Unresolved Bereavement and Other Mental Health Problems in Parents of the Sewol Ferry Accident after 18 Months

Traumatic loss: a systematic review of potential risk factors differentiating between posttraumatic stress disorder and prolonged grief disorder

Background: When traumatic events and losses intersect in the form of traumatic loss, these events can trigger both posttraumatic stress disorder and pathological grief.Objective: This systematic review investigates which characteristics differentiate between the development of the respective disorders or are associated with comorbidity.Method: A systematic literature search using Medline, PubMed, APA PsycInfo and Web of Science yielded 46 studies which met the inclusion criteria. In these studies, PTSD was assessed using 17 and pathological grief using 16 different validated instruments. In the quality assessment, 12 studies were classified as average, 30 as above average, and 4 as excellent. The investigated risk factors were categorized into 19 superordinate clusters and processed using narrative synthesis.Results: The relationship to the deceased, mental health issues, and religious beliefs seem to be associated specifically with pathological grief symptoms compared to PTSD symptoms. Social support and social emotions emerged as significant correlates and potential risk factors for both PTSD and pathological grief. Included studies had mainly cross-sectional designs.Conclusions: Differentiating factors between pathological grief and PTSD appear to exist. The results should be considered within the limitations of the heterogeneity of the included studies and the research field. There is a lack of studies (1) using a longitudinal study design, (2) starting data collection early following the traumatic loss, (3) using standardized, up-to-date measurement instruments and (4) including comorbidity in their analyses. Further research is urgently needed for more accurate (acute) screenings, prognoses, and interventions following traumatic loss.

Hurricane-Force Grief: A Mirror of Fathers' Love

A child's death is a traumatic experience that profoundly impacts parents' psychological, physical, and social wellbeing. The literature describes gender differences in grief response associated with child loss, yet less is known about fathers' grief in comparison that of mothers due to fathers' underrepresentation in bereavement research. There is a need for scholarly exploration to advance understanding of fathers' grief. This article presents selected findings on fathers' grief responses that emerged from a larger qualitative study, which aimed to describe fathers' lived experience of bereavement after a child's death. Profound grief emerged as one essential theme of fathers' bereavement experience. Participants described the meaning of their grief, their multidimensional grief responses, their grief triggers, and their grief intensity. Findings deepen understanding of fathers' grief associated with child loss and advance the body of parental bereavement literature.

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.

What Are the Predictors of Post-traumatic Stress Disorder Among Road Traffic Accident Survivors: A Systematic Review

ABSTRACT

Traffic accidents put tremendous burdens on the psychosocial aspects of communities. Post-traumatic stress disorder (PTSD), after an accident, is one of the most prevalent and incapacitating psychiatric conditions worldwide. In this systematic review, we aimed to investigate the predictors of PTSD in traffic accident victims. Primary search was conducted in November 2021 and updated in 2023. Studies were excluded if they used any analysis except regression for predictors. Cumulatively, primary and update searches retrieved 10,392 articles from databases, and of these, 87 studies were systematically reviewed. The predictors were categorized into sociodemographics, pretrauma, peritrauma, and post-trauma factors. The PTSD assessment time varied between 2 weeks and 3 years. Being a woman, having depression and having a history of road traffic accidents pretraumatically, peritraumatic dissociative experiences, acute stress disorder diagnosis, rumination, higher injury severity, and involvement in litigation or compensation after the trauma were significant predictors of PTSD.

Parents' lived experiences of losing adolescent children in the Korean Ferry Sewol disaster: Lessons through a qualitative meta-synthesis

This study meta-synthesized qualitative studies on the parents' experiences of losing their adolescent children due to the human-made disaster, Ferry Sewol disaster in Korea, 2014. Five Korean and five international electronic databases were searched. Twenty-one studies were selected and critically appraised. Thematic analysis was employed. Four themes (with 10 subthemes) were derived: screaming in excruciating pain at the unbelievable deaths of children, family love evolving amidst pain and deepening into higher value, relationships collapsed and reformed while experiencing various social perspectives, and transitioning from a life of holding on to a life of progress. Bereaved parents experience psychological, physical, social pain for a long time, but gradually tried not to waste their children's death, forming new values and life goals. There is pressing need to devise sustained recovery strategies that account for distinct characteristics and needs of affected population groups.

