participants derived motivation to move on with their lives from their need to create a positive legacy in their child’s memory, articulating a sense of purpose in the face of grief. Actions such as preserving memories or engaging in charitable activities were seen not only as enhancing remembrance but also as a way to counteract societal stigma and alleviate feelings of guilt surrounding their child’s death.

4. Discussion

This study contributed new insights to the literature on women’s grief in Southern Europe and the Eastern Mediterranean by providing data on the expressed needs and the difficulties in receiving formal support faced by Greek-speaking mothers bereaved by their child’s suicide in the RC. To date, very few studies have addressed women’s suicide bereavement in this particular context, since prior research has largely focused on Anglo-Saxon and Eeast Asian settings, often with mixed-gender samples [23]; such study designs risk obscuring gender-specific dynamics of grief and coping [15,22,31]. Our findings extend existing knowledge, mainly provided by Sugrue et al. [30] and Shields et al. [43], by showing how culturally and gendered expectations shape mothers’ needs and bereavement-related self-management strategies.

Based on the present results, participants’ needs cantered on a “persistent effort for protection” encompassing three interconnected domains: (1) protecting themselves from stigma and emotional disintegration, (2) safeguarding surviving family members, and (3) preserving the memory and dignity of their deceased child. These findings are consistent with studies supporting the stigmatization of suicide bereaved parents and those died by suicide [44,45]. Indeed, the participating mothers consistently described a strong desire to counteract societal judgments and ensure that their child was remembered positively, sometimes by engaging in charitable or community activities that served as legacy-building acts. This was partially in line by previous studies showing the importance of countering negative perceptions and keeping the child’s memory alive as part of the grieving process [23,46]. Similarly, Shields et al. [43] highlighted that bereaved mothers strive to protect the memory of their dead child, “disinfected” by the stigma of suicide.

Yet, these protective efforts may reflect culturally prescribed maternal roles, positioning mothers as the primary guardians of family cohesion and reputational honor, even while navigating profound personal grief [47]. Overall, participating mothers’ protective efforts towards surviving family members, mainly surviving siblings, highlighted family cohesion as a core need, but also positioned them as “invisible grievers”. This finding confirmed prior literature on silent grieving in suicide bereaved mothers [30], and further extended these data by revealing that mothers internalize their own distress as a strategy to shield others, especially surviving siblings, from additional emotional harm. Thus, an additional dimension of the phenomenon was highlighted, and the bereavement experience was not only described as a deeply personal psychological struggle but also as a moral and social responsibility, probably shaped by gendered cultural norms [47]. Participating mothers did not experience their loss solely as an inner emotional process; they simultaneously felt compelled to uphold family honor, shield their families from social judgment, and fulfill culturally prescribed maternal duties of care and sacrifice. Their mourning, therefore, was both an intimate process of coping with trauma and a public duty to demonstrate resilience, preserve cohesion, and defend the dignity of the deceased child against stigma. This interpretation aligns with prior research highlighting the gendered burden of grief, whereby mothers, more than fathers, are expected to sustain family unity, regulate emotions, and safeguard reputational standing in the face of loss [48,49,50]. Most importantly, the present study confirms such data for the first time in suicide bereaved mothers.

Overall, these findings emphasized the influence of cultural context on maternal bereavement; the RC is characterized by close-knit communities, strong family ties, and culturally embedded norms regarding honor and reputation [28]. Within this setting, participating mothers’ selective social engagement and emphasis on autonomy can be interpreted as protective strategies against gossip, judgment, and social intrusion. While these behaviors may be appearing as social withdrawal, they more accurately reflect culturally specific efforts to preserve dignity and safeguard both the family’s cohesion and the deceased child’s memory, dynamics further intensified by gender social norms [51].

An additional key finding was participants’ reliance on peer support and informal networks rather than on formal mental health services during the bereavement period. Participating mothers deliberately avoided formal care, citing prior negative experiences with clinicians, perceived lack of empathy, cultural insensitivity, and fear of further stigmatization. This disengagement reflected a dynamic interplay of systemic inadequacies of healthcare services with gendered dynamics: participating mothers internalized social expectations to remain resilient and emotionally contained, while healthcare professionals often viewed them through dehumanizing stereotypes that minimized their vulnerability. As a result, participants’ intense psychological needs were left unmet, reinforcing cycles of isolation and silence. These findings echo prior data showing that bereaved mothers in patriarchic societies internalize distress, experience stigma, and believe that they have to be strong [48]. Additionally, these findings confirm earlier studies showing that women’s help-seeking behaviors are strongly influenced by stigma, social expectations of emotional strength, and negative prior experiences with healthcare systems [52].

4.1. Implications for Practice

These findings have important implications, as they suggest that relevant interventions must recognize that suicide-bereaved mothers often avoid formal services due to systemic, cultural and gender-related barriers. Subsequently, effective postvention strategies should prioritize peer-led, mother-specific support programs that validate grief while addressing the social and moral dimensions of suicide bereavement. Peer support groups, in particular, could reduce feelings of isolation by connecting mothers with others sharing similar loss. Sharing narratives in a compassionate, nonjudgmental setting fosters mutual understanding, reduces stigma, and provides a renewed sense of hope and control [29,53,54].

