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Background Method Results Conclusions People bereaved by suicide are at increased risk of suicide. Potential explanations include changes in the cognitive availability of suicide after suicide bereavement, but this has been under‐investigated. This study aimed to investigate how suicide bereavement influences thoughts about suicide, including methods considered.We interviewed 20 UK‐based adultswho reported having been preoccupied by the suicide of a close contact, analyzing qualitative data using reflexive thematic analysis.We identified four main themes: divergent changes in views about suicide as an option; impact of the method used on consideration of own potential method of suicide (including an aversion to the same method); experience of suicidal ideation as a means of understanding the deceased's state of mind; and thoughts related to reunion with the deceased.Our findings suggest that the trauma of exposure to a close contact's suicide can modify the cognitive availability of suicide in divergent ways, including suicide being perceived as a more or less acceptable option, and a tension between the two. These insights assist clinicians in sensitive exploration of suicide bereavement and in risk mitigation. They suggest revisions to existing models of cognitive availability and the potential for psychological interventions that modify the cognitive availability of suicide. [ABSTRACT FROM AUTHOR]

The impact of traumatic loss on an individuals' mental health is a critical area of study. While most research has focused on general grief patterns, the unique trajectories of trauma survivors have been understudied. This research utilizes a high-resolution dataset from a single individual over several years, including a period of unexpected tragedy. Using person-specific dynamic modeling and network analysis, the study examines the psychological processes related to traumatic loss. The results reveal a complex distress trajectory and emotional variability with increasing resilience over time. Findings suggest that traumatic loss can induce strongly interconnected emotional networks, typically linked to vulnerability to psychological disorders. Yet, a heightened correlation within a network representing both positive and negative aspects could indicate the emergence of adaptive coping strategies. The study emphasizes that analyzing emotional inertia and variability separately provides a holistic clinical perspective and deepens the understanding of diverse psychological states and affective dynamics. This research underlines the benefits of investigating individual experiences and stresses the need for idiographic approaches in trauma and grief studies. Future research utilizing high-resolution data from multiple individuals may provide a more comprehensive understanding of the diverse trajectories of grief and inform the future of personalized intervention and care. [ABSTRACT FROM AUTHOR]

The present study aimed to elucidate the experience of social support in the a​ftermath of a traumatic loss, during which the bereavement ceremony was prohibited. The study was conducted using a research method that combined social constructivism and grounded theory. Participants included all Iranian youth (over 18) in 2022 who experienced a traumatic loss and encountered restrictions in organizing memorials during the COVID-19 pandemic. Semi-structured interviews were conducted with 32 individuals, who were selected through purposeful and theoretical sampling. Charmez’s three-step coding method was implemented to analyze the data. The data was analyzed to extract four primary themes: the challenge in seeking social support, ways of seeking social support, alternative methods of social support, and the most effective social support along with 9 sub-categories. Additionally, nine subcategories were identified. The results indicate that the process of grief was further complicated by the communication limitations during emergencies. However, the redefinition of social support in such situations has the potential to develop novel coping methods for traumatized mourners. Therefore, it is advised that the results of this study be applied to the development of intervention protocols to expedite the bereavement process in the aftermath of such losses in emergency situations.

Sudden, unexpected loss can be particularly devastating for the bereaved as they struggle to make sense of their loss. We interviewed 11 therapists who specialized in loss/trauma about how each of them helped one client make meaning after a traumatic loss. Data, analyzed using Consensual Qualitative Research (CQR), revealed that the traumatic loss had negatively impacted clients’ relationships, mental health, and beliefs/religion/spirituality; therapists utilized a range of interventions to facilitate meaning-making, including supporting clients through the grief process, as well as helping them experience/regulate emotion and change their narratives around the loss; clients made meaning in diverse ways that could be broadly categorized under meaning-as-comprehensibility and meaning-as-significance; and clients experienced positive adjustment (in mental health, relationships, etc.) through the meaning-making work. Implications for counseling psychology research and practice are discussed. [ABSTRACT FROM AUTHOR]

AbstractVirtue is a significant but underexplored factor in comprehending posttraumatic growth and psychosocial adaptation in the aftermath of traumatic loss. While empirical evidence suggests that the dominant virtues and their combinations can vary among individuals, the specific variances and their unique impacts remain uncertain. This research investigated the virtue profiles, based on five virtue subfactors of the Virtue-based Psychosocial Adaptation Model, in association with posttraumatic growth and demographics among 257 South Koreans who experienced either direct or vicarious traumatic loss. Using latent profile analysis, three virtue profiles were discerned: high, mid, and low-virtue groups. Of the participants, 33.9% were categorized into the high-virtue group, displaying pronounced levels across all five virtue sub-factors. The mid-virtue group, comprising 59.9% of participants, exhibited moderate levels for these virtues. The low-virtue group, which encompassed 6.2%, showed the lowest levels across the virtue factors. The high-virtue group demonstrated the most pronounced posttraumatic growth, followed by mid and low-virtue groups. Age, socio-economic status (SES), and chronic illness or disability (CID) were demographic determinants significantly associated with profile memberships. Older age and higher SES were associated with the high-virtue group compared to the mid-group. CID status was a predictor of the mid-virtue group, compared to high-group. The findings suggest the necessity of tailored approaches, which acknowledge the interdependence of virtues and consider the diverse backgrounds and environments of individuals for more nuanced and effective support. [ABSTRACT FROM AUTHOR]

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.

