Trauma and bereavement: examining the impact of sudden and violent deaths

Life After the Storm: An Examination of Bereavement and Posttraumatic Growth Among Urban Adolescents

Although the challenges of bereavement among adolescents are well-documented, there is potential for loss to foster growth, development, and positive psychological changes during this developmental period. To examine this possibility, 408 adolescents (46.6% male; 53.4% female) in grades 6-12 from three urban schools were surveyed about their experiences with bereavement and posttraumatic growth (PTG), along with several hypothesized moderators: type of loss, relationship with the deceased, active and ruminative coping, and social support. Seventy-six percent of the participants reported signs of PTG. Hierarchical linear regression analyses revealed significant main effects for bereavement, active coping, and social support on PTG, but found no evidence of moderation for any variables. The findings are discussed in the context of systemic racism and cultural strengths, with directions for future research provided.

Pathways to Resilience: Exploring Post-Traumatic Growth in the Wake of Drug-Related Deaths

This review examines Post-Traumatic Growth (PTG) in the aftermath of Drug-Related Deaths (DRDs) amid a public health crisis underscored by an increase in overdose fatalities. It examines grief and unique challenges confronting those bereaved by DRDs, such as stigmatization, and synthesizes existing literature to elucidate pathways toward resilience and growth. Fundamental mechanisms facilitating PTG, including reframing loss, engaging in open dialogues with support, and cultivating self-compassion and hope, are highlighted, demonstrating the transformative potential of navigating bereavement with supportive communication and personal development. The review also addresses limitations within current research, such as focusing on specific bereaved populations, which may impact the generalizability of findings. Recommendations for future research include longitudinal studies and broader demographic inclusion to understand and support individuals grieving a DRD. Advocating for holistic, growth-oriented bereavement care models, this review underscores the necessity of comprehensive approaches to facilitate healing and growth in the wake of DRDs.

Traumatic loss: a systematic review of potential risk factors differentiating between posttraumatic stress disorder and prolonged grief disorder

Background: When traumatic events and losses intersect in the form of traumatic loss, these events can trigger both posttraumatic stress disorder and pathological grief.Objective: This systematic review investigates which characteristics differentiate between the development of the respective disorders or are associated with comorbidity.Method: A systematic literature search using Medline, PubMed, APA PsycInfo and Web of Science yielded 46 studies which met the inclusion criteria. In these studies, PTSD was assessed using 17 and pathological grief using 16 different validated instruments. In the quality assessment, 12 studies were classified as average, 30 as above average, and 4 as excellent. The investigated risk factors were categorized into 19 superordinate clusters and processed using narrative synthesis.Results: The relationship to the deceased, mental health issues, and religious beliefs seem to be associated specifically with pathological grief symptoms compared to PTSD symptoms. Social support and social emotions emerged as significant correlates and potential risk factors for both PTSD and pathological grief. Included studies had mainly cross-sectional designs.Conclusions: Differentiating factors between pathological grief and PTSD appear to exist. The results should be considered within the limitations of the heterogeneity of the included studies and the research field. There is a lack of studies (1) using a longitudinal study design, (2) starting data collection early following the traumatic loss, (3) using standardized, up-to-date measurement instruments and (4) including comorbidity in their analyses. Further research is urgently needed for more accurate (acute) screenings, prognoses, and interventions following traumatic loss.

The prevalence of prolonged grief disorder (PGD) after the natural disasters: A systematic review and meta-analysis

Objective

The failure to detect PDG and lack of providing essential interventions accordingly can disrupt the lives of survivors of natural disasters years after the death of their loved ones. The present study aims to investigate PGD after natural disasters using a systematic review and meta-analysis.

Study design

This study was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.

Methods

With the focus on the prevalence of PGD after natural disasters, studies conducted until the end of 2021 were collected without a time limit. To do this, reputable databases such as PubMed, Web of Science, Scopus, Embase, Google Scholar, and Science Direct were used. The random effects model was used to perform a meta-analysis of the studies. To check the heterogeneity between the studies, the I2 index was used. The publication bias of the study was evaluated using Begg's test. Data were analyzed using the STATA software.

Results

Primarily, 2566 studies were collected based on the initial search, from which 12 final studies were entered into the analysis. The results showed that the prevalence of PGD after natural disasters was 38.81 % (95 % CI: 24.12-53.50, I2 = 99.7 %, p = 0 < 001).

Conclusions

It is recommended that policies and plannings of the organizations responsible for disaster management be prepared to send specialized teams of psycho-spiritual counseling, quickly accommodate the injured, and reconstruct the damaged buildings in the shortest time possible.

Protective Factors in the Context of Childhood Bereavement: Youth Gratitude, Future Orientation, and Purpose in Life

The objective of the study was to examine potential associations between positive youth development constructs (gratitude, future orientation, purpose in life) and psychological functioning (posttraumatic stress symptoms, depressive symptoms, maladaptive grief reactions) among bereaved youth and test whether these associations vary by age. A diverse sample of 197 clinic-referred bereaved youth (56.2% female; M = 12.36, SD = 3.18; 36.1% Hispanic, 23.7% White, 20.1% Black, 11.9% Multiracial, and 8.2% another race/ethnicity) completed self-report measures of psychological functioning and positive youth development constructs. Linear regression models indicated that gratitude and purpose were associated with lower posttraumatic stress and depressive symptoms among bereaved youth. Future orientation was associated with higher posttraumatic stress symptoms. Results were consistent across age. If replicated longitudinally, gratitude and purpose may be important protective factors against negative mental health outcomes in the aftermath of losing a loved one.

Risk factors for prolonged grief symptoms: A systematic review and meta-analysis

BACKGROUND

The diagnosis Prolonged Grief Disorder (PGD) has recently been included in ICD-11 and DSM-5-TR. To identify individuals who need help coping with grief, knowledge is needed about who is at risk of developing PGD. We, therefore, conducted a comprehensive systematic review and meta-analysis of the available literature on risk factors for prolonged grief symptoms (PGS).

METHODS

Based on a literature search in PsycInfo, PubMed, Web of Science, and CINAHL, we included the most frequently investigated risk factors in a meta-analysis. The effect size correlation was used as the standardized measure of the strength of the association between the risk factor and PGS.

RESULTS

Based on 120 studies of 61.580 participants published between 1989 and 2023, 19 risk factors were included in the meta-analysis. For the adjusted associations, the strongest associations with PGS were pre-loss grief symptoms (ESr = 0.39, 95%CI[0.24-0.53]) and depression (ESr = 0.30, 95%CI[0.13-0.44]). Small, but statistically significant associations were observed for unexpected death, violent/unnatural death, low educational level, low income, female gender, anxious attachment style, and death of a child or partner.

CONCLUSIONS

An updated overview of risk factors for PGS is presented, including their predictive strength. The results offer knowledge that can aid prevention and early identification of people at risk of PGD.

