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The acute psychological impact on survivors following a train accident
Abstract
Sixty-six passengers surviving a collision of two trains were investigated concerning relevant background data, degree of personal injury, experience of a threat to life, symptoms and problems immediately after the accident, and thoughts about difficulty in coping. The most obvious impact on the survivors was the experience of being close to death. One result of this was that they developed a new coping strategy to minimize emotional pain. Some survivors also suffered problems of "re-living" the accident. This is important for the coping process. The process includes psychological integration of the accident as an important life event. The findings indicate that "re-living" of the accident through nightmares and intrusive thoughts is responsible for problems in carrying out ordinary tasks. The observations are in accordance with those made after other types of accidents and disasters.
... When reactions to trauma by younger, middle-aged and older adults were compared, middle-aged adults were found at higher risk of post-traumatic adjustment difficulties than younger people (Gleser et al., 1981). Another study showed higher distress in older and younger adults than in middle-aged adults in reaction to traumatic events (Hagstrom, 1995). ...
... Goenjian et al. (1994) found that following an earthquake in Armenia older adults reported more arousal symptoms, but fewer intrusive thoughts, than younger individuals. Hagstrom (1995) reported that older adults reported more avoidance, sleep disturbance and intrusive thoughts about the trauma than younger adults (aged 45-65). ...
... The results show a decrease in level of ASS across the three groups. This is in contrast to studies comparing the three age groups that found either a non-linear curve, with higher distress in older and younger adults than in middle-aged (Hagstrom, 1995), or no difference (Chung et al., 2004). Also, in each of the symptoms separately lower mean scores were obtained in the older adults group. ...
Objective:
To examine the relationship between Alzheimer's disease (AD) illness representations and burnout among social workers and nurses, based on the self-regulatory model.
Method:
A mixed-methods study was conducted. First, 327 social workers and nurses completed measures of cognitive and emotional representations, burnout (emotional exhaustion, depersonalization, lack of personal accomplishment), role variables, knowledge about AD, emotion-focused coping, problem-focused coping, and demographic and occupational characteristics. Second, interviews were conducted with eight social workers and nurses to uncover their perceptions about AD and their burnout experience.
Results:
Using structural equation modeling and controlling background variables, findings indicated that emotional representations were associated with burnout while only some of the cognitive illness representations were associated with burnout. While cognitive illness representations were associated directly to burnout, the association between emotional representations and burnout was mediated by emotion-focused coping. The trimmed model showed a good fit of the data and explained 32.2% of the variance in emotion-focused coping, 51% of the variance in emotional exhaustion, 37.7% of the variance in depersonalization, and 22.6% of the variance in lack of personal accomplishment. Interviews demonstrated that AD characteristics were perceived as affecting participants on both personal and professional levels; the participants expressed negative feelings towards AD and stated that these perceptions and feelings had led them to burnout.
Conclusions:
AD illness representations may be a risk factor for developing burnout. New directions for intervention programs, aiming to reduce burnout, should be examined.
... In some cases, younger adults are found to exhibit more severe psychopathology than middle aged or older adults (e.g., Acierno et al. 2006;Cardena et al. 2005;Cohen 2008). In other cases, middle aged adults have been found to be the most resilient group compared to younger or older adults (Hagstrom 1995). ...
... Author's personal copy 2. We hypothesized that the middle aged group would be the most resilient (Hagstrom 1995), with fewer symptoms of stress and stronger coping resources. Further, we considered that the lower socio-economic group would reveal more severe stress reactions and weaker resilient resources ( Finkelstein et al. 2007). ...
... It appears that younger adults are more anxious. This result is supported by previous findings from similar contexts (Cohen 2008;Hagstrom 1995). Additionally, also regarding coping resources, we found SOC to be strongest among the middle aged group compared to young adults. ...
Based on the salutogenic theory, the aim of this study was to examine sense of coherence and communal resiliency as related to stress reactions during missile attacks. Data were gathered in August 2011 while missiles were being shot from Gaza to the Negev communities in Israel from approximately 150 participants, aged 15-85. Participants lived in cities and different types of small rural villages. Self reported questionnaires were administered via the internet and included demographic data, coping resource of sense of coherence and community resiliency as coping resources, as well as state anxiety, state anger and psychological distress as stress reaction outcomes. Overall, the participants in our study reported strong personal and communal resources and relatively low levels of stress reactions. Personal and communal resources were linked negatively to the different stress reactions. However, some differences emerged when we compared participants from different types of communities. The most resilient group was composed of people who lived in the rural and communal communities. Differences also emerged on patterns of relationships between the community resource and state anxiety. While among the rural citizens, community resilience was strongly linked to anxiety, no relationships were revealed in the urban citizens group.
... bereavement, sexual abuse, natural disasters) (Wilson & Raphael, 1996). Research studies on survivors of traffic accidents conducted from this perspective have been mostly based on participants who were referred for psychological evaluation or treatment because of accident-related distress, and have focused on assessing the prevalence of psychopathological symptoms and on their evolution across time (Brom et al., 1993;Delahanty et al., 1997;Feinstein, 1996;Hagstrom, 1995;Janoff-Bulman & Wortman, 1977). Immediately following an accident, several victims show re-experiencing symptoms (e.g. ...
... intrusive recollections, distress at reminders), avoidance of stimuli associated with the traumatic event (e.g. thoughts and feelings associated with the trauma) and hyperarousal (Hagstrom, 1995;Koopman, Classen, Cardena, & Spiegel, 1995), leading to the criteria for diagnosis of acute stress disorder, post-traumatic stress disorder (PTSD), or generalized anxiety and panic disorder (DSM-IV;American Psychiatric Association, 1994). Such symptoms have been reported in 66 percent of victims (Blanchard et al., 1995), although some researchers mention percentages ranging from 14 to 100 percent, depending on the differences in intervals between the MVA and research evaluation, and referral bias (cf. ...
... For example, in a study on 830 victims of traffic accidents, Thorson (1973;cited in Brom et al., 1983) found that about 7 percent of the participants still reported psychological disturbances (fear, depression, shame about the scars) and social effects (disruption of work and lifestyle) four to five years after their hospitalization. The likelihood of a psychopathological evolution depends on the way that individuals cognitively assimilate the traumatic event (Feinstein, 1996) and is influenced by people's cognitive ability, their personality, the nature of the traumatic event, the level of exposure to the trauma, the severity of the injuries suffered and the victims' social background (Blanchard & Hickling, 1997;Feinstein, 1996;Hagstrom, 1995). ...
Research on the consequences of motor vehicle accidents centres mainly on the assessment and treatment of post-traumatic psychological-behavioural reactions of the people involved. Few studies have explored the experience of surviving a serious accident and its impact on different dimensions of individuals' lives. This qualitative study aims at investigating adaptation strategies and quality of life of 20 severely injured accident survivors who spent several months in an intensive care unit of a hospital, and who still suffer permanent injuries of varying extent. Participants completed individual in-depth interviews which were subsequently analysed according to the grounded theory method. The findings indicate that the adaptation process follows a sequence of temporal phases ('past-present', 'present', 'future' and 'being'), characterized by different emotional and behavioural reactions, perceived needs, and by the adoption of specific coping strategies. The duration of the adaptation process is influenced by the severity of the injury suffered, participants' age at the time of the trauma, the occurrence of coma and the availability of social support in participants' life environment.
... A study carried out by North, et al on the firefighters involved in the rescue and recovery in the Oklahoma City bombing incident (Oklahoma USA;1995) found the prevalence of PTSD to be significantly lower in the firefighters (13%) than the primary victims (23%). The PTSD in firefighters was associated with low job satisfaction. ...
... 23 Similar studies were also carried out on other responders like decontamination workers, mortuary workers, and professional rescuers with varying results. [24][25][26][27][28][29] Health Care Professionals and Psychological Health Disasters also have a significant impact on the physical and mental well-being of health care professionals. Health care professionals, particularly the emergency prehospital responders and emergency department (ED) personnel, are continuously faced with highly demanding and critical situations. ...
Introduction
Medical responders are at-risk of experiencing a wide range of negative psychological health conditions following a disaster.
Aim
Published literature was reviewed on the adverse psychological health outcomes in medical responders to various disasters and mass casualties in order to: (1) assess the psychological impact of disasters on medical responders; and (2) identify the possible risk factors associated with psychological impacts on medical responders.
Methods
A literature search of PubMed, Discovery Service, Science Direct, Google Scholar, and Cochrane databases for studies on the prevalence/risk factors of posttraumatic stress disorder (PTSD) and other mental disorders in medical responders of disasters and mass casualties was carried out using pre-determined keywords. Two reviewers screened the 3,545 abstracts and 28 full-length articles which were included for final review.
Results
Depression and PTSD were the most studied outcomes in medical responders. Nurses reported higher levels of adverse outcomes than physicians. Lack of social support and communication, maladaptive coping, and lack of training were important risk factors for developing negative psychological outcomes across all types of disasters.
Conclusions
Disasters have significant adverse effects on the mental well-being of medical responders. The prevalence rates and presumptive risk factors varied among three different types of disasters. There are certain high-risk, vulnerable groups among medical responders, as well as certain risk factors for adverse psychological outcomes. Adapting preventive measures and mitigation strategies aimed at high-risk groups would be beneficial in decreasing negative outcomes.
