Psychological and social consequences of losing a child in a natural or human-made disaster: a review of the evidence

The impact of coping strategies and positive resources on post-traumatic stress symptoms among bereaved families of the Sewol ferry disaster

Introduction

This study investigated the long-term prevalence of, and factors associated with, post-traumatic stress disorder (PTSD) among the bereaved families of the Sewol ferry disaster, in which 250 students lost their lives during a school excursion.

Methods

Eight years after the disaster, 181 family members were surveyed, and the prevalence of clinical PTSD symptoms was estimated. The Positive Resources Test (POREST), the Duke-UNC Functional Social Support Questionnaire, and the Brief COPE were evaluated using self-report measures. The multivariable binomial logistic regression was used to identify protective and risk factors for PTSD.

Results

PTSD symptoms were present in 49.7% of the family members 8 years after the incident. A one-point increase in the score on the optimism subscale of the POREST was associated with a 20.1% decreased likelihood of having clinical PTSD symptoms (OR = 0.799; p = 0.027; 95% CI = 0.655-0.975). Conversely, a one-point increase in the score on the avoidant subscale of Brief COPE was associated with a 13.2% increased likelihood of having clinical PTSD symptoms (OR = 1.132; p = 0.041; 95% CI = 1.005-1.274).

Discussion

Our results provide evidence of the need for long-term mental health monitoring of bereaved families of disaster victims, along with valuable insights for the development of mental health intervention programs.

Reliability and Validity of Chinese Version of the Perceived Competence Scale for Disaster Mental Health Workforce: A Cross-Sectional Study

OBJECTIVE

This study aimed to translate the English version of the Perceived Competence Scale for Disaster Mental Health Workforce (PCS-DMHW) into Chinese, and to test its reliability and validity in Chinese mental health workers.

METHODS

With the consent of Professor Choi, Keimyung University, Korea, and the authorization of the scale, the English version of PCS-DMHW was translated, retranslated and culturally debugged to form the Chinese version of PCS-DMHW. The general information questionnaire and the Chinese version of PCS-DMHW scale were used to investigate 706 mental health workforce from 9 tertiary hospitals in Sichuan province in China from March 24, 2020 to April 14, 2020. The Cronbach's α coefficient was used to evaluate the internal consistency reliability of the scale, and the test-retest correlation coefficient r was used to evaluate the test-retest reliability of the scale. The content validity indexes (CVI) and exploratory factor analysis (EFA) was used separately for evaluating the content validity and structure validity of the scale.

RESULTS

The Cronbach's α coefficient of the Chinese version of PCS-DMHW total scale, individual competences and organizational competences subscale was 0.978, 0.956, and 0.964, respectively. The test-retest reliability of the total scale, individual competences and organizational competences subscale was 0.949, 0.932 and 0.927, respectively. The item-level CVI of all scale were ranged from 0.833-1.000, the scale-level CVI (S-CVI)/universal agreement of the total scale, individual competences and organizational competences subscale was 0.833, 0.875, and 0.857, respectively, and the S-CVI/average was 0.972, 0.979, and 0.976, respectively. EFA showed that two principal components were extracted from the subscale of individual competences and organizational competences.

CONCLUSION

The Chinese version of PCS-DMHW has good reliability and validity, and can be widely used in China.

Prolonged grief, post-traumatic stress, and functional impairment in parents and siblings 8 years after the 2011 Utøya terror attack

