Long-term collective assistance for the bereaved following a disaster: A Scandinavian approach

What elements of a systems' approach to bereavement are most effective in times of mass bereavement? A narrative systematic review with lessons for COVID-19

BACKGROUND

The global COVID-19 pandemic has left health and social care systems facing the challenge of supporting large numbers of bereaved people in difficult and unprecedented social conditions. Previous reviews have not comprehensively synthesised the evidence on the response of health and social care systems to mass bereavement events.

AIM

To synthesise the evidence regarding system-level responses to mass bereavement events, including natural and human-made disasters as well as pandemics, to inform service provision and policy during the COVID-19 pandemic and beyond.

DESIGN

A rapid systematic review was conducted, with narrative synthesis. The review protocol was registered prospectively (www.crd.york.ac.uk/prospero, CRD 42020180723).

DATA SOURCES

MEDLINE, Global Health, PsycINFO and Scopus databases were searched for studies published between 2000 and 2020. Reference lists were screened for further relevant publications, and citation tracking was performed.

RESULTS

Six studies were included reporting on system responses to mass bereavement following human-made and natural disasters, involving a range of individual and group-based support initiatives. Positive impacts were reported, but study quality was generally low and reliant on data from retrospective evaluation designs. Key features of service delivery were identified: a proactive outreach approach, centrally organised but locally delivered interventions, event-specific professional competencies and an emphasis on psycho-educational content.

CONCLUSION

Despite the limitations in the quantity and quality of the evidence base, consistent messages are identified for bereavement support provision during the pandemic. High quality primary studies are needed to ensure service improvement in the current crisis and to guide future disaster response efforts.

Can visiting the site of death be beneficial for bereaved families after terror? A qualitative study of parents' and siblings' experiences of visiting Utøya Island after the 2011 Norway terror attack

Background. After the 2011 terror attack on Utøya Island, a collective visit was organized for bereaved families. There is limited knowledge whether bereaved families can benefit from such visits after terror. Objective. This study aims to explore how bereaved families experienced visiting the site of death after the 2011 terror attack. Method. As part of in-depth interviews, 22 parents and 16 siblings were asked whether they had visited Utøya and, if so, how they experienced the visit. Participants' responses were analysed using thematic analysis. Results. The results showed that for the majority of the bereaved, visiting Utøya had been important in processing their loss. Three key themes emerged as to what they considered important with the visit: 'seeing the actual place of death', 'seeking factual information', and 'learning to know the island'. These factors were associated both with beneficial reactions (e.g. accepting the reality of the loss increased cognitive clarity) and with distressing reactions (e.g. intrusive thoughts, re-enactment images), but the benefits had outweighed the distress. Having the opportunity for multiple visits seemed to optimize the benefits. Conclusion. Bereaved families should be offered the opportunity to visit the site of death after terror.

Professionally Led Peer Support Group Process After the School Shooting in Finland

Background

Traumatic grief is a risk factor for psychological and physiological impairment. In a school shooting incident in Finland, several people lost their lives, and a large number of bereaved family members were at risk for traumatic grief. Psychosocial support for these bereaved was therefore essential, and this article describes a program that was developed for that purpose.

Method

Professionally led peer support group process was provided for the relatives of the deceased in the school shooting in Kauhajoki, Finland, 2008. The 2-year-long process consisted of five weekend gatherings with psychoeducative and group-work elements. The content of the process was based on the existing knowledge of and recommendations for enhancing recovery after a traumatic loss.

Results

On the average, 50 relatives of the deceased in the school shooting participated in the process. The process was based on the principles of (a) timing of the group work and interventions according to stages of bereavement, (b) psychoeducation, awareness rising, and recognizing the signs of posttraumatic symptoms, (c) attachment theory-based elements in parents' and siblings' grief and group work, and (d) encouraging cohesion and strength of families' natural networks and support systems.

Conclusion

Professionally led peer support group process is a trauma-theory-based intervention, which reaches a large number of the bereaved with similar loss. Via group work, psychoeducation, and shared rituals, the bereaved have an opportunity to share and express emotions and experiences, as well as increase their skills in psychological recovery after a violent death of a family member.

Support, opinion of support and psychological health among survivors of a natural disaster

BACKGROUND

Although formal intervention after disasters is recommended, the evidence base for this is weak. Satisfaction with support after disasters is seldom investigated and the relation to psychological symptoms is unknown.

