Strategies of professional assistance after traumatic deaths: Empowerment or disempowerment?

Dyregrov, K. (2004). Strategies of professional assistance after traumatic deaths: Empowerment or disempowerment? Scandinavian Journal of Psychology, 45, 181–189. Referring to research and theory in the field, this discussion paper addresses the more overarching question of current strategies for professional assistance to populations bereaved by traumatic death. The issues and controversies that have long surrounded the “medicalization” of mental health arise anew with respect to the medicalization and professionalization of psychosocial help for people who have been traumatically bereaved. Who should provide what help and how? To what extent should the bereaved be expected to help themselves, receive help and support from friends and family, or even the wider community; and to what extent should the bereaved be able to access appropriate professional help when they are in crisis? Recent studies have indicated that bereaved parents want to receive help from mainstream crisis psychology, and this is not always available. Families experiencing traumatic bereavement are not able to access appropriate services along the same lines as those suffering similar levels of somatic complaints. It is argued that the main factors contributing to this situation are the lack of knowledge and inadequate organization of services; the fact that somatic issues take priority over psychosocial difficulties and dysfunction, and curative services over prophylactic intervention; and particularly the de‐medicalization ideology. By not listening to the needs of user groups, the de‐medicalization movement disempowers rather than empowers users – the very opposite of the desired effect.     

The Göteborg discothèque fire, 1998

Findings from a study of 563 adolescents’ reactions following a discotheque fire that killed 63 young people in Göteborg in October 1998 are presented. The group answered a questionnaire seven months following the disaster. The questionnaire included the Impact of Event Scale (IES) and the Birleson Depression Self‐Rating Scale (DSRS). The level of trauma was found to be very high, while depression scores were less elevated. A little under a third of the students scored above a clinical cut‐off point (> 35) on the IES, indicating high posttraumatic stress levels. Girls evidenced more depression and traumatic stress reactions than boys. Levels of reactions increased with more closeness (knowing victims personally) and if the adolescents were of non‐Swedish origin.     

Bullying and PTSD Symptoms

PTSD symptoms related to school bullying have rarely been investigated, and never in national samples. We used data from a national survey to investigate this among students from grades 8 and 9 (n?=?963). The prevalence estimates of exposure to bullying were within the range of earlier research findings. Multinomial logistic regression showed that boys were 2.27 times more likely to be exposed to frequent bullying than girls. A latent variable second-order model demonstrated an association between frequency of bullying exposure and PTSD symptoms (beta?=?0.49). This relationship was not moderated by gender. However, the average levels of PTSD symptoms as well as clinical range symptoms were higher for girls. For all bullied students, 27.6% of the boys and 40.5% of the girls had scores within the clinical range. A mimic model showed that youth who identify as being both a bully and a victim of bullying were more troubled than those who were victims only. Our findings support the idea that exposure to bullying is a potential risk factor for PTSD symptoms among students. Future research could investigate whether the same holds for PTSD through diagnostic procedures, but this will depend on whether or not bullying is decided to comply with the DSM-IV classification of trauma required for diagnosis. Results are discussed with regard to their implications for school interventions.     

Reactions following the sudden death of a classmate

Findings from a study of adolescents grief reactions following the sudden death of a friend and a classmate are presented. The group (26 classmates) was followed up after one and nine months. Interviews and a questionnaire including the Imapact of Event Scale and the Hogan Grief Inventory were used. The general grief scores on the Hogan Grief Inventory indicated that the grief level was similar to that of adolescents who had lost siblings. The scores on the Impact of Event Scale showed a descline in distress level from 1 to 9 months. However, after 9 months about 1/5 of the students still scored above a clinical cut-off point indicating post-traumatic stress levels. Recommendations for improving help following such events are presented.     