Background: Research on bereavement after terrorism is limited and primarily aiming on short-term consequences.Objective: To better understand the long-term health consequences of terrorism, we studied bereaved parents and siblings eight years after the Utøya terrorist attack in Norway. We examined the participants' symptom levels of prolonged grief (PG) and post-traumatic stress (PTS), as well as their psychosocial functioning and employment status.Method: Bereaved parents (n = 88) and siblings (n = 34) aged 19 and above (mean age  = 49.7 years, SD = 13.8 years, 59.8% female) completed the Inventory of Complicated Grief (ICG), the Impact of Event Scale-Revised (IES-R), and the Work and Social Adjustment Scale (WSAS) to assess PG, PTS, and functional impairment, respectively. In addition, information about employment status was obtained. The proportion of participants scoring above recommended thresholds on the ICG, IES-R, and WSAS was calculated. Differences between parents and siblings and gender differences on these measures were examined.Results: In total, 62.3% of the participants had scores on the ICG indicating a risk for prolonged grief, while 45.9% scored over cutoff on the IES. There was a high overlap between symptoms of PG and PTS. Females had significantly higher scores on both the ICG and the IES compared to males. There were no differences between parents and siblings regarding PG and PTS symptoms. One out of three showed severe functional impairment on the WSAS. Approximately 30% of all the bereaved were outside the labour force, and one third of the parents had become unable to work after the terrorist attack.Conclusion: Many bereaved parents and siblings, following the Utøya terror attack, report long-lasting health consequences with symptoms of PG and PTS and functional impairment. The results suggest a need for follow up of bereaved after a terror attack and identify family members in need of health services.

The mediating effect of social support on the relationship between perceived stress and quality of life among shidu parents in China

BACKGROUND

"Loss-of-only-child family" refers to the family in which the only child died and the mother has passed her child-bearing age. The parents who are unable to reproduce or do not foster other children are known as "shidu parents" in China. This study aimed to estimate the quality of life (QOL) and the mediating role of social support between perceived stress and QOL in Chinese shidu parents.

METHODS

502 shidu parents were recruited in Shenyang city. Shidu parents were asked to complete a questionnaire including the MOS item short from health survey (SF-36), the perceived stress scale-10 (PSS-10) and the functional social support questionnaire (FSSQ). Hierarchical linear regression was performed to assess the associations among perceived stress, social support and QOL. Asymptotic and resampling strategies were used to explore the mediating role of social support.

RESULTS

The mean score of PCS and MCS was 64.83 ± 22.66 and 59.36 ± 21.83, respectively. Perceived stress was found to be negatively associated with both PCS (β =  - 0.21, p < 0.001) and MCS (β =  - 0.28, p < 0.001), while social support was positively associated with both PCS (β = 0.32, p < 0.001) and MCS (β = 0.32, p < 0.001). For shidu parents, the proportion of mediation of social support between perceived stress and QOL was 36.85% for PCS and 29.45% for MCS, respectively.

CONCLUSIONS

Perceived stress was associated with QOL and social support had a partially mediating effect between perceived stress and QOL in Chinese shidu parents. Low PCS and MCS of shidu parents highlight the need of timely developing interventions to reduce stress and reinforce social support to further improve their QOL.

Risk factors for PTSD of Shidu parents who lost the only child in a rapid aging process: a cross-sectional study

BACKGROUND

The elderly population is rising globally, especially in China where a large population base causes the largest number of older adults in the world. Notably, Shidu people who are over the age of 60 and have lost their only child have drawn great public attentions as they become more elderly, medically unstable and worse mentally unhealthy. Posttraumatic stress disorder (PTSD) is one of the most common consequences resulted from the loss of the only child. However, few previous studies have examined PTSD in Shidu older aldults, and the risk factors are a relatively understudied area. Our study aims to estimate the prevalence and potential risk factors of PTSD and improve the possibility of early identifying the high-risk Shidu parents with PTSD, and successively provide timely and effective interventions.

METHOD

Based on the register of population statistic information provided by the health family planning commission, 149 participants were enrolled randomly. Data was collected by interviews and questionnaires. Socio-demographic and bereavement-related information and physical health outcomes were obtained. PTSD Checklist-Civilian Version was used to screen for bereavement-related PTSD.

RESULT

The morbidity of PTSD reached 30.9%, while in the group of age over 60 the morbidity reached 31.6%. Stratified by potential demographic risk factors, SDPs have significant between-group differences of PTSD. Specially, being women, higher income, losing the single child at older age, more serious medical conditions and being Shidu for a shorter period indicated higher severity of PTSD in SDPs. The single child dying at a older age and from accidence were also significant indicators. Regression analysis showed the gender of SDPs, hospital visits, and the cause of child death significantly predicted the severity of PTSD.