Children and adolescents who experience the loss of a beloved one in traumatic circumstances can experience prolonged grief symptoms, characterized by symptomatology that may alter the grieving process, impair global functioning, and interact with cognitive development. Cognitive behavioral therapy (CBT) has been showing significant results in treating grief-related issues. The present systematic review assessed the effectiveness of CBT for prolonged grief symptoms in the pediatric population. This study was carried out by two independent reviewers who searched electronic databases through a combination of keywords and a set of inclusion and exclusion criteria. A total of 20 studies were selected and data were synthesized in these categories: characteristics of the participants; specificities of the instruments; effectiveness of CBT. The results of this systematic review highlighted significant improvements in prolonged grief symptoms and global functioning following CBT. No significant age, gender, or ethnicity differences were found in most studies. The Inventory of Prolonged Grief for Children/Adolescents and the Inventory of Complicated Grief-Revised for Children appear to be the pediatric population's most sensitive prolonged grief measures. The treatments were adapted based on various contextual and structural factors without losing clinical significance. Significant effect sizes were found for primary and most secondary outcomes. This systematic review underlines the effectiveness of CBT for prolonged symptoms in the pediatric population. Nonetheless, the included studies had a certain degree of heterogeneity, and their quality varied due to some biases. A validation procedure of standard methodologies for prolonged grief symptoms in children and adolescents is required to establish shared directions both in research and clinical settings. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Children who experience the traumatic (i.e., violent and/or unexpected) death of a loved one are at risk for a range of adverse developmental and mental health problems, including pathological processes of grief. Over the last decades, conceptualizations of maladaptive grief have varied, resulting in a range of assessment tools and no "gold standard" measure to assess symptoms of prolonged grief in children. The current paper is a systematic review of studies that measured grief in children who experienced traumatic loss in order to determine the measures currently used in the literature with children who experience traumatic loss. Searches were conducted according to the preferred reporting items for systematic reviews and meta-analyses in PUBMED, PsycINFO, and OVID and through hand searches of relevant reference lists. Two authors reviewed each study yielded by searches and conducted data extraction on included studies. Studies were included if they were peer-reviewed, included a measure of grief, and consisted of samples of children (age 18 and younger) whereby at least a portion experienced traumatic loss. Thirty-nine studies met inclusion criteria, from which 17 measures were identified. The most commonly used measure was the Inventory of Complicated Grief (n = 10 studies) followed by the Extended Grief Inventory (n = 6). Most studies used different measures and variations of the same measures to assess similar constructs. All but one measure relied on child self-report. More standardization of measurement across studies is needed, along with parent and/or teacher reported measures. [ABSTRACT FROM AUTHOR]

Background: Close friends are often an overlooked group of bereaved people. This study is based on a sub-project on young adults who experienced the loss of a close friend in the terrorist attack on Utøya, Norway, on 22 July 2011. Objective: The aim of this longitudinal study was to explore the relationship between complicated grief reactions, the need for help, and help received after losing a close friend to a traumatic death. Method: In total, data from 89 people (with a mean age of 21 years, 76.4% female) were collected at one or more of the four time-points: 18, 28, 40, and 102 months after the incident. Latent growth modelling was used to analyse levels of grief reactions and change over time, experienced need for help, and help received. Results: According to the results, the bereaved friends in our study were profoundly impacted by the loss and experienced level of reactions indicating complicated grief (mean scores on the Inventory of Complicated Grief varied from 36.2 to 23.7). A need for help was related to a decrease in grief symptoms, whereas a prolonged need for help was related to no reduction or an increase in grief. Received help was not related to decrease in grief symptoms. Conclusions: These findings underscore the need for continuous professional help, and demonstrate that the present help measures used after traumatic events may not adequately meet the needs of close bereaved friends. This emphasizes the importance of acknowledging friends as bereaved and that follow-up measures should also include this group. Finally, the study highlights the need to learn more about how professional can help bereaved friends. Young adults who experience the traumatic loss of a close friend may experience levels of grief reactions indicating complicated grief. The need for help reported after experiencing the loss of a close friend is high; this is also the case when some time has passed since the loss. Bereaved friends need more acknowledgement, and help measures after traumatic events often do not meet their need for help and follow-up after the loss. [ABSTRACT FROM AUTHOR]

Following traumatic loss, defined as the death of a loved one due to unexpected or violent circumstances, adults may experience a myriad of grief-related problems. Given the addition of Prolonged Grief Disorders into the Diagnostic and Statistical Manual for Mental Disorders Fifth Edition, Text-Revision and influx of unexpected deaths due to the global Coronavirus pandemic, there is heightened interest in the measurement of grief-related processes. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify measures of grief used in studies of adults who experienced traumatic loss. Searches yielded 164 studies that used 31 unique measures of grief-related constructs. The most commonly used instrument was the Inventory of Complicated Grief-Revised. Half of the measures assessed constructs beyond diagnosable pathological grief responses. Given the wide variation and adaptations of measures reviewed, we recommend greater testing and uniformity of measurement across the field. Future research is needed to adapt and/or design measures to evaluate new criteria for Prolonged Grief Disorder. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground: Close friends are often an overlooked group of bereaved people. This study is based on a sub-project on young adults who experienced the loss of a close friend in the terrorist attack on Utøya, Norway, on 22 July 2011.Objective: The aim of this longitudinal study was to explore the relationship between complicated grief reactions, the need for help, and help received after losing a close friend to a traumatic death.Method: In total, data from 89 people (with a mean age of 21 years, 76.4% female) were collected at one or more of the four time-points: 18, 28, 40, and 102 months after the incident. Latent growth modelling was used to analyse levels of grief reactions and change over time, experienced need for help, and help received.Results: According to the results, the bereaved friends in our study were profoundly impacted by the loss and experienced level of reactions indicating complicated grief (mean scores on the Inventory of Complicated Grief varied from 36.2 to 23.7). A need for help was related to a decrease in grief symptoms, whereas a prolonged need for help was related to no reduction or an increase in grief. Received help was not related to decrease in grief symptoms.Conclusions: These findings underscore the need for continuous professional help, and demonstrate that the present help measures used after traumatic events may not adequately meet the needs of close bereaved friends. This emphasizes the importance of acknowledging friends as bereaved and that follow-up measures should also include this group. Finally, the study highlights the need to learn more about how professional can help bereaved friends.

