Comparative Analysis of the Psychosocial Symptoms and Experiences of Bereaved Parents and Parents of Children Who Survived the Sewol Ferry Accident After 5 Years: A Qualitative Interview Study

BACKGROUND

This study aimed to investigate the psychosocial symptoms and experiences of bereaved parents of victims and parents of survivors of the Sewol Ferry accident five years after the accident.

METHODS

In-depth interviews of 186 bereaved parents of victims or survivors of the Sewol Ferry accident were conducted. We elicited and categorized meaning units relevant to the psychological, cognitive, and physical traits of the participants from these interviews. Differences in responses between bereaved parents and survivors' parents and between genders were examined using frequency analyses and χ² tests.

RESULTS

Data were organized under seven headings: observed attitude and impression of participants, difficulties due to mental health problems, difficulties due to physical pain, difficulties in relationships, negative changes following the incident, positive changes following the incident, and help needed. Within these headings, 27 themes, 60 sub-themes, and 80 meaning units were elicited.

CONCLUSION

This study explored the psychiatric, physical, and relational problems reported by bereaved parents and those of survivors as well as major changes in their personal and social lives after the Sewol Ferry accident. Differences in responses according to gender were also identified. The results from this study could inform and facilitate the implementation of intervention measures, such as long-term psychological evaluation, to bereaved parents of victims or survivors of disasters.

Survivors of avalanche accidents: posttraumatic stress disorder symptoms and quality of life: a multicentre study

BACKGROUND

As any traumatic event, avalanches could trigger psychological disorders on survivors. Our objectives were to determine the prevalence of post-traumatic stress disorder among avalanche survivors and to evaluate post-traumatic stress disorder risks factors as well as the impact on quality of life.

METHODS

A multicentre study was conducted in victims included in the North Alpine Avalanche Registry from 2014 to 2018. Data were collected through a standard questionnaire during semi-directed phone interviews. The primary outcome was the total score on the Impact of Event Scale Revised. Secondary outcomes were the Mental Component Scale and the Physical Component Scale scores of the Short Form 12 questionnaire.

RESULTS

During the study period, 132 of 211 victims survived. Among the 107 victims included, 55 (51.4%) phone interviews were obtained. Six patients (10.9, 95% CI 1.76-20.05) had an Impact of Event Scale Revised score ≥ 33 indicating a strong probability for post-traumatic stress disorder. Median Mental Component Scale score was 39.0 (IQR 30.5-46.3) for post-traumatic stress disorder patients and 40.1 (IQR 36.5-43.4) for non post-traumatic stress disorder (p = 0.76). Median Physical Component Scale score was 39.4 (37.2-44.3) for post-traumatic stress disorder patients and 44.2 (39.1-46.8) for non post-traumatic stress disorder (p = 0.39). No significant difference in the quality of life in both populations was observed, and no independent risk factors of post-traumatic stress disorder was identified.

CONCLUSION

Avalanche accidents may induce post-traumatic stress disorders among survivors in a comparable prevalence to the most traumatic event already studied. Early recognition and preventive measures should be set up in order to reduce the psychological burden in these victims.

TRIAL REGISTRATION

NCT03936738 .

Effect of work-related events on depressive symptoms in Japanese employees: a web-based longitudinal study

While a number of work-related events have been proposed as risk factors for depression, a majority of studies have focused only on a few events in a single study. Therefore, we conducted a web-based longitudinal study to comprehensively investigate the impact of various work-related events on depressive symptoms. Ten thousand Japanese workers representing the Japanese working population were recruited online and questioned on their experiences of 36 work-related events in the past year. Their depressive symptoms were also assessed based on the Center for Epidemiologic Studies Depression Scale. Two years later, 3,098 participants responded to a follow-up study. By excluding 1,030 participants who were classified as being depressed in the baseline survey, data of 2,068 participants were analyzed. Odds ratios (OR) were calculated using multivariate logistic regression to assess the effect of work-related events on depressive symptoms. Sixteen events were found to be risk factors and were sorted into four types as follows: experience of an accident or disaster (OR: 4.78-7.67), excessive responsibility (OR: 3.01-3.62), drastic change in workstyle or workload (OR: 2.38-3.08), and interpersonal conflict (OR: 2.41-11.16). The current results, including magnitude relationship of ORs, should be utilized for promoting psychosocially healthy work environment.

Personality traits as predictors of cyclist behaviour

Road user behaviour and personality traits are important determinants of driver crash risk. While a great deal of research has been undertaken to understand the relationships between crash involvement, behaviours and personality traits for motor vehicle drivers, comparatively few studies have considered these factors for cyclists. This manuscript presents the findings of a study conducted amongst a sample of six hundred and fifteen (615) Australian cyclists, investigating these issues. The aim of this research was to establish a structure for a cycling behaviour questionnaire applicable to a cohort of Australian cyclists. Using the dimensions identified from the questionnaire, the research investigated the relationship between self-reported crashes, behaviours and personality traits, in order to further develop our understanding of risk factors associated with cycling. Personality traits (agreeableness, extroversion, conscientiousness, neuroticism and openness to experience) were measured using the Big Five Inventory. While cyclist behaviour was measured using a modified version of the cyclist behaviour questionnaire developed by the Dutch national road safety research centre (SWOV). Principal Components Analysis (PCA) was performed on the cycling behaviour questionnaire to identify underlying subscales of behaviour. The PCA identified a two dimension model representing violations (α = 0.74) and errors (α = 0.65), consisting of 16 items from the original 22 item cyclist behaviour questionnaire. Linear regressions for each of the cyclist behaviour factors identified that age was negatively associated with errors and violations, indicating that older cyclists report fewer errors or violations. Similarly, there was a negative association with average weekly kilometres travelled. Gender was a significant predictor of errors, but not violations, with male cyclists reporting fewer errors than females. When considering personality traits, there was a positive association between extroversion and both errors and violations. Significant negative associations were identified for agreeableness and conscientiousness. Neither neuroticism nor openness to experience were associated with the frequency of errors or violations. The research identified that demographics, travel characteristics and personality traits provide insight into engagement in aberrant cycling behaviours and these behaviours are associated with self-reported crash involvement. The research provides insight into behaviours that could be targeted with appropriate education and enforcement strategies.