Factors Associated with Complicated Grief Following a Railway Tragedy

On July 6, 2013, a train with 72 crude oil tank cars derailed in the heart of Lac-Mégantic, a small municipality of 6,000 inhabitants located in Québec (Canada). This tragedy killed 47 people. Technological disasters are rarely studied in bereavement research, and train derailments even less. The goal of this article is to increase our understanding of the bereavement consequences of technological disasters. Specifically, we aim to identify the factors that lead to the experience complicated grief and distinguish from the protective factors. A representative population-based survey was conducted among 268 bereaved people, three and a half years after the train accident. Of these, 71 people (26.5%) experienced complicated grief. People with complicated grief (CG) differ significantly from those without CG in terms of psychological health, perception of physical health, alcohol use and medication, as well as social and professional relationships. Hierarchical logistic regression analysis identified four predictive factors for CG: level of exposure to the disaster, having a negative perception of the event, as well as having a paid job and low-income increase the risk of CG. The importance of having health and social practitioners pay attention to these factors of CG are discussed along with future directions for research.

Complicated Grief Following the Traumatic Loss of a Child: A Systematic Review

Complicated grief is a disabling condition that occurs when the natural grief process is disturbed or prolonged. Research demonstrates that complicated grief is more prevalent following the sudden or violent loss of a child. Despite the high incidence of accidental death worldwide, little research has focused on parental grief trajectories following this form of traumatic loss. A systematic review was conducted to explore parental bereavement outcomes following accidental death. Studies were included if they specifically examined complicated grief in parents bereaved by the accidental death of their child. A total of 767 articles were identified and seven studies met the eligibility criteria for review. Poorer outcomes were identified in relation to the mode of death, relationship type, time post-loss, perceived support, perceived justice and comorbidities. Results of the current study may be used to inform the development of clinical practice guidelines for the treatment of complicated grief.

Predictors of prolonged grief disorder in Chinese elderly shidu parents: The role of perceived stigma and perceived stress

INTRODUCTION

Parents who have lost their only child and over the age of 60 are known as elderly shidu parents. This study aimed to investigate predictors of prolonged grief disorder (PGD) among Chinese elderly shidu parents.

METHODS

Two hundred and ninety-eight elderly shidu parents from Shenyang were included in this cross-sectional study. Participants completed a questionnaire including the Prolonged Grief questionnaire-13 (PG-13), the PTSD (post-traumatic stress disorder) Checklist for DSM-5 (PCL-5), the Center for Epidemiologic Studies Depression Scales (CES-D), the Self-Rating Anxiety Scale (SAS), and the Perceived Stress Scale-10 (PSS-10). Multiple linear regression was used to examine socio-demographic, bereavement-related and perceived stress associated with PGD symptoms.

RESULTS

The prevalence of PGD among Chinese elderly shidu parents was 13.8%. Among the 41 PGD patients, 29, 39, 36 patients had comorbidity of PTSD, depressive symptoms and anxiety, respectively. Perceived stress, higher educational level, lower annual household income, perceived stigma, violent death of the child, and being in debt were associated with severer PGD symptoms.

DISCUSSION

The present study revealed the prevalence of PGD and the important role of PGD in diagnosing other mental disorders in Chinese elderly shidu parents. Providing financial help, eliminating social stigma, and stress should be included in PGD prevention among Chinese elderly shidu parents.

Disaster Resilience Differs between Survivors and Victims’ Families: A Semantic Network Analysis

The main purpose of this study is to clarify the difference in disaster resilience between survivors and victims’ families by analyzing the language used in popular literature on disaster cases. The results showed that there were differences in emotions, behaviors, attitudes, role perceptions, etc., between survivors and victims’ families in dealing with a disaster. In particular, survivors remember and think about the situation that occurred at the time of the disaster, which creates resilience to the incident, while victims’ families attempt to establish resilience to the incident by investigating the facts and government countermeasures. While survivors were focused on building their own resilience, victims’ families were more focused on improving government countermeasures to prevent such accidents from recurring. This can be considered as social or national resilience. Based on this comparative analysis, it is necessary to prepare various theoretical foundations for disaster preparedness and resilience, while further elaborating the theory.

