Kari Dyregrov

PREDICTORS OF PSYCHOSOCIAL DISTRESS AFTER SUICIDE, SIDS AND ACCIDENTS

This article compares the outcome and predictors of psychosocial distress of parents bereaved by young suicides, sudden infant death syndrome (SIDS), and child accidents. One objective is to explore whether suicide bereavement is more difficult for those left behind than other forms of bereavement. Data have been collected from 140 families, consisting of 232 parents, by the use of the Impact of Event Scale, the General Health Questionnaire, and the Inventory of Traumatic Grief. Qualitative aspects of bereavement are assessed by in-depth interviews with family members from 40 families. The results show that the similarities between the samples on outcome and predictors are more striking than the differences, which is explained by the common traumatic aspect of unexpected and violent deaths. One and a half years post-loss, 57-78% of the survivors scored above the cut-off levels for traumatic grief reactions. Although no significant differences are found between survivors of suicide and accidents, both groups evidence significantly greater subjective distress than the survivors of SIDS. Self-isolation is by far the best predictor of psychosocial distress in all three samples. Rather than focusing on the exceptional position of suicide survivors, it seems important to call attention to sudden and traumaticdeathingeneral as a factor to be associated with post-traumatic reactions and complicated mourning.

Refugee Families' Experience of Research Participation

Because refugees can experience crisis, bereavement, and traumatization, there has been a rapid increase of research carried out with refugees. This study investigated how refugee families respond to participation in research. A previous study explored how adults and children had communicated about the difficult question of repatriation after arriving in a new country. Did the in-depth interviews harm or benefit them? Are there any ethical risks in research on traumatized refugees? From an original sample of 74 Bosnian refugees (5–73 years), 30 family members from 9 families including 14 children aged 6 to 19, were re-interviewed. The refugees rated participation as positive. A few parents lacked information that could have enabled them to inform the children better before the interviews. The study shows that studies on traumatized/bereaved populations can have beneficial effects.

Psychological Autopsy Studies as Diagnostic Tools: Are They Methodologically Flawed?

One of the most established “truths” in suicidology is that almost all (90% or more) of those who kill themselves suffer from one or more mental disorders, and a causal link between the two is implied. Psychological autopsy (PA) studies constitute one main evidence base for this conclusion. However, there has been little reflection on the reliability and validity of this method. For example, psychiatric diagnoses are assigned to people who have died by suicide by interviewing a few of the relatives and/or friends, often many years after the suicide. In this article, we scrutinize PA studies with particular focus on the diagnostic process and demonstrate that they cannot constitute a valid evidence base for a strong relationship between mental disorders and suicide. We show that most questions asked to assign a diagnosis are impossible to answer reliably by proxies, and thus, one cannot validly make conclusions. Thus, as a diagnostic tool psychological autopsies should now be abandoned. Instead, we recommend qualitative approaches focusing on the understanding of suicide beyond mental disorders, where narratives from a relatively high number of informants around each suicide are systematically analyzed in terms of the informants’ relationships with the deceased.

Meaning-making through psychological autopsy interviews: the value of participating in qualitative research for those bereaved by suicide.

Too often ethical boards delay or stop research projects with vulnerable populations, influenced by presumed rather than empirically documented vulnerability. The article investigates how participation is experienced by those bereaved by suicide. Experiences are divided into 3 groups: (a) overall positive (62%), (b) unproblematic (10%), and (c) positive and painful (28%). The positive experiences are linked to processes of meaning-making, gaining new insight, and a hope to help others. Objective factors concerning the gender of participants, their relationship to the deceased, the method of suicide, and time since loss were largely unrelated to their experience of the interview.

