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De Leo D, Zammarrelli J, Marinato G, Capelli M, Viecelli Giannotti A. Best Practices for Notification of Unexpected, Violent, and Traumatic Death: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6222. [PMID: 37444070 PMCID: PMC10341669 DOI: 10.3390/ijerph20136222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Death reporting is a delicate task. The ways in which it is carried out can have a significant impact on both the recipient and the notifier, especially in the event of a sudden, violent, and traumatic death. Empathetic, sensitive, and attentive communication with survivors can represent a first opportunity to support the bereavement process. The acquisition of specific skills for the delivery of the death notification is necessary for the professional who carries out the communication to increase self-efficacy, knowledge, and perception of competence in this area. OBJECTIVE To map what the literature has produced on the theme of best practices for the notification of unexpected, violent, and traumatic deaths and to provide guidance for the formulation of appropriate best practices and the development of effective educational programs. METHODS A review was conducted using the PRISMA Scoping Review extension on English language literature published between 1966 and 2022. RESULTS Starting from the initial 3781 titles, 67 articles were selected. From a thematic point of view, the analysis of the contents made it possible to identify five dimensions: (1) general guidelines in relation to various professional figures; (2) specific protocols; (3) guidelines for notifying death to children; (4) guidelines for notification of death by telephone; and (5) recommendations and suggestions for death notification training programs. DISCUSSION Death notification is configured as a process, divided into sequential phases. The act of notification constitutes the central phase during which communication is carried out. The communication of death is context-specific; therefore, it should require the creation of specific protocols for the various professions involved in the task, along with targeted theoretical and practical training. CONCLUSIONS The importance of defining specific guidelines for the various professionals and standardized programs of theoretical and practical training emerges. The implementation of future sectoral studies will allow evaluations of the effectiveness of these protocols and programs.
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Affiliation(s)
- Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, QLD 4122, Australia
- Slovene Centre for Suicide Research, Primorska University, 6000 Koper, Slovenia
- De Leo Fund, 35137 Padua, Italy
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De Leo D, Guarino A, Congregalli B, Zammarrelli J, Valle A, Paoloni S, Cipolletta S. Receiving Notification of Unexpected and Violent Death: A Qualitative Study of Italian Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10709. [PMID: 36078425 PMCID: PMC9518459 DOI: 10.3390/ijerph191710709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
(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.
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Affiliation(s)
- Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane 4122, Australia
- Slovene Center for Suicide Research, Primorska University, 6000 Koper, Slovenia
- De Leo Fund, 35137 Padua, Italy
| | | | | | | | - Anna Valle
- Autonomous Syndicate of Police (SAP), 00184 Rome, Italy
| | | | - Sabrina Cipolletta
- Department of General Psychology, University of Padua, 35100 Padua, Italy
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Hofmann L, Glaesmer H, Przyrembel M, Wagner B. The Impact of Police Behavior During Death Notifications on Mental Health of the Bereaved: A Cross-Sectional Study. OMEGA-JOURNAL OF DEATH AND DYING 2021; 87:344-362. [PMID: 34034552 DOI: 10.1177/00302228211019202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The delivery of death notifications may affect the mental health of bereaved individuals. Police officers are often the first people with whom the bereaved have contact in this exceptional situation. Therefore, it is essential to assess the behavior of police officers and the impact on the bereaved. We examined the experiences of 86 individuals who received the notification through the police and assessed symptoms of prolonged grief, depression, and posttraumatic stress symptoms. The interaction with police was associated with posttraumatic avoidance behavior and the presence of another supporting person was associated with higher scores of depression. Handing out information material and staying with the bereaved was related to a positive evaluation of police behavior. It appears important to identify helpful and problematic behavior for a better understanding and for an adaptation of existing guidelines.