Furthermore, although engagement in activism and community service has been previously identified as a core need of suicide-bereaved family members [23], the present study has emphatically addressed its importance for suicide-bereaved mothers; the participants clearly linked such actions to their need to counteract the negative social image of their child, underscoring how maternal bereavement carries reputational stakes. While a previous meta-synthesis highlighted the importance of maintaining a non-traumatizing memory of the deceased child and participation in supportive activities [23], the present study demonstrated an additional maternal imperative, as the participants intense need to ensure that their child's memory was preserved positively. This new deeper understanding has critical implications for women’s mental health across the lifespan, particularly in conservative cultural settings where stigma strongly shapes help-seeking behavior.

Importantly, not all suicide-bereaved mothers are willing to engage in public remembrance or activism; some may prefer private, symbolic practices or even silence. Both strategies represent culturally and personally valid grief responses [55,56]. Thus, postvention programs need to be flexible, offering personalized grief pathways, ranging from private journaling to small-group peer support, or public-facing advocacy, allowing suicide-bereaved mothers to choose the form of remembrance that best aligns with their needs [55,56].

Moreover, the participants herein expressed a strong desire to transform public perceptions of suicide and advocate for their children’s dignity. Their involvement in public awareness campaigns may thus serve a dual purpose: contributing to broader de-stigmatization efforts while providing mothers with channels for post-traumatic growth and identity reconstruction [57,58]. Survivor advocacy groups could play a key role by facilitating campaigns where mothers share their stories, framing narratives around self-compassion over blame.

While encouraging mothers’ engagement in activism is important, professional support towards them remains essential. Suicide-bereaved parents often struggle with PTSD, depression, and anxiety in addition to grief [59]. Early access to counselling, specifically tailored to suicide bereavement, may reduce guilt, self-blame, and other cognitive distortions [60]. Nevertheless, the participants herein constantly mentioned the lack of professional training on suicide bereavement. Previous studies also underscored the need for clinicians to be equipped to provide this type of care [59]. Based on the present findings, training should go beyond standard grief models; professionals need to be prepared to empathically recognize that for mothers suicide bereavement represents not only a personal loss but also a social and a reputational crisis, particularly in stigmatizing societies [55,61]. Therefore, relevant training modules should include: a) case-based scenarios highlighting mothers' struggles with stigma, reputational worries, and memory preservation, b) role-playing experiences to sensitize clinicians to survivors’ fears of judgment, gossip, or community scrutiny, c) Stigma-informed, culturally competent content, with attention to kinship ties and collective identity in contexts similar to the RC. Developing continuing education curricula around “stigma-informed care” for suicide grief would improve professional capacity, encourage trust, and facilitate greater engagement with services.

Despite these needs, in the RC, formal postvention systems remain underdeveloped. General mental health services are available, but there are no specialized suicide-bereavement programs, no gender-sensitive interventions, and no structured peer support groups. Informal bereavement support, where it exists, typically focuses on losses due to chronic illness rather than suicide. Limited community awareness and public discourse reinforce stigma, further discouraging help-seeking. As a result, bereaved mothers often grief in isolation, with minimal support from either state institutions or community organizations. This service gap is particularly alarming, given that in both the RC and Greece bereaved parents due to chronic illness (e.g., cancer) do have access to specialized groups, while parents bereaved by suicide do not. This disparity reflects the intensity of stigma around suicide and illustrates how mothers. Indeed, most participants herein reported that such absence of service left them exposed to insensitive behaviors from family and friends, resulting in social isolation and rejection, findings consistent with previous data [29,42,44,45,62].

Finally, there is a strong case for establishing a registry of suicide-bereaved families in the RC. Such a tool would enable targeted interventions, ensure outreach to those at risk of isolation, and facilitate the implementation of tailored, culturally and gender relevant services.

4.2. Limitations and Future Research

Despite its strengths, the present study encompasses a number of limitations. While focusing exclusively on suicide-bereaved mothers allowed for an in-depth understanding of gender-specific needs and challenges in help-seeking, however, this approach inevitably limited the generalizability of the findings to fathers, or mixed-gender samples. It is recommended, therefore, that future research should examine gender differences in grief, self-management strategies, and help-seeking, while also considering cultural variations. Broader sampling strategies, including online surveys or mixed-methods approaches, could capture a wide range of bereavement experiences and may provide a more comprehensive understanding of how gender and sociocultural context shape grief.

Another limitation concerns methodological reporting. While the current study adhered to the COREQ checklist to enhance transparency and completeness, we acknowledge the ongoing scholarly debate regarding COREQ’s credibility and applicability. As Braun and Clarke [63] have argued, COREQ should not be treated as a universally applicable standard for qualitative research, particularly when applied without attention to methodological congruence. In light of these critiques, we clarify that our use of COREQ was intended to support transparency rather than to substitute rigor. The design and implementation of this study were grounded in inductive content analysis and guided by principles of methodological coherence, reflexivity, and transparency [41]. Additionally, Munhall’s nine criteria for qualitative search [42] were used to assess rigor. Thus, the COREQ checklist was used as a reporting scaffold rather than a methodological template. Future studies may benefit from more critically tailoring their reporting so they align more closely with the epistemological and methodological paradigms underpinning their design.

5. Conclusions

This study supported that participating mothers bereaved by suicide experienced profound, gender-specific needs: protecting themselves, preserving their child’s memory, and maintaining family cohesion. Despite intense psychological distress, stigma and societal expectations limited their engagement with formal mental health services. Peer support, culturally competent interventions, and legacy-focused programs are expected to provide promising avenues to meet these needs, emphasizing the importance of gender-informed and culturally sensitive postvention care. Recognizing suicide bereaved mothers’ protective instincts and validating both private and public coping strategies can serve as a foundation for effective interventions, supporting mothers’ ability to navigate grief while safeguarding their child’s legacy and family integrity.