The Hong Kong Survey on the Epidemiology of Trauma Exposure and Posttraumatic Stress Disorder

This study examined the epidemiology of trauma exposure (TE) and posttraumatic stress disorder (PTSD) among community-dwelling Chinese adults in Hong Kong. Multistage stratification sampling design was used, and 5,377 participants were included. In Phase 1, TE, probable PTSD (p-PTSD), and psychiatric comorbid conditions were examined. In Phase 2, the Structured Clinical Interview for the DSM-IV (SCID-I) was used to determine the weighted diagnostic prevalence of lifetime full PTSD. Disability level and health service utilization were studied. The findings showed that the weighted prevalence of TE was 64.8%, and increased to 88.7% when indirect TE types were included, with transportation accidents (50.8%) reported as the most common TE. The prevalence of current p-PTSD among participants with TE was 2.9%. Results of logistic regression suggested that nine specific trauma types were significantly associated with p-PTSD; among this group, severe human suffering, sexual assault, unwanted or uncomfortable sexual experience, captivity, and sudden and violent death carried the greatest risks for developing PTSD, odds ratio (OR) = 2.32-2.69. The occurrence of p-PTSD was associated with more mental health burdens, including (a) sixfold higher rates for any past-week common mental disorder, OR = 28.4, (b) more mental health service utilization, p < .001, (c) poorer mental health indexes in level of symptomatology, suicide ideation and functioning, p < .001, and (d) more disability, ps < .001-p = .014. The associations found among TE, PTSD, and health service utilization suggest that both TE and PTSD should be considered public health concerns.

[Strangulation as scenic behavior. A case report of a pseudosuicide in the course of a NREM-parasomnia]

It is generally accepted, that sleepwalkers show complex behaviors leading to non-intended consequences. It is not unusual that these persons are thereby injured. However, sporadically a bizarre endangering of themselves or others is reported also, which ranges from homicide of the life partner to accidental (pseudo-)suicide.In this article, we report on a 28year-old man who unexpectedly attempted to hang himself by a whip at night. We discuss the reasons, why this bizarre act should actually be taken as a scenic behavior in the course of a NREM-parasomnia, and the difficulty to proof this claim.

Age Group Differences in Household Accident Risk Perceptions and Intentions to Reduce Hazards

Very little is known about the extent to which seemingly vulnerable younger and older adults appraise household risks and relatedly whether safety information focused on raising risk awareness influences intentions to reduce hazards in the home. The present study assessed age differences in accident experience, risk attitudes, household accident risk perceptions, comparative optimism, personal control, efficacy judgements, and intentions to remove household hazards. It also examined the predictors of these intentions. Thirty-eight younger adults (aged 18 to 25) and forty older adults (aged 65 to 87) completed study booklets containing all measures. There were significant age group differences for all accident experience and risk-related variables. Younger adults experienced more accidents, had riskier attitudes, and had significantly lower cognitive risk perceptions (i.e., they were less likely to be injured due to a household accident). They also had lower affective risk perceptions (i.e., they were less worried) about their accident risk and perceived more personal control over the risk compared with older adults. Young adults were comparatively optimistic about their risk while older adults were pessimistic. Older adults had higher response efficacy and intentions to reduce hazards in the home. Only worry, response efficacy, and risk attitudes predicted intention, however, these relationships were not moderated by age or efficacy appraisal. Although tentative theoretical and practical implications are presented, further research is required in order to better understand the objective and subjective risk associated with household accidents, and to determine the factors that may improve safety, particularly for those most vulnerable.

Factors associated with health-related quality of life (HRQOL) in students who survived the Sewol ferry disaster in South Korea

BACKGROUND

The purpose of this study was to analyze the mental health status of Danwon students who survived the Sewol ferry disaster. The study also evaluated the mental health effects of the disaster on the survivors.

METHODS

Questionnaires were used to collect data from selected respondents. It was found that high family function and adolescent's strengths influence the quality of life of the survivors significantly.

RESULTS

Higher scores on the Family Adaptability and Cohesion Evaluation Scales (p < 0.001) or the strengths domain of Strengths and Difficulties Questionnaire (p = 0.027) were significantly associated with higher KIDSCREEN-27 scores.

LIMITATION

It is difficult to explain the causal relationship and generalize due to cross-sectionals study with small sample size.

CONCLUSIONS

Family function and adolescent's strengths had the significant relationship with higher quality of life of survivors. This finding offers important insight into understanding the effects of such accident, and suggest the importance the family and mental health to survivors of disasters.

Female Gender, Marital and Family Problems, and Feelings of Guilt Are Related to Self-Immolation Suicide Attempts

BACKGROUND

Self-immolation (SI) is considered one of the most painful, dramatic, and at the same time most inexplicable methods of suicide, with a high social impact. Prevalence rates are particularly high in Iran, and in north-western Iran specifically. Here, we report sociodemographic, psychological, and psychiatric characteristics of patients attempting self-immolation (PSIs), compared to patients with accident burns (PABs).

METHOD

Patients referred to the Burns Emergency Unit of the Besat Hospital (Hamadan, Iran) were enrolled in the present study between winter 2015 and summer 2016. After burn-related treatments and surgery, a thorough interview was undertaken covering sociodemographic characteristics, burn-related information, and psychiatric background.

RESULTS

A total of 79 patients were enrolled. Among these, 19 (31.7%) had attempted suicide via SI. Compared to the PABs, the PSIs were predominantly females; they reported family and marital problems as the main triggers for SI. The psychiatric interviews indicated that PSIs often suffered from major depressive disorders, adjustment disorders, and bipolar disorders. The prevailing feelings reported were guilt and shame. A binary logistic regression showed that feelings of guilt and marital and family problems predicted SI.

CONCLUSIONS

The prevalence of SI was surprisingly high. Marital and family conflicts as a proxy for highly distressing social interactions, along with female gender and feelings of guilt and shame were strongly associated with SI. Family and couple counseling specifically tailored to difficulties experienced by women might reduce the risk of SI.

Avoidance behaviours of young adults during a head-on collision course with an approaching person

Individuals use visual information to guide their avoidance behaviours. More specifically, individuals may directly perceive the time prior to colliding with an approaching obstacle (i.e., time to contact, TTC) to determine when to avoid. In addition, individuals use body-scaled information to control their movements. These avoidance behaviours differ when avoiding a human obstacle compared to an inanimate object. As such, the purpose of this experiment was to examine the avoidance behaviours of individuals during a head-on collision course with an approaching person. Young adults (N = 20, [Formula: see text] = 22.25 ± 1.5 years, 10 males) were instructed to walk along a 10 m path towards a goal located along the midline. A female confederate positioned along the midline walked towards the participants to one of the four predetermined final positions: (1) along the midline in the participants' starting position; (2) stopped along the midline 2.5 m from her starting position; (3) to the left of the participants' starting position; and (4) to the right of the participants' starting position. Results revealed when the path of the confederate was certain, individuals used a greater TTC to determine when to change their path in comparison with when the path of the confederate was uncertain. Males were found to avoid significantly earlier (i.e., larger TTC) than females. However, following a change in path, sex did not impact the avoidance behaviours of the groups, but rather, the environment was the regulating factor.