... In several cases it was found that young adults show more severe psychopathology than middleage adults (Acierno, Ruggiero, & Kilpatrick, 2006;Cardeña, Dennis, & Winkel, 2005;Cohen, 2008). Overall, middle-age adults seem to be the most resilient group of adults also when comparing them to older adults (Hagström, 1995). The personal resource of SOC seems to decline with age (Nilsson, Holmgren, Stegmayr, & Westman, 2003). ...
... (2) Are there differences in psychological distress and in personal and community coping resources according to the socio-demographic indicators of gender, age, SES and type of community? We hypothesized that the middle-aged group would be the most resilient (Hagström, 1995), with fewer symptoms of stress and stronger coping resources. Further, we expected and predicted that the lower socio-economic group would reveal more severe stress reactions and weaker resilience resources (Finkelstein, Kubzansky, Capitman, & Goodman, 2007). ...
Based on the salutogenic model, this study aimed to examine the role of personal and communal resiliency in reducing individuals’ psychological distress when facing intensive missile attacks. We examined the relationships between these resources and psychological distress in communities which were exposed to different intensities of attacks. Data was gathered via anonymous self-report questionnaires from 843 adults during the period from one week to one month after intensive attacks in southern Israel. Questionnaires included demographic data as well as sense of coherence (SOC), community resiliency and psychological distress. Differences in levels of resiliency and distress were found among the groups with different ‘exposure levels’. Moreover, only personal resilience SOC explained psychological distress in the entire population, while community resiliency had no effect. Results are discussed on the basis of the salutogenic model with implications for developments of interventions with populations who are exposed to differing intensities of missile attacks.
... Research in fields such as medicine, engineering, and psychology has examined a variety of health and safety aspects of transit travel in the developed transit systems of western Europe, Australia, and North America, (4)(5)(6)(7)(8)(9) yet the effects of fatal public transit accidents on risk preferences and other attitudes regarding transit system characteristics have received little study. This likely reflects in part the relative safety of most transit systems compared to travel by personal vehicle. ...
... Our recruitment method entailed interception of transit passengers outside the entrances to a subset of Metrorail stations and commuter park-and-ride lots for two county bus systems (Fairfax Connector and Montgomery Ride-On), and distribution of postcards inviting these passengers to complete our online survey at their leisure. 4 In each of the three waves of the survey, enumerators distributed postcards during two daily time periods-6:30 a.m. to 8:30 a.m. and 4:30 p.m. to 6:30 p.m.-at each of six Metrorail stations and four parkand-ride lots (depicted as triangles in Fig. 1). Each wave therefore comprised 20 separate postcard distributions. ...
In 2009, two trains of Washington, DC's Metrorail system collided, resulting in nine deaths and 50 serious injuries. Based on a multiwave survey of Metrorail users in the months after the crash, this article reports how the accident appears to have (1) changed over time the tradeoffs among safety, speed, frequency of service, cost, and reliability that the transit users stated they were willing to make in the postaccident period and (2) altered transit users’ concerns about safety as a function of time and distance from the accident site. We employ conditional logit models to examine tradeoffs among stated preferences for system performance measures after the accident, as well as the influence that respondent characteristics of transit use, location, income, age, and gender have on these preference tradeoffs. As expected, respondents appear averse to longer headways between trains, longer travel durations, higher travel costs, a higher number of late trains, and a higher number of fatalities. The models also show evidence of higher aversion to fatalities from transit system operation among females compared to males. In addition, respondents less experienced with Metrorail travel and those with lower household incomes show higher aversion to fatalities, and this aversion increases as a subject's psychological distance from the accident site decreases. Contrary to expectations shaped by previous studies, aversion to fatalities appears to have increased between the early months after the accident and the end of the survey period, and the expected relationship between age and aversion to fatalities is not statistically significant.
... According to Arozenius (1977), as many as 75% of the survivors of a train disaster had some kind of mental or psychosomatic disorder, and the majority of the survivors thought regularly about the traumatic event even after a year had passed. Furthermore, we deduce from other studies of injury events involving trains that posttraumatic stress symptoms were present (Hagströ m, 1995; Lundin, 1991; Raphael, 1977; Selly, King, Peveier, Osola & Thomson, 1997). ...
... Nightmares and intrusive thoughts became problematic for the survivors. After the event, difficulties traveling by train and fear noises similar to those of train travel were also common (Hagströ m, 1995). Globally, the rapid development of train traffic, including rising speeds and increasing traffic, in the world results in a growing trend of train crashes that is named disasters if ]10 are killed and/or ]100 are nonfatally injured. ...
Rarely described are people's lived experiences from severe injury events such as train crashes. The number of train crashes named disasters with ≥10 killed and/or ≥100 nonfatally injured grows globally and the trend shows that more people survive these disasters today than did so in the past. This results in an increased number of survivors needing care. The aim of the study was to explore survivors’ experiences from a train crash. Narrative interviews were performed with 14 passengers 4 years after a train crash event. Qualitative content analysis was used to analyse the interviews. Experiences were captured in three main themes: (1) Living in the mode of existential threat describes how the survivors first lost control, then were thrown into a state of unimaginable chaos as they faced death. (2) Dealing with the unthinkable described how survivors restored control, the central role of others, and the importance of reconstructing the event to move forward in their processing. (3) Having cheated death shows how some became shackled by their history, whereas others overcame the haunting of unforgettable memories. Furthermore, the result shows how all experienced a second chance in life. Experiencing a train crash meant that the passengers experienced severe vulnerability and a threat to life and interdependence turned out to play a crucial role. Focusing on helping other passengers on site was one way to regain the loss of control and kept the chaos at bay. Family, friends, and fellow passengers turned out to be extremely important during the recovery process why such closeness should be promoted and facilitated.
... More recently, a growing body of research has begun to examine coping specifically as it applies to traumatic stress (e.g., Green, Lindy, & Grace, 1988;Fairbank, Hansen, & Fitterling, 1991;Hagstrom, 1995;Hyer, McCranie, Boudewyns, & Sperr, 1996;Somer, Keinan, & Carmil, 1996;Wolfe, Keane, Kaloupek, Mora, & Wine, 1993). For example, increased pathology has been found in those combat veterans who cope with their traumatic memories primarily via emotion-focused and avoidance strategies (e.g., Green et al.; Hyer et al.), whereas problem-focused and nonavoidant coping has been associated with better emotional functioning (e.g., Wolfe et al.). ...
... For example, Fairbank et al. (1991) found that repatriated prisoners of war with PTSD appraised their traumatic memories as less controllable than those without PTSD did. Hagstrom (1995) found that among train collision victims, those who appraised their lives as being threatened (versus those who did not) experienced more nightmares and intrusive thoughts and felt more emotionally unbalanced. These studies affirm the importance of cognitive processing, which has previously been posited as particularly relevant to coping with trauma (e.g., Greenberg, 1995;Janoff-Bulman, 1992;McIntosh, Silver, &Wortman, 1993). ...
Previous analog research (Bjorck & Cohen, 1993), in which Caucasian college students' projected coping responses to major stressors differed as a function of stressor type (threat, loss, or challenge), was replicated with an ethnoculturally diverse sample. Because Bjorck and Cohen's findings might have been confounded by participants' prior life experiences and/or differing perceptions of event controllability, these two dimensions were also assessed. Even after statistically controlling for these two potential confounds, however, projected coping again differed as a function of stressor type. Effects of both controllability and prior experience were also found. Results are discussed in terms of their application to coping processes in general and to coping with trauma in particular.
... Another factor that could influence our results is the age of the participants. In most previous studies, younger adults were found to be less resilient than middle-aged or older adults 28,[33][34][35][36][37] . Our study focused on older adults, aged 40 or more. ...
Background
Modern wars have a catastrophic effect on the wellbeing of civilians. However, the nature of this effect remains unclear, with most insights gleaned from subjective, retrospective studies.
Methods
We prospectively monitored 954 Israelis (>40 years) from two weeks before the May 2021 Israel-Gaza war until four weeks after the ceasefire using smartwatches and a dedicated mobile application with daily questionnaires on wellbeing. This war severely affected civilians on both sides, where over 4300 rockets and missiles were launched towards Israeli cities, and 1500 aerial, land, and sea strikes were launched towards 16,500 targets in the Gaza Strip.
Results
We identify considerable changes in all the examined wellbeing indicators during missile attacks and throughout the war, including spikes in heart rate levels, excessive screen-on time, and a reduction in sleep duration and quality. These changes, however, fade shortly after the war, with all affected measures returning to baseline in nearly all the participants. Greater changes are observed in individuals living closer to the battlefield, women, and younger individuals.
Conclusions
The demonstrated ability to monitor objective and subjective wellbeing indicators during crises in real-time is pivotal for the early detection of and prompt assistance to populations in need.
... Terrorism, World Trade Centre and Pentagon attacks [17] Turning to open discussion, religion, and community activities to cope with the reactions. Increased use of substances Train accident [18] Coping process included psychological integration of the accident as an important life event. This new coping strategy was observed to minimize emotional pain in the survivors Oil spill [19] Behavioral disengagement as a coping strategy was associated with income loss and was linked to psychiatric morbidity Technological disasters [20] Confrontive coping -more frequent after aircraft crash than a train collision. ...