The current study sheds light on the continuing bonds experience of adult Israeli daughters whose mothers were murdered by their fathers. Through 11 semi structured interviews, common externalized and internalized continuing bonds with the deceased mothers were closely examined. The interpreted results supported the existence of bonds, yet revealed a unique manifestation; the bonds were purposefully and defensively restricted, which seemed to be an adjustive compromise in light of the strong traumatic component of the loss. Our results contribute to the theoretical and clinical understanding of the restrictive effect that trauma components have on loss components in cases of traumatic bereavement. [ABSTRACT FROM AUTHOR]

The current qualitative study aimed to examine the narrative identities of women bereaved to intimate partner femicide. Eleven adult Israeli female offspring whose biological mothers were murdered by their biological fathers were interviewed for the purpose of this study. Due to the uniqueness of their loss experience and circumstances, participants' identity is narrated as a "trisonance": They are not like their fathers, their mothers, nor as society perceives them. This very particular route for identity reconstruction as a means of psychological survival is discussed in light of the literature on identity construction and bereavement and derives recommendations for practice. [ABSTRACT FROM AUTHOR]

Existing evidence suggests that adverse effects are numerous after a traumatic event. This research aims to validate that by revealing the lived experiences of trauma survivors over the span of two years. A descriptive phenomenological approach was used to accomplish this goal. For data collection, face-to-face and virtual semi-structured interviews were used. The researchers interviewed thirteen parents who had tragically lost a child due to homicide, murder, suicide, or a traffic accident. Four themes appear to emerge, with 17 subthemes. The five subthemes of hurting are behavioral dysfunction, affective destruction, biological pain, cognitive disruption, and interpersonal conflict. Meanwhile, coping has five subthemes: emotion-focused, social interaction-focused, digital-focused, behavior-focused, and cognitive-focused. The growing theme is composed of five subthemes: interpersonal enhancement, life appreciation, spiritual growth, parenting actualization, and insight imparting. The remembering theme is divided into two themes, the presence, and absence of the deceased child. Though limited, this study can nonetheless serve as the country's first to focus on grief by traumatic loss. It will serve as additional knowledge in the fields of psychotraumatology, thanatology, positive psychology, and suicidology in the Philippines. Clinicians and other mental health care providers would benefit from the information based on their own experiences as grieving parents. Additionally, research ideas are provided. Indeed, this paper proves that a survivor can not just experience the negative impacts but also grow personally from one of the most traumatic events in human experience.

Traumatic death is a risk factor for prolonged grief. Network analysis offers a perspective for understanding traumatic bereavement at a symptom interaction level. This study estimates regularized partial correlation grief networks for bereavement due to earthquake (n = 818) and illness (n = 237), using symptoms from the Inventory of Complicated Grief (ICG) as the nodes. Difficulty in accepting death and loneliness were highly central nodes in both networks. Trust difficulties and longing for the deceased exhibited high centrality in the earthquake-bereaved sample but not in the illness-bereaved sample. The earthquake bereavement network was characterized by high connectivity and a diversity of central symptoms. These results provide insights into understanding the severity of grief after a traumatic loss. Although promoting the integration of the reality of loss and alleviating loneliness is important, it might also be worth considering the role of post-loss interpersonal trust and the distress associated with longing for the deceased for traumatic bereavement., (© 2024 John Wiley & Sons Ltd.)

Significant research demonstrates that positive transformation from a traumatic loss is possible. Furthermore, a declining trend of growth is conceivable over time. The authors devised an intervention program comprised of several modalities. Twenty grieving parents who lost a child from traumatic loss in different municipalities in Bataan underwent two treatments (one-time psychoeducation and a posttraumatic growth intervention program). A mixed method was employed to obtain a more detailed and accurate result. The quantitative phase demonstrated that the BUMABANGON Posttraumatic Growth Intervention Program (BPTGIP) helped grieving parents (z = -2.40, p = 0.17) moderately (effect size of 0.54). Five themes developed throughout the qualitative phase: skill acquisition, spiritual growth, interpersonal enhancement, social support, and change perspective. This pilot study provides evidence that further studies to explore the effectiveness of BPTGIP in a larger and broader scale.

Background: Many refugees have experienced the death of a loved one under traumatic circumstances. Accordingly, the prevalence of Prolonged Grief Disorder (PGD) among refugees is high. Culture-specific symptoms of PGD have been described previously, but beliefs about causes and cures of PGD among refugees remain unknown. We therefore aimed at identifying illness beliefs and treatment expectations regarding PGD among refugees. Method: We focused on refugees from Arab countries (n = 14) and from Sub-Sahara Africa (n = 9) and applied qualitative and quantitative methods. In a semi-structured interview, participants first answered questions about assumed causes and potential cures for prototypical PGD symptoms according to ICD-11 that were presented in a vignette as representatives of their own culture. In the quantitative part, they completed the Cause Subscale of the Illness Perception Questionnaire (IPQ-R) that included additional culture-specific items. Interviews were analyzed with Qualitative Content Analysis. Results: In both groups of refugees, PGD symptoms were predominantly attributed to a close relationship to the deceased, lack of social support, personal vulnerabilities, and circumstances of the death. Participants also named a number of flight-related causes (e.g., inability to perform or participate in rituals, feeling isolated in the host country). None of the participants attributed PGD symptoms to supernatural causes. Descriptive analyses of responses on the IPQ-R indicated that participants predominantly attributed PGD symptoms to psychological causes. Participants believed that PGD can be cured and predominantly mentioned social and religious support. Psychological help was only mentioned by a minority of participants. In both groups, participants emphasized that a therapist must be familiar with the patient's culture and rituals. Participants also mentioned stigma associated with seeking psychological help. Conclusion: Results suggest specific beliefs of refugees regarding causes and cures of PGD as well as similarities with Western conceptualizations. A culture-sensitive approach to the treatment of PGD in refugees that can include knowledge of culture-specific rituals and incorporating religious beliefs as well as decreasing stigma and increasing mental health literacy seem important. The study is limited by its focus on only two groups of refugees and its small sample size. [ABSTRACT FROM AUTHOR]