Taiwanese family members' bereavement experience following an expected death: a systematic review and narrative synthesis

BACKGROUND

Bereavement experience is shaped by cultural and social contexts. No systematically constructed reviews were identified to explore the bereavement experience for people who are influenced by Chinese culture valuing filial piety and mutual dependence. This review aimed to systematically review the bereavement experience of Taiwanese family members living in Taiwan following an expected death.

METHODS

MEDLINE, PsycINFO, CINAHL, China Academic Journal Database, and Chinese Electronic Periodical Services were searched with no date restrictions from inception to 20 October 2022. The methodological rigour of studies was assessed using Hawker's appraisal tool. A narrative synthesis approach using Popay's work was employed to synthesise the findings of the studies. Studies investigating Taiwanese family members' bereavement experiences were included. We excluded papers studying bereavement through the death of a child.

RESULTS

Searches retrieved 12,735 articles (after de-duplication), 17 of which met the inclusion criteria and were included for synthesis: English [9] and Chinese [8], published between 2006 and 2021. The studies varied in quality with scores ranging from 22 to 33 out of 36. The studies differed in the relationship between participants and the deceased, the bereaved time frames, and the definitions of bereavement. Most studies focussed on family members of cancer patients receiving specialist palliative care. Three bereavement theories and four tools were used. Risk factors of bereavement outcomes included family members feeling less prepared for death and deaths where palliative sedative therapy was used. Protective factors were higher caregiving burden and longer caregiving periods. Four themes regarding Taiwanese bereavement experience were generated: multiple impacts of death; problem-based coping strategies; importance of maintaining connections; influential religious beliefs and rituals.

CONCLUSION

Continuing the relationship with the deceased is a key element of Taiwanese bereavement experience and it is influenced by religious and cultural beliefs. Suppressing or hiding emotions during bereavement to connect with the deceased and maintain harmonious relationships needs to be acknowledged as culturally acceptable and encouraged by some religions in Taiwan. The findings could be potentially relevant for other Chinese populations, predominantly Buddhist countries or other East Asian societies. The role of preparing for death in bereavement outcomes is little understood and requires further research.

An Ecological Review of Homicide Bereavement's Risk Factors: Implications for Future Research

This literature review focused on homicide bereavement (HB) risk factors. A content analysis was conducted on 83 empirical papers published in English from January 2000 to December 2021 in peer-reviewed journals. Extracted HB risk factors were synthesized according to six main dimensions: individual level; situational homicide-related factors; and micro, meso, exo, and macro social levels. The review demonstrates that macro-level and situational homicide-related risk factors are in special need of further study. In addition, how HB risk factors interact with one another to influence HB also requires further study. Future research may benefit from examining whether and how individuals experiencing HB influence related factors at various social levels. Last, given that almost all reviewed studies were conducted in Western societies, the sociocultural and ethnic diversity in HB risk factors is in dire need of future study.

Assessment Tools for Children who Experience Traumatic Loss: A Systematic Review

Children who experience the traumatic (i.e., violent and/or unexpected) death of a loved one are at risk for a range of adverse developmental and mental health problems, including pathological processes of grief. Over the last decades, conceptualizations of maladaptive grief have varied, resulting in a range of assessment tools and no "gold standard" measure to assess symptoms of prolonged grief in children. The current paper is a systematic review of studies that measured grief in children who experienced traumatic loss in order to determine the measures currently used in the literature with children who experience traumatic loss. Searches were conducted according to the preferred reporting items for systematic reviews and meta-analyses in PUBMED, PsycINFO, and OVID and through hand searches of relevant reference lists. Two authors reviewed each study yielded by searches and conducted data extraction on included studies. Studies were included if they were peer-reviewed, included a measure of grief, and consisted of samples of children (age 18 and younger) whereby at least a portion experienced traumatic loss. Thirty-nine studies met inclusion criteria, from which 17 measures were identified. The most commonly used measure was the Inventory of Complicated Grief (n = 10 studies) followed by the Extended Grief Inventory (n = 6). Most studies used different measures and variations of the same measures to assess similar constructs. All but one measure relied on child self-report. More standardization of measurement across studies is needed, along with parent and/or teacher reported measures.

Exploring the role of empathy in prolonged grief reactions to bereavement

Grief reactions to the bereavement of a close individual could involve empathy for pain, which is fundamental to social interaction. To explore whether grief symptoms interact with social relatedness to a person to whom one directs empathy to modulate the expression of empathy, we administered an empathy task to 28 bereaved adults during functional magnetic resonance imaging, in which participants were subliminally primed with facial stimuli (e.g., faces of their deceased or living relative, or a stranger), each immediately followed by a visual pain stimulus. Individuals' grief severity promoted empathy for the pain stimulus primed with the deceased's face, while it diminished the neural response to the pain stimulus primed with the face of either their living relative or a stranger in the medial frontal cortex (e.g., the right dorsal anterior cingulate cortex). Moreover, preliminary analyses showed that while the behavioral empathic response was promoted by the component of "longing" in the deceased priming condition, the neural empathic response was diminished by the component of "avoidance" in the stranger priming condition. Our results suggest an association between grief reactions to bereavement and empathy, in which grief symptoms interact with interpersonal factors to promote or diminish empathic responses to others' pain.

Markers in Time: Expanding Our Concept of Trauma Triggers to Include Subjective Experiences of Time Among Adults Surviving Traumatic Loss

We outline two studies that collected exploratory data on the meaningful time approach and explore the notion of temporal triggers that emerge in the process of coping with traumatic loss. Qualitative data analysis was completed on data gathered from face-to-face interviews as well as open ended responses to an online survey. 35 themes and sub-codes were identified. 30 of these were replicated in both studies. Our data supported the notion of "markers in time" and identified three clear phases to these markers. Participants also noted the consequences of loss on their lives, and the influence of societal and religious approaches to bereavement on their process of coping. Results of this study support a cyclical approach to understanding coping with loss and provides clinicians working with bereaved individuals yet another tool to address the dynamic experience of bereavement.

A digital health intervention to stabilize the 24-hour rhythm of sleep, meals, and physical activity for reducing depression among older bereaved spouses: Protocol for a randomized controlled trial

BACKGROUND

Despite the high prevalence of depression and disruption to 24-h sleep-wake routines following the death of a spouse in late-life, no bereavement interventions have been developed to re-entrain a regular sleep-wake routine among older widow(er)s. We describe the rationale and methodology of the NIH-funded WELL Study (Widowed Elders' Lifestyle after Loss), a randomized controlled trial (RCT) comparing the efficacy of a digital health intervention (DHI) to enhanced usual care (EUC) arm for reducing depression symptoms in older spousally-bereaved adults.

