Int. J. Environ. Res. Public Health 2012, 9 25 support initiatives organised by survivors themselves, mental health professionals and concerned communities are available, numerous challenges lie ahead with regards to program and policy development, research and clinical practice, to ensure effective care for the bereaved by suicide, i.e., postvention. Two basic, but nonetheless challenging questions have to be answered before starting a discussion on the potential impact of loss by suicide, the needs of the bereaved and the prerequisites of effective postvention. The first question is: how can we define a “suicide survivor”? The second question addresses the magnitude of the problem: how many suicide survivors are there? 2. Who Is a Suicide Survivor and How Many Survivors Are There? There is a lack of consensus in the literature regarding the definition of a “suicide survivor”; however, the proposed definitions share several commonalities. They focus on the fact that there existed a relationship between the deceased and the bereaved, on the closeness of this relationship and/or the impact of the loss on the bereaved. For example, McIntosh [1] defined suicide survivors as “the family members and friends who experience the suicide of a loved one” (p. 146) and Andriessen [2] defined a survivor as “a person who has lost a significant other (or a loved one) by suicide, and whose life is changed because of the loss” (p. 43). Jordan and McIntosh [3] in their definition acknowledged the wide range of experiences of the bereaved: “a suicide survivor is someone who experiences a high level of self-perceived psychological, physical, and/or social distress for a considerable length of time after exposure to the suicide of another person” (p. 7). There is a distinction between “suicide survivorship” and “exposure to suicide” [2-5]. The former applies to the bereaved who had a personal and close relationship with the deceased (e.g., a friend or a family member), the latter reflects a situation of a person who did not know the deceased personally but who knows about the death through reports of others or media reports (e.g., suicide of a celebrity) or who has personally witnessed the death of a stranger (e.g., train drivers or police). Indeed, a suicide death can affect people in various types of relationships with the deceased: from close family members to more distant relatives, friends, neighbours, and employers [6] and several attempts at assessing the number of suicide survivors have been made. For example, Shneidman [7] has suggested that an average of six survivors are bereaved by a suicide and according to Wrobleski [8], there were 10 survivors left after a suicide death. The first systematic estimation of the number of suicide survivors, a survey among members of suicide survivor support groups [4], found that the number varied considerably depending on the type of the relationship, the frequency of contact between the deceased and the bereaved, and the age of the deceased. For example, parents who lost a child by suicide estimated that the death has left 80 suicide survivors behind, the spouses and/or partners of the suicides estimated the number at 60, while siblings and/or friends at 45–50. Five survivors after one suicide, the estimate of survivors limited to the members of a typical nuclear family, was almost identical to the original “guesstimate” of Shneidman [7]. The metaphor of a stone thrown into a lake reflects well the wide-reaching impact of suicide. It causes many ripples which turbulently affect the water’s surface. The big challenge for effective postvention is ensuring that every survivor, from the close family members and friends to those indirectly exposed to suicide, can receive help and support they need. Provision of timely and adequate