CONTEXT: The catastrophic stress of disasters and the associated secondary traumas lead to negative mental health outcomes in a great proportion of survivors. A range of coping strategies are used, which may have possible preventive and therapeutic effects related to posttraumatic stress-related manifestation. AIMS: It is essential to learn about the coping strategies employed by the survivors following disasters to reflect about their usability as possible intervention methods. This review intended to explore the literature about coping mechanisms used by adult survivors of the disasters. METHODS: Comprehensive literature search and review. RESULTS: It was observed that various coping strategies have been reported, along with posttraumatic mental health conditions. Many of the coping strategies differ in different cultures and other demographic groups. Some articles have made reference to the effectiveness of the coping strategies. It has been observed that the ways coping can be facilitated at different levels. These observations may help in designing culture-specific, pre-and post-disaster management programs for effective and holistic recovery of the survivors. CONCLUSION: There is a need to understand the coping mechanisms in different cultures and the factors associated with the resilience in the face of the massive trauma of disasters. It is probable that these could be instrumental in recovery process and expected to help in supporting disaster survivors.
... A railroad accident in the early 19th century injured a large number of people, opening the public's eyes and evoking society's interest in traumatic disasters (1). This event led to a number of findings about disease, anniversary reactions after the accident, and a tendency for symptoms to be prolonged due to a lack of social support (2) ; the presence of intrusive memories, nightmares, and avoidance symptoms, more pronounced in cases of life-threatening situations (3) ; and physical and mental disease that may persist nearly 20 years later (4). ...
Objective : The purpose of this study was to examine the relationship between peritraumatic reactions, posttraumatic stress disorder (PTSD) symptoms, and pain in people injured in train disasters. Methods : The participants were injured in a train crash in Japan that left more than 100 dead. There were 218 participants in the analysis, with a mean age of 37.50 ± 14.67 years. Peritraumatic reactions were assessed using the Peritraumatic Distress Inventory. PTSD symptoms were evaluated using the Impact of Event Scale-Revised Japanese-language version. Pain was measured using the Visual Analog Scale. Results : Peritraumatic reactions did not directly affect PTSD symptoms but were found to be associated via latent variables. Regarding pain and PTSD symptoms, intrusive memories were more associated with pain than other symptoms were. There was an associative path from intrusion to pain, but no such path from pain to intrusion. Conclusions : Our results suggest that a therapeutic approach to intrusion may be effective in ameliorating the pain caused by injury. Future research should examine integrated treatment approaches for both PTSD and pain, rather than just for aspects of PTSD. J. Med. Invest. 68 : 85-89, February, 2021
... There is some research to imply that PTSD may be experienced or expressed differently in older as opposed to younger adults [12]. For example, some older adults who experience trauma in late life appear to demonstrate higher levels of avoidance, more sleep disturbances, crying spells, and hyperarousal symptoms than middle-aged or younger adults [13,14]. When comparing older and younger male veterans, Frueh and colleagues [15] found that older veterans (age 60 and over) had lower overall PTSD, particularly on arousal and avoidance/numbing symptom clusters. ...
Purpose of Review
The aim of this paper is to present a succinct summary of the major scientific findings on trauma, posttraumatic stress disorder (PTSD), and aging over the past few years.
Recent Findings
There have been several reports from longitudinal investigations using representative samples of veterans regarding traumatic exposure and subsequent effects on health and functioning. There has also been further documentation of the significant association between PTSD and dementia as well as accelerated aging in late life. Several studies indicate that older adults with PTSD are at risk of not receiving timely and appropriate mental health treatment, indicating that targeted outreach could be helpful in increasing service use and improving care.
Summary
The current knowledge base would benefit from more research on traumatized older adults from non-industrialized countries, as well as those in North America from diverse backgrounds, including ethnic and racial minorities, women, and those with cognitive impairments. Studies limited to adults aged 65 and over as well as those addressing disparities in the availability of mental health-related services within this population are warranted.
... Jia and colleagues (2010) found adults age 60 or older to be more likely to exhibit PTSD symptoms following the 2008 Sichuan earthquake. Similarly, Hagström (1995) found that older adults had more crying spells, avoidant behaviors, and sleep disturbances than younger adults after experiencing a train crash. ...
... During the first year after a disaster, the prevalence of PTSD ranges between 30 percent and 40 percent among individuals who were directly exposed to the disaster; between 10 percent and 20 percent among first responders; and between 5 percent and 10 percent among the general population (Neria et al., 2008). However, certain factors can place people at a higher risk of developing psychopathology if exposed to a disaster, including (1) extent of exposure (measured by severity of physical injuries, possibility of death, magnitude of property destruction, and rate of casualties) (Neria et al., 2008); (2) female gender (Green et al., 1991;Hagstrom, 1995;Pulcino et al., 2003); (3) younger age (Kar, 2009); (4) history of previous traumatic experiences and life stressors (Galea et al., 2003;Maes, Mylle, Delmeire, & Janca, 2001); (5) history of previous psychiatric conditions (Smith, North, & Spitznagel, 1993;Udwin, Boyle, Yule, Bolton, & O'Ryan., 2000); (6) low social support (Dalgleish, Joseph, Thrasher, Tranah, & Yule, 1996;Weiss, Marmar, Metzler, & Ronfeldt, 1995); (7) low socioeconomic status (Bonanno & Gupta, 2009;Norris et al., 2002); (8) ethnic minority status (Galea et al., 2005;Norris et al., 2002); and (9) exposure to the disaster through media outlets Pfefferbaum et al., 2000;Schlenger et al., 2002). Longitudinal studies have shown changestypically declinesin PTSD rates over time (Carr et al., 1997;Sloan, 1988). ...
... There is some research to imply that PTSD may be experienced or expressed differently in older as opposed to younger adults [12]. For example, some older adults who experience trauma in late life appear to demonstrate higher levels of avoidance, more sleep disturbances, crying spells, and hyperarousal symptoms than middle-aged or younger adults [13,14]. When comparing older and younger male veterans, Frueh and colleagues [15] found that older veterans (age 60 and over) had lower overall PTSD, particularly on arousal and avoidance/numbing symptom clusters. ...
This review presents recent empirical developments on posttraumatic stress disorder (PTSD) in older adults, highlighting some of the most interesting lines of investigation that have taken place over the past few years. The majority of the extant literature has focused on male veterans or former prisoners of war, Caucasians, and those from the United States. Major advances have taken place in terms longitudinal investigations of representative samples of veterans and their health and functioning in relation to traumatic exposure. The current review explores the prevalence and impact, course and associated consequences, as well as available treatment for older adult survivors of traumatic experiences in an effort to increase education and awareness to improve overall health and functioning among this population.
... Traffic injuries in China has been highlighted in several studies in recent years Hu et al., 2008;Wu et al., 2008;Zhao, 2009, Alcorn, 2011Yuan et al., 2012). Both China and Sweden have a great deal of experience and knowledge about treatment for victims of major disasters and accidents (Kulling, 1994;Hagström, 1995;Kulling and Riddez, 2001;Broberg et al., 2005;Lundin and Jansson, 2007;Berg Johannesson et al., 2009;Arnberg et al., 2012). In China several studies have provided insights on major disasters such as earthquakes and their consequences for the inhabitants (Cuiling, 2010;Fan et al., 2011;Ma et al., 2011;Ya-Hong et al., 2012). ...
This article describes the role that media coverage plays in creating awareness of the psychosocial support available to people in Sweden who are affected by crises, accidents, and trauma. The connection between media coverage, psychosocial support and traffic accidents has not been made clear in the literature or previous research. Trauma and fatal injuries in road accidents in Sweden has decreased in recent decades. Developments in China and the European countries shows that many people are killed on the roads and the resulting trauma would be significant for relatives and families who are affected. Therefore, it is important that those affected can get the support needed and requested. The importance of insurance and insurance companies in China has been desribed by Dellien (Dellien, 2011). In Sweden the municipal authorities operate POSOM-groups that provide psychological and social care in the event of major community crisis. However, knowledge and awareness of social support for trauma victims is also very important for insurance companies in Sweden. The economic and social costs of long-term consequences is very important to prevent in society. A Swedish study show that a system called “pay-as-you-speed” (PAYS) could save lives and create at safer road transport system (Stigson et al, 2014). This article describes how team leaders in the POSOM-groups experience accessibility, communication and interactions with the media. The article focuses on how to increase awareness of emergency crisis support for one of today's major public health problems - traffic accidents in the community.
... Traffic injuries in China has been highlighted in several studies in recent years ( Hu et al., 2008; Wu et al., 2008; Zhao, 2009, Alcorn, 2011 Yuan et al., 2012). Both China and Sweden have a great deal of experience and knowledge about treatment for victims of major disasters and accidents (Kulling, 1994; Hagström, 1995; Kulling and Riddez, 2001; Broberg et al., 2005; Lundin and Jansson, 2007; Berg Johannesson et al., 2009; Arnberg et al., 2012). In China several studies have provided insights on major disasters such as earthquakes and their consequences for the inhabitants (Cuiling, 2010; Fan et al., 2011; Ma et al., 2011; Ya-Hong et al., 2012). ...
This article describes the role that media coverage plays in creating awareness of the psychosocial support available to people in Sweden who are affected by crises, accidents, and trauma. The connection between media coverage, psychosocial support and traffic accidents has not been made clear in the literature or previous research. Trauma and fatal injuries in road accidents in Sweden has decreased in recent decades. Developments in China and the European countries shows that many people are killed on the roads and the resulting trauma would be significant for relatives and families who are affected. Therefore, it is important that those affected can get the support needed and requested. The importance of insurance and insurance companies in China has been desribed by Dellien (Dellien, 2011). In Sweden the municipal authorities operate POSOM-groups that provide psychological and social care in the event of major community crisis. However, knowledge and awareness of social support for trauma victims is also very important for insurance companies in Sweden. The economic and social costs of long-term consequences is very important to prevent in society. A Swedish study show that a system called “pay-as-you-speed” (PAYS) could save lives and create at safer road transport system (Stigson et al, 2014). This article describes how team leaders in the POSOM-groups experience accessibility, communication and interactions with the media. The article focuses on how to increase awareness of emergency crisis support for one of today's major public health problems - traffic accidents in the community.