METHODS

We will randomize approximately 200 recently bereaved (<12 months) adults aged 60+ years to one of two 12-week interventions: digital monitoring of the timing and regularity of sleep, meals, and physical activity plus weekly motivational health coaching; or enhanced usual care consisting of weekly telephone calls and similar assessment schedules. Participants will complete self-report and clinical assessments at baseline, post-intervention, and 3-, 6-, and 12-months post-intervention, and objective actigraphic assessments of their 24-h rest-activity rhythm (RAR) at baseline and 1-, 2-, and 3-months during the intervention. The primary outcome is change in depression symptoms burden (using the Hamilton Rating Scale for Depression) from pre- to post-intervention and over 12 months of follow-up.

DISCUSSION

WELL Study findings will inform the development of widely generalizable and scalable technology-based interventions to support bereaved spouses in community-based settings. Clinical http://Trials.gov Identifier: NCT04016896.

A qualitative study of the experiences of relatives to brought in dead persons in an emergency department

AIMS

The aim was to explore the experiences of relatives seeing and saying goodbye to brought in dead persons in a Danish emergency department.

DESIGN

This was a qualitative study based on interpretive description methodology.

METHODS

Data were collected through semi-structured individual interviews with relatives (n = 11) of brought in dead persons and 30 h of participatory observations of these relatives visiting the emergency department to see and say goodbye to the deceased. Data were collected between February 2019 and December 2020.

RESULTS

Our analyses revealed internal and external chaos as an overarching theme, covering 4 themes and 10 subthemes. The four themes were traumatic events, restricted access, briefly being together again, and final goodbyes and departures.

CONCLUSION

Emergency departments were highly acute and busy settings that prioritized survival more than the care of deceased people and their relatives. The relatives were, in every way, affected by internal and external chaos; the external chaos in the emergency department reinforced the feeling of internal chaos. It is necessary for managers and nurses in emergency departments to organize and practice care for relatives, whilst bringing in deceased individuals in a less chaotic and more caring manner.

IMPACT

This study contributes to the knowledge of relatives' experiences regarding brought in dead persons, underpinning the need to care for this subpopulation in emergency departments. Care for relatives of brought in dead individuals has the potential to relieve suffering and prevent diseases, which are core elements of nursing.

Receiving Notification of Unexpected and Violent Death: A Qualitative Study of Italian Survivors

(1) Background: The loss of a significant person can be especially traumatic when death comes without warning and is due to causes such as suicide, murder and accidents. The way an individual is informed about the loss can affect the way of adapting to the loss and the quality of life of survivors. Communication modalities of the notifier may deeply influence the bereavement process. Aim: The present investigation aimed to explore the experience of those who received communication of such a type of death by a professional figure. (2) Method: Snowball sampling was used to recruit the participants to this qualitative study. Social networks, word of mouth and researchers' acquaintances were used, including clients of the NGO De Leo Fund. A total of 52 Italian people (eight males and forty four females, mean age = 49.44; SD = 14.23) who received notification of the death of a loved one by police officers or by health professionals participated in the study. Deaths involved cases of suicide, murder, road accident and mountain accident. (3) Results: The following four key themes were identified: (a) how the communication took place; (b) reactions; (c) support; and (d) coping strategies. Only 22 participants reported having received clear information about the dynamics of what happened; the rest of the sample obtained only poor or ambiguous information. The majority of participants sought or received informal support from family and friends immediately after notification; however, some participants experienced a total lack of support. The opportunity to see the body of the loved one for the last farewell, when denied, caused discomfort in recipients of the news. (4) Conclusions: Even the impactful notification of a traumatic death such as suicide or road accident can be mitigated by the appropriate behaviour and attitude of notifiers, who should always avoid providing generic or ambiguous information about what happened. The notification process should not end with the simple transmission of the communication, but should also look at the following phases by including referral to supportive networks or bereavement services, aimed at assisting individuals in the immediate aftermath but also in the long term.

Posttraumatic growth following a drug-related death: A family perspective

This paper explores the experience of posttraumatic growth in families who have lost a family member to a drug-related death. Seven family units (17 participants) were interviewed, and interviews were analyzed using reflexive thematic analysis. Analyses revealed themes that reflected positive adaptation and growth, including (a) reframing the loss, (b) open dialogue and social support, and (c) reclamation of purpose. Themes are presented in this paper for their pertinence in understanding how best to negotiate adaptation through complicated grief. The paper concludes that posttraumatic growth can occur once families begin a process of acceptance and receive support through the journey.

The emotional impact of disrupted environmental contexts: Enrichment loss and coping profiles influence stress response recovery in Long-Evans rats

With increasing rates of anxiety and mood disorders across the world, there is an unprecedented need for preclinical animal models to generate translational results for humans experiencing disruptive emotional symptoms. Considering that life events resulting in a perception of loss are correlated with depressive symptoms, the enrichment-loss rodent model offers promise as a translational model for stress-initiated psychiatric disorders. Additionally, predisposed temperament characteristics such as coping styles have been found to influence an individual's stress response. Accordingly, male rats were profiled as either consistent or flexible copers and assigned to one of three environments: standard laboratory housing, enriched environment, or enriched environment exposure followed by downsizing to standard laboratory cages (i.e., enrichment-loss group). Throughout the study, several behaviors were assessed to determine stress, social, and reward-processing responses. To assess recovery of the stress response, fecal samples were collected following the swim stress in 3-h increments to determine the recovery trajectory of corticosterone (CORT) and dehydroepiandrosterone (DHEA) metabolite levels. Upon death, neural markers of neuroplasticity including doublecortin, glial fibrillary acidic factor, and brain-derived neurotrophic factor were assessed via immunohistochemistry. Results indicated the flexible coping animals in the continuous enriched group had higher DHEA/CORT ratios (consistent with adaptive responses in past research); furthermore, the enrichment-loss animals exhibited a blunted CORT response throughout the assessments and enriched flexible copers had faster CORT recovery rates than consistent copers. Standard housed animals exhibited less exploratory behavior in the open field task and continuous enriched, flexible rats consumed more food rewards than the other groups. No differences in neuroplasticity neural markers were observed. In sum, the results of the present study support past research indicating the disruptive consequences of enrichment-loss, providing evidence that the model represents a valuable approach for the investigation of neurobiological mechanisms contributing to interindividual variability in responses to changing experiential landscapes.

Examining bereavement-related needs and outcomes among survivors of sudden loss: A latent profile analysis

OBJECTIVE

Recognizing important bereavement-related needs among sudden loss survivors (e.g., suicide, overdose)-a population that is burgeoning and at risk for deleterious outcomes-is a critical task as needs may reflect modifiable grief-related variables that can assist with post-loss adjustment.

METHODS

Latent profile analysis was used among 347 sudden loss survivors to (a) identify distinct patterns of needs among survivors of sudden loss, (b) assess predictors of such profiles, and (c) investigate differences in profiles in terms of bereavement outcomes.