O tempo do luto materno pelo filho que morreu na infância

Resumo Objetivo desvelar o movimento existencial da mãe após a morte do filho por acidente doméstico na infância. Método pesquisa embasada no referencial teórico-filosófico-metodológico da fenomenologia de Martin Heidegger, com dados coletados entre maio e junho de 2017, mediante entrevista fenomenológica com 10 mães cujos filhos morreram em decorrência de acidentes domésticos na infância. Resultados da compreensão dos relatos, emergiram três temáticas: Lembrando o sofrimento profundo diante da morte do filho e os primeiros dias/meses sem ele; Revivendo a dor no presente, por meio da falta diária e das datas importantes e objetos/símbolos da criança; e Antecipando que a dor e a falta que sentem dos filhos nunca irão passar. Conclusão e implicações para a prática o tempo não é preditor da elaboração do luto materno. Neste contexto, o vivido da mãe é composto por um conjunto de significados, que envolvem multiplicidade de fatores e geram importantes repercussões ao longo da vida. Na perspectiva para promoção do cuidado, emergem, assim, a necessidade de ampliar a compreensão e as ações de acolhimento à mãe enlutada, refletindo sobre a temporalidade como constituinte do enlutamento materno.

Death of children by domestic accidents: unveiling the maternal experience

ABSTRACT Objectives: to unveil the meanings of mothers whose children died as a result of domestic accidents in childhood. Methods: a qualitative research, in the light of Heideggerian phenomenology, with ten mothers whose children died from domestic accidents. It was carried out in a municipality of the Northeast Region of Brazil through phenomenological interviews between May and June 2017. The existential analytic was constituted by the comprehensive moments of the Heideggerian method. Results: the meanings unveiled pointed out that, to understand the sudden death of her child, the mother oscillates between feeling guilty, pointing and denying guilt. She reports emptiness, permanent pain, non-acceptance of her child’s death, and the desire to keep him in her life. In this journey, the fear that brings limitations to her life and that of her other children is revealed. Final Considerations: it was revealed that the death of the child in infancy compromises the integrality of being a mother, indicating the need for systematic and continuous care for the adequate management of the emotional and social effects.

Psychological Consequences Among Residents and Fellows During the COVID-19 Pandemic in New York City: Implications for Targeted Interventions

PURPOSE

To examine the psychological impact of the COVID-19 pandemic on medical trainees (residents and fellows) working at Mount Sinai Hospital (MSH) in New York City (NYC), the initial epicenter of the United States pandemic.

METHOD

The authors administered a survey to 991 trainees in frontline specialties working at MSH in NYC between April and May 2020. The instrument assessed symptoms of major depressive disorder, generalized anxiety disorder, COVID-19-related posttraumatic stress disorder, and burnout. Psychiatric screens were aggregated into 1 composite measure, and meeting criteria on any of the 3 scales was considered a positive screen for psychiatric symptoms. The survey also assessed COVID-19-related exposures, worries, coping strategies, and desired interventions. Multivariable logistic regressions were conducted to identify factors associated with psychiatric symptoms and burnout.

RESULTS

Of the 560 respondents (56.6% response rate), 29.7% screened positive for psychiatric symptoms and 35.8% screened positive for burnout. History of a mental illness, COVID-19-related duties and personal/career worries, and coping by substance use were associated with increased likelihood of screening positive for psychiatric symptoms. Positive emotion-focused coping and feeling valued by supervisors were associated with decreased likelihood. Internal medicine and surgical specialties, a history of mental illness, increased duty hours, duty-related worries, personal/career worries, coping via self-blame and venting, and coping via substance use were associated with higher odds of burnout. Feeling valued by supervisors was associated with decreased burnout odds. The most common crisis-related needs included access to personal protective equipment, food provisions, and financial support.

CONCLUSIONS

Psychological distress and burnout affected approximately one-third of trainees sampled during the height of the pandemic in NYC. As the pandemic surged beyond NYC, these findings suggest that interventions should include addressing basic needs, promoting leadership affirmation, moderating duty hours, supporting trainees financially, and enhancing mental health support.

The brain oxytocin and corticotropin-releasing factor systems in grieving mothers: What we know and what we need to learn

The bond between a mother and her child is the strongest bond in nature. Consequently, the loss of a child is one of the most stressful and traumatic life events that causes Prolonged Grief Disorder in up to 94 % of bereaved parents. While both parents are affected, mothers are of higher risk to develop mental health complications; yet, very little research has been done to understand the impact of the loss of a child, stillbirth and pregnancy loss on key neurobiological systems. The emotional impact of losing a child, e.g., Prolonged Grief Disorder, is likely accompanied by dysregulations in neural systems important for mental health. Among those are the neuropeptides contributing to attachment and stress processing. In this review, we present evidence for the involvement of the brain oxytocin (OXT) and corticotropin-releasing factor (CRF) systems, which both play a role in maternal behavior and the stress response, in the neurobiology of grief in mothers from a behavioral and molecular point of view. We will draw conclusions from reviewing relevant animal and human studies. However, the paucity of research on the tragic end to an integral bond in a female's life calls for the need and responsibility to conduct further studies on mothers experiencing the loss of a child both in the clinic and in appropriate animal models.