The panic triangle: onset of panic in scuba divers

Panic arising from physical or psychological stress is a common issue in reported incidents and accidents in scuba diving. Due to its effect on perception, thinking and diver behavior, the panic reaction is often a significant factor in the generation or escalation of problems, potentially leading to injuries and fatalities. The instinctive behaviors associated with panic are incompatible with the constraints of scuba diving (e.g., flight response to threat, leading to rapid ascent). Although the dangers are well known, the psychological mechanisms of panic and the implications for prevention/risk reduction are not sufficiently highlighted to recreational divers. In applied psychology, there are grounded theoretical models which describe the onset and maintenance of anxiety and panic, and an evidence base for approaches to anxiety management. For example, these models are used within structured psychological approaches for people experiencing anxiety disorders; and panic attacks are resolvable. Based on these models and underlying theory, this article proposes a new, accessible model for panic in divers. The potential uses of the model are to: (1) provide a simple framework for divers to understand the onset of panic; (2) promote the need for adequate training; (3) describe the importance of staying within training standards, qualifications and personal limitations; (4) support diver and dive educator understanding of individual factors in panic reactions (e.g. psychiatric conditions) placing greater emphasis on psychological fitness to dive; and (5) draw attention to approaches to improved regulation of emotion and promote individual responsibility.

Violent injury predicts poor psychological outcomes after traumatic injury in a hard-to-reach population: an observational cohort study

BACKGROUND

People who experience physical trauma face a range of psychosocial outcomes. These may be overlooked by busy clinicians. While some risk factors are understood, understanding of the psychological effects of violent injury remains limited, particularly in UK settings. This study compared psychological outcomes following interpersonal violence and accidental injury, including the persistence of psychological distress.

METHODS

A questionnaire survey was carried out at two time points of patients admitted to a large teaching hospital in London between July 2012 and April 2014. Participants were consecutive adult patients admitted to the Royal London Hospital with traumatic injuries, with 219 participants at baseline. Follow-up survey was 8  months later (n=109). Standardised measures assessed post-traumatic stress symptoms (PTSS) (Acute Stress Disorder Scale and PTSD Checklist) and depressive symptoms (Hospital Anxiety and Depression Scale).

RESULTS

PTSS and depressive symptoms affected 27% and 33%, respectively, at baseline. At 8  months, 27% and 31% reported these symptoms for PTSS and depressive symptoms, respectively. The repeated measures were assessed with multilevel models: after adjusting for demographic factors, patients with violent injury showed more PTSS (OR 6.27, 95% CI 1.90 to 20.66) and depressive symptoms (OR 3.12, 95% CI 1.08 to 8.99).

CONCLUSIONS

There were high levels of psychological distress among traumatic injury patients. Violent injuries were associated with an increased risk of both post-traumatic and depressive symptoms. People vulnerable to distress would benefit from psychological support, and hospital admission provides a unique opportunity to engage hard-to-reach groups in interventions.

Predicting the Transition From Acute Stress Disorder to Posttraumatic Stress Disorder in Children With Severe Injuries

INTRODUCTION

The purpose of this study was to examine predictors of risk for and the transition between acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in a longitudinal sample of youth with severe injuries admitted to the hospital. These data would assist with treatment and discharge planning.

METHODS

Youth were assessed for ASD during the initial hospital stay and were followed-up over an 18-month period for PTSD (n = 151). Youth were classified into four groups, including Resilient (ASD-, PTSD-), ASD Only (ASD+, PTSD-), PTSD Only (ASD-, PTSD+), and Chronic (ASD+, PTSD+). Demographic, psychiatric, social context, and injury-related factors were examined as predictors of diagnostic transition.

RESULTS

The results of multivariate analysis of variance and pairwise comparisons found that peritraumatic dissociation, gender, and socioeconomic status were significant predictors after controlling for multiple testing.

DISCUSSION

Results suggest that both within-child and contextual factors contribute to the longitudinal response to trauma in children. Clinicians should consider early screening and discharge planning, particularly for children most at risk.

The Pretravel Consultation

Key components of the pretravel consultation include intake questions regarding the traveler's anticipated itinerary and medical history; immunizations; malaria prophylaxis; and personal protection measures against arthropod bites, traveler's diarrhea, and injury. Most vaccinations that are appropriate for international travelers are included in the routine domestic immunization schedule; only a few travel-specific vaccines must also be discussed. The most common vaccine-preventable illnesses in international travelers are influenza and hepatitis A. Malaria prophylaxis should be offered to travelers to endemic regions. Personal protection measures, such as applying an effective insect repellent to exposed skin and permethrin to clothing and using a permethrin-impregnated bed net, should be advised for travelers to the tropics. Clinicians should offer an antibiotic prescription that travelers can take with them in case of traveler's diarrhea. Additional topics to address during the pretravel consultation include the risk of injury from motor vehicle crashes and travel-specific risks such as altitude sickness, safe sex practices, and emergency medical evacuation insurance.

Psychosocial service needs of pediatric transport accident survivors: Using clinical data-mining to establish demographic and service usage characteristics

The objectives in this article are the exploration of demographic and service usage data gained through clinical data mining audit and suggesting recommendations for social work service delivery model and future research. The method is clinical data-mining audit of 100 sequentially sampled cases gathering quantitative demographic and service usage data. Descriptive analysis of file audit data raised interesting trends with potential to inform service delivery and usage; the key areas of the results included patient demographics, family involvement and impact, and child safety and risk issues. Transport accidents involving children often include other family members. Care planning must take into account psychosocial issues including patient and family emotional responses, availability of primary carers, and other practical needs that may impact on recovery and discharge planning. This study provides evidence to plan for further research and development of more integrated models of care.