The trauma of having a family member missing is commonly described as an ambiguous loss where the finality of the loss is not realized, as is experienced with a death. There is uncertainty due to the trauma of the absence and subsequent police investigation, leading to physical and emotional impacts for the aftercare of those left behind. There are 850 unidentified human remains and 2,600 long-term missing persons cases in Australia. The Australian Federal Police (AFP) National DNA Program for Unidentified and Missing Persons aims to scientifically link these cases using modern DNA techniques and databases. A DNA-led identification effort may assist to provide answers to Australian families searching for missing relatives, but may also contribute to the trauma experienced by these families. A literature review demonstrated empirical research for the development of scientific best practices for the collection of reference DNA samples for forensic purposes, but minimal evidence about the impact of reference DNA sample collection on kin when attempting to identify the deceased remains of missing people in non-mass casualty situations. The aim of this study was to develop an academically robust understanding of the unique impact of reference DNA sample collection on families of missing persons and support pathways tailored to the experience. This study involved 26 Australian families of long-term missing (ranging from 1 to 20+ years) people in Australia anonymously completing a mixed-methods online survey about their experiences of providing reference DNA samples to aid missing persons investigations. Respondents were representative of a range of ages, genders and relationships to the missing individual. The thematic analysis of the survey results identified the provision of a reference DNA sample: (1) resembles an overt act of hope as families perceive their sample assists the investigation, whilst also being traumatic, triggered by the prospect of scientifically matching their missing family member to a set of unknown human remains; (2) can cause immediate interpersonal impacts and ongoing impacts to families' wellbeing; and (3) can be improved by considering the environment where the sample is collected, professionalism of the police officer collecting the sample, timeliness of the provision of the sample, level of support provided during and after sample collection, and effective communication of forensic procedures and processes as they relate to the missing persons investigation. The study concludes that the complexity associated with provision of family reference samples requires the development and implementation of best practice guidelines, including psycho-education strategies to be used by practitioners to minimize the vicarious trauma for relatives already traumatized by the loss of their missing family member. These guidelines would support the objectives of the AFP Program and benefit all routine missing persons investigations. [ABSTRACT FROM AUTHOR]

BackgroundMany refugees have experienced the death of a loved one under traumatic circumstances. Accordingly, the prevalence of Prolonged Grief Disorder (PGD) among refugees is high. Culture-specific symptoms of PGD have been described previously, but beliefs about causes and cures of PGD among refugees remain unknown. We therefore aimed at identifying illness beliefs and treatment expectations regarding PGD among refugees.MethodWe focused on refugees from Arab countries (n = 14) and from Sub-Sahara Africa (n = 9) and applied qualitative and quantitative methods. In a semi-structured interview, participants first answered questions about assumed causes and potential cures for prototypical PGD symptoms according to ICD-11 that were presented in a vignette as representatives of their own culture. In the quantitative part, they completed the Cause Subscale of the Illness Perception Questionnaire (IPQ-R) that included additional culture-specific items. Interviews were analyzed with Qualitative Content Analysis.ResultsIn both groups of refugees, PGD symptoms were predominantly attributed to a close relationship to the deceased, lack of social support, personal vulnerabilities, and circumstances of the death. Participants also named a number of flight-related causes (e.g., inability to perform or participate in rituals, feeling isolated in the host country). None of the participants attributed PGD symptoms to supernatural causes. Descriptive analyses of responses on the IPQ-R indicated that participants predominantly attributed PGD symptoms to psychological causes. Participants believed that PGD can be cured and predominantly mentioned social and religious support. Psychological help was only mentioned by a minority of participants. In both groups, participants emphasized that a therapist must be familiar with the patient's culture and rituals. Participants also mentioned stigma associated with seeking psychological help.ConclusionResults suggest specific beliefs of refugees regarding causes and cures of PGD as well as similarities with Western conceptualizations. A culture-sensitive approach to the treatment of PGD in refugees that can include knowledge of culture-specific rituals and incorporating religious beliefs as well as decreasing stigma and increasing mental health literacy seem important. The study is limited by its focus on only two groups of refugees and its small sample size.