Validation of distinct amnesic and executive type memory deficit in a psychiatric sample based on retrieval performance

Studies of localized brain dysfunctions have revealed connections between patterns of cognitive dysfunction and specific profiles of memory impairment. The amnesic type of memory impairment is defined by deficits in both free recall and recognition memory, whereas the dysexecutive memory impairment is characterized by retrieval deficits, i.e. a disproportional impairment in free recall relative to recognition memory. The present study tests whether classifications of psychiatric patients into recall impaired only (= RO group) and Recall and Recognition impaired (= RR group) correspond to the executive type and amnesic type of memory impairment. The alternative hypothesis is that the two groups merely differ in degree of neuropsychological and psychiatric disturbance. Forty-four subjects impaired on California Verbal Learning Test (CVLT) were selected from a larger database of 103 impaired and non-impaired subjects with schizophrenia or recurrent major depression. Subjects were classified into RO and RR groups and compared on measures of memory strategy (recency effect and interference on CVLT), overall neuropsychological function (Stroop Test and WAIS-R similarity) and psychiatric symptom load (positive and negative symptoms). Repeated measures ANOVA showed no effects of group, i.e. the RR group did not perform consistently below the RO group with regard to memory strategy, neuropsychological function or psychiatric symptom load. Two out of three analyses showed group x test interaction, supporting the dissociation of distinct executive and amnesic profiles among psychiatric patients. The RO group was more susceptible to interference but had better recency score than the RR group. The RO had higher negative symptoms while the RR group had higher positive symptoms.     

Siblings after suicide--"the forgotten bereaved"

There is scarce research on "the forgotten bereaved"--the children and adolescents who lose a sibling by suicide. In this paper we explore their psychosocial situation and needs for assistance through a Norwegian nationwide study. The results show that particularly younger bereaved siblings are suffering from posttraumatic and grief reactions, depression, and anxiety. Most of the difficulties are not individual, but rather relational and social in nature, and largely contextually dependent. Necessary help is impeded due to the extraordinary experience leaving the siblings outside the circle of friends and parental grief community. A systematic outreach help program is presented.     

Factor structure of the Children's Revised Impact of Event Scale among children and adolescents who survived the 2008 Sichuan earthquake in China

To evaluate the psychometric properties of the Chinese version of Children's Revised Impact of Event Scale (CRIES) and its applicability among Chinese children and adolescents, a study was conducted on two samples, the first, 1 month after the 2008 Sichuan earthquake, the second, 7 months after the earthquake. High levels of posttraumatic stress symptoms were found among both groups of children. The results also showed a decline of intrusion and arousal symptoms in accordance with the different periods of time elapsed since the earthquake; however, no difference was found in the avoidance symptoms between the two samples. Both the subscales and the CRIES total showed moderate to good reliability. Confirmatory factor analysis (CFA) of CRIES supported the presumed three inter-correlated factors model. However, the results of the second sample (with more than 6 months elapsed subsequent to the earthquake) are more likely to support this model than those of the first sample. This study generally justifies the use of CRIES as a screening instrument for probable PTSD victims among children and adolescents exposed to horrible natural disasters in China. Limitations of the present study and directions for future research are also discussed.     

Cognitive Complexity and Dissociative Identity Disorder

Thirteen patients with dissociative identity disorder (DID), 13 with other mental disorders, and 10 nondiagnosed comparison participants were given individual grids. Results showed that displaying alternate personalities did not portend a more multidimensional level of thinking. Instead, the nonclinical comparison group had the greater degree of complexity in comparison to both clinical groups. A notable clinical observation was that DID patients, as compared to non-DID participants, had a greater understanding and speed in completing the grid. Findings are discussed in terms of the advantages of personal construct theory for conceptualizing the construct of dissociation.     

Brain activation on pre-reading tasks reveals at-risk status for dyslexia in 6-year-old children

In this fMRI-study, 6-year-old children considered at risk for dyslexia were compared with an age-/gender-matched control group for differences in brain activation when presented with visual stimuli differing in demands for literacy processing. Stimuli were nameable pictures, brand logos familiar to children, and written words - these were either regularly spelled using early-acquired rules ("alphabetic") or more complex ("orthographic"). Brain responses distinguished between the presentation conditions, as a function of group, within many cortical areas. Activation in the alphabetic and orthographic conditions in the left angular gyrus correlated with individual at-risk index scores, and activation in inferior occipito-temporal regions further indicated differential activation for the two groups related to orthographic processing, especially. Since similar patterns are reported in adult dyslexics when processing written words, it appears that sensitivity to the cortical differentiation of reading networks is established prior to formal literacy training.