RESULTS

Four classes of bereavement-related needs were identified: a low needs class, a moderate needs-spiritual class, a moderate needs-relational class, and a high needs (HN) class. Clear differences emerged between need classes with the HN class evidencing the greatest level of grief and mental health sequelae.

CONCLUSION

Tending to bereavement-related needs is critical, as they indicate the degree of distress and reflect modifiable therapeutic variables.

Network analysis of PGD, PTSD and insomnia symptoms in Chinese shidu parents with PGD

Background

Chinese shidu parents (bereaved parents over the age of 49 who have lost their only child) are potentially at a high risk of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD) and insomnia.

Objective

The current study aimed to estimate three network models in 310 shidu parents who met the ICD-11 criteria for PGD: (1) a PGD network to identify central symptoms; (2) a comorbidity network to explore bridge symptoms between PGD and PTSD; (3) a comorbidity network to examine the associations between PGD and insomnia symptoms.

Methods

The R-packages bootnet, qgraph and networktools were used to investigate the structure of network models and centrality indices of symptoms. In addition, robustness and significance analyses for the edge weights and the order of centrality were performed.

Results

Emotional pain and numbness emerged as the most central symptoms in the PGD network. In the PGD-PTSD comorbidity network, the highest bridge strength symptoms were inability to trust others (PGD) and feeling upset (PTSD). Inability to trust others (PGD), avoidance (PGD), and impairment of life quality (insomnia) were possible bridge symptoms connecting PGD and insomnia.

Conclusions

Reducing emotional pain and numbness may be a viable target in PGD interventions for shidu parents. Additionally, findings suggest that future studies could examine the role of inability to trust others and avoidance in PGD comorbidities.

HIGHLIGHTS

• Emotional pain and numbness were the most influential symptoms in shidu parents with PGD. The role of PGD symptoms of inability to trust others and avoidance in the comorbidities of PGD with PTSD and insomnia might be worthy of further study.

Bereavement in the Aftermath of Suicide, Overdose, and Sudden-Natural Death: Evaluating a New Measure of Needs

Bereavement has been associated with a number of adverse outcomes, including mortality, particularly among those who experience the sudden loss of a close other. With rising rates of sudden death in the United States, fueled by an alarming increase in fatal overdose deaths, identifying bereavement-related needs among the sudden-death bereaved is essential. The present study investigated the factor structure, internal reliability, and validity of the Sudden Bereavement Needs Inventory (SBNI) in a sample of sudden loss survivors (i.e., fatal overdose, suicide, and sudden-natural loss; N = 403). Confirmatory factor analysis supported a six-factor structure, with items reflecting pragmatic, informational, spiritual, relational, meaning, and emotional needs. SBNI factors showed adequate internal consistency, with significant associations between SBNI scores, loss characteristics, and mental health outcomes (e.g., prolonged grief symptoms, meaning-making, posttraumatic stress disorder [PTSD] symptoms, and anxiety), supporting the scale's validity and highlighting the potential applicability of the instrument in both research and clinical contexts. Future research should examine test-retest reliability of the SBNI, particularly through the lens of understanding whether and how bereavement needs change over time.

Posttraumatic Growth Experiences of Adolescents With Parental Loss: A Phenomenological Study

This study examines the post-traumatic growth of adolescents who have lost their parents about their experiences. Eight adolescents whose parents had died participated in the study conducted in the phenomenological design. The data were collected with three-step semi-structured interviews and analyzed using the phenomenological analysis technique performed in five stages. The findings were grouped into three main themes as "reactions to loss," "readjustment," and "post-traumatic growth," and nine subthemes under each, and these sub-themes were categorized into forty-five codes.

Attachment and grief in young adults after the loss of a close friend: a qualitative study

Background

Although many lose a close friend each year, they are seldom the focus of grief research. However, these losses often cause severe and long-lasting reactions. Deaths among adolescents and young adults are also often caused by traumatic events, e.g. from accidents, suicides, and homicides, placing them at significant risk for complicated grief reactions. The focus of this paper is bereaved friends after the shootings at Utøya, Norway in 2011, which is among a few studies that focus on bereaved friends, exploring how attachment affects the grief process after the loss of a close friend.

Methods

This paper explores qualitative data from in-depth interviews with thirteen bereaved friends, conducted about 28 months after the loss. The interview sample consisted of eight females and five males, aged 18–31 years. The interviews were semi-structured, with a theme guide of 14 questions, and the method used for analyses was systematic text condensation.

Results

Two main themes were identified from the analyses of the interviews: Friendship and Grief, with the subordinate themes: The importance of the friendship, Longing and remembrance, How the loss has affected other relationships, How the loss has affected the friend’s daily lives, Processing of the grief and Not being family. For most of the bereaved friends the loss and the grief had a profound effect on them and their overall lives, from daily functioning in school or at work, to changes in attitudes, and the way they were met as bereaved.

Conclusions

The support, intimacy, and feelings of togetherness we share with our friends are of great importance and value for all people, but maybe especially for young people. When adolescents and young adults experience losses, their reactions are often intense and long-lasting, and especially complicated grief reactions can affect school performance and concentration, health, result in emotional problems; and disrupt development (e.g. identity formation and social skills). We don’t know much about the grief of bereaved friends and how their reactions can be explained. Thus, we hope that these findings could shed light on their grief reactions, and provide new knowledge on the short- and long-term psychological impact of losses of friends.

Bereavement during the COVID-19 Pandemic: Impact on Coping Strategies and Mental Health

The COVID-19 coronavirus has caused 5.4 million deaths worldwide, including over 800,000 deaths in the United States (as of December 2021). In addition to these staggering statistics, an even greater number of individuals have died from other causes during the COVID-19 pandemic. As a result, a large portion of the global population has faced bereavement during the COVID-19 pandemic and resulting quarantine. The often rapid and unexpected nature of COVID-19 deaths and the presence of pandemic-related stressors and living restrictions make it more difficult for individuals bereaved during the pandemic to implement effective strategies for coping with the loss compared to non-pandemic periods. Quarantine-related constraints (e.g., social distancing, availability of and access to resources) impede coping strategies that have been found to be adaptive after a loss, such as supportive (e.g., seeking emotional and instrumental support) and active (e.g., problem-focused and cognitive reframing) coping, and they augment avoidant strategies (e.g., substance use, denial, and isolation) that have been found to be maladaptive. Poorer mental health outcomes (including prolonged grief disorder; PGD) have been associated with less healthy coping. This article reviews research findings regarding bereavement during the COVID-19 pandemic, discusses the effects of pandemic-related stressors on bereavement coping strategies, and proposes how different types of coping during the pandemic may account for the poorer mental health outcomes described in recent reports. Interventions for promoting adaptive coping strategies and minimizing maladaptive coping strategies are also outlined.