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Affiliation(s)
- Laura Hofmann
- Department of Clinical Psychology, Medical School Berlin, Berlin, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Marisa Przyrembel
- Akkon University of Applied Sciences for Human Sciences, Berlin, Germany
| | - Birgit Wagner
- Department of Clinical Psychology, Medical School Berlin, Berlin, Germany
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Hofmann L, Glaesmer H, Przyrembel M, Wagner B. An Evaluation of a Suicide Prevention E-Learning Program for Police Officers (COPS): Improvement in Knowledge and Competence. Front Psychiatry 2021; 12:770277. [PMID: 34966307 PMCID: PMC8710598 DOI: 10.3389/fpsyt.2021.770277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Police officers are at high risk for mental and physical health problems and suicidal ideation. The specific risk factors are numerous and concern stressful missions and administrative aspects of the police profession. So far, the police get only little training on specific missions as well as on coping with stress and suicidal ideation in the police profession. In this study we test the efficacy of the online training COPS (Coping with Suicide) for police officers. Methods: A total of 142 police officers from Germany and Switzerland participated in the study; complete data (baseline and post) are available from 102 participants. The training consisted of three modules covering the topics of delivering death notifications, dealing with individuals with suicidal ideation and dealing with one's own distress and suicidal ideation in the police profession. The primary outcomes are perceived knowledge and self-rated competence regarding the contents of the program, actual knowledge as well as symptoms of depression and anxiety (PHQ-9), and attitudes toward suicide (ATTS). The data are collected at baseline and after completing the training. Results: We found a significant increase in knowledge as well as in perceived competence after completing the training. Mental health and attitudes toward suicide did not change significantly. Years on the job had no moderating effect on the effectiveness of the training. Discussion: The results suggest that a short e-learning program significantly improves knowledge and self-rated competence in delivering death notifications, in suicide prevention and stress management. It can be easily integrated into the daily routine of police-officers, and participants could participate at their own pace and from any location. One limitation of this study is the lack of a control-group. Further advantages and limitations of this study are discussed. Clinical Trial Registration: https://www.drks.de/drks_web/, identifier: DRKS00023882.
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Affiliation(s)
- Laura Hofmann
- Department of Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Marisa Przyrembel
- Akkon University of Applied Sciences for Human Sciences, Berlin, Germany
| | - Birgit Wagner
- Department of Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
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De Leo D, Zammarrelli J, Viecelli Giannotti A, Donna S, Bertini S, Santini A, Anile C. Notification of Unexpected, Violent and Traumatic Death: A Systematic Review. Front Psychol 2020; 11:2229. [PMID: 33101106 PMCID: PMC7546769 DOI: 10.3389/fpsyg.2020.02229] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022] Open
Abstract
Background: The way the death of a person is communicated can have a profound impact on the bereavement process. The words and expressions that are used to give the tragic news, the characteristics of who communicates it, the physical setting in which the notification is given, the means used (e.g., in person, via phone call, etc.) are just some of the factors that can influence the way survivors face one of the most difficult moments in their lives. Aim: To review the literature on the topic of death notification to verify the state of the art related to this important procedure. Methods: A systematic review was conducted with PRISMA criteria on English-written materials produced from 1966 to 2019. Results: Out of the initial 3,166 titles considered, 60 articles were extracted for this review. A content analysis has revealed four main areas of interest: (1) protocols and guidelines; (2) emotional reactions of recipients and notifiers; (3) professional figures involved in the notification process; and, (4) types of death. Discussion: The communication of death represents a complex and stressful experience not only for those who receive it but also for those who give it. Alongside the acquisition of a necessary technique and execution methods, the process should involve the selection of notifiers based on personality characteristics and communication styles. Conclusion: Indications for the need of better training and protocols sensitive to different circumstances emerge. Adequate preparation can positively influence the quality of communication and the effects it produces, both on recipients and notifiers. In vocational training, more space should be devoted to this demanding task.