CONCLUSION

With the accelerate process of aging, especially in China, Shidu older adults become a group deserved more attentions. PTSD is clearly a possible reaction to the loss of the only child. The gender and hospital visits of the Shidu older adults and the causes of their child's death significantly related to the prevalence of PTSD, which could help to improve the possibility of early intervening.

Heart rate variability associated with posttraumatic stress disorder in victims' families of sewol ferry disaster

Posttraumatic stress disorder (PTSD), which is caused by a major traumatic event, has been associated with autonomic nervous function. However, there have been few explorations of measuring biological stress in the victims' family members who have been indirectly exposed to the disaster. Therefore, this longitudinal study examined the heart rate variability (HRV) of the family members of victims of the Sewol ferry disaster. We recruited 112 family members of victims 18 months after the disaster. Sixty-seven participants were revisited at the 30 months postdisaster time point. HRV and psychiatric symptoms including PTSD, depression and anxiety were evaluated at each time point. Participants with PTSD had a higher low frequency to high frequency ratio (LF:HF ratio) than those without PTSD. Logistic regression analysis showed that the LF:HF ratio at 18 months postdisaster was associated with a PTSD diagnosis at 30 months postdisaster. These results suggest that disrupted autonomic nervous system functioning for longer than a year after trauma exposure contributes to predicting PTSD vulnerability. Our finding may contribute to understand neurophysiologic mechanisms underlying secondary traumatic stress. Future studies will be needed to clarify the interaction between autonomic regulation and trauma exposure.

Posttraumatic Stress among Not-Exposed Traumatically Bereaved Relatives after the MS Estonia Disaster

Background

Little is known about posttraumatic stress (PTS) reactions in bereaved individuals following loss in disaster who were not directly exposed to disaster. The aim of the present study was to examine the course of PTS up to three years after losing relatives in the MS Estonia ferry disaster, one of the worst maritime disasters in modern times.

Methods

Seven postal surveys were sent out over three years post-disaster. The respondents were invited and added consecutively during the three years and 938 relatives participated in one or more of the surveys, representing 89% of the MS Estonia’s Swedish victims. The survey included the Impact of Event Scale (IES) to measure PTS. Latent growth curve modeling was used to analyze PTS over time.

Results

The majority of bereaved individuals had high levels of PTS. At three years post-loss, 62% of the respondents scored above the recommended cut-off value on the IES. Over time, PTS symptoms declined, but initially high symptoms of PTS were associated with a slower recovery rate.

Conclusion

The present finding suggests that being an indirectly-exposed disaster-bereaved close-relative can lead to very high levels of PTS which are sustained for several years.

The relationship between post-traumatic stress disorder and quality of life in infertile Shidu parents from the 2008 Sichuan earthquake: the moderating role of social support

WHAT IS KNOWN ON THE SUBJECT?: Since the promulgation of the one-child policy in 1979, most families have had only one child. Shidu parents, as a special group of Sichuan 2008 earthquake victims, are parents who lost their only child in the earthquake. WHAT DOES THIS PAPER ADDED TO EXISTING KNOWLEDGE?: Shidu parents are an especially vulnerable group in China. This study was the first systematic population-based investigation to explore quality of life (QOL) risk factors and to examine the moderating role of social support between post-traumatic stress disorder (PTSD) and QOL in Shidu parents. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The results found that further social support should be provided as a long-term mental health intervention strategy to promote QOL in Shidu parents suffering from PTSD. The research may provide information to assist psychologists in post-disaster mental health interventions with Shidu parents and to inspire decision makers who work with similar groups in other countries.