A Latent Class Analysis on Symptoms of Prolonged Grief, Post-Traumatic Stress, and Depression Following the Loss of a Loved One

BACKGROUND

The loss of a significant other can lead to variety of responses, including prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression. The aim of this study was to replicate and extend previous research that indicated that three subgroups of bereaved individuals can be distinguished based one similar post-loss symptom profiles using latent class analysis (LCA). The second aim was to examine whether sociodemographic and loss-related characteristics as well as the extent of meaning making were related to classes with more pervasive psychopathology.

METHODS

Telephone-based interviews with 433 Dutch and German speaking persons who had lost a significant other at last 6 months earlier were conducted. Self-rated PGD, PTSD, and depression symptoms were assessed. LCA was conducted and correlates of class-membership were examined using the 3step approach.

RESULTS

The LCA resulted in three distinct classes: a no symptoms class (47%), a moderate PGD, low depression/PTSD class (32%), and a high PGD, moderate depression/PTSD class (21%). A multivariate analysis indicated that female gender, a shorter time since loss, an unexpected loss and less meaning made to a loss were significantly associated with membership to the moderate PGD, low depression/PTSD and high PGD, moderate depression/PTSD class compared to membership to the no symptom class. Losing a child or spouse, a shorter time since loss, and having made less meaning to the loss further distinguished between the high PGD, moderate depression/PTSD symptom class and the moderate PGD, low depression/PTSD class.

DISCUSSION

We found that the majority of individuals coped well in response to their loss since the no symptom class was the largest class. Post-loss symptoms could be categorized into classes marked by different intensity of symptoms, rather than qualitatively different symptom patterns. The findings indicate that perceiving the loss as more unexpected, finding less meaning in the loss, and loss-related factors, such as the recentness of a loss and the loss of a partner or child, were related to class membership more consistently than sociodemographic factors.

Trauma exposure and the PTSD symptoms of college teachers during the peak of the COVID-19 outbreak

This study aimed to explore influencing factors for the psychological impact of coronavirus disease 2019 (COVID-19) on Wuhan college teachers, posttraumatic stress symptoms in particular, so as to inform evidence-based strategy development to ameliorate such adverse impacts. An online survey was conducted from 26 to 29 April 2020, and 1650 teachers (47.54% male; M = 40.28 years, SD = 8.3 years) enrolled in Wuhan universities and colleges participated. The results showed that the overall incidence of posttraumatic stress disorder (PTSD) among college teachers was as high as 24.55%, but the average level of PTSD score was low (M = 1.06, SD = 0.72). Logistic regression analysis showed that for those with confirmed COVID-19, the ratio was much higher, up to 2.814 (95% confidence interval [CI]: [1.542, 5.136], p < 0.001); that is, compared with those without symptoms, the ratio of PTSD increased by 181%. For those who had family members or relatives who died of COVID-19, the ratio was 5.592 (95% CI: [2.271, 13.766], p < 0.001), 459% higher than those who had no one who died. But the living places during the pandemic had no significant effect on PTSD. The findings suggest that mental health services reducing PTSD should be provided. Teachers who confirmed COVID-19 or lost loved ones to COVID-19 should be given particular care.

Psychological Interventions for Individuals Bereaved by Homicide: A Systematic Review

Research has demonstrated that approximately 45-50% of individuals show healthy levels of psychological and physical functioning in the first 12 months post-loss. Homicidal bereavement (loss due to murder or manslaughter) does not appear to follow this pattern. Homicide-related mental health difficulties are a serious problem worldwide, displaying high rates of lifetime incidence, high chronicity, and role impairment. Individuals are at increased risk to develop symptoms of post-traumatic stress disorder (PTSD), complicated grief (CG), and depression. Nevertheless, a systematic review specifically on the efficacy of psychological interventions following homicidal loss has not yet been conducted. The current systematic review (registered via PROSPERO) aimed to review the psychological interventions available and report their effectiveness. Of 77 records, 7 met predefined inclusion criteria. Studies presented different methodologies, tested different clinical models, and treatment conditions. Thus, a narrative systematic review was conducted. Studies included manualized interventions to deliver 1:1 and group sessions. Cognitive behavioral therapy, restorative retelling, and eye movement desensitization and reprocessing were the main models used together with psychoeducational elements about trauma and grief responses. Overall, symptoms of PTSD, CG, and depression decreased significantly postintervention. Sustained improvements were reported for PTSD and depressive symptoms at the follow-up measurements. Mixed results were found regarding how individual (age, gender) and external factors (time since loss, relationship with the deceased) impact on symptom progression. As a result of differences in methodologies, categorization of therapies, methodological differences, and small sample sizes, important questions remain unanswered. Further randomized controlled trials and expert consensus could be considered.

From virtual to real healing: a critical overview of the therapeutic use of virtual reality to cope with mourning

In recent years, virtual reality (VR) has been effectively employed in several settings, ranging from health care needs to leisure and gaming activities. A new application of virtual stimuli appeared in social media: in the documentary ‘I met you’ from the South-Korean Munhwa Broadcasting, a mother made the experience of interacting with the avatar of the seven-year-old daughter, who died four years before. We think that this new application of virtual stimuli should open a debate on its possible implications: it represents contents related to grief, a dramatic and yet natural experience, that can have deep psychological impacts on fragile subjects put in virtual environments. In the present work, possible side-effects, as well as hypothetical therapeutical application of VR for the treatment of mourning, are discussed.

A Qualitative Study on Traumatic Experiences of Suicide Survivors

The suicide of a loved one can be a traumatic experience. The objective of this study was to investigate trauma-related experiences of suicide survivors. This is a qualitative study with people who had recently lost a family member or a close one to suicide, conducted at least two months after the event. Forty-one participants agreed to take part in the study and were interviewed. The interviewees' perception was that suicide brought harm, symptoms, and suffering. Traumatic experiences can begin immediately after the event, with many reporting symptoms lasting many months and persistent impact, both personal and to the family. Postvention models after suicide should incorporate such findings, and investigate trauma consistently.

Prevalence of and factors associated with nightmares in the elderly in a population based cohort study

OBJECTIVES

Nightmares are extremely unpleasant and vivid recurring dreams that are accompanied with awakening during sleep. However, earlier studies were mostly conducted with children and adults, with very few studies on nightmares in older adults. This population-based study aims to investigate the prevalence of nightmares and its associated factors nightmares in the elderly.

METHODS

This study utilized a subsample from the Korean Genome and Epidemiology Study (KoGES). Participants (n = 2940; mean age 63.71 ± 6.73) completed the questionnaires on nightmares (Disturbing Dream and Nightmare Severity Index; DDNSI), depression, suicidal ideation, sleep quality and stress.

RESULTS

Among the sample, 2.7% (n = 79) were classified into the nightmare group (NG), which was classified with DDNSI scores. In the age group over 70, prevalence of nightmares was 6.3% (n = 37), which was significantly higher than other age groups. Marital status, employment status and family income were associated with nightmares. Additionally, NG reported significantly more sleep problems, higher suicidal ideation, depression and stress compared to the non-nightmare group (N-NG). Logistic regression analyses results indicated that the NG was 4.35 times at higher risk for depression, and 3.16 higher risks for stress, and 3.45 higher risks for suicidal ideation compared to the N-NG after controlling for covariates.