Caregiver Speaks Study Protocol: A Technologically-Mediated Storytelling Intervention for Hospice Family Caregivers of Persons Living With Dementia

OBJECTIVE

We present the protocol of a study aiming to examine the efficacy of a technologically-mediated storytelling intervention called Caregiver Speaks in reducing distress and grief intensity experienced by active and bereaved hospice family caregivers of persons living with dementia (PLWD).

DESIGN

The study is a mixed-method, 2-group, randomized controlled trial.

SETTING

This study takes place in 5 hospice agencies in the Midwest and Northeastern United States.

PARTICIPANTS

Participants include hospice family caregivers of PLWD.

INTERVENTION

Participants are randomized to usual hospice care or the intervention group. In the Caregiver Speaks intervention, caregivers engage in photo-elicitation storytelling (sharing photos that capture their thoughts, feelings, and reactions to caregiving and bereavement) via a privately facilitated Facebook group. This intervention will longitudinally follow caregivers from active caregiving into bereavement. The usual care group continues to receive hospice care but does not participate in the online group.

OUTCOMES MEASURED

We anticipate enrolling 468 participants. Our primary outcomes of interest are participant depression and anxiety, which are measured by the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder screening (GAD-7). Our secondary outcomes of interest are participants' perceived social support, measured by the Perceived Social Support for Caregiving (PSSC) scale, and grief intensity, which is measured by the Texas Revised Inventory of Grief Present Subscale (TRIG-Present).

Factors associated with post-traumatic stress disorder among bereaved family members and surviving students two and half years after the Sewol ferry accident in South Korea

BACKGROUND

The Sewol ferry accident was a human-made disaster that caused the death of 250 high school students on board the ferry. Post-traumatic stress disorder (PTSD) is one of the most serious mental health sequela among those exposed to disasters. Therefore this study assessed the PTSD symptoms among bereaved family members and surviving students after the disaster, along with associated risk factors.

METHODS

Bereaved family members (N = 80) and surviving students (N = 48) of the disaster were assessed by self-reported questionnaires 2.5 years after the disaster. Sociodemographic and psychological variables (i.e., PTSD, depression, embitterment, rumination, and others) were obtained. Multivariable Poisson regression analyses were conducted to identify the factors associated with PTSD symptoms.

RESULTS

Sixty-seven (83.8%) of the bereaved family members and three (6.3%) of the surviving students were suffering from probable PTSD. Depression and embitterment were associated with PTSD symptoms in both groups. Social support and meaning in life were related to PTSD symptoms only in the surviving students, while intrusive rumination and posttraumatic growth were related to PTSD symptoms only in the bereaved family members.

CONCLUSIONS

These findings may help identify high-risk groups for PTSD and aid the development of psychological interventions to ameliorate PTSD symptoms of those affected by disasters.

Feasibility of Present-Centered Therapy for Prolonged Grief Disorder: Results of a Pilot Study

Present-centered therapy (PCT) was originally developed as a strong comparator for the non-specific effects of psychotherapy in the treatment of posttraumatic stress disorder. PCT qualifies as a not strictly supportive treatment as it is structured and homework is assigned between sessions. It does not focus on cognitive restructuring or exposure. A growing body of literature supports its beneficial effects. For example, it demonstrated only slightly inferior effect sizes and lower dropout rates compared to that of trauma-focused cognitive behavioral therapy in several trials with patients suffering from posttraumatic stress disorder. The current study is the first to evaluate the feasibility and the treatment effects of PCT in adults with prolonged grief disorder (PGD). Meta-analyses on psychotherapy for PGD have yielded moderate effect sizes. N = 20 individuals suffering from PGD were treated with PCT by novice therapists as part of a preparation phase for an upcoming RCT in an outpatient setting. Treatment consisted of 20-24 sessions á 50 min. All outcomes were assessed before treatment, at post-treatment, and at the 3-month follow-up. The primary outcome, PGD symptom severity, was assessed using the Interview for Prolonged Grief-13. Secondary outcomes were self-reported PGD severity, depression, general psychological distress, and somatic symptom severity. Furthermore, therapists evaluated their experiences with their first PCT patient and the treatment manual. In intent-to-treat analyses of all patients we found a significant decrease in interview-based PGD symptom severity at post-treatment (d = 1.26). Decreases were maintained up to the 3-month follow-up assessment (d = 1.25). There were also significant decreases in self-reported PGD symptoms, depression, and general psychological distress. No changes were observed for somatic symptoms. The completion rate was 85%. Therapists deemed PCT to be a learnable treatment program that can be adapted to the patient's individual needs. The preliminary results of PCT as a treatment for PGD demonstrate large effects and indicate good feasibility in outpatient settings. The treatment effects were larger than those reported in meta-analyses. Thus, PCT is a promising treatment for PGD. Possible future research directions are discussed.

