Father kills mother: post-traumatic stress disorder in the children

Raising a child bereaved by domestic homicide: caregivers' experiences

Background: Optimising support for children and families affected by fatal family violence requires understanding all aspects of their experience. So far, little is known regarding the views of those who provide a home to children bereaved due to parental intimate partner homicide.Objective: The aim of the current study was to provide an in-depth exploration of the experiences of caregivers raising children after the loss of a parent due to intimate partner homicide.Method: Within the context of a mixed-methods study among 22 caregivers (16 female, 6 male, aged 33 to 71 years old) related to 35 children and young people (19 female, 16 male), bereaved due to parental intimate partner homicide in the Netherlands, we conducted a reflexive thematic analysis of the qualitative caregiver interviews.Results: Based on caregivers' accounts, we conceptualised four interrelated and ongoing challenges: (1) bringing the children into the family fold; (2) dealing with the perpetrator and relatives; (3) managing underprepared services; and (4) enduring it, mentally and physically. Sticking with their commitment to the children despite these challenges, caregivers also pointed to the potential for positive outcomes or turns of events, and recounted experiences of finding or making meaning.Conclusions: The complexity of the challenges the caregivers in our study faced and their remarkable commitment and perseverance underscore the importance of concerted, continuing efforts to understand and respond to families' needs in the aftermath of parental intimate partner homicide. We discuss practical implications regarding caregivers' assessment of children's needs, mental health care, information provision and agency, mediation of family conflict, provision of respite care, addressing financial and practical needs, and long-term and equitable access to support. We also propose a research agenda involving evaluation of current protocols, in-depth qualitative research, quantitative analyses (where possible based on pooled data), and intervention studies.

Children bereaved by fatal intimate partner violence: A population-based study into demographics, family characteristics and homicide exposure

BACKGROUND

In the context of violence against women, intimate partner homicide increasingly receives research and policy attention. Although the impact of losing a parent due to intimate partner homicide is intuitively obvious, little is known about the children involved. We aimed to identify all children bereaved by parental intimate partner homicide in the Netherlands in the period 2003-2012, describe their demographics and family circumstances, and assess their exposure to prior violence at home and to the homicide itself.

METHODS AND FINDINGS

We cross-examined 8 national data sources and extracted data about children's demographics and circumstances prior to, and during the homicide. Our primary outcomes were prior violence at home (child maltreatment, neglect or domestic violence) and homicide witness status (ranging from being at a different location altogether to being present at the scene). During the decade under study, 256 children lost a biological parent due to 137 cases of intimate partner homicide. On average, the children were 7.4 years old at the time of the homicide (51.1% were boys; 95% CI 47.3-54.7) and most lost their mother (87.1%; full population data). Immigrant children were overrepresented (59.4%; 95% CI 52.8-66.0). Of the children for whom information about previous violence at home was gathered, 67.7% (95% CI 59.7-73.7) were certainly exposed and 16.7% (95% CI 11.3-22.2) probably. Of the children who had certainly been exposed, 43.1% (95% CI 41.1-60.9) had not received social services or mental health care. The majority of the children (58.7%; 95% CI 52.1-65.3) were present at the location of the homicide when the killing took place, with varying levels of exposure. Homicide weapons mostly involved cutting weapons and firearms, leading to graphic crime scenes.

CONCLUSIONS

Care providers need capacity not only to help children cope with the sudden loss of a parent but also with unaddressed histories of domestic violence and exposure to graphic homicide scenes, in a culture-sensitive way. Future directions include longitudinal monitoring of children's mental health outcomes and replication in other countries.

Children's Mental Health and Well-Being After Parental Intimate Partner Homicide: A Systematic Review

When one parent kills the other, children are confronted with multiple losses, involving their attachment figures and their direct living environment. In these complex situations, potentially drastic decisions are made, for example, regarding new living arrangements and contact with the perpetrating parent. We aimed to synthesize the empirical literature on children's mental health and well-being after parental intimate partner homicide. A systematic search identified 17 relevant peer-reviewed articles (13 independent samples). We recorded the theoretical background, methodology, and sample characteristics of the studies, and extracted all child outcomes as well as potential risk and protective factors. Children's outcomes varied widely and included psychological, social, physical, and academic consequences (e.g., post-traumatic stress, attachment difficulties, weight and appetite changes, and drops in school grades). Potential risk and protective factors for children's outcomes included 10 categories of pre-, peri-, and post-homicide characteristics such as cultural background of the family, whether the child witnessed the homicide, and the level of conflict between the families of the victim and the perpetrator. We integrated the findings into a conceptual model of risk factors to direct clinical reflection and further research.