The trauma of having a family member missing is commonly described as an ambiguous loss where the finality of the loss is not realized, as is experienced with a death. There is uncertainty due to the trauma of the absence and subsequent police investigation, leading to physical and emotional impacts for the aftercare of those left behind. There are 850 unidentified human remains and 2,600 long-term missing persons cases in Australia. The Australian Federal Police (AFP) National DNA Program for Unidentified and Missing Persons aims to scientifically link these cases using modern DNA techniques and databases. A DNA-led identification effort may assist to provide answers to Australian families searching for missing relatives, but may also contribute to the trauma experienced by these families. A literature review demonstrated empirical research for the development of scientific best practices for the collection of reference DNA samples for forensic purposes, but minimal evidence about the impact of reference DNA sample collection on kin when attempting to identify the deceased remains of missing people in non-mass casualty situations. The aim of this study was to develop an academically robust understanding of the unique impact of reference DNA sample collection on families of missing persons and support pathways tailored to the experience. This study involved 26 Australian families of long-term missing (ranging from 1 to 20+ years) people in Australia anonymously completing a mixed-methods online survey about their experiences of providing reference DNA samples to aid missing persons investigations. Respondents were representative of a range of ages, genders and relationships to the missing individual. The thematic analysis of the survey results identified the provision of a reference DNA sample: (1) resembles an overt act of hope as families perceive their sample assists the investigation, whilst also being traumatic, triggered by the prospect of scientifically matching their missing family member to a set of unknown human remains; (2) can cause immediate interpersonal impacts and ongoing impacts to families' wellbeing; and (3) can be improved by considering the environment where the sample is collected, professionalism of the police officer collecting the sample, timeliness of the provision of the sample, level of support provided during and after sample collection, and effective communication of forensic procedures and processes as they relate to the missing persons investigation. The study concludes that the complexity associated with provision of family reference samples requires the development and implementation of best practice guidelines, including psycho-education strategies to be used by practitioners to minimize the vicarious trauma for relatives already traumatized by the loss of their missing family member. These guidelines would support the objectives of the AFP Program and benefit all routine missing persons investigations.

This article shares my personal experiences using writing therapy after the death of my son. I found that writing some of my most traumatic experiences as fiction helped me acknowledge and process my grief but still maintain a protective distance from it. Fictionalizing my story also allowed me to look at my experiences in a new way. My goals in sharing this article are to (a) promote fiction writing as both trauma therapy and research method, (b) propose expanded and more humane bereavement leave, and (c) suggest social change in the way people respond to grief and the grieving. [ABSTRACT FROM AUTHOR]

Due to the COVID-19 pandemic, several social modifications have been made in the United States to reduce the infection rate that resulted in changes to the workforce, education system, and general community interactions. This evolving new normal has caused distress in many individuals. The purpose of this article was to conceptualize these changes from a loss perspective and determine if any traumatic symptomology might emerge from the loss, thus producing traumatic loss due to the changing normal. Clinical recommendations are given to mental health professionals when working with individuals who report distress due to the changing normal. [ABSTRACT FROM AUTHOR]

The research was conducted with the aim of understanding the far-reaching psychological consequences of the war that took place in the territory of former Yugoslavia (1991-1995). The study examines the relationships between wartime traumatic experience of loss, the quality of life and mental health, and the role of social support across three categories of respondents: the first consisting of the respondents who had lost a close family member in the war and whose remains have not been found to date; the second category consisting of the persons who had lost a close family member in the war, and the third category including the respondents who participated in the war socialization but did not experience the loss of a close family member in the war. The survey used the Psychosomatic symptoms lists, the Depression Symptoms Questionnaire, the Subjective Happiness Scale, the Life Satisfaction Scale, and the Social Support Significance Assessment Scale. The results show that the respondents who continue to search for the body of a missing family member have a lower quality of life than the other two categories of respondents, as well as a more pronounced presence of depressive and psychosomatic symptoms. The role of social support in the trauma recovery process remains unclear. The results of the study are discussed in relation to completed and prolonged traumatic loss, and point to further research into the complex emotional dynamics as a consequence of war socialization and the importance of professional psychological support.

In Italy, in the very first phase of the COVID-19 pandemic there was a dramatic rise in mortality. However, families were forbidden because of lockdown regulations to be with their loved ones at their deathbeds or to hold funerals. This qualitative study examined bereavement experiences among family members, how they processed their grief, and how they used social networks in particular by uploading photographs during the working-through of bereavement. The sample was composed of 40 individuals aged 23–63 (80% women) from different Italian cities severely impacted by the virus, including a subgroup from the province of Bergamo, which was the city with the highest mortality rate during that time. All interviews were conducted by phone, Skype, or Zoom. Then, the transcriptions underwent a thematic analysis using Atlas.ti. The main themes that emerged were: abandonment anger and guilt, dehumanized disappeared, derealization and constant rumination, and social support and the importance of sharing photos on Facebook. Importantly, the use of social networks proved to be a valuable source of support and photographs were a powerful tool in facilitating the process of mourning by encouraging narration and sharing. Grief had a complex profile: on the one hand, it was traumatic and characterized by all the risk factors causing mourners to experience prolonged grief, but on the other, some features were similar to ambiguous loss (that occurs without closure and clear understanding) because of the impossibility to be with their relatives in their final moments. The possible relationships between ambiguous loss, the use of internet, and the risk of prolonged grief are discussed.