Attachment Style, Complicated Grief and Post-Traumatic Growth in Traumatic Loss: The Role of Intrusive and Deliberate Rumination

OBJECTIVE

The present study examines the effects of attachment styles on the grief response and the indirect effect of rumination in parents who lost a child in the Sewol Ferry accident.

METHODS

Bereaved parents (n=81) completed self-report questionnaires evaluating their attachment style (Experience in Close Relationship-Short form), traumatic loss related rumination (Event-Related Rumination Inventory), degree of complicated grief (Inventory of Complicated Grief), and post-traumatic growth (Post-Traumatic Growth Inventory). Data were analyzed using correlation analysis, structural equation modeling, and bootstrapping.

RESULTS

The indirect effect of event-related intrusive rumination was significant in the relationship between attachment avoidance and complicated grief. The path from attachment avoidance to post-traumatic growth via deliberate rumination was not significant. With respect toattachment anxiety and post-traumatic growth, the indirect effect of deliberate rumination was significant. But the indirect effect of intrusive rumination was not significant in the relationships among attachment anxiety, complicated grief, and post-traumatic growth.

CONCLUSION

Individuals with attachment anxiety could obtain post-traumatic growth via deliberate rumination. By contrast, attachment avoidance was associated with the risk of maladaptive grief. Grief interventions should account for individual differences in attachment styles through interventions that manage intrusive rumination and strengthen deliberate rumination.

The Grief of Parents After the Death of a Young Child

Research demonstrates that severe forms of grief and grief-related pathology exist in the general population. Less attention, however, has been paid to the grief of parents following the death of a young, dependent child. In this review, we summarize a search of Pubmed, PsycINFO and Web of Science from 1995 to 2017, using the terms 'parental complicated grief', 'parental traumatic grief', and 'parent Prolonged Grief Disorder', specifically addressing parental grief and identified risk factors for complicated or prolonged grief. Forty-two studies met criteria and indicate a significant burden of complicated or prolonged grief in parents of children dying from virtually any cause. It appears that the empiric literature is undermined by great variability, including the composition of samples, the causes of death studied, the psychometric measures used, and post-loss intervals. We conclude that the uniform severity of grief experiences following the death of a young child is potentially a distinct subtype of grief, deserving of attention in its own right in future research and diagnostic formulations.

Sleep disturbances in bereavement: A systematic review

Severe, persistent and disabling grief occurs among a sizable minority experiencing bereavement, with diagnostic manuals newly including complicated grief (CG) disorders. Sleep disturbances/disorders have been established as worsening affective and stress-related conditions. However, the role of sleep difficulties in bereavement and CG has not received similar scientific attention. We therefore conducted a systematic review with narrative syntheses on this topic to clarify the role of sleep in bereavement (PROSPERO: CRD42018093145). We searched PubMed, Web of Science and PsychInfo for peer-reviewed English-language articles including (at least one) bereaved sample and sleep disturbance measure. We identified 85 articles on 12.294 participants. We answered seven pre-defined research questions demonstrating: high prevalence of sleep disturbances in bereavement; positive associations of grief intensity with sleep difficulties; preliminary indications of risk factors of post-loss sleep disturbance; higher prevalence of sleep disturbances in CG, enhanced by psychiatric comorbidity (i.e., depression); and initial evidence of causal relationships between (complicated) grief and sleep. Grief therapy partly improves sleep difficulties, yet no intervention studies have specifically targeted sleep problems in bereaved persons. Causal relationships between sleep and grief require further examination in intensive longitudinal investigations, including randomized trials, thereby clarifying whether treating sleep problems enhances CG treatment effects.

The prevalence of prolonged grief disorder in bereaved individuals following unnatural losses: Systematic review and meta regression analysis

BACKGROUND

Previous research has indicated that one out of ten naturally bereaved individuals develops prolonged grief disorder (PGD). Less is known about the prevalence of PGD following unnatural deaths, such as accidents, disasters, suicides, or homicides. The aim of this study was to compute the pooled prevalence of PGD and to determine possible causes of its varied estimates.

