Does losing a parent early influence the education you obtain? A nationwide cohort study in Denmark.

BACKGROUND: Health inequalities are rooted in education and we investigate the association between early parental death and attainment across the educational spectrum. METHODS: Using total population data on Danes born between 1982 and 2000 (n = 1 043 813), we assess incidence rate ratios (RRs) by gender for attainment of each educational level (basic school, high school or vocational training, bachelor degree or professional programme, and university graduate degree) according to loss of a parent before the age of 18 years. We adjust for family income, education and psychiatric illness and examine parent's gender, cause of death and child's age at time of death as potential moderators. RESULTS: Bereaved people had significantly lower attainment rates than non-bereaved people: basic school (RR = 0.95; 95% CI: 0.93-0.97 for men and 0.96; 0.94-0.98 for women), high school or vocational training (0.78; 0.76-0.80 for men and 0.82; 0.80-0.84 for women), bachelor degree or professional programme (0.74; 0.70-0.79 for men and 0.83; 0.79-0.86 for women) and university graduate degree (0.77; 0.68-0.86 for men and 0.77; 0.69-0.86 for women). Parent's gender, cause of death and child's age at the death did not modify the associations. CONCLUSIONS: As education impacts population health, support for bereaved school children may be more important than realized.

Adolescent suicide and suicide contagion in three secondary schools.

This study investigated crisis intervention in three secondary schools after the suicides of five students, focusing on the relation between crisis intervention and suicide contagion. The contagion hypothesis was supported. Following a suicide, the number of suicides that occurred in secondary schools in one year were markedly increased beyond chance. No new suicides took place at schools where adequate first talk-throughs and psychological debriefing were conducted by a mental health professional. Proper crisis intervention is recommended to prevent suicide contagion in schools.

Reactions to adolescent suicide and crisis intervention in three secondary schools.

This study investigated crisis intervention in three secondary schools after the suicides of five students, focusing on the 89 classmates' risk of developing symptoms of PTSD (measured by IES) and high intensity (HI) grief as measured by Hogan Sibling Inventory of Bereavement. Crisis interventions for the students varied from none to first talk-throughs and psychological debriefings. Six months after the suicide, 30% of the classmates evidenced scores indicative of PTSD and 9.8% evidenced HI grief. Friendship was a predictor of PTSD and HI grief. Inadequate crisis intervention was a risk factor for HI grief. Proper crisis intervention, and appropriate screening and focused post-trauma psychotherapy after a suicide of a student are recommended.

Refugee families' experience of research participation.

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

Trauma exposure and psychological reactions to genocide among Rwandan children.

A total of 3030 children age 8-19 years from Rwanda was interviewed about their war experiences and reactions approximately 13 months after the genocide that started in April 1994. Rwandan children had been exposed to extreme levels of violence in the form of witnessing the death of close family members and others in massacres, as well as other violent acts. A majority of these children (90%) believed that they would die; most had to hide to survive, and 15% had to hide under dead bodies to survive. A shortened form of the Impact of Event Scale used in a group of 1830 of these children documented high levels of intrusion and avoidance. While children living in shelters were exposed to more trauma, they evidenced less posttraumatic reactions. Analyses showed that reactions were associated with loss, violence exposure, and, most importantly, feeling their life was in danger.

Mental mobilization processes in critical incident stress situations.

In this article, the psychological emergency mobilization process that takes place in threat situations is postulated. Mental mobilization is the increased mental capability of the mind in critical situations to process incoming and stored information to enable adaptive survival responses. The processes that are mobilized in the service of survival are enhanced sensory awareness, focused attention, rapid processing of incoming data, and use of previous experience, enhanced memory, altered time perception, and temporary deactivation of emotional reactions. From a clinical standpoint, it is important that the survival value of these processes is understood, as survivors can be helped to feel a sense of accomplishment and empowerment when they are taken through a critical situation in a detailed way and discover that they have been able to function well and survive by use of their stored "experience," rapid processing of information or other aspects of their mental mobilization.

[Support to relatives after suicide]. / Omsorg for etterlatte etter selvmord.

Professionals who have worked with survivors of suicide have emphasized the need for systematic support and care, especially for children. The aim of this study was to evaluate the community support for survivors following suicide of young people (< 30 y). The organization and content of the help was evaluated with a view to develop advice regarding improvement of care. 321 out of 481 communities (67%) in Norway answered a questionnaire. A sub-sample of 266 communities which reported having special support programs for survivors of suicide is presented in this article. Data were analysed by quantitative and qualitative methods. The support offered varies across the nation. While the community physician and the parish priest have crucial roles throughout the country, psychological/psychiatric professionals are more often available in the southern parts of Norway and in larger communities. Most communities establish early contact with the survivors. However, the way contact is established seems casual, the length of the follow-up is varying, and the care for children is inadequate. Smaller communities, communities with a coordinator, a crisis team and written routines, seem to offer the best support. Recommendations for crisis and bereavement intervention programs are proposed in this article.

Helpful and hurtful aspects of psychological debriefing groups.