Mountaineers' Risk Perception in Outdoor-Adventure Sports: A Study of Sex and Sports Experience

The purpose of this study was to examine mountaineers' (expert, less-experienced, nonparticipant) risk perception in 19 outdoor-adventure sports related to their sex and sports experience. A total of 299 experienced mountaineers (90 women, 209 men), 321 less-experienced mountaineers (110 women, 211 men) and 193 volunteers nonparticipants in sport (95 women and 98 men) took part. Data were collected with items on a Likert-type 5-point scale. Test-retest over 15 days ranged from .64–86. A two-way variance analysis of sex × group showed that men's mean risk perception was lower than that of women for orienteering, mountain biking, rowing, surfing, sailing, nordic skiing, tour skiing, snowboarding, parachuting, and cliff jumping. Also, experienced mountaineers' mean risk perception was lower than that of those less experienced.

Personal, situational and organizational aspects that influence the impact of patient safety incidents: A qualitative study

OBJECTIVES

When a patient safety incident (PSI) occurs, not only the patient, but also the involved health professional can suffer. This study focused on this so-called "second victim" of a patient safety incident and aimed to examine: (1) experienced symptoms in the aftermath of a patient safety incident; (2) applied coping strategies; (3) the received versus needed support and (4) the aspects that influenced whether one becomes a second victim.

MATERIALS AND METHODS

Thirty-one in-depth interviews were performed with physicians, nurses and midwives who have been involved in a patient safety incident.

RESULTS

The symptoms were categorized under personal and professional impact. Both problem focused and emotion focused coping strategies were used in the aftermath of a PSI. Problem focused strategies such as performing a root cause analysis and the opportunity to learn from what happened were the most appreciated, but negative emotional responses such as repression and flight were common. Support from colleagues and supervisors who were involved in the same event, peer supporters or professional experts were the most needed. A few individuals described emotional support from the healthcare institution as unwanted. Rendered support was largely dependent on the organizational culture, a stigma remained among healthcare professionals to openly discuss patient safety incidents. Three aspects influenced the extent to which a healthcare professional became a second victim: personal, situational and organizational aspects.

CONCLUSION

These findings indicated that a multifactorial approach including individual and emotional support to second victims is crucial.

Temporal uncertainty analysis of human errors based on interrelationships among multiple factors: a case of Minuteman III missile accident

In traditional approaches of human reliability assessment (HRA), the definition of the error producing conditions (EPCs) and the supporting guidance are such that some of the conditions (especially organizational or managerial conditions) can hardly be included, and thus the analysis is burdened with incomprehensiveness without reflecting the temporal trend of human reliability. A method based on system dynamics (SD), which highlights interrelationships among technical and organizational aspects that may contribute to human errors, is presented to facilitate quantitatively estimating the human error probability (HEP) and its related variables changing over time in a long period. Taking the Minuteman III missile accident in 2008 as a case, the proposed HRA method is applied to assess HEP during missile operations over 50 years by analyzing the interactions among the variables involved in human-related risks; also the critical factors are determined in terms of impact that the variables have on risks in different time periods. It is indicated that both technical and organizational aspects should be focused on to minimize human errors in a long run.

Unintentional Injuries and Psychosocial Correlates among in-School Adolescents in Malaysia

The study aimed to provide estimates of the prevalence and psychosocial correlates of unintentional injury among school-going adolescents in Malaysia. Cross-sectional data from the Global School-Based Health Survey (GSHS) included 21,699 students (predominantly ≤13 to ≥17 years) that were selected by a two-stage cluster sample design to represent all secondary school students in Forms 1 to 5. The percentage of school children reporting one or more serious injuries in the past year was 34.9%, 42.1% of boys and 27.8% of girls. The two major causes of the most serious injury were “fall” (9.9%) and motor vehicle accident or being hit by a motor vehicle (5.4%), and the most frequent type of injury sustained was cut, puncture, or stab wound (6.2%) and a broken bone or dislocated joint (4.2%). In multivariable logistic regression analysis, sociodemographic factors (being male and low socioeconomic status), substance use (tobacco and cannabis use), frequent soft drink consumption, attending physical education classes three or more times a week, other risky behavior (truancy, ever having had sex, being bullied), psychological distress, and lack of parental or guardian bonding were associated with annual injury prevalence. Several factors were identified, which could be included in injury prevention promotion programs among secondary school children.

What Constitutes a Good and Bad Death?: Perspectives of Homeless Older Adults

This qualitative study explored perspectives toward a good or bad death among 21 older homeless adults residing in transitional housing. Using grounded theory approach, the themes for a good death were (a) dying peacefully; (b) not suffering; (c) experiencing spiritual connection; and (d) making amends with significant others. Themes for a bad death were (a) experiencing death by accident or violence; (b) prolonging life with life supports; (c) becoming dependent while entering a dying trajectory; and (d) dying alone. Healthcare professionals need to develop approaches for end-of-life care grounded in understanding unique needs of older homeless adults.

Who takes risks in high-risk sport?: the role of alexithymia

People who have difficulty identifying and describing their emotions are more likely to seek out the experience of emotions in the high-risk domain. This is because the high-risk domain provides the experience of more easily identifiable emotions (e.g., fear). However, the continued search for intense emotion may lead such individuals to take further risks within this domain, which, in turn, would lead to a greater likelihood of experiencing accidents. Across three studies, we provide the first evidence in support of this view. In Study 1 (n = 762), alexithymia was associated with greater risk taking and a greater propensity to experience accidents and close calls. In Study 2 (n = 332) and Study 3 (n = 356), additional bootstrapped mediation models confirmed these relationships. The predictive role of alexithymia remained significant when controlling for sensation seeking (Study 1) and anhedonia (Study 2 and Study 3). We discuss the practical implications of the present model as they pertain to minimizing accidents and close calls in the high-risk domain.

Attachment, continuing bonds, and complicated grief following violent loss: testing a moderated model

There is increasing consensus that mourners' general attachment security and ongoing sense of connectedness to the deceased figure prominently in adjustment to bereavement. However, the interplay between these variables has not been investigated thoroughly. We therefore studied 195 young adults who were bereaved by violent causes (homicide, suicide, and fatal accidents) in the previous 2 years, measuring their attachment-related insecurities (anxiety and avoidance), their specific ongoing attachment or "continuing bond" (CB) to the deceased, and their complicated grief (CG) symptomatology over the loss of this relationship. Analyses indicated that CBs were concurrently linked with greater CG symptomatology. However, other results also suggested that attachment could moderate the adaptiveness of maintaining a sense of connection to the deceased loved one. Specifically, CBs were less predictive of CG symptomatology for individuals with high anxiety and low avoidance, and most predictive of intense grieving for bereaved people whose attachment styles were more highly avoidant and minimally anxious. These findings suggest the relevance of evaluating the appropriateness of clinical techniques that emphasize or deemphasize the CB for mourners who differ in their styles of attachment. Such studies could potentially promote a better match of interventions to clients whose styles of coping are congruent with these procedures.