METHODS

A literature search was conducted in PsycINFO, Ovid Medline, PILOTS, Embase, Web of Science, and CINAHL. A meta-analysis using random effects models was performed to calculate the pooled prevalence rate of PGD. Multivariate meta-regression was used to explore heterogeneity among the studies.

RESULTS

Twenty-five articles met eligibility criteria. The random-effects pooled prevalence was 49%, 95% CI [33.6, 65.4]. Death of only child, violent killings and non-western study location were associated with a higher PGD prevalence. A longer time since loss and a loss in a natural disaster were associated with a lower PGD prevalence.

LIMITATIONS

These findings should be interpreted with caution, because of the heterogeneity in study methodology.

CONCLUSIONS

This first meta-analysis of PGD following unnatural losses indicated that nearly half of the bereaved adults experienced PGD. This illustrates the importance of assessing PGD in individuals affected by loss and trauma.

Prolonged grief disorder in Chinese Shidu parents who have lost their only child

Background: China has the largest population of '"loss-of-only-child' parents, that are also known as Shidu parents in Chinese society; however, little is known about their unresolved grief. Objective: This is the first study to examine the grief symptoms, prevalence, comorbidity and potential predictors of prolonged grief disorder (PGD) in such parents, taking into consideration that the new PGD diagnostic criteria ICD-11 will soon be implemented in China. Methods: 149 Shidu parents completed assessments of PGD (PG-13), PTSD (PCL-C), depression (CES-D) and general psychiatric morbidity (GHQ-12) via in-person interviews. Results: Of the 149 Shidu parents, 22.2% met the PGD criteria, with a mean of 7.59 years post-loss, and 62.4% experienced daily longing or yearning. Regression analysis indicated that fewer years since loss, subjective perception of poor economic situation, female gender and more hospital visits were prominent risk factors for the development of PGD. Older age of the parents at the time of child loss was also associated with PGD. Parents with PGD had higher comorbidity of PTSD or depression compared with those without PGD. Conclusions: There is a high prevalence of PGD and a high rate of comorbidity between PGD and PTSD or depression in Shidu parents in China, which highlights the need of timely developing effective assessments and interventions to prevent PGD in this population, particularly in female, recently bereaved, low-income and aged parents who lost their only child.

Machine Learning-Based Data Mining Method for Sentiment Analysis of the Sewol Ferry Disaster's Effect on Social Stress

The Sewol Ferry Disaster which took place in 16th of April, 2014, was a national level disaster in South Korea that caused severe social distress nation-wide. No research at the domestic level thus far has examined the influence of the disaster on social stress through a sentiment analysis of social media data. Data extracted from YouTube, Twitter, and Facebook were used in this study. The population was users who were randomly selected from the aforementioned social media platforms who had posted texts related to the disaster from April 2014 to March 2015. ANOVA was used for statistical comparison between negative, neutral, and positive sentiments under a 95% confidence level. For NLP-based data mining results, bar graph and word cloud analysis as well as analyses of phrases, entities, and queries were implemented. Research results showed a significantly negative sentiment on all social media platforms. This was mainly related to fundamental agents such as ex-president Park and her related political parties and politicians. YouTube, Twitter, and Facebook results showed negative sentiment in phrases (63.5, 69.4, and 58.9%, respectively), entity (81.1, 69.9, and 76.0%, respectively), and query topic (75.0, 85.4, and 75.0%, respectively). All results were statistically significant (p < 0.001). This research provides scientific evidence of the negative psychological impact of the disaster on the Korean population. This study is significant because it is the first research to conduct sentiment analysis of data extracted from the three largest existing social media platforms regarding the issue of the disaster.

The relationship between hope and post-traumatic stress disorder in Chinese shidu parents: The mediating role of perceived stress

BACKGROUND

Parents who lost their only child and can not conceive another child, are known as shidu parents in China. This study aimed to estimate the prevalence of post-traumatic stress disorder (PTSD) and examine the mediating role of perceived stress between hope and PTSD symptoms in Chinese shidu parents.

METHODS

295 shidu mothers and 197 shidu fathers were recruited in Shenyang city. Shidu parents were asked to complete a questionnaire including the PTSD Checklist for DSM-5 (PCL-5), the Herth hope index (HHI) and the Perceived Stress Scale-10 (PSS-10). Hierarchical linear regression was performed to assess the associations among hope, perceived stress and PTSD symptoms. Asymptotic and resampling strategies were used to explore the mediating role of perceived stress.

