Warning signals? An explorative study of distant recollections of the moments before a disaster

Background: How do we remember what happened shortly before a traumatic experience? There has been little focus on the temporal context of trauma memories, but a few studies suggest that aspects of what happened in the moments prior to a traumatic experience may be selectively enhanced and prioritized in memory.Objective: The main aim of this study was to investigate the occurrence, nature, and content of voluntary memories about what happened shortly before a disaster. The participants were individuals who had survived a fire on the passenger ferry Scandinavian Star 26 years earlier.Methods: Data collection took the form of face-to-face interviews. The analysis was carried out in two steps. First, all the narratives from participants who were aged 7 years or older at the time of the fire (N = 86) were coded in terms of the presence of detailed descriptions of what happened before the fire. Next, the narratives that included detailed descriptions of the moments before (N = 28) were included in a thematic analysis, focusing on coding the mode and the content.Results: More than one-third of the participants reported detailed accounts of what happened in the hours, minutes, or seconds before the fire. These memories included detailed descriptions of sensory impressions, dialogues, actions, and thoughts. Two themes stood out in the thematic analysis: (1) unusual observations and danger cues; and (2) counterfactual thoughts.Conclusion: The finding that specific details from the moments before a traumatic event may be vividly recalled indicates that peripheral details of traumatic events can be prioritized in memory. Such details may be interpreted as warning signals. Future research should examine whether such memories might stimulate long-standing thoughts of the world as being dangerous, and hence carry the threat forward in time.

Profiles of grief, post-traumatic stress, and post-traumatic growth among people bereaved due to COVID-19

BACKGROUND

COVID-19 deaths elevate the prevalence of prolonged grief and post-traumatic stress symptoms among the bereaved, yet few studies have examined potential positive outcomes. Moreover, how COVID-19 bereavement affects individual-level mental health outcomes is under-researched.

OBJECTIVE

This is the first study to use latent profile analysis (LPA) to identify heterogeneous profiles of prolonged grief, post-traumatic stress and post-traumatic growth among people bereaved due to COVID-19 and to identify predictors of latent class membership.

METHODS

Four hundred and twenty-two Chinese participants who were bereaved due to COVID-19 completed an online survey between September and October 2020. The survey included the International (ICD-11) Prolonged Grief Disorder Scale (IPGDS), the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) and the Post-traumatic Growth Inventory (PTGI). LPA was run in Mplus, and the 3-step auxiliary approach was used to test the predicting effects of potential predictors of latent class membership identified with chi-square tests and ANOVAs.

RESULTS

Four latent profiles were identified: resilience (10.7%), growth (20.1%), moderate-combined (42.2%) and high-combined (27.0%). The bereaved who shared a close relationship with the deceased and identified COVID-19 as the fundamental cause of death were more likely to be in the high-combined group. A conflictful bereaved-deceased relationship reduces the chance of being in the growth group. Moreover, the death of a younger person and loss of a partner attributed to maladaptive outcomes.

CONCLUSIONS

Serious attention needs to be paid to the mental health issues of people bereaved due to COVID-19 because nearly 70% of this group would have a moderate-combined or high-combined symptom profile. Special care should be given to those who lost someone younger, lost a partner or shared a close relationship with the deceased. Grief therapies that work on the conflicts between the deceased and the bereaved and unfinished business can be applied to facilitate growth.

Piloting a scalable, post-trauma psychosocial intervention in Tuvalu: the Skills for Life Adjustment and Resilience (SOLAR) program

BACKGROUND

The Skills for Life Adjustment and Resilience (SOLAR) programme is a brief, scalable, psychosocial skill-building programme designed to reduce distress and adjustment difficulties following disaster.

OBJECTIVES

We tested the feasibility, acceptability, efficacy and safety of a culturally adapted version of SOLAR in two remote, cyclone-affected communities in the Pacific Island nation of Tuvalu.

METHOD

This pilot adopted a quasi-experimental, control design involving 99 participants. SOLAR was administered to the treatment group (n = 49) by local, non-specialist facilitators (i.e. 'Coaches') in a massed, group format across 5 consecutive days. The control group (n = 50) had access to Usual Care (UC). We compared group differences (post-intervention vs. post-control) with psychological distress being the primary outcome. We also examined whether changes were maintained at 6-month follow-up.

RESULTS

Large, statistically significant group differences in psychological distress were observed after controlling for baseline scores in favour of the SOLAR group. Mean group outcomes were consistently lower at 6-month follow-up than at baseline. SOLAR was found to be acceptable and safe, and programme feedback from participants and Coaches was overwhelmingly positive.

CONCLUSIONS

Findings contribute to emerging evidence that SOLAR is a flexible, culturally adaptable and scalable intervention that can support individual recovery and adjustment in the aftermath of disaster. RCTs to strengthen evidence of SOLAR's efficacy are warranted.