Death thoughts and images in treatment-seekers after violent loss

Violent loss survivors often describe experiencing recurrent imagery about their loved one's death. The Death Imagery Scale assesses 5 kinds of imagery: reenactment, rescue, revenge, reunion, and remorse. We explored the frequency of these forms of imagery and their associations with PTSD, depression, and/or complicated grief (CG) among 130 treatment-seeking survivors who were, on average, 3.5 years postloss. Reenactment, rescue, and remorse imagery were most frequently endorsed, and all forms of imagery were associated with PTSD, depression, and CG. Bereaved parents reported more remorse and reunion imagery than others. Homicide survivors reported more revenge imagery than suicide and accident survivors.

[Interventions for mental health sequelae of accidents]

Emergency psychology and psychotraumatology deal with the psychological sequelae of traumatic experiences, i.e., the prevention and early intervention of posttraumatic mental health disorders. Accidents are the most prevalent traumatic events in the general population that may result in a range of severe trauma and adjustment disorders. Accidents happen suddenly, unexpectedly, and can gravely threaten health, personal integrity, and life. The prevalence of intermittent and chronic psychiatric disorders in the aftermath of severe accidents varies between 5 and 30 %. Victims suffer from unknown and frightening posttraumatic symptoms, often irreversible handicaps as a consequence of their injuries, impairments in everyday functioning, and negative impact on the quality of life. The direct and indirect burden for society is high. Comprehensive secondary prevention, starting with early detection and early intervention of post-accident disorders, is not well established in clinical care. In case of severe accidental injuries, emergency and medical treatment has absolute priority. But all too often, severe mental health problems remain undetected in later treatment phases and therefore cannot be addressed adequately. In primary care, knowledge of specific psychodiagnostic and treatment options is still insufficient. Prejudices, denial, and fear of stigmatization in traumatized victims as well as practical constraints (availability, waiting time) in the referral to special evidence-based interventions limit the access to adequate and effective support. This overview presents the objectives, concepts, and therapeutic tools of a stepped-care model for psychological symptoms after accidental trauma, with reference to clinical guidelines.

[Hypnosis as an effective management of a child with posttraumatic stress disorder after perineal trauma]

Children and teenagers may face trauma that threatens their life, but also their psychological integrity. These injuries can lead to posttraumatic stress disorder (PTSD), which is the most common psychopathological consequence after a trauma. Age is not a protective factor and this disorder can be severe and may last over a long-term period. Effective therapies on PTSD are scarce and research on this topic is rare in children. We report a case of a 12-year-old girl affected by PTSD after a carousel accident at the age of 4 years. A therapy based on hypnosis and psychological support was rapidly effective. This psychotherapeutic option was chosen on the basis of common features shared by hypnosis and the posttraumatic symptoms. Clinical manifestations of PTSD disappeared after 4 weeks of therapy and the patient remained symptom-free during a 1-year follow-up. Our report suggests that hypnosis could be an effective therapy for children with PTSD. Prospective studies on a larger number of patients are needed to validate this hypothesis.

Psychological factors for driver distraction and inattention in the Australian and New Zealand rail industry

A signal passed at danger (SPAD) event occurs when a train moves past a stop signal into a section of unauthorised track. SPAD events are frequently attributed to driver distraction and inattention, but few studies have explored the failure mode from the perspective of task demand and the ability of the driver to self-regulate in response to competing activities. This study aimed to provide a more informed understanding of distraction, inattention and SPAD-risk in the passenger rail task. The research approach combined focus groups with a generative task designed to stimulate situational insight. Twenty-eight train drivers participated from 8 different rail operators in Australia and New Zealand. Data were analysed thematically and revealed several moderating factors for driver distraction. Time-keeping pressure and certain aspects of the driver-controller dynamic were considered to distort performance, and distractions from station dwelling and novel events increased SPAD-risk. The results are conceptualised in a succinct model of distraction linking multiple factors with mechanisms that induced the attentional shift. The commonalities and inter-dynamics of the factors revealed insight into driving anxiety in the passenger rail mode, and suggested that SPAD-risk was intensified when three or more factors converged. The paper discusses these issues in the context of misappropriated attention, taxonomic implications, and directions for future research.

Mental disorders and risk of accidental death

BACKGROUND

Little is known about accidental death risks among psychiatric patients.

AIMS

To examine this issue in the most comprehensive study to date.

METHOD

National cohort study of all Swedish adults (n = 6 908 922) in 2001-2008.

RESULTS

There were 22 419 (0.3%) accidental deaths in the total population, including 5933 (0.9%) accidental deaths v. 3731 (0.6%) suicides among psychiatric patients (n = 649 051). Of persons who died from accidents, 26.0% had any psychiatric diagnosis v. 9.4% in the general population. Accidental death risk was four- to sevenfold among personality disorders, six- to sevenfold among dementia, and two- to fourfold among schizophrenia, bipolar disorder, depression or anxiety disorders, and was not fully explained by comorbid substance use. Strong associations were found irrespective of sociodemographic characteristics, and for different types of accidental death (especially poisoning or falls).

CONCLUSIONS

All mental disorders were strong independent risk factors for accidental death, which was substantially more common than suicide.

Sounding the warning bells: the need for a systems approach to understanding behaviour at rail level crossings

Collisions at rail level crossings are an international safety concern and have been the subject of considerable research effort. Modern human factors practice advocates a systems approach to investigating safety issues in complex systems. This paper describes the results of a structured review of the level crossing literature to determine the extent to which a systems approach has been applied. The measures used to determine if previous research was underpinned by a systems approach were: the type of analysis method utilised, the number of component relationships considered, the number of user groups considered, the number of system levels considered and the type of model described in the research. None of research reviewed was found to be consistent with a systems approach. It is recommended that further research utilise a systems approach to the study of the level crossing system to enable the identification of effective design improvements.