... Bew?ltigungsstrategien der Betroffenen. Ein allgemein hohes Copingniveau und emotionsfokussier- tes Coping ( Buckelew et al. 1990;Malt 1992;Spurrell und McFarlane 1993), vermeidendes Verhalten, Gr?beln und Wunschdenken ( Buckelew et al. 1990;Hagstr?m 1995;Moore et al. 1994), sowie die subjektive Einsch?tzung, dass das Ereignis h?tte verhindert werden k?nnen (Bulman und Wortman 1977;Rogner et al. 1987), wurden dabei als maladaptive Strategien identifiziert. Widerspr?chlich ...
Im Subgruppenvergleich unterscheiden sich Unfallpatienten mit und ohne posttraumatische Belastungsstörungen hinsichtlich soziodemographischer Merkmale, prätraumatischer Life Events, auffälliger Persönlichkeitszüge oder des Verletzungsschweregrads kaum voneinander (Feinstein und Dolan 1991). Einzig Shalev und Mitarbeiter fanden eine signifikant geringere Schulbildung bei Unfallopfern mit posttraumatischen Belastungsstörungen (Shalev et al. 1996). Auf der anderen Seite zeigen diese Patienten wesentlich höhere Werte hinsichtlich der subjektiv erlebten Todesbedrohung (Green et al. 1993) und mehr dissoziative, depressive und Angst-Symptome (Shalev et al. 1996). Auch sind sie offensichtlich in der Erfüllung ihrer sozialen Rollen stärker beeinträchtigt als Unfallopfer ohne PTSD (Blanchard et al. 1995c).
... There is a growing body of research examining PTSD symptom expression, with the majority of studies indicating lower symptom counts among older adults (5,(19)(20)(21)(22)(23) . To date, however, population-based data are lacking regarding the expression of PTSD symptoms across the adult lifespan. ...
Objective:
There is a dearth of community-based epidemiologic literature that examines post-traumatic stress disorder (PTSD) across the adult lifespan. In the current study the authors address this gap by examining the ways in which PTSD differs among young (ages 20-34), middle-aged (ages 35-64), and older (age 65+) adults with respect to past-year prevalence, nature of "worst" stressful experience ever experienced before the onset of PTSD, all traumatic experiences, symptom expression, psychiatric comorbidities, and mental health-related quality of life.
Methods:
We analyzed Wave 2 data from the National Epidemiologic Survey on Alcohol and Related Conditions, including adults with past-year diagnoses of PTSD (N = 1,715).
Results:
The prevalence of past-year PTSD was significantly higher for young (4.3% [SE: 0.3]) and middle-aged (5.2% [SE: 0.2]) adults compared with older adults (2.6% [SE: 0.2]). Respondents in the three age groups differed with regard to their "worst" stressful experience ever experienced before the onset of PTSD and to all traumatic experiences. Older adults experienced significantly fewer traumatic experiences (mean: 5.2; SE: 0.2) compared with young (mean: 5.7; SE: 0.2) and middle-aged adults (mean: 6.4; SE: 0.1). Young and middle-aged adults had significantly greater symptom counts and greater odds of comorbid psychiatric disorders when compared with older adults. PTSD had similar effects on mental health-related quality of life across the adult lifespan.
Conclusion:
Results highlight key differences in the characteristics of PTSD across the adult lifespan. The overall pattern of findings indicates that increasing age is associated with less severe PTSD profiles, including lower prevalence, fewer traumatic experiences, lower symptom counts, and lower odds of psychiatric comorbidity.
... Des chercheurs ont aussi démontré que l'ampleur des dommages est liée à la détresse psychologique (Pickens et al, 1995 ;Rubonis et Bickman, 1991). L'évaluation subjective qui est faite du désastre par les victimes doit également être prise en considération lors de l'étude des impacts d'un sinistre sur la santé psychologique (Hagstrôm, 1995 ;Houston, 1987 ;Joseph et al, 1993). Toutefois, des questions demeurent quant aux variables se rapportant à l'impact des désastres naturels sur la santé des individus (Benight et al, 1999). ...
Social support, coping and psychological health after a flood
Two years after serious flooding, a study was conducted involving 177 disaster victims. This article presents the results of analyses aiming to identify the principal factors associated with post-disaster psychological problems by examining mediating or moderating influences of social support and adjustment strategies in the stressor-health link. The results show, within the variables studied, that there are very few significant differences between men and women; however, women did receive more help for evacuation, cleaning, and rebuilding. The results also demonstrate that exposure to the stressor is the greatest contributor in explaining manifestations of post-traumatic stress, while variables like social support and adjustment strategies are more likely to explain the existence of depression symptoms and psychological stress. The analyses also allow conclusions to be drawn about mediating and moderating effects of adjustment strategies in the stressor-health link. In other respects, the observed effects involving social support variables are direct.
... Research on survivors' experiences of major incidents and disasters mainly focus on the pathological reactions of survivors, e.g., psychopathological consequences of disasters (Fullerton and Ursano, 2005) and distress and sick leave after, for example, surviving a tsunami (Wahlström et al., 2009). Research concerning posttraumatic stress disorder (PTSD) is particularly in focus after disasters (Johannesson et al., 2009;Neria et al., 2008), and following major incidents such as bus (Arnberg et al., 2011) or train crashes (Hagström, 1995). Other studies on bus crash experiences primarily study psychopathological consequences, for example, symptoms of intrusion, avoidance, and distress among children involved in a bus crash (Winje and Ulvik, 1998). ...
AimTo explore the survivors' experiences after a major bus crash. Background
Survivors' experiences of emergency care after transportation related major incidents are relatively unexplored, with research involving survivors mainly focused on pathological aspects or effects of crisis support. Methods
Semi-structured telephone interviews were conducted with 54 out of 56 surviving passengers 5 years after a bus crash in Sweden. Interviews were analyzed using qualitative content analysis. ResultsPrehospital discomfort, lack of compassionate care, dissatisfaction with crisis support and satisfactory initial care and support are the categories. Lack of compassion in emergency departments was identified as a main finding. Lack of compassion caused distress among survivors and various needs for support were not met. Survivors' desire to be with their fellow survivors the day of the crash was not facilitated after arriving at emergency departments. Conclusions
Connectedness among survivors ought to be promoted upon arrival at emergency departments. There is a need for emergency department professionals to be sufficiently educated in compassionate care.
... The effects of trauma in older people may also be different to those experienced by younger people. Preoccupation with the trauma, avoidance, sleep disturbance, intrusive thoughts, and crying may be more frequent, compared to younger and middle aged adults (Hagstrom, 1995). ...
As psychiatrists, we assess, diagnose, and manage psychiatric problems in older adults. We also have an important role as their advocates and in promoting positive attitudes toward this group. Only in the 1950s was there increasing recognition that older age did not necessarily equate to senility, that treatment of psychiatric disorders in this group was possible, and could have good outcomes (Roth, 1955). There is, however, still an undercurrent of pervasive negative attitudes toward the elderly, and their psychiatric needs continue to be marginalized, with less attention from the media, funding bodies, and even from our medical and surgical colleagues (Penson et al. , 2004).
... Department of Transportation, 2001. Whereas physical injury and loss of life may be results of these mishaps, other -less apparent -behavioral and psychological consequences also are likely (Baum, Fleming, & Davidson, 1983;Bowler, Mergler, Huel, & Cone, 1994;Chung, Farmer, Werett, Easthope, & Chung, 2001;Hagstroem, 1995). Research on technological mishaps and disasters has shown that technological accidents can greatly impact upon psychological, behavioral, and physiological functioning (Gleser, Green, & Winget, 1981;Rubonis & Bickman, 1991). ...
The derailment of a train carrying hazardous material resulted in the evacuation of an entire Midwestern community. Risk perceptions and stress were assessed in evacuees and controls (N=90) during the acute phase of the disaster while threat of explosion was looming. Consistent
with the social amplification of risk theory (Kasperson et al., 1988), risk perceptions for routine transportation technologies did not become amplified in evacuees during the technological disaster; however, some elevation of risk perceptions related to less familiar chemical and nuclear
technologies was evident in evacuees as compared to controls. Investigation of the relationship between risk perceptions and stress response showed that high risk perceptions for transportation technologies were associated with elevated emotional and psychological stress, and poorer concentration
in evacuees compared to controls. Results suggest that monitoring risk perceptions related to the cause of a technological accident is useful in predicting variance in evacuee response during a disaster.
... However, some researchers argue against this age- related differential vulnerability hypothesis or addi- tive burden hypothesis. Following a train disaster, one study showed that although elderly people were more symptomatic than middle-aged people (45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64), younger people (18-24) showed similar symp- toms to elderly people, suggesting a non-linear relationship between age and trauma-related sympto- matology (Hagstrom, 1995). Other researchers have suggested that age could in fact be a protective factor against the development of post-traumatic stress dis- order following a traumatic event, particularly when elderly people have dealt successfully with previous trauma (Gibbs, 1989), were able to re-experience a trauma with a high degree of voluntary control, find meaning in some outcome of the trauma, and find social support (Lyons, 1991). ...