CONCLUSIONS

Our results indicate that psychological and demographic factors are associated with nightmares in the elderly. Furthermore, this population-based cohort study showed the prevalence of nightmares increased after age 70, which suggests the need for further studies of nightmares in older populations.

Prolonged grief, emotion regulation and loss-related factors: An investigation based on cognitive and behavioral conceptualization

The study aimed to examine the variables that play a role in the process of prolonged grief within the framework of the cognitive-behavioral model. Participants (N = 475) from Turkey took part in a cross-sectional questionnaire survey. The study used structural equation modeling to test a hypothesized model via AMOS v23. After testing two options, the final model was found to be good fit for the data. Results suggested the importance of adopting a comprehensive approach to prolonged grief interventions which includes the loss- and relationship-related factors as well as emotion regulation difficulties, autobiographic memory characteristics, and the grief cognitions.

Spouses bereaved by suicide: A population-based longitudinal cohort comparison of physician-diagnosed mental disorders and hospitalized suicide attempts

BACKGROUND

This study compares a longitudinal population-based sample of spouses bereaved by suicide and those bereaved by other sudden deaths to determine if suicide-bereaved spouses (SBS) experience greater rates of physician-diagnosed mental disorders.

METHODS

First, married individuals whose spouse died by suicide, sudden natural death (SND) and unintentional injury (UI) were compared to non-bereaved matched cohorts to determine if there were differences in mental disorder rates between bereavement groups and non-bereaved matches. Second, SBS (n = 365), spouses bereaved by SND (n = 1000), and spouses bereaved by UI (n = 270), were compared using inverse probability treatment weighting and generalized estimating equations to calculate relative rates of mental disorders 5 years before/after death.

OUTCOMES

All bereaved cohorts had higher rates of mental disorders compared to non-bereaved cohorts. SBS had the greatest rate of depression post-bereavement (50·96%), followed by UI (38·52%) and SND (33·70%) spouses. When comparing bereavement cohorts, a significant group-by-time interaction (P = 0·047) revealed the rate change for depression was significantly different between suicide and UI-bereaved spouses, with SBS having higher rates of depression before bereavement. SBS had increased rates of any mental disorder both pre (ARR = 1·35, 95% CI = 1·03-1·18, P<·05) and post spousal death (ARR = 1·24, 95% CI = 1·03-1·45, P<·05) when compared to UI spouses signifying pre-existing mental disorders. Post-bereavement, SBS had greater rates of depression only when compared to SND-bereaved spouses (ARR = 1·31, 95% CI = 1·10-1·55, P<·01).

INTERPRETATION

SBS have the greatest rates of depression and any mental disorder before the death of their spouse, suggesting suicide bereavement may be unique. Sudden spousal bereavement is a vulnerable time for mental disorders.

The Complexity of Military Bereavement in Gender Regime: Experiences of Turkish Martyr Spouses

This feminist qualitative study investigates spousal bereavement experiences of Turkish martyr spouses within the context of gender regime, based on semi-structured interviews with 21 martyr spouses. From on the thematic analysis of these interviews, this study demonstrates that (1) the spousal bereavement process was complicated conjointly by traumatic and military context as well as martyrdom, (2) this complexity created conditions requiring struggle, and (3) coping resources were available to deal with this complexity. Further, it presents "how the Turkish gender regime affected the spousal bereavement process of martyr spouses." This study finds that martyr spouses' steps toward back to normal life, namely recovery after loss, were not supported or acknowledged by society. The authors propose the concept of "disenfranchised recovery" to explain this situation, based on concept of disenfranchised grief.

Tracking the reach of COVID-19 kin loss with a bereavement multiplier applied to the United States

The coronavirus disease 2019 (COVID-19) pandemic has led to a large increase in mortality in the United States and around the world, leaving many grieving the sudden loss of family members. We created an indicator-the COVID-19 bereavement multiplier-that estimates the average number of individuals who will experience the death of a close relative (defined as a grandparent, parent, sibling, spouse, or child) for each COVID-19 death. Using demographic microsimulation-based estimates of kinship networks in the United States, the clear age gradient in COVID-19 mortality seen across contexts, and several hypothetical infection prevalence scenarios, we estimate COVID-19 bereavement multipliers for White and Black individuals in the United States. Our analysis shows that for every COVID-19 death, approximately nine surviving Americans will lose a grandparent, parent, sibling, spouse, or child. These estimates imply, for example, that if 190,000 Americans die from COVID-19, as some models project, then ∼1.7 million will experience the death of a close relative. We demonstrate that our estimates of the bereavement multiplier are stable across epidemiological realities, including infection scenarios, total number of deaths, and the distribution of deaths, which means researchers can estimate the bereavement burden over the course of the epidemic in lockstep with rising death tolls. In addition, we provide estimates of bereavement multipliers by age group, types of kin loss, and race to illuminate prospective disparities. The bereavement multiplier is a useful indicator for tracking COVID-19's multiplicative impact as it reverberates across American families and can be tailored to other causes of death.

A systematic review of studies describing the influence of informal social support on psychological wellbeing in people bereaved by sudden or violent causes of death

BACKGROUND

Whilst any type of bereavement can be traumatic, bereavement through violent or sudden causes is associated with more severe negative health and wellbeing outcomes compared to other types of loss. Social support has been found to have a positive impact on wellbeing after traumatic events in general. However, this association appears to be less consistently demonstrated in studies that focus on bereavement, and the literature in this area has not yet been systematically reviewed. This study aimed to review the international literature to examine systematically whether there is an association between informal social support from family and friends after bereavement through sudden and/or violent causes and post-bereavement wellbeing.

METHODS

We conducted a systematic search for quantitative studies that tested for an association between social support and any outcome related to wellbeing after a sudden and/or violent loss. Included studies were assessed for quality, and findings were reported using the approach of narrative synthesis. The review was pre-registered on Prospero (registration number CRD42018093704).

RESULTS

We identified 16 papers that met inclusion criteria, 11 of which we assessed as being of good or fair quality and 5 as poor quality. Fifteen different wellbeing outcomes were measured across all studies. We found consistent evidence for an inverse association between social support and symptoms/presence of depression, predominantly consistent evidence for an inverse association between social support and symptoms/presence of post-traumatic stress disorder (PTSD), and conflicting evidence for an inverse association between social support and symptoms/presence of complicated grief.

CONCLUSIONS

Our systematic review identified evidence to suggest that social support after sudden or violent bereavement is associated with a reduced severity of depressive and PTSD symptoms. Further longitudinal research is needed to explore potential causality in this relationship, widening the focus from common mental disorders to include other mental illnesses, wellbeing outcomes, and suicide-related outcomes after bereavement. There is also a need for consensus on the conceptualisation and measurement of social support. Our findings imply that interventions to improve access to and quality of social support may reduce the burden of mental illness after bereavement, and may therefore be worth investing in.