Femicide and murdered women's children: which future for these children orphans of a living parent?

BACKGROUND

To assess the prevalence of femicides in Italy over the last three years and the potential long lasting effects of these traumatic events for the children of a woman who dies a violent death.

METHODS

The data used in this study come from an internet search for the number of femicides occurring in Italy between 1(st) January, 2012 and 31(st) October, 2014.

RESULTS

The total number of femicides was 319; the average age of murdered women was 47.50 ± 19.26. Cold arms in the form of sharp object -mostly knives- have caused the death of 102/319 women; firearms were used in 87/319 cases; asphyxiation was the chosen method in 52/319 cases. About the place where the femicides occurred, 209/319 were committed inside the victim's house. Children of women who died a violent death were 417 with a total of 180 minors in less than three years. A total of 52/417 children were witness to the killing and, among these 30/52 were minors; in 18/417 cases, children were murdered together with their mother and among these 9/18 were minors.

CONCLUSIONS

Long-term studies are needed to ascertain what happens to these children, to understand what are the most appropriate psychological treatments, the best decisions about the contact with their father and the best placement for these children.

"No rights or wrongs, no magic solutions": teachers' responses to bereaved adolescent students

The study aimed to understand how teachers responded to students bereaved of a parent. The authors interviewed 12 secondary school teachers and implemented a grounded theory design. Participants described how they engage in six central processes: flexibility, openness, support, emotionality, sharing, and communication. The authors conceptualized these processes as continua with opposing actions at each end. Teachers' movement on the continua is fluid, influenced by systemic factors, student-specific factors and factors individual to the teacher. Responses on the continua in relation to each student's bereavement are unique to each teacher-student relationship.

Psychological distress amongst AIDS-orphaned children in urban South Africa

BACKGROUND

South Africa is predicted to have 2.3 million children orphaned by Acquired Immune Deficiency Syndrome (AIDS) by 2020 (Actuarial Society of South Africa, 2005). There is little knowledge about impacts of AIDS-related bereavement on children, to aid planning of services. This study aimed to investigate psychological consequences of AIDS orphanhood in urban township areas of Cape Town, South Africa, compared to control groups of children and adolescents orphaned by other causes, and non-orphans.

METHOD

One thousand and twenty-five children and adolescents (aged 10-19) were interviewed using socio-demographic questionnaires and standardised scales for assessing depression, anxiety, post-traumatic stress, peer problems, delinquency and conduct problems.

RESULTS

Controlling for socio-demographic factors such as age, gender, formal/informal dwelling and age at orphanhood, children orphaned by AIDS were more likely to report symptoms of depression, peer relationship problems, post-traumatic stress, delinquency and conduct problems than both children orphaned by other causes and non-orphaned children. Anxiety showed no differences. AIDS-orphaned children were more likely to report suicidal ideation. Compared to Western norms, AIDS-orphaned children showed higher levels of internalising problems and delinquency, but lower levels of conduct problems.

CONCLUSIONS

Children orphaned by AIDS may be a particularly vulnerable group in terms of emotional and, to a lesser extent, behavioural problems. Intervention programs are necessary to ameliorate the psychological sequelae of losing a parent to AIDS.

Risk and protective factors for psychological well-being of children orphaned by AIDS in Cape Town: a qualitative study of children and caregivers' perspectives

By 2020, an estimated 2.3 million South African children will be orphaned by HIV/AIDS (Actuarial Society of South Africa, 2005), but little is known about risk and protective factors for their emotional and behavioural well-being. This qualitative study explores perspectives of affected families. Orphaned children (n = 60), caregivers of orphaned children (n = 42) and social care professionals (n = 20) completed semi-structured interviews and focus groups. Participants were recruited from schools, shelters and welfare services. Findings from multiple sources indicate potential risk and protective factors in a range of dimensions, including bereavement, family functioning, social support, poverty, access to education and perceived stigma. Many factors reflected international literature on children experiencing similar stressors (e.g. non HIV/AIDS-related bereavement). However, this study also identified factors which may be specific to this group, notably stigma, abuse and peer factors. Current research is quantitatively testing associations between these identified factors and psychological outcomes.

The psychological well-being of children orphaned by AIDS in Cape Town, South Africa

BACKGROUND

An estimated 2 million children are parentally bereaved by AIDS in South Africa. Little is known about mental health outcomes for this group.

METHODS

This study aimed to investigate mental health outcomes for urban children living in deprived settlements in Cape Town. 30 orphaned children and 30 matched controls were compared using standardised questionnaires (SDQ) on emotional and behavioural problems, peer and attention difficulties, and prosocial behaviour. The orphan group completed a modified version of a standardised questionnaire (IES-8), measuring Post-Traumatic Stress symptoms. Group differences were tested using t-tests and Pearson's chi-square.