Debate persists about whether people of different ages react similarly to traumatic events, and whether elderly people are more vulnerable to such events, or better able to cope with them. The first aim of this paper was to shed light on this debate by comparing the post-traumatic responses of young, middle-aged and elderly community residents who had been exposed to technological disasters. The second aim was to differentiate between these three age groups in terms of coping strategies.
One hundred and forty-eight community residents, who were exposed to two technological disasters, participated in the study. They were assessed using the Impact of Event Scale (IES), the General Health Questionnaire (GHQ-28) and the Ways of Coping Checklists (WOC).
The results showed that in terms of IES, GHQ and WOC scores, no significant differences were found across the three age groups. However, main effects were found according to type of disaster and intensity of exposure to disaster. One significant interaction effect was that residents exposed to the aircraft crash used significantly more confrontive coping than those exposed to the train collision, in all three age groups. Correlation coefficients results showed that for all three age groups, on the whole, the more they experienced intrusive thoughts and avoidance behaviour, the more they experienced general health problems.
Following exposure to technological disasters, young, middle-aged and elderly community residents could display similar post-traumatic responses and employ similar coping strategies, which contradicts the vulnerability hypothesis and the inoculation hypothesis.
... Several researchers have noted that lesser trauma severity was associated with greater posttraumatic stress reactions. Hagstrom (1995) found that among 66 individuals who experienced a train crash, those with light injuries had significantly more intrusive thoughts than those with moderate injuries. Hagstrom suggested that a more serious injury acted as a "catharsis," such that individuals may think that the worst has already happened and therefore may have fewer intrusive thoughts concerning the accident, compared with those who experienced minor injuries. ...
Objective: To examine the associations and predictors of posttraumatic stress among individuals with spinal cord injuries (SCI) in the framework of a Person x Disability x Traumatic Event model. Design: An exploratory study involving analyses of variance, correlations, and a hierarchical multiple regression of a cross-sectional sample. Participants: Three hundred twelve individuals with SCI using a veteran or a civilian SCI clinic. Main Outcome Measures: Purdue Posttraumatic Stress Disorder--Revised scale (PPTSD-R). Results: Four out of all the examined variables had significant regression coefficients: spiritual-religious coping, pain level, severity of SCI, and number of traumatic events. Severity of SCI was a significant predictor, but data suggested that severity of SCI had a curvilinear association with both total posttraumatic stress levels and hyperarousal scores. Conclusion: Treatment of an individual's pain may reduce posttraumatic stress symptoms. Clinicians also can evaluate for previous trauma unrelated to the onset of the SCI and can intervene with the goal of reducing the impact of previous trauma on the individual's present emotional state and reactions to SCI. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... For example, compared to younger male veterans with PTSD, older male veterans with PTSD have been found to be less likely to have a comorbid major depression episode or current substance abuse diagnosis (Frueh et al., 2004 ). Furthermore, other research has shown that older adults who experience a traumatic life event during later life tend to experience more avoidance, sleep problems, crying spells, and hyperarousal compared to middle-aged or younger adults who experienced similar traumas (Goenjian, Najarian, Pynoos, & Steinberg, 1994 ; Hagström, 1995 ). Studies like these that point to potential diff erences in the expression of PTSD among older and younger adults highlight the need for age-appropriate assessment instruments. ...
Older adults are increasingly making up an increasingly larger segment of the worldwide population,
which presents both challenges and opportunities for the clinical psychologist in the 21st century. In
this chapter, we address some of the unique aspects of working with this population, focusing on
general guidelines for tailoring interventions for older adults, specific treatments for particular
problems commonly faced in later life, as well as issues of diversity and how they might impact
psychotherapy with older clients. We also outline several areas in geropsychology that are in need of
further investigation, namely the use of technology, post-traumatic stress, and family therapy, and offer
some recommendations for future directions in this field of study.
... Certains chercheurs énoncent que les désastres qui occasionnent de nombreux décès ou des blessures, qui constituent une menace importante à l'intégrité physique ou à la vie, qui provoquent des pertes matérielles significatives et une dévastation environnementale sont associés à une plus importante fréquence de traumatismes psychologiques chez la population. Cette situation est aussi constatée lors d'événements où la soudaineté et l'imprévisibilité prédominent (Bland et al, 1996 ;Bolin, 1989 ;Freedy et al, 1994 ;Green et al, 1992 ;Hagstrom, 1995 ;Parker, 1977 ;Pickens et al, 1995 ;Rubonis et Bickman, 1991 ;Smith et North, 1993 ;Wood et Cowan, 1991). Une évidente détresse psychologique est aussi remarquée lors de catastrophes où seulement l'aspect technologique intervient où lorsqu'il supplante la composante naturelle (Baum et al, 1983a ;Hodgkinson, 1989 ;Lindy et al, 1981 ;Raphael, 1986). ...
Purpose
This article aims to analyse the links between Alzheimer’s disease (AD) and Post-Traumatic Stress Disorder (PTSD) and to assess the feasibility of treating PTSD in AD.
Methods
We review the literature around the links between PTSD and AD, consider this within several theoretical models. We propose the hypothesis that the treatment of PTSD in AD can improve episodic memory with some positive effects on AD. We present a pilot study in order to confirm the likely benefits of such an approach. There were 10 participants for the target group (AD and PTSD) and 10 participants in the control group (AD without PTSD). During two sessions separated by an interval of six months, different components of episodic memory were assessed with specific tests. AD evolution was assessed with the Mini-Mental State Examination (MMSE). For the target group, PTSD presence and quality of life were also assessed, and treatment for PTSD was undertaken between the two sessions.
Results/Findings
The analysis of scientific literature highlighted some clinical, cognitive and neurobiological similarities between AD and PTSD. The key-role of episodic memory is evident. The results of the pilot study suggest that PTSD treatment in AD participants improves all assessed indicators: word recall, word recognition, immediate recall, delayed recall, personal recent events recall, personal lifetime events recall, global cognitive abilities (MMSE) and quality of life.
Discussion/conclusion
There are strong theoretical and practical reasons to search for an effective intervention for PTSD in AD patients. These preliminary results need to be confirmed but already suggest a promising avenue for therapeutic care of AD patients with trauma due to unknown or unsolved factors.
Post-traumatic stress disorder (PTSD) is a highly prevalent disorder and a highly debilitating condition. Although anhedonia is an important construct of the disorder, the relationship between PTSD and reward functioning is still under-researched. To date, the majority of research on PTSD has focused on fear: fear learning, maintenance, and extinction. Here we review the relevant literature—including clinical observations, self-report data, neuroimaging research, and animal studies—in order to examine the potential effects of post-traumatic stress disorder on the reward system. Our current lack of sufficient insight into how trauma affects the reward system is one possible hindrance to clinical progress. The current review highlights the need for further investigation into the complex relationship between exposure to trauma and the reward system to further our understandings of the ethology of PTSD.
Objective
Failure to diagnose and treat Posttraumatic Stress Disorder (PTSD) may help explain the substantial disability, increased cognitive decline, and adverse health outcomes suffered by older adults with this disorder. To evaluate this possibility, we examined symptom differences among older and younger individuals with PTSD and measured the frequency with which older adults receive standard of care treatment.
Methods
Clinician‐Administered PTSD Scale for DSM (CAPS) scores were compared between younger and older adults with PTSD. Profiles were calculated for the most dominant CAPS symptom cluster reported by each participant, and the age cutoff best differentiating symptom clusters between individuals was determined. Clinical interview data (older adult sample only) were evaluated by trained raters to determine rates at which PTSD participants accessed treatment.
Results
Among 108 individuals with PTSD, 69% of participants <67 years old had Criterion C (avoidance) symptoms as the most dominant cluster compared to 39% of participants ≥67 (p=0.016). Eight percent of participants <67 years had Criterion E (hyperarousal) symptoms as the most dominant cluster compared to 30% of participants ≥67 (p = 0.016). Less than 25% of the older adults (N=53 subsample) were receiving a first‐line pharmacotherapy option for PTSD, and 0% of participants were currently participating in an evidence‐based psychotherapy for PTSD.
Conclusions
Clinicians evaluating patients should be aware that different symptom profiles may be present between younger and older adults with PTSD. Despite their high risk for adverse neuropsychiatric and other health consequences, older adults with PTSD appear to infrequently receive first‐line clinical treatment.
This article is protected by copyright. All rights reserved.
Being diagnosed and treated for cancer can be a stressful experience and a substantive number of those who have to face and deal with that experience show symptoms of posttraumatic stress disorder (PTSD). Over the last decade or so, the literature on cancer survivorship and PTSD has grown. If PTSD is a psychological sequela of cancer diagnosis and treatment, then the possibility exists that psychological interventions may offer some relief from this additional burden. This chapter attempts an overview of this area of concern covering both the nature and prevalence of PTSD in those with cancer, the utility of psychological interventions in dealing with it, and the possibility of resultant positive change or posttraumatic growth: the silver lining to the cancer cloud.
Résumé
Des travaux récents mettent en évidence l’existence fréquente de plaintes somatiques co-morbides lors d’États de Stress Post-Traumatique avec des facteurs de maintien similaires pour les deux entités. Cependant, concernant le sujet âgé, les données disponibles sont très restreintes. Nous proposons l’hypothèse que les douleurs chroniques présentées par les sujets âgés institutionnalisés peuvent révéler un État de Stress Post-Traumatique. Nous vérifions la pertinence de cette hypothèse chez cinq sujets âgés douloureux féminins récemment entrés en institution. Dans ces cinq situations, la douleur chronique s’avère être en lien avec la réactivation d’un traumatisme ancien ou l’impact d’un traumatisme récent. De plus, un protocole thérapeutique bref fait régresser tant la douleur que l’État de Stress Post-Traumatique. Nos résultats invitent à rechercher systématiquement une telle pathologie lors de douleurs somatiques chez une personne âgée entrée en institution.