[Health-related quality of life of people with severe traumatic injury: a longitudinal study using the SF-36 health survey]

Even though 85 percent of those who have been severely injured in an accident in Germany survive, complex and serious long-term consequences are still a major problem not only for health and care insurance providers but also for the accident victims themselves because their quality of life is affected permanently. Therefore the aim of the current study is to identify factors that significantly improve the quality of life after a severe traumatic injury and to investigate whether the support by a reintegration service has a positive effect on the victims' quality of life. The sample consisted of severely injured accident victims who were supported by a reintegration service. The data collection comprised three data points. At every data point the SF-36 questionnaire was used to assess the participants' quality of life. The results indicate that an individual medical-vocational support by a reintegration service has the potential to significantly and stably improve the physical aspects of quality of life, even if the accident dates back several years. Furthermore it appears to be important to support the independence of the accident victims because assistance by a third person correlates with a lower degree of physical quality of life, regardless of severity or type of injury. Moreover it becomes clear that it is important to pay more attention to the treatment of psychological consequences of severe accidents.

Association of depressive symptoms with recurrent falls: a cross-sectional elderly population based study and a systematic review

BACKGROUND

Screening of depressive symptoms is recommended in recurrent fallers. Compared to the 30-item and 15-item Geriatric Depression Scales (GDS), the 4-item GDS is easier to administer and quicker to perform. The association between abnormal 4-item GDS score and recurrent falls has not yet been examined. In addition, while depressive symptoms-related gait instability is well known, the association with recurrent falls has been few studied.

OBJECTIVE

1) To examine the association between abnormal 4-item GDS score and recurrent falls in community-dwelling older adults using original data from health examination centers (HEC) of French health insurance of Lyon, and 2) to perform a systematic review of studies that examined the association of depressive symptoms with recurrent falls among older adults.

METHODS

Firstly, based on a cross-sectional design, 2,594 community-dwellers (mean age 72.1±5.4years; 49.8% women) were recruited in HEC of Lyon, France. The 4-item GDS score (abnormal if score≥1) and recurrent falls (i.e., 2 or more falls in the past year) were used as main outcomes. Secondly, a systematic English and French Medline literature search was conducted on May 28, 2012 with no limit of date using the following Medical Subject Heading (MeSH) terms "Aged OR aged, 80 and over", "Accidental falls", "Depressive disorder" and "Reccurence". The search also included the reference lists of the retrieved articles.

RESULTS

A total of 19.0% (n=494) participants were recurrent fallers in the cross-sectional study. Abnormal 4-item GDS score was more prevalent among recurrent fallers compared to non-recurrent fallers (44.7% versus 25.0%, with P<0.001), and was significantly associated with recurrent falls (Odd ratio (OR)=1.82 with P<0.001 for full model; OR=1.86 with P<0.001 for stepwise backward model). In addition to the current study, the systematic review found only four other studies on this topic, three of them examining the association of depressive symptoms with recurrent falls using 30-item or 15-item GDS. All studies showed a significant association of depressive symptoms with recurrent falls.

CONCLUSIONS

The current cross-sectional study shows an association between abnormal 4-item GDS score and recurrent falls. This association of depressive symptoms with recurrent falls was confirmed by the systematic review. Based on these results, we suggest that recurrent falls risk assessment should involve a systematic screening of depressive symptoms using the 4-item GDS.

Transport mode preferences, risk perception and worry in a Norwegian urban population

The main aim of the present study was to compare risk perception among Norwegians (n=512) living in the region of Oslo. This study was part of an ERANET 13 project entitled PETRIS, Perception of transport risk in France and Norway. The data collection was carried out in January 2011. The response rate was 51 percent. The results showed that respondents, divided in two groups according to their transport mode preferences, assessed differently risk perception in public and private transportation. Respondents who preferred collective transportation assessed the probability of experiencing criminality in collective transport modes as higher than those who preferred private modes. They were also more worried of experiencing accidents, criminality, and terror attacks in collective transportation. The relationship between transport mode preferences and use, risk perception and worry are discussed.

Personality and risk perception in transport

Within research on individual variations in risk perception, personality has been suggested as one important factor. In the present study, personality traits (44 items from the Big Five inventory) were investigated in relation to risk perception in transport and transport behavioural adaptations. In a sample of 312 participants, we found that the personality trait 'emotional stability versus neuroticism' was negatively correlated with risk perception (operationalised as "thinking about the possibility") of an accident (-0.38) and an unpleasant incident, such as crime, violence, robbery (-0.25). 'Agreeableness' was also negatively related to risk perception, however first and foremost in relation to perceived risk for unpleasant incidents on transport modes in which one interacts with other people (0.25). Moreover, regression analyses showed that 'emotional stability' was a significant predictor of behavioural adaptations on bus. Regression analyses explained between 17 and 26 percent of variance in behavioural adaptations. The results show that different groups of people vary systematically in their perception of risk in transport. Furthermore, these differences are manifest as a difference in risk-preventive behaviour at a strategic level, i.e. as decisions about avoiding risky situations.

Association of life threat and betrayal with posttraumatic stress disorder symptom severity

The Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000) emphasizes life threat as the defining feature of psychological trauma. Recent theoretical and empirical work, however, indicates the need to identify and evaluate other key aspects of trauma. Betrayal has been proposed as a pertinent, distinct, and complementary factor that can explain effects of trauma not accounted for by life threat alone. This study examined the relationship between injury, perceived life threat (PLT), and betrayal with posttraumatic stress disorder (PTSD) symptom severity. Trauma-exposed college students (N = 185) completed self-report measures of trauma exposure and PTSD, as well as items regarding life threat, betrayal, and level of medical care received. In hierarchical regressions incorporating injury, PLT, and betrayal, betrayal was associated with all PTSD symptom clusters and PTSD total severity (f(2) = .08), whereas PLT was associated with hyperarousal (f(2) = .05) and PTSD total (f(2) = .03), and injury had no association with PTSD symptoms. In a revised model with trauma type as an additional variable, betrayal was associated with avoidance (f(2) = .03), numbing (f(2) = .04), and PTSD total (f(2) = .03), whereas PLT was associated with reexperiencing (f(2) = .04), hyperarousal (f(2) = .04), and PTSD total (f(2) = .03), and injury was associated with avoidance (f(2) = .03). These findings support the idea that betrayal is a core dimension of psychological trauma that may play an important role in the etiology of PTSD.

Predictors of parental posttraumatic stress disorder symptoms in the year after adolescent traumatic injury

OBJECTIVES

Parental posttraumatic stress disorder (PTSD) is common after pediatric traumatic injury and may negatively impact parental functioning and quality of life during this key period of the child's early postinjury recovery. This study aimed to evaluate the course and predictors of PTSD in parents during the year after an adolescent traumatic injury.