Traumatic Bereavement and Terror: The Psychosocial Impact on Parents and Siblings 1.5 Years After the July 2011 Terror Killings in Norway

On July 22, 2011, 69 people attending a political youth camp in Norway were killed in a terror attack. Findings concerning the psychosocial impact on bereaved parents (n = 67) and siblings (n = 36) showed a high prevalence of complicated grief (82% vs. 75%), posttraumatic stress reactions (63% vs. 72%), and general psychological distress (88% vs. 75%) 1.5 years after the killings. There were significant gender differences, and the loss had a substantial negative impact on parents’ and siblings’ work and school situations. Potential contributing factors are discussed in light of the magnitude of the event and the chronic stress following the terror attack.

Teachers’ perceptions of their role facing children in grief

A questionnaire was sent to teachers in the western part of Norway to survey the attitudes and thoughts teachers have about grief in young people and how they look upon their supportive role. A total of 138 school personnel answered the questionnaire, a 44.5% response rate. In addition six focus group interviews were conducted to get in-depth knowledge from the same population of teachers and headmasters. Participants in both groups had extensive experience from working in schools (most > 10 years). Both the quantitative and qualitative results showed that Norwegian teachers were well aware of childrens needs and were understanding of their situation. They did not perceive grief to be something that children easily forget and they were aware of how important it is to show empathy for their grieving students. Most agreed that grieving students were overlooked in school. There were few differences between teachers with and without practical experience with grief among students.

Exploring vulnerability to suicide in the developmental history of young men: a psychological autopsy study

This study explores the developmental history of ten young men who completed suicide in the transition to adulthood. The young men, aged 18–30, had no previous history of suicide attempts or treatment in mental health. In-depth interviews with four to eight informants for each suicide were analyzed using Interpretative Phenomenological Analysis. Three developmental issues from early age onwards emerged: (a) unsuccessful in becoming independent; (b) weakened competence to deal with shame; and (c) trapped in anger. The capacity to regulate emotions like shame and anger could make certain men vulnerable to suicide when facing adult challenges and defeats.

Complicated Grief in Children—The Perspectives of Experienced Professionals

A total of 39 very experienced clinicians and researchers worldwide responded to a survey consisting of both structured and open-ended questions on complicated grief in children. The questions assessed their opinion on: a) what constitutes complicated grief in children; b) whether to develop a diagnosis for children as suggested for adults and, if so, would adult criteria be sufficient for children; and c) other aspects of normal and complicated grief in children. The analyses showed that the professionals struggled with defining complicated grief in children, although they agreed that the major defining aspects were intensity, duration, and longevity of reactions. They identified traumatic and delayed or inhibited grief as major types, and also agreed that adult criteria were inappropriate for children.

Participants with prolonged grief--how do they benefit from grief group participation?

Data analyzed in this article is part of a study conducted to explore grief support groups in Norway. Participants that fulfilled the criteria of Prolonged Grief Disorder (PGD) were compared with participants that did not in order to explore whether they differed on satisfaction and experiences with participation. To allow for comparison, a subsample of 22 participants that fulfilled the criteria of PGD were drawn from the total of 262 participants. Demographic and loss-related variables were analyzed to explore factors associated with PGD. Fulfillment of PGD was then analyzed to explore the groups effect on life quality and overall satisfaction. The main finding is that participants who fulfill the criteria of prolonged grief are in general less satisfied with the groups and report less positive effect on life quality. We also found age- and gender-differences regarding fulfillment of PGD, with older bereaved women especially at risk of developing symptoms of PGD.

Grief and Traumatic Grief in Children in the Context of Mass Trauma.

Children who have had someone close die as a result of a mass trauma event such as war, armed conflict, acts of terror, political violence, torture, mass accidents, and natural disasters are at risk for biopsychosocial problems. Research on how to classify when grief becomes complicated or traumatic in children is scarce, and while functioning level may provide a good indication, assessing functioning may be difficult in mass trauma environments where routines and structure are often lacking. There are promising trauma- and grief-focused interventions for children post-mass trauma, which are mostly provided in school settings. However, more advanced multi-method interventions are needed that address grief and trauma in the context of the child’s overall mental health, parent/caregiver role in assisting the child, family system issues, ways to provide safe caring environments amidst chaos and change, and interventions that take into account local consumer perspectives, including the voices of children.