The pathogenic effects of traumatic events have been consistently documented over a large range of populations and occurrences (Wilson & Raphael, 1993). At the same time, considerable variability in human response to trauma has been documented (e.g., Solomon, Mikulincer, & Waysman, 1991). Although many survivors are able to put the trauma behind them and resume their lives, others are detrimentally affected. They may suffer a deterioration of health and social functioning, along with a large variety of psychological disturbances, including anxiety, depression, somatization (Solomon, 1993), and posttraumatic stress disorder (PTSD), which is the most common and conspicuous psychological sequela of trauma (American Psychiatric Association, 1994).
Two years after serious flooding, a study was conducted involving 177 disaster victims. This article presents the results of analyses aiming to identify the principal factors associated with post-disaster psychological problems by examining mediating or moderating influences of social support and adjustment strategies in the stressor-health link. The results show, within the variables studied, that there are very few significant differences between men and women; however, women did receive more help for evacuation, cleaning, and rebuilding. The results also demonstrate that exposure to the stressor is the greatest contributor in explaining manifestations of post-traumatic stress, while variables like social support and adjustment strategies are more likely to explain the existence of depression symptoms and psychological stress. The analyses also allow conclusions to be drawn about mediating and moderating effects of adjustment strategies in the stressor-health link. In other respects, the observed effects involving social support variables are direct.
This article reviews the current literature on mental control of trauma-related intrusions. First, the characteristics of intrusions and related phenomena, such as appraisals of the trauma and maladaptive thought control strategies arc reviewed. Secondly, the relationship of intrusions and distress is explored. This is followed by a discussion of mental control and persistence of trauma-related intrusions. The treatment of unwanted intrusions is also included. Finally, future directions of research are discussed. It is suggested that future research more clearly define intrusions and associated characteristics. In addition it is recommended that treatment outcome studies report their results for specific symptoms, including intrusions, to help in further refining treatments.
G‹R‹fi Travma sonras› stres bozukluu (TSSB) yafll›lar›n, hayat›n geç dönemlerindeki geliflimsel evrelerin bafla- r›l› bir flekilde üstesinden gelebilme ve ileri yafllarda karfl›laflt›klar› hayat stresleriyle bafla ç›kabilme yetile- rini bozan bir hastal›kt›r. Hayat›n herhangi bir döne- mindeki bir travma yaflant›s›ndan kaynaklanabilir. Semptomlar› devaml› veya aral›kl› olabilen bu bozuk- luk ya zaman içinde kendini s›n›rlar ya da kronik bir seyir izler. Yafll› bir bireyde, artan travma fliddeti ve önceden mevcut olan psikiyatrik hastal›klar TSSB ge- liflimine öncülük edebilirken, belirli kiflilik özellikleri ve iyi bir psikososyal destek ortam› bireyi bu bozuk- luktan koruyucu etki gösterebilir. Yafll› insanlar TSSB geliflimine genç insanlardan daha fazla yatk›n deil- dirler ve bozukluun "travman›n yeniden yaflanmas›, kaç›nma ve afl›r› uyar›lm›fll›k" fleklindeki belli bafll› semptomlar› yafl gruplar› aras›nda benzer nitelik gös- termektedir (Weintraub ve Ruskin 1999). Psikolojik travma, geçtiimiz yüzy›l›n ikinci yar›- s›nda araflt›rmac›lar›n en çok üzerinde durduklar› ko- nulardan birisi olduu hâlde, travma yaflant›s›n›n geç yetiflkinlik ve yafll›l›k dönemindeki etkileri konusunda yap›lm›fl olan klinik çal›flmalar ve bu döneme âit epi- demiyolojik veriler oldukça s›n›rl›d›r (Busuttil 2004). ABSTRACT Post-traumatic Stress Disorder In the Elderly The significance and characteristics of posttraumatic stress disorder (PTSD) in the elderly populati- on and the studies on the neurobiology of this disorder as well as the treatment interventions for PTSD are reviewed in this paper. PTSD is a disabling psychiatric condition that tends to have a chro- nic course and often overlooked in the elderly population. The studies in this area have demonst- rated that the elderly people do not appear more predisposed to develop PTSD compared to the young people and the symptomatology of the disorder is similar between these age groups. Ho- wever, controlled research in the context of epidemiology, neurobiology, diagnosis and the mana- gement of the PTSD among the elderly population is limited in the current literature; therefore new researches evaluating the various aspects of PTSD in the elderly population are required.
Background
Crashes occur regularly throughout the world and can result in multiple fatalities and many injuries. Research into how survivors experience a crash is very limited. AimTo describe and analyse the nonphysical consequences of a multifatality bus crash in Sweden and the subsequent effect on the surviving passengers' lives. Method
The participants were all (n=56) of the survivors of a major bus crash. The passengers were interviewed approximately one month after the bus crash. The interviews were analysed using a qualitative content analysis. ResultsPrior to the arrival of rescue personnel at the crash site, helpfulness emerged among the passengers. Further, the crash generated an impact on the surviving passengers' lives from a short-term perspective. The passengers displayed a diverse need for crisis support; informal support from family and friends was essential for the early healing process. Sleep difficulties and a change in travel routines were the most common consequences. Lastly, passengers sought closure in order to move on with their lives. Conclusion
The passengers' reactions to and behaviour following a crash offer an insight into the, relatively unexplored, interaction between people experiencing a major road traffic crash. It is necessary to have a flexible crisis support system, and the vital role of family support ought to be upgraded.
Disasters have multitude of effects on the victims; as the direct loss and damage during disasters and the indirect consequences continue for years. In the developing world disasters have colossal impact where the resources are scarce, disaster relief systems are inadequate and post-disaster long-term care is abysmally poor. Psychiatric morbidities are observed in a large majority of affected population and these often become chronic. It is imperative to study how the victims cope following the catastrophic disasters, the relation between various coping strategies and manifest morbidities and variations across disasters and cultures. This article reviews the available literature regarding coping following various disasters and summarizes the coping strategies employed by disaster victims around the world. Variations in coping across cultures are highlighted and areas for therapeutic intervention are suggested. These understandings in coping may help in facilitating positive coping and developing culture specific and appropriate intervention programmes.
Disasters occur more often since the world gets overpopulated, air traffic is busier, terrorists are operating worldwide and therefore, risks are increasing. According to the Federal Emergency Management Agency major disasters in the USA have been increasing in frequency, form fewer than 25 per year in the 1980s to more than 40 per year in the 90s. Disasters have happened throughout history. But the reaction to these events has varied according to the mood that a prevailed in society at the time. As Frank Furedi stated: "Many of our fears are not based on personal experiences. Despite an unprecedented level of personal security, fear has become an ever-expanding part of our live. Western societies are increasingly dominated by a culture of fear". Characteristic of trauma ater a disaster is perceived loss of control. The accustomed sense of security has vanished; the victim fears being struck by a new calamity. Especially after 9-11 there is a lot of attention to the aftermath of diasaters, to posttraumatic stress (disorders), medically unexplained physical symptoms (MUPS) and functional somatic syndromes (FSS). However, there is not much long-erm research on this phenomena (with a few exceptions like Three Mile Island, which was only a disaster because residents thought it was, and the Gulf war). For that reason we use in this chapter the Amsterdam air disaster as a 'casus belli'. for public health and for the authorities there are lessons to be learned, in the absence of a protocol for dealings with disasters, and in the lack of experince in dealing with man-made disasters. We pay attention to the role of the media in the aftermath of disaster as well: 'The ironic thing about the seemingly endless coverage of the 1986 Chernobyl accident - and the relatively harmless, because much diluted, radiation that then blew around the world-, is that, with few exceptions, the media have done more injury to th truth than was ever done by cover-up or whitewash. Television is the worst offendev r because the visual impact is unforgettable and any reasonable sense of proportion goes out of the window..." Earlier research showed the impact of media on consultation frequency in general practice.
On May 12(th) 2008, a devastating earthquake measuring 8.0 on the Richter scale, struck Wenchuan county and surrounding areas in China. The prevalence of mental illness among children and adolescents in a rural town far from the earthquake epicenter is unknown.
To assess the prevalence of posttraumatic stress disorder (PTSD) and depression among junior middle school students in a rural town Ningqiang county, 327 km from the earthquake epicenter.
A population-based mental health survey was conducted in March, 2009.
Survey Self-designed General Condition Survey Scale, Children's Revised Impact of Event Scale (CRIES-13), and the Depression Self-rating Scale for Children (DSRSC) were used to sample 1,841 junior middle school students in Ningqiang county, ten months after the Wenchuan earthquake.
The prevalence rate of a high-risk for PTSD was 28.4%, with 32.7% among females, 23.8% among males (female vs. male, p<0.001), 38.6% in the severe exposure group and 24.3% in the mild exposure group (severe vs. mild exposure, p<0.001). For depressive symptoms, the overall prevalence was 19.5%, with 24.0% among females, 14.7% among males, 24.5% in the severe exposure group and 17.5% in the mild exposure group (female vs. male, p<0.001; severe vs. mild exposure, p<0.001, respectively). In multivariate analysis, factors such as "having felt despair", or "danger" and "having own house destroyed or damaged" were significantly associated with PTSD symptoms. Female gender and delayed evacuation in females, and earthquake related experiences in males were significantly associated with depression.