METHODS

This prospective cohort study included a population-based sample of 99 parent-adolescent dyads. Assessment was through structured interview administration of standardized measures. Interviews were conducted within 30 days of injury and 2, 5, and 12 months after injury. Mixed model regression was used to evaluate variables potentially associated with repeated measures of parental PTSD symptoms at the follow-up time points.

RESULTS

Twenty-three percent of parents met symptomatic criteria for PTSD at the first postinjury evaluation, as did 15% at 2 months, 7% at 5 months, and 6% at 12 months after the injury. The percentage of parents meeting symptomatic PTSD criteria decreased significantly between the 2-month and 12-month evaluations. Mixed-model regression analyses revealed greater PTSD symptoms within 30 days of injury and a greater number of postinjury parental traumatic and/or stressful life events as significant predictors of parental PTSD. Adolescent factors did not affect the risk of parental PTSD.

CONCLUSIONS

A substantial subgroup of parents demonstrate high PTSD symptom levels during the course of the year after an adolescent injury. Given that early modifiable risk factors can be identified, future investigations focusing on screening and intervention are warranted.

Earthquakes on the mind: implications of disasters for human performance

OBJECTIVE

The present study explored the impact a natural disaster has on human performance.

BACKGROUND

Previous research indicates that traffic accidents increase after disasters. A plausible explanation for this finding is that disasters induce cognitive disruption and this disruption negatively affects performance (e.g., driving quality).

METHOD

A total of 16 participants (7 men and 9 women) performed a sustained-attention-to-response task before and after a 7.1-magnitude earthquake. Performance (errors of omission, errors of commission, and reaction time) was compared before and after the earthquake.

RESULTS

Errors of omission increased after the earthquake. Changes in errors of commission and reaction times were, however, dependent on individual differences in stress response to the earthquake.

CONCLUSION

The results indicate that natural disasters may have a negative impact on performance.

APPLICATION

Communities need to be aware of the increased risk of accidents following disasters and develop countermeasures, including individualized assessment tools.

A traumatic death support group program: applying an integrated conceptual framework

This article describes an 8-week, curriculum-based traumatic death support group program that is offered at Bo's Place, a grief and bereavement center in Houston, Texas. The program was implemented in 2006 in an effort to help family members who had experienced a death in the family by suicide, murder, accident, or sudden medical problem. The program provides the opportunity for families to come to the center and engage in selected activities as a unit, while also providing adults and children the opportunity to participate in separate support groups with curricula adapted to different age levels. The program uses an integrated conceptual framework that draws upon elements from a variety of theoretical and conceptual models related to grief. The purpose of the program is to provide multiple paths for progress in the grief journey for the bereaved. In 2008, Bo's Place incorporated a brief questionnaire into the weekly meetings, in an effort to gain a better understanding of the perceptions of adult participants of the program and their own progress in their grief. The questionnaire asked adults to provide self-ratings of their perceptions of support from the program and of their progress in their grief journey. The positive results from this pilot study have encouraged Bo's Place to develop plans for more rigorous research into the mechanisms that contribute to progress in the grief journey for bereaved adults and children.

Live deaths online: internet suicide and lethality

The Internet provides an infinite platform for the portrayal of lethal events. Beyond mere display, however, it dispenses information, allows for participation and sharing of content, and constitutes a virtual interactive forum. The Internet may ultimately shape society's approach to perceiving and dealing with death. Thus, psychiatrists may wish to be aware of these matters so that they may be considered in assessments and clinical care. In this article, the author attempts to identify key online locations where lethality is portrayed and how it may affect the individual patient and practitioner and the population at large.

Self-rating scales assessing subjective well-being and distress correlate with rCBF in PTSD-sensitive regions

BACKGROUND

The aim of this study was to investigate the distribution of the regional cerebral blood flow (rCBF) in occupational-related post-traumatic stress disorder (PTSD) subjects and to seek possible correlations between brain perfusion and self-rating scales (SRS) in order to cross-check their diagnostic value and to look for their neural correlates.

METHOD

A total of 13 traumatized underground and long-distance train drivers developing (S) and 17 not developing (NS) PTSD who had experienced a 'person under train' accident or who had been assaulted at work underwent clinical assessment and 99mTc-HMPAO SPECT imaging during autobiographical trauma scripts. Statistical parametric mapping was applied to analyse rCBF changes in S as compared with NS and to search for correlations between rCBF and the administered SRS scores, modelling age, months to SPECT and the ratio 'grey matter/intra-cranial volume' as nuisance variables.

RESULTS

Significantly higher activity was observed during trauma script in left posterior and anterior insula, posterior cingulate, inferior parietal lobule, precuneus, caudate and putamen in PTSD subjects as compared with the trauma-exposed control group. Impact of Event Scale and World Health Organisation (10) Well-Being Index scores highly correlated with tracer uptake to a great extent in the same regions in which rCBF differences between S and NS were found.

CONCLUSIONS

These findings support the involvement of insular, cingulate and parietal cortices (as well as the basal ganglia) in the pathogenesis of PTSD and in the processing of related subjective well-being and distress.

Railway-controller-perceived competence in incidents and accidents

Railway controllers play a pivotal role in service recovery of normal rail system operations when incidents and accidents occur. Those in this position must have sufficient competence to overcome task difficulties caused by accident uncertainties. This study adopts Taiwan's railway system as a case study to diagnose railway-controller-perceived competence when facing diverse tasks during incidents and accidents that are derived from a proposed conceptual model. Railway-controller-perceived competence is measured using the Rasch model. Analytical results indicate that working with an external rescue agency handling a rescue operation, explanations to the public, and communication with an external rescue agency are considered the most troublesome tasks. Additionally, railway-controller-perceived competence differs based on the work experience. This information will prove useful for rail system operators and government regulators when designing and regulating railway controller competence management systems. STATEMENT OF RELEVANCE: This study presents a systematic approach for examining the gap between railway-controller-perceived competence and task difficulties associated with incidents and accidents. The relevance of findings encompasses the effects of transportation ergonomics and railway issues on the problem-solving competence and decision-making skills of railway controllers, and the competence management system.