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Affiliation(s)
- Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, QLD, Australia
- Slovene Center for Suicide Research, Primorska University, Koper, Slovenia
- De Leo Fund, Padua, Italy
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Reny D, Root S, Chreiman K, Browning R, Sims C. A Body of Evidence: Barriers to Family Viewing After Death by Gun Violence. J Surg Res 2019; 247:556-562. [PMID: 31757370 DOI: 10.1016/j.jss.2019.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 07/26/2019] [Accepted: 09/13/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Gun violence remains a staggering public health care crisis. Although viewing the victim's body is essential to the grieving process, this practice is not universally practiced in the trauma bay and may not be supported by nurses. This study investigates how trauma nurses perceive bereavement and the potential barriers to family viewing after death by gun violence. METHODS A survey designed to assess demographics, current practices, knowledge of policies, and personal beliefs regarding family viewing after violent crime was sent electronically to members of the Society of Trauma Nurses. Participants were asked to rank the importance of 14 viewing barriers. Descriptive analysis and perception of barriers between those who did and did not permit viewing were compared using Mann-Whitney tests. *P < 0.05 is considered significant. RESULTS Of the 212 participants, the majority were white, female nurses (86%), aged 30 to 60 y who worked in an urban or suburban setting (58% and 30%). Only 15% had a written hospital policy with the majority not knowing if the police (68%) or medical examiner (74%) had written policies. Despite lack of guidelines, viewings did routinely occur (68%), but only 37% permitted touching. Nurses who did not permit viewing were more likely to rank legal concerns and trauma bay environment as significant barriers. CONCLUSIONS Although family viewing after gun violence frequently occurs in the trauma bay, there are significant barriers that are compounded by lack of formal policies. Collaboration with police and medical examiners could mitigate these fears while promoting a safe and more family-centered experience.
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Affiliation(s)
- Danielle Reny
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah Root
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristen Chreiman
- Division of Traumatology, University of Pennsylvania, Surgical Critical Care, and Emergency Surgery, Philadelphia, Pennsylvania
| | - Rhonda Browning
- Division of Traumatology, University of Pennsylvania, Surgical Critical Care, and Emergency Surgery, Philadelphia, Pennsylvania
| | - Carrie Sims
- Division of Traumatology, University of Pennsylvania, Surgical Critical Care, and Emergency Surgery, Philadelphia, Pennsylvania.
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Omerov P, Steineck G, Nyberg T, Runeson B, Nyberg U. Viewing the body after bereavement due to suicide: a population-based survey in Sweden. PLoS One 2014; 9:e101799. [PMID: 24999660 PMCID: PMC4085007 DOI: 10.1371/journal.pone.0101799] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 06/11/2014] [Indexed: 01/20/2023] Open
Abstract
Background Research on the assumed, positive and negative, psychological effects of viewing the body after a suicide loss is sparse. We hypothesized that suicide-bereaved parents that viewed their childs body in a formal setting seldom regretted the experience, and that viewing the body was associated with lower levels of psychological morbidity two to five years after the loss. Methods and Findings We identified 915 suicide-bereaved parents by linkage of nationwide population-based registries and collected data by a questionnaire. The outcome measures included the Patient Health Questionnaire (PHQ-9). In total, 666 (73%) parents participated. Of the 460 parents (69%) that viewed the body, 96% answered that they did not regret the experience. The viewing was associated with a higher risk of reliving the child's death through nightmares (RR 1.61, 95% CI 1.13 to 2.32) and intrusive memories (RR 1.20, 95% CI 1.04 to 1.38), but not with anxiety (RR 1.02, 95% CI 0.74 to 1.40) and depression (RR 1.25, 95% CI 0.85 to 1.83). One limitation of our study is that we lack data on the informants' personality and coping strategies. Conclusions In this Swedish population-based survey of suicide-bereaved parents, we found that by and large everyone that had viewed their deceased child in a formal setting did not report regretting the viewing when asked two to five years after the loss. Our findings suggest that most bereaved parents are capable of deciding if they want to view the body or not. Officials may assist by giving careful information about the child's appearance and other details concerning the viewing, thus facilitating mental preparation for the bereaved person. This is the first large-scale study on the effects of viewing the body after a suicide and additional studies are needed before clinical recommendations can be made.
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Affiliation(s)
- Pernilla Omerov
- Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Gunnar Steineck
- Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg, Sweden
| | - Tommy Nyberg
- Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Bo Runeson
- Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ullakarin Nyberg
- Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
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