Traumatic events experienced during the earthquake were significantly associated with symptoms of PTSD and depression in children and adolescents, ten months after the Wenchuan earthquake. These data highlight a need for mental health services for children and adolescents in rural areas, far from earthquake epicenters.
In 2002, my colleagues and I published an empirical review of the disaster literature that presented results for 160 samples that were coded as to sample type, disaster type, disaster location, outcomes observed, and overall severity of impairment. Here, I present an update of this review, now based on 225 samples and 132 events. Outcomes included PTSD, depression, anxiety, nonspecific distress, and health problems. Regression analyses showed that samples were most likely to be affected severely if they were from developing countries or experienced mass violence (e.g., terrorism, shooting sprees). Most samples of rescue and recovery workers showed remarkable resilience. (Review posted to www.redmh.org March 2005.) On average, a disaster occurs somewhere in the world each day. It may be a flood, hurricane, or earthquake, a nuclear, industrial, or transportation accident, a shooting spree or peacetime terrorist attack. What these various events share in common is their potential to affect many persons simultaneously and to engender an array of stressors, including threat to one's own life and physical integrity, exposure to the dead and dying, bereavement, profound loss, social and community disruption, and ongoing hardship. As a result of both the high prevalence and high stressfulness of disasters, the question of whether they impact mental health has been of interest for decades, and a substantial literature has developed that identifies these effects.
L’état de stress post-traumatique est une notion à la fois ancienne et récente qui pose divers problèmes, que ce soit à un
niveau médical, diagnostique ou juridique. Ce travail cherche essentiellement à faire le point sur les données de la littérature
du point de vue psychopathologique, en se référant notamment au DSM-IV et à la CIM-10, sans aborder le problème de la thérapeutique
ou du biologique. II importe de comprendre d’abord s’il s’agit d’une situation pathologique ou si on doit considérer la réaction
psychologique comme normale, c’est-à-dire comme faisant partie d’un processus d’adaptation. L’aspect juridique est abordé,
une méthodologie d’étude est également proposée.
The state of posttraumatic stress disorder is a both ancient and recent notion which poses diverse problems, should it be
on a medical, on a diagnostic or on a juridical level. This work tries essentially to point out the particulars in the literature
on the psychopathological point of view, in reference among others to DSM-IV and to ICD-10, without entering the therapeutical
or the biological problem. It is important to first understand if it is a pathological situation or if the psychological reaction
should be considered as normal, meaning as being part of the adaptation process. The juridical aspect is being taken up, a
methodology of study is also proposed.
This article explores the experiences of fire and Emergency Medical Services (EMS) personnel during and immediately after a technological event using a phenomenological approach. Personnel engaged in the rescue operations during and immediately after the Ghislenghien gas explosion reflected upon their experiences in their responses to a specially designed, self-reporting questionnaire that included open-ended questions. Firefighters reported more perceived threat and direct exposure to death than did EMS personnel. Qualitative analysis indicates that the central characteristics of this potentially traumatizing event were the suddenness and massiveness of the impact, and the fact that it involved young victims and/or multiple deaths. With regard to emotions, powerlessness, horror, fear, a sense of apocalypse, and grief were experienced by both firefighters and EMS personnel. Firefighters noted that the death of colleagues, the involvement of friends and family, the massive impact, and exposure to the burned victims were most shocking. Emergency Medical Services personnel and in-hospital staff reported the impact, the confrontation with death, the involvement of friends and family, and the pain, suffering, and screaming of burned victims as the most shocking aspects of this event. Qualitative differences in the lived experiences of firefighters, EMS personnel, and in-hospital staff might be explained by differences in life threat, contact with death, and various degrees of training.
De Soir E, Knarren M, Zech E, Mylle J, Kleber R, Van der Hart O. A phenomenological analysis of disaster-related experiences in fire and Emergency Medical Services personnel. Prehosp Disaster Med. 2012;27(2):1-8.
This study investigated the changes in electroencephalography (EEG) activity in train drivers during a monotonous train-driving session. Four combinations of EEG activities were also compared to investigate the difference in performance of these equations. The four equations tested were equation 1 (θ/β), equation 2 (θ/(α + β)), equation 3 ((θ + α)/β), and equation 4 ((θ + α)/(α + β)). A total of fifty male train drivers were recruited to perform a 30-min monotonous train-driving task while 2-channels of EEG (frontal and temporal) were recorded. At the frontal site, significant differences were found for theta (p = 0.045) and alpha (0.0001) activities, and at the temporal site, significant differences were found for delta (p = 0.007) and theta (0.01) activities. For the average of frontal and temporal site activities, significant differences were found for delta (p = 0.004), theta (p = 0.001), and beta (p = 0.048). Significant difference were found for temporal site for equation 1 (θ/β) (p = 0.04), and equation 4 ((θ + α)/(α + β)) (p = 0.02), and for the average of frontal and temporal site activities, significant differences were found for all four equations (equation 1 (p = 0.001), equation 2 (p = 0.006), equation 3 (p = 0.04), and equation 4 (p = 0.002)). These findings can be utilised as a potential fatigue indicator.
The significance and characteristics of posttraumatic stress disorder [PTSD] in the elderly population and the studies on the neurobiology of this disorder as well as the treatment interventions for PTSD are reviewed in this paper. PTSD is a disabling psychiatric condition that tends to have a chronic course and often overlooked in the elderly population. The studies in this area have demonstrated that the elderly people do not appear more predisposed to develop PTSD compared to the young people and the symptomatology of the disorder is similar between these age groups. However, controlled research in the context of epidemiology, neurobiology, diagnosis and the management of the PTSD among the elderly population is limited in the current literature; therefore new researches evaluating the various aspects of PTSD in the elderly population are required.
Using the DSM-IV diagnostic criteria for acute stress disorder, the authors examined whether the acute psychological effects of being a bystander to violence involving mass shootings in an office building predicted later posttraumatic stress symptoms.
The participants in this study were 36 employees working in an office building where a gunman shot 14 persons (eight fatally). The acute stress symptoms were assessed within 8 days of the event, and posttraumatic stress symptoms of 32 employees were assessed 7 to 10 months later.
According to the Stanford Acute Stress Reaction Questionnaire, 12 (33%) of the employees met criteria for the diagnosis of acute stress disorder. Acute stress symptoms were found to be an excellent predictor of the subjects' posttraumatic stress symptoms 7-10 months after the traumatic event.
These results suggest not only that being a bystander to violence is highly stressful in the short run, but that acute stress reactions to such an event further predict later posttraumatic stress symptoms.
Previous research has consistently demonstrated a positive association between intrusive thoughts about stressful experiences and psychological distress. The strength of this relation, however, has varied considerably across studies. To examine the possibility that an individual's sense of global meaning (i.e., the existential belief that one's life has purpose and order) may moderate the relation between intrusive thoughts and psychological distress, the authors conducted telephone assessments of 61 women who had survived breast cancer. Results confirmed that the frequency of intrusive thoughts was positively related to psychological distress. Global meaning, moreover, moderated the relation between intrusive thoughts and psychological distress consistent with the authors' hypotheses. Among women with lower global meaning, more frequent intrusive thoughts were associated with higher psychological distress. No association was found between intrusive thoughts and psychological distress among those participants with higher global meaning.
Immediately following a rail disaster in Sydney, Australia, on January 18, 1977, in which 83 people were killed, an attempt was made to organize a preventive psychiatry outreach program for the relatives of the bereaved and the survivors. Bereavement counseling was offered to all families considered to be at risk for development of postbereavement morbidity. A follow-up study was performed 15 to 18 months later to assess the level of functioning of the bereaved relatives. The next of kin of 36 victims (43 per cent of the total number killed) were interviewed and filled in questionnaires (general health, Goldberg's General Health Questionnaire, loss, and social support). They included 15 widows, nine widowers, 11 mothers, and eight fathers who had lost children. The trends were for the bereaved spouses to have done better than bereaved parents; the widowers to have done better than the widows; those with a supportive network to have done better than those without one; those who saw the body to have done better than those who did not; and, in addition, there was a tendency for those who had bereavement counseling to do better than those who had no such intervention. Examples are given of several types of outcome, and conclusions are drawn about the results and the difficulties of implementing and evaluating such a program.
Clinicians have gained considerable knowledge about psychopathology and treatment but this knowledge is poorly systematized and hard to transmit. One way to organize clinical knowledge is to circumscribe a limited area and describe within it the interactions between personality dispositions, states of disorder, and treatment techniques.
This report models such an approach by limiting disorder to stress response syndromes, personality to obsessional and hysterical neurotic styles, and treatment to focal dynamic psychotherapy. Within this domain, an information processing approach to working through conflicted ideas and feeling is developed. The result is a series of assertions about observable behavior and nuances of technique. Since these assertions are localized conceptually, they can be checked, revised, refuted, compared, or extended into other disorders, dispositions, and treatments.
A primary prevention program implemented immediately following a major rail disaster is described. Because of the high mortality, services were oriented towards the provisions of preventive counselling for bereaved families as well as support for the injured. Emergency counselling services were provided at the City Morque. Subsequently, coordinating consultative and educative programmes were instituted in the affected health region. Counselling bereaved families was continued through appropriate specialised community services. High-risk groups of bereaved were delineated and special emphasis given to individual care of these persons. Recommendations are made concerning the relevance of such a programme to the personal disasters of life.