RESULTS

The prevalence of PTSD in Chinese shidu parents was 23.78%. Mothers were more likely to develop PTSD than fathers. For shidu fathers, the proportion of mediation of perceived stress was 39.48%. For shidu mothers, the proportion of mediation of perceived stress was 40.00%.

LIMITATIONS

Due to the cross-sectional design, the findings of the present study can not be used to establish formal causal relationships or to determine the direction of causality. Longitudinal studies are need to validate our findings.

CONCLUSIONS

Perceived stress partly mediated the relationship between hope and PTSD symptoms in Chinese shidu parents. The interventions of hope and perceived stress should be included in PTSD prevention. More assistance should be directed to improve the mental health of shidu mothers.

A systematic review and meta-analysis of correlates of prolonged grief disorder in adults exposed to violent loss

Background: Violent loss (i.e. loss through homicide, suicide, or accident) is associated with high levels of prolonged grief disorder (PGD). Objective: The current meta-analysis aims at identifying correlates of PGD in adults exposed to violent loss. Method: We conducted a systematic literature search in PsycINFO, PsycARTICLES, PubMed, Web of Science, and Scopus. We used the Pearson correlation coefficient r as an effect size measure and a random effects model was applied to calculate effect sizes. Results: Thirty-seven eligible studies published between 2003 and 2017 (N = 5911) revealed 29 potential correlates. Most studies used a cross-sectional design. Analyses revealed large significant effect sizes for comorbid psychopathology (r = .50-.59), suicidality (r = .41, 95% confidence interval [CI] [.30; .52]), and rumination (r = .42, 95% CI [.31; .52]), while medium effect sizes were found for exposure to traumatic events and factors concerning the relationship to the deceased. Small effect sizes emerged for sociodemographic characteristics, multiple loss, physical symptoms, and religious beliefs. Ten variables did not show a significant association with PGD. Heterogeneity and a small number of studies assessing certain correlates were observed. Conclusions: The associations with psychological disorders may indicate shared mechanisms of psychopathology. Moreover, we recommend that clinicians carefully assess suicidal ideation among individuals with PGD who have been exposed to violent loss. Further research is warranted using longitudinal study designs with large sample sizes to understand the relevance of these factors for the development of PGD.

Normal Complications and Abnormal Assumptions After Perinatal Death

There are several ways, clinically, to approach grief after perinatal death, including from a humanistic or a medicalized perspective. The death of a baby is complicated. The loss is an embodied one that incites deep psychological wounds and can be isolating for many parents. Parents process their grief experiences within a sometimes oppressive social context that either sees their expressions of loss as a normal response to an abnormal tragedy or as pathology. Several diagnostic categories have been proposed relative to the traumatic grief experiences of grieving parents that potentially affect them. We explore this nomenclature and, through the lens of a Social-Cognitive Processing Model, examine social support, attitudes, context, and oppressive interpersonal and social structures that affect parents. Clinical implications are discussed.

A Qualitative Study on the Process of the Mental Health Assessment and Intervention after the Sewol Ferry Disaster: Focusing on Survivors among Danwon High School Students

Objectives

This study aimed to identify the process of psychosocial assessment, the experience of intervention, and the improvement after the disaster that Danwon high school students survived from the sinking of the Motor Vessel (MV) Sewol in South Korea on April 16, 2014.

Methods

We conducted in-depth qualitative research using individual interviews from January to February 2017. Twenty-one of 75 Danwon high school students survived by the MV Sewol disaster were studied. Two interviewers participated in the in-depth interview. Interviews were transcribed verbatim, coded, and analyzed through content analysis based on psychosocial assessment and intervention after the disaster.

Results

Twenty-one participants were 20 years old, where 10 were male (47.62%), and 11 were female (52.38%). More than 75% of the interviewed students felt that mental health services were needed, and more than 85% required mental health assessments. Regarding psychiatric symptoms, the students reported that they suffered depression and insomnia (19.05%), anxiety (14.29%), nightmares and phobias (9.52%), and difficulties regarding concentration, aggression, and game addiction (4.76%).

Conclusion

Despite survivors experiencing the same disaster, there were differences in their responses to mental health assessments and interventions experienced during the three years, and conflicting opinions were reported. In planning future evaluations and interventions, it is necessary for strategies to cope with flexibly to consider the characteristics and symptoms of the survivors while maintaining principles.