ABSTRACT

Introduction Because of the one-child policy in force in China from 1979 to 2015, most parents were only allowed to have a single child. Of all the Sichuan earthquake victims, there was a special group called the Shidu parents who lost their only child in the earthquake. Aim The aim of this study was to identify the related risk factors for the Shidu parents' quality of life (QOL) and to examine the role of social support as a moderator between post-traumatic stress disorder (PTSD) and QOL in Shidu parents. Method A cross-sectional sample survey was conducted to collect data from 10 heavily damaged counties in Sichuan province (n = 176). Discussion PTSD was found to be negatively associated with the Shidu parents' QOL, and social support had a major effect on moderating the association between the PTSD and QOL in Shidu parents. Implications for practice Developing suitable social support could be considered a key part of psychological intervention strategies to promote QOL in Shidu parents suffering from PTSD. This study could provide decision support for mental health professionals (e.g. nurses and psychiatrists) working on mental crisis interventions with Shidu parents.

Posttraumatic growth in aging individuals who have lost their only child in China

This article examined the extent of posttraumatic growth (PTG) and factors related to PTG in aging individuals who have lost their only child in China. The sample included 201 bereaved parents from different families residing in Chongqing, China. They were between 49-80 years old (M = 61) and had lost their only child. Personal interviews were conducted in their homes. PTG was assessed with a revised Posttraumatic Growth Inventory (PTGI-R). Descriptive and multiple linear regression analyses were conducted. Overall, the sample showed a positive tendency toward PTG. The older the child was at death, the less PTG the parent experienced. Time since the child's death was negatively correlated with PTG, and parents whose children died by accident/suicide had lower PTG than those whose children died of illness. Lower education and poor parental health were significantly associated with lower levels of PTG. Community support was significantly and positively associated with PTG. A majority of aging parents who have lost their only child in China experience PTG. Characteristics related to the loss (child's age at death, time since the death, and cause of death), personal resources (parent's education and health), and community support are associated with the degree of growth.

General Health Among Parents Who Lost Their Children in the Bam Earthquake

AIM

Bam earthquake and its profound tragedy of thousands killed has caused emotional and psychological trauma for tens of thousands of people who have survived. This study aimed to investigate general health of parents who lose their children in Bam earthquake 10 years after the earthquake.

METHOD

General health of 166 parents who lost their children in Bam earthquake was assessed using a translated version of General Health Questionnarie-28 items.

RESULTS

The mean score of GHQ was 25.63±15.28. Among all domains, the higher mean score belonged to the category of "anxiety/insomnia" and the lower one belonged to the category of "severe depression". The results revealed significant correlation between total GHQ mean score and gender as well as educational level (0.003).

CONCLUSION

Providing reflective narrative environments in which survivors can express their own experiences and feelings about earthquake, their loss and how they cope with it seems to be as an effective approach to identify their psychosocial situation and its influential factors. In such narrative environments special attention should be given to older participants, females and those who are single.

Effect of having a subsequent child on the mental health of women who lost a child in the 2008 Sichuan earthquake: a cross-sectional study

OBJECTIVE

To assess whether having a subsequent child had an effect on the mental health of Chinese mothers who lost a child during an earthquake.

METHODS

A cross-sectional survey of bereaved mothers was conducted 30 to 34 months after the 2008 Sichuan earthquake using individual structured interviews to assess sociodemographic characteristics, post-disaster experiences and mental health. The interviews incorporated standardized psychometric measures of anxiety, depression, post-traumatic stress disorder (PTSD) and complicated grief (CG). Social support was also assessed. An adjusted model taking potential confounders into account was used to explore any association between psychological symptoms and the birth of a subsequent child.

FINDINGS

The prevalence of psychological symptoms was higher in mothers who did not have a child after losing the first one. In an adjusted model, symptoms of anxiety (odds ratio, OR: 3.37; 95% confidence interval, CI: 1.51-7.50), depression (OR: 9.47; 95% CI: 2.58-34.80), PTSD (OR: 5.11; 95% CI: 2.31-11.34) and CG (OR: 10.73; 95% CI: 1.88-61.39) were significantly higher among the 116 women without a subsequent child than among the 110 mothers who had another child after bereavement. More than two thirds of the mothers with new infants had clinically important psychological symptoms.

CONCLUSION

Women who have lost an only child in a natural disaster are especially vulnerable to long-term psychological problems, especially if they have reached an age when conception is difficult. Research should focus on developing and evaluating interventions designed to provide women with psychosocial support and reproductive services.