In Italy, in the very first phase of the COVID-19 pandemic there was a dramatic rise in mortality. However, families were forbidden because of lockdown regulations to be with their loved ones at their deathbeds or to hold funerals. This qualitative study examined bereavement experiences among family members, how they processed their grief, and how they used social networks in particular by uploading photographs during the working-through of bereavement. The sample was composed of 40 individuals aged 23–63 (80% women) from different Italian cities severely impacted by the virus, including a subgroup from the province of Bergamo, which was the city with the highest mortality rate during that time. All interviews were conducted by phone, Skype, or Zoom. Then, the transcriptions underwent a thematic analysis using Atlas.ti. The main themes that emerged were: abandonment anger and guilt, dehumanized disappeared, derealization and constant rumination, and social support and the importance of sharing photos on Facebook. Importantly, the use of social networks proved to be a valuable source of support and photographs were a powerful tool in facilitating the process of mourning by encouraging narration and sharing. Grief had a complex profile: on the one hand, it was traumatic and characterized by all the risk factors causing mourners to experience prolonged grief, but on the other, some features were similar to ambiguous loss (that occurs without closure and clear understanding) because of the impossibility to be with their relatives in their final moments. The possible relationships between ambiguous loss, the use of internet, and the risk of prolonged grief are discussed. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic is causing major social changes to which significant psychological effects are linked. During the first phase of the pandemic wave in Italy, whilst there was insufficient information about the phenomenon and the strategies to safeguard the population against it, many categories of people, whose professions required constant contact with the public, were affected by the contagion.Aims: The literature has shown how religiousness can support the management of stress due to diseases and health risks. In relation to this, the current study wanted to investigate how priests managed the early stages of the pandemic. This work, therefore, aimed to investigate the psychological experiences related to the contagion and the eventual death of colleagues as well as the resilience strategies activated by the priests during the process.Participants: The research involved 12 Catholic priests, all male and aged between 42 and 63 years. They came from the same pastoral community in one of the regions in Northern Italy that were most affected during the first phase of the pandemic. Those ministers had been constantly in contact with the faithful of their parishes since the breakout of the virus.Methodology: A qualitative research design was adopted, and in-depth interviews were conducted. The dialogues aimed at investigating the deep, personal and relational experiences of the priests, together with their concerns and the tools they adopted to manage anxiety. The texts obtained from the interviews were subjected to thematic analysis.Results: The areas studied concerned the experiences of the participants during the lockdown, the implications of social distancing and lack of funeral rituality and, finally, the importance of prayer as a resilience factor.Conclusions: In the current scenario dominated by the pandemic, it is significant and stimulating to understand and reflect on the functions and roles of the experiences of faith, particularly the act of elaborating the process of mourning due to COVID-19.

This study was designed as an action research aimed to help students to elaborate their feelings of traumatic grief, due to a car accident and a suicide of two of their classmates, in an Italian high school. A death education project was realized in order to prevent the Werther effect. The intervention was based on psychodramatic techniques and meditation with Tibetan bells to encourage reflection on the suffering of traumatic loss, the sense of life, and their future. A total of 89 students from four classes (46 in the experimental group: two classes, 43 in the control groups: two classes) participated in the study, among which 82 (45 in the experimental group, 37 in the control group) completed the pre- and post-test survey. The intervention consisted of eight 2-h meetings, during which the themes of death and loss were dealt with through theoretical discussions, dramatization, and meditation. Two other classes which participated in the assessment as a control group did not attend the activities. The following instruments were used: Death Attitude Profile-Revised, which measures individual attitudes toward death; Psychological Well-being Scale, which measures a person’s psychological well-being; Resilience Scale for Adolescents, which measures the construct of resilience in adolescents; Self-Transcendence Scale, which measures self-transcendence; and Testoni Death Representation Scale, which measures the ontological representations of death. The results demonstrated that in the experimental group, there was a reduction in the fear of death and its avoidance, and that the students normalized the representation of death as something natural, thus improving their well-being. It is consequently possible to say that well-being is not simply the absence of suffering and worries, but rather, is rooted in the possibility of thinking of creative solutions to the trauma.

Background: Prolonged grief disorder (PGD) is newly included in the text revision of the DSM-5 (DSM-5-TR). So far, it is unknown if DSM-5-TR PGD is distinguishable from bereavement-related posttraumatic stress disorder (PTSD). Prior research examining the distinctiveness of PTSD and pathological grief focused on non-traumatic loss samples, used outdated conceptualizations of grief disorders, and has provided mixed results. Objective: In a large sample of traumatically bereaved people, we first evaluated the factor structure of PTSD and PGD separately and then evaluated the factor structure when combining PTSD and PGD symptoms to examine the distinctiveness between the two syndromes. Methods: Self-reported data were used from 468 people bereaved due to the MH17 plane disaster (N = 200) or a traffic accident (N = 268). The 10 DSM-5-TR PGD symptoms were assessed with the Traumatic Grief Inventory-Self Report Plus (TGI-SR+). The 20-item Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) was used to tap PTSD symptoms. Confirmatory factor analyses were conducted. Results: For PTSD, a seven factor, so-called ‘Hybrid’ model yielded the best fit. For PGD, a univariate factor model fits the data well. A combined model with PGD items loading on one factor and PTSD items on seven factors (associations between PGD and PTSD subscales r ≥ .50 and ≤.71), plus a higher-order factor (i.e. PTSD factors on a higher-order PTSD factor) (association between higher-order PTSD factor and PGD factor r = .82) exhibited a better fit than a model with all PGD and PTSD symptom loading on a single factor or two factors (i.e. one for PGD and one for PTSD). Conclusions: This is the first study examining the factor structure of DSM-5-TR PGD and DSM-5 PTSD in people confronted with a traumatic loss. The findings provide support that PGD constitutes a syndrome distinguishable from, yet related with, PTSD.

While the American public is increasingly waking up to the pervasiveness of police violence, the family-level impacts of police killings are severely understudied. This study partnered with families bereaved by police to explore how interactions with law enforcement before and after the killing impacted their psychological wellbeing. Eleven in-depth, semi-structured interviews were conducted with relatives of men of color killed by police. Interviews were analyzed using Interpretative Phenomenological Analysis and organized into two domains with five themes. The first domain (The Victim's Treatment by Police) describes the lost loved one's history with law enforcement, his killing, and the immediate aftermath of the death. The second domain (The Bereaved Family's Experience of Law Enforcement) explores the family's treatment by police subsequent to the death, how participants understood the role of racism, and how they interpreted their children's view of law enforcement. Participants reported that the pain of their violent loss was compounded by traumatic experiences with law enforcement before and after the killing. The majority saw this treatment as racialized and noted a profound impact on their children's sense of safety around police. Clinical implications include the imperative to integrate psychological services with legal services, material support, and community building. [ABSTRACT FROM AUTHOR]