Lessons Learned: Forty Years of Clinical Work With Suicide Loss Survivors

The author has been a grief therapist in private practice for almost 40 years. The largest percentage of his clients have been suicide loss survivors, and in this article, the author reflects on the “lessons learned” about how grief therapy with survivors is both the same as, and very different from, work with clients bereaved after other types of losses. After briefly reviewing some of the empirical literature about differences between suicide bereavement and grief after other modes of death, the author argues that perhaps the most distinguishing and difficult aspect of a suicide loss is the “perceived intentionality” of the death, and the related “perceived responsibility” for the death. The author goes on to identify a number of tasks of psychological reintegration after a suicide loss that can serve as a template for treatment goals for clinicians and clients alike. These include the cultivation of a very specific type of secure and nurturing therapeutic alliance; extensive psychoeducation about suicide, trauma, and grief; the need to help the client repair the psychological continuing bond with the deceased; and providing gentle support for the survivor in rebuilding an assumptive world that has been shattered by the suicide of a loved one. Finally, the article concludes with a discussion of the clinical implications of these differences for work with suicide loss survivors.

Signs of Traumatic Grief, Lack of Justice, Magnitude of Loss, and Signs of Resilience Following the Homicidal Loss of Their Adult Child Among Caribbean Black Mothers

This study examined the aftermath of adult homicide on Trinidadian mothers. This is an understudied population, and the ability of these mothers to cope with the aftermath of such a tragedy needs to be fully acknowledged in order to understand their mental health status after the traumatic death of an adult child. This study utilized a narrative analysis approach to interview 20 mothers and used NVIVO 12 software to analyze the data. The findings highlight that factors such as multiple deaths, the scale of loss, and attempts to seek justice complicated the grief process. Although none of the mothers interviewed were diagnosed with a grief disorder, it was evident that their grief was indeed traumatic. It took more than a year for some mothers to find ways and opportunities for resilience, while others continue to struggle in the aftermath. Homicidally bereaved mothers are a distinct population that should be studied as they have the experiential knowledge and are willing to share the feelings and trauma-related needs after their loss.

Death by request in Switzerland: Posttraumatic stress disorder and complicated grief after witnessing assisted suicide

Background

Despite continuing political, legal and moral debate on the subject, assisted suicide is permitted in only a few countries worldwide. However, few studies have examined the impact that witnessing assisted suicide has on the mental health of family members or close friends.

Methods

A cross-sectional survey of 85 family members or close friends who were present at an assisted suicide was conducted in December 2007. Full or partial Post-Traumatic Distress Disorder (PTSD; Impact of Event Scale–Revised), depression and anxiety symptoms (Brief Symptom Inventory) and complicated grief (Inventory of Complicated Grief) were assessed at 14 to 24 months post-loss.

Results

Of the 85 participants, 13% met the criteria for full PTSD (cut-off≥35), 6.5% met the criteria for subthreshold PTSD (cut-off≥25), and 4.9% met the criteria for complicated grief. The prevalence of depression was 16%; the prevalence of anxiety was 6%.

Conclusion

A higher prevalence of PTSD and depression was found in the present sample than has been reported for the Swiss population in general. However, the prevalence of complicated grief in the sample was comparable to that reported for the general Swiss population. Therefore, although there seemed to be no complications in the grief process, about 20% of respondents experienced full or subthreshold PTSD related to the loss of a close person through assisted suicide.

Intensive outpatient treatment of PTSD and complicated grief in suicide-bereaved military widows

We report on a novel 2-week intensive outpatient treatment program (IOP) for 24 widows bereaved by the suicide death of their veteran spouse. We targeted symptoms of posttraumatic stress disorder (PTSD) and complicated grief (CG) concurrently in three separate cohorts. All patients either witnessed the death or discovered the body of their deceased partner, who was a veteran of the United States military. PTSD, CG, and depression symptom severity decreased significantly from pre- to post-treatment, with effect sizes of 0.85, 1.21, and 1.35, respectively. These outcomes provide preliminary support for an IOP to treat co-occurring PTSD and CG among widowed survivors of veteran suicide.

The prevalence of prolonged grief disorder in bereaved individuals following unnatural losses: Systematic review and meta regression analysis

BACKGROUND

Previous research has indicated that one out of ten naturally bereaved individuals develops prolonged grief disorder (PGD). Less is known about the prevalence of PGD following unnatural deaths, such as accidents, disasters, suicides, or homicides. The aim of this study was to compute the pooled prevalence of PGD and to determine possible causes of its varied estimates.

METHODS

A literature search was conducted in PsycINFO, Ovid Medline, PILOTS, Embase, Web of Science, and CINAHL. A meta-analysis using random effects models was performed to calculate the pooled prevalence rate of PGD. Multivariate meta-regression was used to explore heterogeneity among the studies.

RESULTS

Twenty-five articles met eligibility criteria. The random-effects pooled prevalence was 49%, 95% CI [33.6, 65.4]. Death of only child, violent killings and non-western study location were associated with a higher PGD prevalence. A longer time since loss and a loss in a natural disaster were associated with a lower PGD prevalence.

LIMITATIONS

These findings should be interpreted with caution, because of the heterogeneity in study methodology.

CONCLUSIONS

This first meta-analysis of PGD following unnatural losses indicated that nearly half of the bereaved adults experienced PGD. This illustrates the importance of assessing PGD in individuals affected by loss and trauma.

A call for epidemiology and thanatology to address the dying, death, and grief pipeline among Blacks in the United States

Dying, death, and grief are significant events that impact individuals, families, and communities. In the United States, Blacks historically have higher morbidity and mortality rates than other racial-ethnic groups. While death is a normal and natural phase of the life-course process, high incidents of infant mortality, premature death, and preventable death are not. The disproportionate burden of dying, death and grief among Blacks have detrimental consequences which demand interdisciplinary interventions from public health and death study researchers. This manuscript explores dying, death and grief from three distinct fields of study: (1) epidemiology of death, (2) social epidemiology of death, and (3) thanatology.

Posttraumatic growth in parentally bereaved children and adolescents: A systematic review

The systematic review aims to evaluate the posttraumatic growth in parentally bereaved children and adolescents. Six studies were obtained from the literature review. The total number of participants in the studies was 395. The age of the participants ranged from 6 to 25 years. When the studies were examined, it could be seen that the parentally bereaved children and adolescents showed post traumatic growth. Multiple circumstances surrounding loss including participants' age, cause of death, the closeness of the deceased person, and the time passed after the loss which can each affect the posttraumatic growth in parentally bereaved children and adolescents.