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The 1st volume, in a planned trilogy dealing with the prevention and control of mental disorders, focuses on the need for new knowledge and clinical understanding as they pertain to community dynamics. Program planning, staffing, and staff training are discussed from the standpoint of preventive psychiatry which "must containually take into account the multifactorial nature of the forces which provoke or ameliorate mental disorders." Programs to reduce the incidence of, the duration of, and the impairment which may result from mental disorders of all types in a community are touched upon. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A review of clinical, experimental, and field research on stress, together with the author's own research, provides the background for a theory that emphasizes the importance of cognitive processes. Harvard Book List (edited) 1971 #370 (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In order to explore the impact of catastrophic stress on health problems, the insurance records of workers (N = 73) surviving an oil rig disaster were studied longitudinally. The figures were compared with a group (N = 89) of offshore oil workers not exposed to disaster and matched for an age and sex. The observation period lasted from the disaster in 1980 through the first six months of 1988. Baseline data from the two years prior to the disaster showed no significant differences between the populations. However, among the survivors a significant increase in general morbidity appeared during the aftermath of the disaster with regard to both occurrence and persistence. When diagnoses were divided into ‘psychiatric’ and ‘non-psychiatric’ the most striking changes were found for the psychiatric diagnoses. More moderate, yet significant differences emerged for the non-psychiatric diagnoses. Of these, the psychosomatic diagnoses tended to show significant differences while the group of general somatic diagnoses did not. Indications of an increased accident proneness in the survivors were also demonstrated. Occurrence rates and the level of persistence remained fairly stable throughout the observation period; no obvious decline over the years was found. The findings emphasize the need for appropriate help programme for the victims of catastrophic stress aiming at the reduction of the occurrence and persistence of psychiatric and non-psychiatric health problems.
A description of the behavioural responses of some of the survivors of the Granville train disaster in Sydney has been given covering the eighteen months since the accident. A high and persisting level of psychiatric morbidity was found mainly involving neurotic and psychosomatic symptoms. This has been followed by a review of the literature on stress and its relevance for psychiatry. Initial problems with terminology have been examined and a definition covering environmental, psychological and biological factors proposed. A relationship between stressful experience and a variety of phenomena including physical ill health, psychiatric disorders and accidents has been found. Much evidence is also present to highlight the value of a supportive and cohesive social network in enabling the individual to cope with events of a stressful nature. Conclusion and proposals for future work in the area have been given.
Distressed victims and their relatives have passed through the early days of horror and uncertainty, and for the most part they received the very best in comforting support, in psychological first aid for their distress. Such psychological first aid involved a caring empathy from concerned others that allowed those affected to express all feelings openly and safely, particularly the initial overwhelming anxiety and helplessness and the rage induced by impact of loss. However, the psychological effects of disasters extend well beyond this initial phase. They will affect not only those who have survived the disaster - the injured, and those who travelled on that train - but also the bereaved, the rescuers, those more peripherally connected with the disaster and the total community. Some important principles of understanding and managing the psychological sequelae of this tragic event are explained.
Nine months post-disaster, 134 rescuers involved in an off-shore oil rig disaster were investigated by using a structured self report questionnaire to chart their experience of coping with disaster impact stressors and their mental and physical health 9 months after the disaster. Of the 134 rescuers, 24 were categorized as professional rescuers, 101 as non-professionals and 9 could not be classified. Of the 212 victims, all oil rig workers, 89 (42%) were rescued. Seventy-six percent of the rescuers reported they had been exposed to danger during the rescue operation, and 62% found the experience to be the worst ever. Eighty to ninety percent felt they had coped fairly well with the task, and severely disturbed coping was reported to be below 10% for decision-making, ability to judge risk, capacity to function as leader, and finally ability to cooperate and act efficiently. For the non-professionals, severe disturbance in ability to plan before acting was reported by 10% and moderate disturbance was reported by 38%. The frequency of emotional stress reactions during the rescue work can be assessed from the fact that 64% to 52% reported discouragement, restlessness, uncertainty, anxiety and irritation. The stressors inherent in this type of disaster seem to satisfy the DSM III stressor criterion for post-traumatic stress disorder. Nine months after the disaster 24% reported their mental health to be poor due to the disaster impact, and only the most experienced rescuers had a low health risk compared to the others.
Acute and subacute post‐traumatic stress reactions are reported among 246 employees of an industrial factory which was severely damaged by an explosion and fire. Sixty‐six A‐subjects had narrow escape experiences (high stress exposure group), while 59 B‐subjects were less severely exposed (medium stress exposure group). The 121 C‐subjects were not present at work when the explosion occurred (low stress exposure group). A response rate of 97.6% was achieved at the primary examination, and a 100% response at the 7 months follow‐up.
The frequency and intensity of post‐traumatic stress reactions were linked to the severity (A,B,C) of the stress exposure; specific post‐traumatic anxiety reactions reported by more than 80% of A‐subjects. The reactions appeared immediately or within hours, only 5% of A had delays of a few weeks. While 24.3% of A had State Anxiety Inventory scores 1 week post‐disaster higher than 60, 8.5% of B and 2.5% of C had similar scores. Depressive reactions, social withdrawal, guilt, shame and irritability were less frequent, and appeared nearly always concommittant with anxiety symptoms. While the anxiety symptoms made up a tight knit syndrome, the less frequent non‐anxiety symptoms were linked to the post‐traumatic anxiety syndrome. The subjects' fears reflected the trauma, they feared inanimate objects, and there were hardly any paranoid ideations.
The disaster exposure of the A and B but not of the C group members constituted a stressor which fulfilled the PTSD stressor criterion of the DSM III R. A minority of the C group developed a post‐traumatic stress syndrome. After 7 months, all 30 post‐traumatic stress reactions were more frequent and severe in the A than B group which again differed from the C group. Irritability was the only post‐traumatic stress reaction that increased in frequency and intensity during the 7 months observation period. The findings represent evidence that supports the face validity, descriptive and construct validity of the PTSD diagnosis.
Non‐response and psychological resistance, i.e. degree of unwillingness to undergo the primary examination (screening), and its implications for estimation of PTSD prevalences was measured in a longitudinal study of 246 employees exposed to an industrial disaster (explosion/fire). Resistance including refusal, was measured by counting the number of contacts needed in the calling‐in procedure to secure cooperation. Resistance to the primary examination related to severity of exposure (24.2% in the high exposure versus 6.8% in the medium exposure and 4.2% in the low exposure group). If those who initially resisted had been lost to the 7 month follow‐up the total response rate would have been 82.8%, with an estimated frequency of high PTSS scores of 15. By increasing the response rate to 100%, the true prevalence of high PTSS scores increased to 22.4%. The initial resistance related strongly (P < 0.001) to the severity of outcome at 7 months. The potential loss to the follow‐up would have included 42% of the PTSD cases, and 64% of the severe PTSD cases would have fallen out, resulting in distorted prevalence rates of PTSD.
The high potential loss to follow‐up in the high exposure category would reduce the predictor value of belonging to that exposure group. The initial resistance in many who later developed PTSD was found to relate to the psychological defences such as avoidance against the re‐experiences in the acute post‐traumatic stress syndrome. For traumatic stress studies on the after‐effects of shock traumas the implication of findings is that response rates need to be high. For primary and secondary prevention the implication may be that early outreach must be very active.
With the advent of community psychiatry, the pressure of care of the mentally ill will increasingly fall on the family and the community. In order for this transition to succeed, it is important to bear in mind the attitudes of the community and the caregivers. This article reviews the literature on public attitudes and suggestions are made for future research and lessons to be learnt from the experience in North America.
This paper attempts to draw together some of the current questions related to the methodology of exploring the psychological and psychiatric aspects of human response to disaster. It sets out some of the key areas in which research questions might be mounted. A range of relevant instruments are suggested. The value of a structured interview which can explore issues of relevance to disaster victims is demonstrated. Early screening measures and proposals regarding these, as well as the particular instruments for longer term follow-up and assessment of outcome, are discussed in considerable detail. The article concludes with an overview of the principal issues to be addressed in methodology research, and emphasises the need for a collaborative approach using core items so that studies embracing different disasters and different countries can have some comparative basis.
There is a consensus among clinicians treating patients who have experienced a trauma that a number of common themes emerge. Using a manual that codified ten of these themes, their frequency was measured in the case material of 30 psychotherapy patients treated for posttraumatic stress disorders after bereavement or personal injury. The themes found to be most prominent in bereavement cases included sadness over loss and discomfort over discovered personal vulnerability. In the personal-injury cases, fear of a repetition of the event and feelings of responsibility emerged most frequently. Rage at the source of the trauma figured prominently in both bereavement and personal-injury cases.
Immediately following a rail disaster in Sydney, Australia, on January 18, 1977, in which 83 people were killed, an attempt was made to organize a preventive psychiatry outreach program for the relatives of the bereaved and the survivors. Bereavement counseling was offered to all families considered to be at risk for development of postbereavement morbidity. A follow-up study was performed 15 to 18 months later to assess the level of functioning of the bereaved relatives. The next of kin of 36 victims (43 per cent of the total number killed) were interviewed and filled in questionnaires (general health, Goldberg's General Health Questionnaire, loss, and social support). They included 15 widows, nine widowers, 11 mothers, and eight fathers who had lost children. The trends were for the bereaved spouses to have done better than bereaved parents; the widowers to have done better than the widows; those with a supportive network to have done better than those without one; those who saw the body to have done better than those who did not; and, in addition, there was a tendency for those who had bereavement counseling to do better than those who had no such intervention. Examples are given of several types of outcome, and conclusions are drawn about the results and the difficulties of implementing and evaluating such a program.
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