This study was designed as an action research aimed to help students to elaborate their feelings of traumatic grief, due to a car accident and a suicide of two of their classmates, in an Italian high school. A death education project was realized in order to prevent the Werther effect. The intervention was based on psychodramatic techniques and meditation with Tibetan bells to encourage reflection on the suffering of traumatic loss, the sense of life, and their future. A total of 89 students from four classes (46 in the experimental group: two classes, 43 in the control groups: two classes) participated in the study, among which 82 (45 in the experimental group, 37 in the control group) completed the pre- and post-test survey. The intervention consisted of eight 2-h meetings, during which the themes of death and loss were dealt with through theoretical discussions, dramatization, and meditation. Two other classes which participated in the assessment as a control group did not attend the activities. The following instruments were used: Death Attitude Profile-Revised, which measures individual attitudes toward death; Psychological Well-being Scale, which measures a person's psychological well-being; Resilience Scale for Adolescents, which measures the construct of resilience in adolescents; Self-Transcendence Scale, which measures self-transcendence; and Testoni Death Representation Scale, which measures the ontological representations of death. The results demonstrated that in the experimental group, there was a reduction in the fear of death and its avoidance, and that the students normalized the representation of death as something natural, thus improving their well-being. It is consequently possible to say that well-being is not simply the absence of suffering and worries, but rather, is rooted in the possibility of thinking of creative solutions to the trauma. [ABSTRACT FROM AUTHOR]

Prolonged grief disorder (PGD) is newly included in the text revision of the DSM-5 (DSM-5-TR). So far, it is unknown if DSM-5-TR PGD is distinguishable from bereavement-related posttraumatic stress disorder (PTSD). Prior research examining the distinctiveness of PTSD and pathological grief focused on non-traumatic loss samples, used outdated conceptualizations of grief disorders, and has provided mixed results. In a large sample of traumatically bereaved people, we first evaluated the factor structure of PTSD and PGD separately and then evaluated the factor structure when combining PTSD and PGD symptoms to examine the distinctiveness between the two syndromes. Self-reported data were used from 468 people bereaved due to the MH17 plane disaster (N = 200) or a traffic accident (N = 268). The 10 DSM-5-TR PGD symptoms were assessed with the Traumatic Grief Inventory-Self Report Plus (TGI-SR+). The 20-item Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) was used to tap PTSD symptoms. Confirmatory factor analyses were conducted. For PTSD, a seven factor, so-called 'Hybrid' model yielded the best fit. For PGD, a univariate factor model fits the data well. A combined model with PGD items loading on one factor and PTSD items on seven factors (associations between PGD and PTSD subscales r ≥.50 and ≤.71), plus a higher-order factor (i.e. PTSD factors on a higher-order PTSD factor) (association between higher-order PTSD factor and PGD factor r =.82) exhibited a better fit than a model with all PGD and PTSD symptom loading on a single factor or two factors (i.e. one for PGD and one for PTSD). This is the first study examining the factor structure of DSM-5-TR PGD and DSM-5 PTSD in people confronted with a traumatic loss. The findings provide support that PGD constitutes a syndrome distinguishable from, yet related with, PTSD. This is the first factor analytic study on PGD and PTSD after traumatic loss. PTSD and PGD factors are related, but distinguishable. DSM-5-TR PGD is distinct from DSM-5 PTSD. [ABSTRACT FROM AUTHOR]

Literature suggests that the occurrence of psychological trauma (PT) from various negative life experiences beyond events mentioned in the DSM-criterion A, receives little to no attention when comorbid with psychosis. In fact, despite research indicating the intricate interplay between PT and psychosis, and the need for trauma-focused interventions (TFI), there continue to be mixed views on whether treating PT would worsen psychosis, with many practitioners hesitating to initiate treatment for this reason. This study, therefore, aimed to understand patient perspectives on the role of PT in psychosis and related treatment options. A qualitative exploratory approach was adopted using in-depth interviews with individuals experiencing psychosis. The Global Assessment of Functioning (GAF) scale was administered on a predetermined maximum variation sample resulting in two groups of participants- those with moderate-mild disability (GAF 54–80; n = 10) and those experiencing moderate-severe disability (GAF 41–57; n = 10). With the former group, a semi-structured interview schedule was used, while with the latter, owing to multiple symptoms and difficulty in cognitive processing, a structured interview schedule was used. Results from interpretative phenomenological analysis (IPA) indicated that traumatic loss was central to experienced PT, but received no attention; this often contributed to the psychotic experience and/or depression, through maintenance factors such as cognitive distortions and attenuated affective responses. Further, the experience of loss seems to be more consequential to trauma-related symptoms than the event itself. Participants opined strongly the need for TFI and the role of it in promoting recovery from psychosis.

BackgroundResettled refugees exposed to trauma and loss are at risk to develop mental disorders such as posttraumatic stress disorder (PTSD) and persistent complex bereavement disorder (PCBD). Post-migration stressors have been linked to poor mental health and smaller treatment effects.AimOur aim was to evaluate reductions in PTSD and PCBD symptoms and to explore the presence of post-migration stressors and their associations with symptom change and non-completion in a traumatic grief focused treatment in a cohort of refugees.MethodsPaired sample t-tests were used to test the significance of the symptom reductions in PTSD and PCBD symptoms during treatment. The presence of post-migration stressors was derived from a qualitative analysis of the patient files. Associations between post-migration stressors and symptom reductions as well as non-completion were calculated.ResultsIn this uncontrolled study, 81 files of consecutive patients were included. Significant reductions in both PCBD and PTSD symptomatology with medium effect sizes were found. Patients experienced a mean of three different post-migration stressors during the treatment. Undocumented asylum seekers were more likely to be non-completers. Ongoing conflict in the country of origin was associated with smaller PTSD symptom reductions and the total number of post-migration stressors was associated with smaller PCBD symptom reductions.ConclusionsTreatment for resettled refugees for traumatic grief coincides with alleviations in both PCBD and PTSD symptomatology. Specific post-migration stressors were associated with reduced treatment effects and increased non-completion. This is a first step towards well-informed improvements of mental health interventions for resettled refugees.