Mental health conditions in bereaved military service widows: A prospective, case-controlled, and longitudinal study

BACKGROUND/OBJECTIVES

Bereavement is associated with increases in prevalence of mental health conditions and in healthcare utilization. Due to younger age and bereavement by sudden and violent deaths, military widows may be vulnerable to poor outcomes. No systematic research has examined these effects.

METHOD

Using outpatient medical records from wives of active-duty military service members (SMs), we compared the prevalence of mental health conditions and mental healthcare visits among case widows (n = 1,375) to matched (on age, baseline healthcare utilization, SM deployment, and rank) nonbereaved control military wives (n = 1,375), from 1 year prior (Yr-1) to 2 years following (Yr+1 and Yr+2) SM death. Prevalence risk ratios and confidence intervals were compared to determine prevalence rates of mental health conditions and outpatient mental healthcare visits over time.

RESULTS

The prevalence of any mental health condition, as well as a distinct loss- and stress-related mental health conditions, significantly increased from Yr-1 to Yr+1 and Yr+2 for cases as did mental healthcare utilization. Widows with persistent disorders (from Yr+1 to Yr+2) exhibited more mental conditions and mental healthcare utilization than widows whose conditions remitted.

CONCLUSION

Bereavement among military widows was associated with a two- to fivefold increase in the prevalence of depression, posttraumatic stress disorder, and adjustment disorder postdeath, as well as an increase in mental healthcare utilization. An increase in the prevalence of loss- and stress-related conditions beyond 1 year after death indicates persistent loss-related morbidity. Findings indicate the need for access to healthcare services that can properly identify and treat these loss-related conditions.

The Effect of Sudden Death Bereavement on the Risk for Suicide

Background: Bereavement after a sudden death is associated with psychiatric sequelae including suicidal ideation and behavior. However, there is still uncertainty about whether bereavement due to suicide increases the risk for suicidal behavior more than bereavement due to other causes of death does. Aims: This study aimed to evaluate suicidal risk among sudden death-bereaved participants and to identify risk factors for suicidality that may be over-represented in those who are suicide-bereaved. Method: In total, 180 adult participants, half of whom had experienced the sudden death of a first-degree relative within the previous 5 years, completed self-report questionnaires assessing suicidal risk, symptoms of depression, somatization, posttraumatic stress disorder (PTSD), complicated grief, perceived social support, and demographic information. Results: Sudden death bereavement was associated with increased suicide risk even after adjusting for psychiatric symptomatology. Within the bereaved groups, the highest risk for suicide was among those bereaved by suicide, with additional contributions from depressive symptomatology, PTSD, somatization, lower perceived social support, and secular religious orientation. Limitations: The study was cross-sectional and bereaved participants had lost their loved one an average of 5 years before the assessment. Conclusion: These results are consistent with the conclusion that suicide bereavement is a risk factor for suicidal behavior.

Posttraumatic Stress Disorder, Depression, and Prolonged Grief Disorder in Families Bereaved by a Traumatic Workplace Death: The Need for Satisfactory Information and Support

The impact of traumatic workplace death on bereaved families, including their mental health and well-being, has rarely been systematically examined. This study aimed to document the rates and key correlates of probable posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and prolonged grief disorder (PGD) in family members following a workplace injury fatality. The hidden nature of the target population necessitated outreach recruitment techniques, including the use of social media, newspaper articles, radio interviews, and contact with major family support organizations. Data were collected using a cross-sectional design and international online survey. The PCL-C (PTSD), the PHQ-8 (MDD), and PG-13 (PGD) were used to measure mental health disorders. All are well-established self-report measures with strong psychometric qualities. Participants were from Australia (62%), Canada (17%), the USA (16%), and the UK (5%). The majority were females (89.9%), reflecting the gender distribution of traumatic workplace deaths (over 90% of fatalities are male). Most were partners/spouses (38.5%) or parents (35%) and over half (64%) were next of kin to the deceased worker. Most deaths occurred in the industries that regularly account for more than 70 percent of all industrial deaths-construction, manufacturing, transport, and agriculture forestry and fishing. At a mean of 6.40 years (SD = 5.78) post-death, 61 percent of participants had probable PTSD, 44 percent had probable MDD, and 43 percent had probable PGD. Logistic regressions indicated that a longer time since the death reduced the risk of having each disorder. Being next of kin and having a self-reported mental health history increased the risk of having MDD. Of the related information and support variables, having satisfactory support from family, support from a person to help navigate the post-death formalities, and satisfactory information about the death were associated with a decreased risk of probable PTSD, MDD, and PGD, respectively. The findings highlight the potential magnitude of the problem and the need for satisfactory information and support for bereaved families.

Posttraumatic Symptoms and Change of Complicated Grief among Bereaved Families of the Sewol Ferry Disaster: One Year Follow-up Study

BACKGROUND

The objective of this study was to determine whether severity and severity change of coexisting psychiatric symptoms might affect change of complicated grief (CG) regarding the Sewol ferry disaster.

METHODS

Data from a cross-sectional survey were obtained 18 months (Time 1) and 30 months (Time 2) after the disaster. We ascertained sociodemographic variables and variables obtained from self-reporting questionnaires (i.e., CG, depression, anxiety, post-traumatic stress disorder [PTSD], insomnia, embitterment, and suicidal risk) among 56 bereaved family members.

RESULTS

Severity of other psychiatric symptoms at Time 1 had no effect on change of CG at Time 2. However, changes in severity of PTSD over a year affected change of CG.

CONCLUSION

It is important to evaluate changes in severity of PTSD and its treatment during management of CG, especially when it involves bereaved families experiencing a traumatic accident.

Toward a Better Understanding of Psychological Symptoms in People Confronted With the Disappearance of a Loved One: A Systematic Review

OBJECTIVE

The disappearance of a loved one is claimed to be the most stressful type of loss. The present review explores the empirical evidence relating to this claim. Specifically, it summarizes studies exploring the prevalence and correlates of psychological symptoms in relatives of missing persons as well as studies comparing levels of psychopathology in relatives of the disappeared and the deceased.

METHOD

Two independent reviewers performed a systematic search in PsychINFO, Web of Science, and Medline, which resulted in 15 studies meeting predefined inclusion criteria. Eligible studies included quantitative peer-reviewed articles and dissertations that assessed psychopathology in relatives of missing person.

RESULTS

All reviewed studies were focused on disappearances due to war or state terrorism. Prevalence rates of psychopathology were mainly described in terms of post-traumatic stress disorder and depression and varied considerably among the studies. Number of experienced traumatic events and kinship to the missing person were identified as correlates of psychopathology. Comparative studies showed that psychopathology levels did not differ between relatives of missing and deceased persons.

CONCLUSIONS

The small number of studies and the heterogeneity of the studies limit the understanding of psychopathology in those left behind. More knowledge about psychopathology postdisappearance could be gained by expanding the focus of research beyond disappearances due to war or state terrorism.