AIMS

To investigate whether dissatisfaction with social and formalized support are associated with post-disaster psychological symptoms.

METHODS

A total of 1,505 Swedish survivors of the 2004 Indian Ocean tsunami responded to a questionnaire 14 months after the disaster, including the General Health Questionnaire-12, the Impact of Events Scale - Revised, the Crisis Support Scale, and questions concerning the reception and appraisal of social and formalized support from health care, psychological services and insurance agencies. Disaster exposure and background factors were controlled for in the analyses.

RESULTS

Reception of formalized support, but not social support, was associated with both psychological distress and post-traumatic stress. Dissatisfaction with social but not formalized support, with the exception of support from insurance agencies, was associated with psychological distress.

CONCLUSIONS

Social support and formalized support should be differentiated in future studies in order to improve preventive intervention efforts after disasters. The reporting of dissatisfaction with social support merits special attention, since this may indicate increased risk for psychological symptoms.

The tsunami--26 December 2004--experiences from one place of recovery, Stockholm, Sweden

INTRODUCTION

The natural disaster in South-East Asia had a great impact in Sweden affecting many individuals and families. In this paper, a series of strategies from Ersta Association for Diaconal Work (Ersta) are described to reach survivors by the tsunami of 26 December 2004, from January 2005 to August 2007.

AIMS

To find out what needs the survivors had and how professionals may work and take care of their needs during similar events in the future.

BACKGROUND

An immediate empathic effort took place at Ersta; thanks to good funding and many qualified professionals. This is a retrospective, mainly descriptive study of those strategies.

EVALUATION

The work included training of group leaders, support groups, memorials and rituals, weekly Open House meetings, individual contacts, weekend gatherings, day seminars most marketed through Erstas' website, advertisements and word of mouth. A total of 180 trainers/group leaders countrywide were trained and 25 became engaged at Ersta. Through the website and an unknown number of phone calls, an estimated 1362 adults, teenagers and children, grieving, injured and traumatised were reached.

FINDINGS

The Ersta project was in many ways successful, but could not be sustained, due to lack of enough collaboration with other voluntary organisations and change of leadership. Meeting other survivors and the structure of the activities were appreciated. There was much benefit from support groups. Questions arose about how to act efficiently and when to intervene, early or/and later. Particularly to consider, early signs of resilience among survivors, their own initiatives and networks such as 'naturally emerging groups'.

CONCLUSION

Extended collaboration between the authorities is necessary as well as continuous evaluation. A new law aimed at a more divided individual and societal responsibility. A new body (2009) under the Ministry of Defense will coordinate future resources, starting at the parish.

Bereavement and mental health after sudden and violent losses: a review

This paper reviews the literature on the psychological consequences of sudden and violent losses, including disaster and military losses. It also reviews risk and resilience factors for grief and mental health and describes the effects and possible benefit of psychosocial interventions. The review shows gaps in the literature on grief and bereavement after sudden and violent deaths. Still, some preliminary conclusions can be made. Several studies show that a sudden and violent loss of a loved one can adversely affect mental health and grief in a substantial number of the bereaved. The prevalence of mental disorders such as post-traumatic stress disorder (PTSD), major depressive disorder (MDD), and prolonged grief disorder (PGD, also termed complicated grief) varies widely, however, from study to study. Also, mental health disorders are more elevated after sudden and violent losses than losses following natural deaths, and the trajectory of recovery seems to be slower. Several factors related to the circumstances of the loss may put the bereaved at heightened risk for mental distress. These factors may be differentially related to different outcomes; some increase the risk for PTSD, others for PGD. Given the special circumstances, bereavement following sudden and violent death may require different interventions than for loss from natural death. Recommendations for future research and clinical implications are discussed.

EFPA and Work on Disaster, Crisis, and Trauma Psychology

In response to increasing concern about the effects of crises, disaster, trauma and, more recently, terrorism, EFPA established first a working party and then a Standing Committee to advise on the part psychology can play in preparing for emergencies and responding to them. The Committee has drawn together evidence and views from across Europe and the wider international scene. It has worked closely with the European Commission and has embarked on further training for members from recently acceded countries. It has recommended better ways of liaising across countries so that in the event of cross-border incidents, more efficient and effective responses can be assured. In turn this has implications for the training of psychologists and other professionals involved in emergency planning and response. Currently, there is a move to develop quality standards for such training.