Background: Resettled refugees exposed to trauma and loss are at risk to develop mental disorders such as posttraumatic stress disorder (PTSD) and persistent complex bereavement disorder (PCBD). Post-migration stressors have been linked to poor mental health and smaller treatment effects. Aim: Our aim was to evaluate reductions in PTSD and PCBD symptoms and to explore the presence of post-migration stressors and their associations with symptom change and non-completion in a traumatic grief focused treatment in a cohort of refugees. Methods: Paired sample t-tests were used to test the significance of the symptom reductions in PTSD and PCBD symptoms during treatment. The presence of post-migration stressors was derived from a qualitative analysis of the patient files. Associations between post-migration stressors and symptom reductions as well as non-completion were calculated. Results: In this uncontrolled study, 81 files of consecutive patients were included. Significant reductions in both PCBD and PTSD symptomatology with medium effect sizes were found. Patients experienced a mean of three different post-migration stressors during the treatment. Undocumented asylum seekers were more likely to be non-completers. Ongoing conflict in the country of origin was associated with smaller PTSD symptom reductions and the total number of post-migration stressors was associated with smaller PCBD symptom reductions. Conclusions: Treatment for resettled refugees for traumatic grief coincides with alleviations in both PCBD and PTSD symptomatology. Specific post-migration stressors were associated with reduced treatment effects and increased non-completion. This is a first step towards well-informed improvements of mental health interventions for resettled refugees. [ABSTRACT FROM AUTHOR]

Literature suggests that the occurrence of psychological trauma (PT) from various negative life experiences beyond events mentioned in the DSM-criterion A, receives little to no attention when comorbid with psychosis. In fact, despite research indicating the intricate interplay between PT and psychosis, and the need for trauma-focused interventions (TFI), there continue to be mixed views on whether treating PT would worsen psychosis, with many practitioners hesitating to initiate treatment for this reason. This study, therefore, aimed to understand patient perspectives on the role of PT in psychosis and related treatment options. A qualitative exploratory approach was adopted using in-depth interviews with individuals experiencing psychosis. The Global Assessment of Functioning (GAF) scale was administered on a predetermined maximum variation sample resulting in two groups of participants- those with moderate-mild disability (GAF 54–80; n = 10) and those experiencing moderate-severe disability (GAF 41–57; n = 10). With the former group, a semi-structured interview schedule was used, while with the latter, owing to multiple symptoms and difficulty in cognitive processing, a structured interview schedule was used. Results from interpretative phenomenological analysis (IPA) indicated that traumatic loss was central to experienced PT, but received no attention; this often contributed to the psychotic experience and/or depression, through maintenance factors such as cognitive distortions and attenuated affective responses. Further, the experience of loss seems to be more consequential to trauma-related symptoms than the event itself. Participants opined strongly the need for TFI and the role of it in promoting recovery from psychosis. [ABSTRACT FROM AUTHOR]

Suicide loss is an example of traumatic loss, as suicide loss survivors face unique challenges in processing the loss. Consequently, in this conceptual paper, meaning reconstruction will be defined as a theoretical paradigm beneficial for clients navigating suicide loss. The aim of this manuscript is to provide a general overview of meaning reconstruction theory and to offer concrete suggestions on implementation of the meaning reconstruction theory as it relates to suicide loss. Further, the authors will utilize a hypothetical case study to illuminate the integration of meaning reconstruction for suicide loss survivors. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the efficacy of Integral Breath Therapy (IBT) as an appropriate intervention for facilitating meaning-making out of a traumatic loss and reducing symptoms of complicated grief, specifically for those bereaved by suicide. The narrative mixed methods design included pre- and post- measures of the Inventory of Complicated Grief with eight participants selected from a South Texas bereavement facility. The following themes emerged from the pre-interviews: Isolation/Avoidance, Disbelief/Shock, Shattered Sense of Self, Holding On, Guilt/Blame, and Rupture with Spirituality, while themes from the post-interview were Connection, Purpose, Hope, Acceptance, Sense of Self, and Catharsis/Letting Go. [ABSTRACT FROM AUTHOR]

Recent advances in bereavement research, theory, and treatment support a broader understanding of how Poe's traumatic, early losses affected his writing. While psychoanalytic readings have focused on the resonance of Poe's dying mother that haunts his famous narratives about "the death of a beautiful woman," empirical and clinical work associated with constructivist grief theory suggests that both the fascination with mystery and the ostentatious authority Poe carried across the genres he worked in can in part be traced back to a failure to reconstruct meaning that followed his mother's death and subsequent disruptions. [ABSTRACT FROM AUTHOR]

Infant loss occurring prior to, during, or up to one year after birth, is a relatively common event that often affects mothers and fathers deeply. Although infant loss is most commonly characterised as a loss event, it can also be highly traumatic and lead to posttraumatic stress disorder (PTSD) with prevalence rates falling in the moderate-to-severe range compared to other traumatic events. Pre- and post-loss risk factors associated with PTSD following other types of trauma also predict PTSD following infant loss. Early identification of PTSD is extremely important, as the disorder is severely under-diagnosed in the parent population and may have a high number of adverse effects for the bereaved parent as well as his/her family, including children born subsequent to the loss. [ABSTRACT FROM AUTHOR]