A reliability and usability study of TRACEr-RAV: the technique for the retrospective analysis of cognitive errors--for rail, Australian version

The aim of this study was to compare the usability and reliability of two human error identification tools: TRACEr-Rail (developed by the Rail Safety and Standards Board in the UK) and TRACEr-RAV (an Australian specific version of the tool). Following an attempt to modify TRACEr-Rail to more appropriately suit the Australian rail context, it was predicted that TRACEr-RAV would be rated as more usable and be applied more consistently by Australian users than TRACEr-Rail. In Experiment 1, twenty-five rail employees used either TRACEr-Rail or TRACEr-RAV1 to extract and classify errors from six Australian rail incident reports. In Experiment 2, eleven university students used both TRACEr-Rail and TRACEr-RAV2 to extract and classify errors from three incident summaries. The results revealed that although modification of TRACEr-Rail to become TRACEr-RAV1 and TRACEr-RAV2 did not result in improved inter-rater reliability, modification resulted in improved ratings of usability in Experiment 2. Most participants in Experiment 2 preferred TRACEr-RAV2 to TRACEr-Rail. The poor inter-rater reliability observed was most likely the result of inadequate training, limited practice in using the tools, and insufficient human factors knowledge.

Positive income shocks and accidental deaths among Cherokee Indians: a natural experiment

BACKGROUND

Several studies in low-income populations report the somewhat counterintuitive finding that positive income gains adversely affect adult health. The literature posits that receipt of a large portion of annual income increases, in the short term, risk-taking behaviour and/or the consumption of health-damaging goods. This work implies the hypothesis that persons with an unexpected gain in income will exhibit an elevated risk of accidental death-the fifth leading cause of death in the USA. We test this hypothesis directly by capitalizing on a natural experiment in which Cherokee Indians in rural North Carolina received discrete lump sum payments from a new casino.

METHODS

We applied Poisson regression to the monthly count of accidental deaths among Cherokee Indians over 204 months spanning 1990-2006. We controlled for temporal patterns in accidental deaths (e.g. seasonality and trend) as well as changes in population size.

RESULTS

As hypothesized, the risk of accidental death rises above expected levels during months of the large casino payments (relative risk = 2.62; 95% confidence interval = 1.54-4.47). Exploratory analyses of ethnographic interviews and behavioural surveys support that increased vehicular travel and consumption of health-damaging goods may account for the rise in accident proneness.

CONCLUSIONS

Although long-term income gains may improve health in this population, our findings indicate that acute responses to large income gains, in the short term, increase risk-taking and accident proneness. We encourage further investigation of natural experiments to identify causal economic antecedents of population health.

Posttraumatic symptoms in Japanese bereaved family members with special regard to suicide and homicide cases

The authors investigated posttraumatic stress disorder (PTSD) symptoms in Japanese bereaved family members using a questionnaire. Participants were bereaved as a result of suicide and homicide (n = 51 and 49, respectively), with natural death (n = 56) as a control; and their relationships to the deceased were parent-child (n = 79), conjugal (n = 42), and others (n = 35). With regard to the 3 main PTSD-related criteria, (a) re-experiencing symptoms were not dependent on the manner of death or the relationship to the deceased; (b) avoidance behaviors were more highly related to homicide than natural death for relatives other than parent-child and conjugal relationships; and (c) hyperarousal and maladaptation symptoms were more serious for conjugal loss. These findings suggest that avoidance behaviors in homicidal cases are more closely associated with a distant family relationship, whereas conjugal loss is traumatic, irrespective of the manner of death, often causing hyperarousal and maladaptation symptoms.

The association of activity level, parent mental distress, and parental involvement and monitoring with unintentional injury risk in fifth graders

OBJECTIVE

Extend findings with young children by examining the strength of association of activity level, parent mental distress, and parental involvement and monitoring with fifth graders' unintentional injuries.

METHODS

Ordinal logistic regression models were used to predict unintentional injury frequency among 4745 fifth-graders. Examined predictors included demographics, parent reports of mental distress, temperamental activity level (tendency to be fidgety, restless, and constantly in motion), and parental involvement and monitoring in adolescents' lives.

RESULTS

Higher levels of both activity level and parent mental distress predicted more frequent injuries.

CONCLUSIONS

As has been found with younger children, unintentional injuries in fifth graders are associated with both parent and child characteristics. The result is discussed in the context of adolescent development. Implications include those for injury prevention (multi-dimensional prevention strategies that incorporate environmental modifications as well as training of youth and parents) and future research (study of potential mechanisms behind injury risk behavior via longitudinal and experimental research; study of injury risk during this phase of child development).

Childhood trauma and children's emerging psychotic symptoms: A genetically sensitive longitudinal cohort study

OBJECTIVE

Using longitudinal and prospective measures of trauma during childhood, the authors assessed the risk of developing psychotic symptoms associated with maltreatment, bullying, and accidents in a nationally representative U.K. cohort of young twins.

METHOD

Data were from the Environmental Risk Longitudinal Twin Study, which follows 2,232 twin children and their families. Mothers were interviewed during home visits when children were ages 5, 7, 10, and 12 on whether the children had experienced maltreatment by an adult, bullying by peers, or involvement in an accident. At age 12, children were asked about bullying experiences and psychotic symptoms. Children's reports of psychotic symptoms were verified by clinicians.

RESULTS

Children who experienced mal-treatment by an adult (relative risk=3.16, 95% CI=1.92-5.19) or bullying by peers (relative risk=2.47, 95% CI=1.74-3.52) were more likely to report psychotic symptoms at age 12 than were children who did not experience such traumatic events. The higher risk for psychotic symptoms was observed whether these events occurred early in life or later in childhood. The risk associated with childhood trauma remained significant in analyses controlling for children's gender, socioeconomic deprivation, and IQ; for children's early symptoms of internalizing or externalizing problems; and for children's genetic liability to developing psychosis. In contrast, the risk associated with accidents was small (relative risk=1.47, 95% CI=1.02-2.13) and inconsistent across ages.

CONCLUSIONS

Trauma characterized by intention to harm is associated with children's reports of psychotic symptoms. Clinicians working with children who report early symptoms of psychosis should inquire about traumatic events such as maltreatment and bullying.

Auto thrill shows and destruction derbies, 1922–1965: establishing the cultural logic of the deliberate car crash in America

The profuse historiography on the automobile in America near completely overlooks the ubiquitous cultural practice of entertaining live audiences by deliberately crashing cars. This paper seeks to rectify some of this ongoing neglect by providing a socio-historical exploration into the origins of this unique genre. The planned automobile wreck’s birth is traced to the early 1920s and is situated contextually within an established tradition of disaster and destruction reenactments, key historical developments in the system of automobility, and the phenomenon of traffic accidents. By exposing the political economy behind this form of amusement and the dominant discourse surrounding it, the paper provides an explanation for how and why the deliberate demolition of such an iconic and celebrated technology was able to flourish in America.