RESULTS

Both groups scored highly for peer problems, emotional problems and total scores. However, orphans were more likely to view themselves as having no good friends (p = .002), to have marked concentration difficulties (p = .03), and to report frequent somatic symptoms (p = .05), but were less likely to display anger through loss of temper (p = .03). Orphans were more likely to have constant nightmares (p = .01), and 73% scored above the cut-off for Post-Traumatic Stress Disorder.

CONCLUSION

Findings suggest important areas for larger-scale research for parentally-bereaved children.

Homicide bereavement counseling: a survey of providers

The opinions of 116 homicide bereavement caregivers of interventions recommended for survivors were solicited. Presenting problems, optimum treatment framework, and reasons for treatment failure were also surveyed. Respondents preferred methods associated with crisis intervention and grief counseling. Other clinical techniques were rated as moderately helpful, except family therapy, which was highly rated. Suppression of trauma imagery was deemed harmful to survivors, though diversion was recommended often in cases of complicated grief. Caregivers who are themselves survivors appeared more sensitive to some of the emotional aspects of homicide bereavement, such as the potential for retraumatization in therapy.

Posttraumatische Belastungsstörung bei Kindern und Jugendlichen

Zusammenfassung. Theoretischer Hintergrund: Bislang liegen im Vergleich zur Forschung zur Posttraumatischen Belastungsstörung (PTB) bei Erwachsenen erst wenige Studien zur Epidemiologie und zur Behandlung der Störung bei Kindern und Jugendlichen vor. Ätiologische Modelle berücksichtigen bislang nur wenig entwicklungsbedingte Besonderheiten der Traumatisierung im frühen Lebensalter. Fragestellung: Überblick zum Stand der Forschung zu Häufigkeit, Entstehung, Aufrechterhaltung und Behandlung der PTB im Kindes- und Jugendalter. Methode: Analyse bislang vorliegender empirischer und theoretischer Arbeiten. Ergebnisse: Das Symptombild bei Kindern unterscheidet sich deutlich von dem der Erwachsenen, Unterschiede sowie diagnostische Instrumente werden beschrieben. Nach dem Erleben von Gewalt, besonders sexueller Art, erkranken Kinder und Jugendliche im Vergleich zu anderen Formen der Traumatisierung am häufigsten an einer PTB. Jungen sind insgesamt nach einer Traumatisierung weniger stark von posttraumatischer Symptomatik betroffen als Mädchen. Das Risiko, an PTB zu erkranken, steigt mit sinkendem Lebensalter bei Traumatisierung. Behandlungsprogramme beziehen diese besondere Vulnerabilität bislang nur wenig ein. Kontrollierte und randomisierte Studien zur Überprüfung ihrer Wirksamkeit fehlen. Schlussfolgerung: Kognitive Modelle, welche Besonderheiten der Wahrnehmung, Verarbeitung und Speicherung traumatischer Informationen in den Mittelpunkt stellen, liefern - durch die Berücksichtigung der Entwicklung kognitiver Fähigkeiten - Erklärungsmöglichkeiten für die negative Assoziation zwischen Lebensalter bei Traumatisierung und Vulnerabilität für PTB und Behandlungsansätze für die PTB im Kindes- und Jugendalter.

Psychological disturbance and service provision in parentally bereaved children: prospective case-control study

OBJECTIVES

To identify whether psychiatric disturbance in parentally bereaved children and surviving parents is related to service provision.

DESIGN

Prospective case-control study.

SETTING

Two adjacent outer London health authorities.

PARTICIPANTS

45 bereaved families with children aged 2 to 16 years.

MAIN OUTCOME MEASURES

Psychological disturbance in parentally bereaved children and surviving parents, and statistical associations between sample characteristics and service provision.

RESULTS

Parentally bereaved children and surviving parents showed higher than expected levels of psychiatric difficulties. Boys were more affected than girls, and bereaved mothers had more mental health difficulties than bereaved fathers. Levels of psychiatric disturbance in children were higher when parents showed probable psychiatric disorder. Service provision related to the age of the children and the manner of parental death. Children under 5 years of age were less likely to be offered services than older children even though their parents desired it. Children were significantly more likely to be offered services when the parent had committed suicide or when the death was expected. Children least likely to receive service support were those who were not in touch with services before parental death.

CONCLUSIONS

Service provision was not significantly related to parental wishes or to level of psychiatric disturbance in parents or children. There is a role for general practitioners and primary care workers in identifying psychologically distressed surviving parents whose children may be psychiatrically disturbed, and referring them to appropriate services.