Soydas Suzan, Smid Geert E, Goodfellow Barbara, Wilson Rachel, Boelen Paul A
Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands.
ARQ Centrum'45, ARQ National Psychotrauma Centre, Diemen, Netherlands.
Front Psychiatry. 2020 Aug 28;11:878. doi: 10.3389/fpsyt.2020.00878. eCollection 2020.
Homicidal bereavement puts survivors at risk of developing a broad range of lasting and severe mental health problems. Previous research has often relied on relatively small and homogenous samples. Still, little is known about what factors influence the expression of symptoms following homicidal bereavement. Preventive and curative treatments often do not consider the complex coherence between the emotional, judicial, financial, and societal challenges that likely arise following a homicide. Despite the severity of its consequences on mental health, no gold standard for the preventative and curative treatment of mental health issues in homicide survivors exists. We aimed to introduce a time-limited, traumatic grief-focused outreaching model of care designed specifically for homicide survivors, and to examine its potential effectiveness. Furthermore, we aimed to investigate what factors influence the severity of mental health problems and response to treatment. In the current study, self-reported data on five different outcome measures, namely, symptoms of posttraumatic stress, prolonged grief, depression, anxiety, and functional impairment were available from 929 homicidally bereaved treatment receiving adults. We used Latent Growth Modeling to analyze our repeated measures data and to classify individuals into distinct groups based on individual response patterns. Results showed that the current model of care is likely to be effective in reducing mental health complaints following homicidal bereavement. Having a history of mental illness, being younger of age and female, and having lost either a child or spouse consistently predicted greater symptom severity and functional impairment at baseline. For change in symptom severity and functional impairment during treatment, having a history of mental illness was the only consistent predictor across all outcomes. This study was limited by its reliance on self-reported data and cross-sectional design without a control group. Future prospective, longitudinal research across different cultures is needed in order to replicate the current findings and enhance generalizability. That notwithstanding, findings provide a first step toward evaluating a novel service-delivery approach for homicide survivors and provide further insight in the development of mental health complaints following bereavement by homicide.
杀人导致的丧亲之痛会使幸存者面临一系列持久且严重的心理健康问题。以往的研究往往依赖相对较小且同质化的样本。然而,对于哪些因素会影响杀人导致丧亲后的症状表现,人们仍知之甚少。预防和治疗措施通常并未考虑到杀人事件后可能出现的情感、司法、经济和社会挑战之间的复杂关联。尽管其对心理健康的后果严重,但针对杀人事件幸存者心理健康问题的预防和治疗尚无金标准。我们旨在引入一种专门为杀人事件幸存者设计的、限时的、以创伤性悲伤为重点的外展护理模式,并检验其潜在效果。此外,我们旨在调查哪些因素会影响心理健康问题的严重程度以及对治疗的反应。在当前研究中,我们获取了929名接受治疗的杀人事件丧亲成年人关于创伤后应激症状、持续性悲伤、抑郁、焦虑和功能损害这五种不同结果指标的自我报告数据。我们使用潜在增长模型来分析重复测量数据,并根据个体反应模式将个体分为不同组。结果表明,当前的护理模式可能有效地减少杀人导致丧亲后的心理健康问题。有精神疾病史、年龄较小且为女性,以及失去孩子或配偶,始终预示着在基线时症状更严重和功能损害更大。对于治疗期间症状严重程度和功能损害的变化,有精神疾病史是所有结果中唯一一致的预测因素。本研究的局限性在于依赖自我报告数据以及缺乏对照组的横断面设计。为了复制当前研究结果并提高普遍性,未来需要在不同文化中开展前瞻性纵向研究。尽管如此,研究结果为评估针对杀人事件幸存者的新型服务提供方式迈出了第一步,并为杀人导致丧亲后心理健康问题的发展提供了进一步的见解。