Bereaved families are still embittered after the Sewol ferry accident in Korea: A follow-up study 18 and 30months after the disaster

INTRODUCTION

The Sewol ferry accident that occurred in April 2014 was one of the most tragic human-made disasters in Korean history. Due to the deaths of hundreds of children, bereaved families likely feel embittered; however, there is little extant research documenting embitterment among those who experienced the disaster. Consequently, we investigated bereaved family members' embitterment and other psychiatric symptoms 18months and 30months after the disaster.

METHODS

Data from a cross-sectional survey were obtained 18months (Time 1) and 30months (Time 2) after the disaster. We ascertained socio-demographic variables and variables obtained from a self-reporting questionnaire (i.e., depression, anxiety, posttraumatic stress disorder, complicated grief, and embitterment) among 56 bereaved family members.

RESULTS

Bereaved families showed substantial embitterment at Time 1 (64.3%), which increased at Time 2 (76.8%, t=1.761, p=0.084). The participants who displayed increased embitterment at Time 2 also increased in anxiety, post-traumatic stress symptoms, and complicated grief (but not depression). Furthermore, participants who displayed decreased embitterment at Time 2 also decreased in all other psychiatric symptoms. (time×group interaction in depression (F 0.644, p=0.426), anxiety (F 4.970, p=0.030), PTSD (F 10.699, p=0.002), and complicated grief (F 8.389, p=0.005)).

CONCLUSIONS

Embitterment of bereaved families had not ceased after 18months and even increased 1year later. Additionally, as embitterment increased, many other psychiatric symptoms also increased, and vice versa. Our results suggest that embitterment is associated or can even influence other psychiatric symptoms; therefore, embitterment should be examined after disasters.

Factors Associated with Post-traumatic Stress Symptoms in Students Who Survived 20 Months after the Sewol Ferry Disaster in Korea

BACKGROUND

The Sewol ferry disaster caused national shock and grief in Korea. The present study examined the prevalence and associated factors of post-traumatic stress disorder (PTSD) symptoms among the surviving students 20 months after that disaster.

METHODS

This study was conducted using a cross-sectional design and a sample of 57 students (29 boys and 28 girls) who survived the Sewol ferry disaster. Data were collected using a questionnaire, including instruments that assessed psychological status. A generalized linear model using a log link and Poisson distribution was performed to identify factors associated with PTSD symptoms.

RESULTS

The results showed that 26.3% of participants were classified in the clinical group by the Child Report of Post-traumatic Symptoms score. Based on a generalized linear model, Poisson distribution, and log link analyses, PTSD symptoms were positively correlated with the number of exposed traumatic events, peers and social support, peri-traumatic dissociation and post-traumatic negative beliefs, and emotional difficulties. On the other hand, PTSD symptoms were negatively correlated with psychological well-being, family cohesion, post-traumatic social support, receiving care at a psychiatry clinic, and female gender.

CONCLUSION

This study uncovered risk and protective factors of PTSD in disaster-exposed adolescents. The implications of these findings are considered in relation to determining assessment and interventional strategies aimed at helping survivors following similar traumatic experiences.

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.

Attachment styles, grief responses, and the moderating role of coping strategies in parents bereaved by the Sewol ferry accident

Background: Previous studies on the influence of different types of attachment on grief responses have yielded contradictory outcomes. Little research has been conducted to identify the psychological processes that moderate the relationship between attachment representations and patterns of grief in disaster-related grief. Objective: The present study examines the effects of different attachment types on the grief responses of parents bereaved by loss of a child in a ferry accident, along with the moderating role of coping strategies. Methods: Bereaved parents (n = 81) completed self-report questionnaires evaluating attachment, coping strategies, complicated grief, and shame/guilt. We performed correlational analyses to examine the associations among variables. We also conducted hierarchical regression analyses and simple slope analyses to examine the moderation effects of coping strategies. Results: Anxious attachment was associated with severe shame/guilt, and avoidant attachment correlated with complicated grief. Anxious attachment was positively associated with all types of coping strategies, and avoidant attachment was negatively related to problem- and emotion-focused coping. The use of problem-focused coping strategies was a significant moderator of the relationship between the avoidant attachment dimension and shame/guilt. Avoidant attachment had a significant effect on shame/guilt in groups with a high level of problem-focused coping. In contrast, none of the coping strategies significantly moderated the relationship between anxious attachment and grief response. Conclusions: The results suggest that people with highly avoidant attachment might be overwhelmed by shame and guilt when they try to use problem-focused coping strategies. This finding suggests that grief interventions should be organized with consideration of individual differences in attachment representations.