Factors Associated with Complicated Grief in Students Who Survived the Sewol Ferry Disaster in South Korea

Suicide warning signs that are challenging to recognize: a psychological autopsy study of Korean adolescents

BACKGROUND

In South Korea, the leading cause of youth death has been suicide for about 20 years. In this study, we conducted a multi-method psychological autopsy to identify the psychiatric diagnosis, developmental history, personality traits, family history, school life, warning signs of suicide, and risk factors related to suicide for the first time in Korea.

METHODS

This was a postmortem, retrospective, and descriptive study of 36 adolescents who died by suicide between August 2015 and July 2021 in South Korea. We obtained qualitative and quantitative data from the Korean Psychological Autopsy of Adolescent, conducted by the Suicide and School Mental Health Institute, the official student mental health policy-focused research institute of the Korean Ministry of Education.

RESULTS

The adolescents comprised equal percentage of girls and boys. Approximately half of the deaths (55.6%) occurred at home and most (72.2%) involved jumping from a height. Most of the adolescents (97.2%) had one major psychiatric disorder before death, with depressive disorder being the most prevalent (75%). They were at a high risk for internet addiction before death. The most common personality trait was avoidance (28.6%), followed by submissiveness (27.3%). Half of the parents reported that the adolescents were satisfied with their school life and the teachers observed that they had no behavioral problems. One year before death, seven (19.4%) adolescents injured themselves and five (13.9%) had attempted suicide. Most of the deceased (80.6%) had expressed suicide warning signs to their families within one year before death. Adolescents had a long experience of family-related adverse events.

CONCLUSIONS

Most of the adolescents had mental health disorders and expressed suicidal intentions using verbal and nonverbal signs. However, it was challenging for families to recognize the risk signs because of adolescents' personality traits or a good school life. To prevent adolescent suicide, adolescents, parents, and teachers need to be educated to recognize signs of suicide warning signs and equipped to guide adolescents to appropriate care.

Prevalence of prolonged grief disorder in bereaved children and adolescents: A systematic review

PURPOSE

Prolonged Grief Disorder (PGD) is a condition recently introduced in international classifications of mental disorders. Although PGD is associated with significant distress and impairment that may have developmental consequences, to date, little is known about its prevalence and associated factors in children and adolescents. The present systematic review registered in PROSPERO (CRD42021236026) aimed to: (i) review existing data on the prevalence of PGD in bereaved children and adolescents; and (ii) identify factors associated with PGD in this population.

METHODS

Six electronic databases, grey literature and a manually searched journal identified 1,716 articles with no backward limit to September 2021. Epidemiological studies were included if they reported the prevalence of PGD in bereaved children and adolescents. Study characteristics, diagnostic and assessment tools, population, loss-related characteristics and prevalence of PGD were reviewed.

RESULTS

Five studies met our inclusion criteria. The reported prevalences of PGD ranged from 10.4% to 32%. Female gender, cognitive avoidance, chronic stressors such as economic hardship, exposure to trauma or other losses appear to be associated with more severe symptoms or even a higher risk of PGD. Conversely, data suggest social support may be protective.

CONCLUSION

This first systematic review found a relatively high prevalence of PGD in bereaved children and adolescents. While further large epidemiological studies are needed, this review highlights the importance of evaluating PGD in current clinical practice and suggests that further research into diagnostic and therapeutic approaches targeting this disorder is warranted.

Do insecure attachment styles predict prolonged grief symptoms? Significant null findings

Insecure attachment is proposed to be a risk factor in the development and persistence of severe grief. Although prior research demonstrates positive cross-sectional and longitudinal correlations between attachment styles and prolonged grief symptoms, controlled longitudinal analyses yield fewer convincing results. Therefore, we sought to further clarify the concurrent and longitudinal associations between these constructs. A sample of 225 bereaved Dutch adults (87% women; Mean age: 48.86 years) participated in a three-wave longitudinal survey including measures of attachment anxiety and attachment avoidance at baseline and prolonged grief symptoms at baseline and 6- and 12-month follow-up. Attachment anxiety and attachment avoidance were significantly positively correlated with prolonged grief symptoms at all time-points. However, multiple regressions, controlling for baseline symptoms, showed that attachment anxiety, attachment avoidance, and their interaction did not predict residual change in prolonged grief symptoms. These findings cast doubt on the proposed role of insecure attachment styles in prolonged grief.

An Exploration of Discrepancies and Concordances Between Hospital Disaster Directors and General Health Care Providers in Gyeonggi Province, South Korea: Quantitative Analysis of a Multicenter Cross-Sectional Survey Study

OBJECTIVE

The purpose of this study was to investigate differences in the perception of disaster issues between disaster directors and general health care providers in Gyeonggi Province, South Korea.

METHODS

The Gyeonggi provincial committee distributed a survey to acute care facility personnel. Survey topics included awareness of general disaster issues, hospital preparedness, and training priorities. The questionnaire comprised multiple choices and items scored on a 10-point Likert scale. We analyzed the discrepancies and characteristics of the responses.

RESULTS

Completed surveys were returned from 43 (67%) of 64 directors and 145 (55.6%) of 261 health care providers. In the field of general awareness, the topic of how to triage in disaster response showed the greatest discrepancies. In the domain of hospital level disaster preparedness, individual opinions varied most within the topics of incident command, manual preparation. The responses to "accept additional patients in disaster situation" showed the biggest differences (> 21 versus 6~10).

CONCLUSIONS

In this study, there were disaster topics with discrepancies and concordances in perception between disaster directors and general health care providers. The analysis would present baseline information for the development of better training programs for region-specific core competencies, knowledge, and skills required for the effective response.

Cardiovascular Events after the Sewol Ferry Disaster, South Korea

BACKGROUND

Major incidents affecting large numbers of people may increase the rate of acute cardiovascular events, even among those who are not directly involved in the incident. It is hypothesized that the MV Sewol ferry disaster (South Korea) would increase the incidence of cardiovascular events nation-wide.

METHODS

Data on all adult patients (>18 years) who were diagnosed with acute cardiovascular events, including acute myocardial infarction (MI), angina, and cardiac arrhythmias, were extracted from the National Emergency Department Information System (NEDIS) from March 15 through June 17, during the years 2011-2014 (four weeks before to eight weeks after the event date). Poisson regression models were used to calculate the incidence rate ratios (IRRs) comparing the weekly changes in the occurrences of cardiovascular events from the week of the Sewol event (April 16-22, 2014) to eight weeks after the disaster (June 11-17, 2014), using the one-month period before Sewol as a reference period (March 15-April 15), adjusting for calendar years (years 2011-2014) and environmental factors.

RESULTS

During the study periods, cardiovascular events were identified in 73,823 patients. Compared to the reference period, the week of the Sewol disaster and the three weeks after the disaster showed a significant increase in the number of acute cardiovascular events, IRRs of 1.09 (95% CI, 1.03-1.15) and 1.08 (95% CI, 1.02-1.15), respectively (P <.01 for both). In particular, there was 21% increase in incidence of arrhythmia (IRR = 1.21; 95% CI, 1.02-1.44; P = .03) during the week of the Sewol disaster compared with the reference period.

CONCLUSION

This study showed a significant increase in the incidence of acute cardiovascular events during the week of, and the three weeks after, the Sewol ferry disaster in 2014. These additional cardiac emergencies may be triggered by emotional stressors related to the event, highlighting the public health importance of indirect exposure to a tragic catastrophe.Kong SY, Song KJ, Shin SD, Ro YS. Cardiovascular events after the Sewol ferry disaster, South Korea. Prehosp Disaster Med. 2019;34(2):142-148.