Psychological debriefing groups have become one of the most common interventions to help people in trauma and crisis. The rapid spread of such groups makes it important to consider both positive and possible negative results of such groups. Debriefing groups provide an opportunity for normalization of a crisis experience. However, as with any powerful intervention, there is the danger that such groups may harm participants. Good leadership reduces the possibility of a negative outcome and requires an emphasis on the early parts of the debriefing to build trust and authority. This, as well as different ways of handling problems in the group process, are outlined. Future challenges to the genre of psychological debriefing are presented, including when not to use debriefing groups.

Long-term impact of sudden infant death: a 12- to 15-year follow-up.

To understand parents' subjective feelings, experiences, and understanding connected to the loss of a child over time, the authors chose semi-structured, in-depth interviews as the method of examination in a study of 26 parents who lost a child to sudden infant death syndrome (SIDS) between 1981 and 1984. In addition, parents were asked to complete different inventories to compare their present responses (1996) with their responses to the same inventories in 1981-1984. Most parents still viewed the death of their child as affecting their daily life in important ways. Inventory data show that gender differences have diminished 12-15 years after the loss, and few parents are psychologically at risk in 1996. The study clearly shows the benefit of method triangulation in providing a total picture of the parent's experiences.

The process in psychological debriefings.

Critical Incident Stress Debriefings have become an intervention method used in various cultures, countries and groups following critical incidents. Although the structure of such meetings has been adequately described, utilization of the group processes involved has received less attention. A model, process debriefing (PD), based on experiences from Europe, is presented. Some differences between the current CISD process in the United States and the Europe based model are outlined. Various factors that impact the process of debriefings are discussed with a special emphasis on leadership, and implications of these group process variables for psychological debriefing are presented. It is emphasized that the continued exploration and discussion of process issues is critical to advance the understanding of the critical elements of debriefing.

Factor analysis of the impact of event scale with children in war.

To evaluate the psychometric properties of the Impact of Event Scale (IES scale) in children a study was conducted on 1787 children exposed to the warfare in Croatia, Bosnia and Herzegovina. The study group comprised 877 girls and 910 boys ranging in age from 6 to 15 years attending 28 arbitrary selected schools in Zagreb. High levels of posttraumatic reactions were found in the group of children. The pattern of endorsement and the factor structure of the IES scale were similar to that found in other samples. This supports the use of the IES in the assessment of posttraumatic stress reactions in children. Two factors emerged from a Principal Component Analysis, labeled intrusion (9 items), and avoidance (4 items). As in other studies, this study documented problems with several items (items 2, 12 and 15), items that should be considered omitted from the IES. Girls reported significantly more distress on 13 out of the 15 items. Both the overall IES score as well as the intrusion and avoidance score were significantly higher in girls than boys. The factor structure for boys and girls were very similar, and the reliability of the scale was adequate across different age groups and for subgroups of displaced and refugee children.

Voluntary and professional disaster-workers: similarities and differences in reactions.

Forty-three rescuers responding to a bus crash that killed 12 children and 4 adults and injured many more answered questionnaires at 1 and 13 months following the crash. This study compared the responses of the voluntary and professional helpers, using the Impact of Event Scale (IES) and the General Health Questionnaire (GHQ). For all helpers taken together, the decline in IES-intrusion and IES-total scores was significant from 1 to 13 months. The voluntary helpers reported significantly more intrusion and avoidance on the IES at 1 month than professional helpers, and for avoidance the voluntary helpers still evidenced a significantly higher score than professional helpers at 13 months. The GHQ scores at 13 months reflected that the long-term negative impact of the event was low.

Cockpit-cabin crew interaction: satisfaction with communication and information exchange.

BACKGROUND: There were 1240 members of flight deck crews (F/D) and cabin crews (C/C) in SAS Norway who responded to a questionnaire that included issues related to communication between crews. The response rate was 84%. HYPOTHESIS: Possible differences between F/D and male and female C/C concerning evaluations of information exchange and communication between crews were examined. METHODS: A multi-faceted questionnaire containing 250 questions concerning organizational and psychosocial issues, safety questions, and subjective health was employed. Regression analyses were applied to examine predictors of satisfaction with information and communication. RESULTS: One half of aircrew members were dissatisfied with information exchange and cooperation between the cockpit and the cabin in general. About 70% were dissatisfied with interaction related to debriefing and stop. Differences between F/D and C/C were significant concerning debriefing. Cabin crews, and especially females, reported being inadequately informed about specific operational procedures and technical matters. Nine of ten female C/C wanted better information about technical aspects of the airplane or flying. Pilots reported inadequate information about how emergency procedures influence C/C and passengers. Between 72% and 94% were satisfied with interpersonal relationships, while 53% expressed satisfaction with supervision and social support. A majority (86%) confirmed that frequent changes between crews were stressful. Regression analyses yielded significant relationships between frequencies of meetings, supervision and support issues, and scheduling schemes and satisfaction with information exchange and cooperation. CONCLUSIONS: Results suggest a strong need to provide more open, continuous and effective communication between the cockpit and the cabin. Several practical suggestions for improvements are discussed.

Children in war: a silent majority under stress.

To assess the amount of stress exposure and reactions among children following a war situation, two comparative groups of non-displaced (N = 64) and displaced children (N = 70) from Croatia were administered a modified version of the War Trauma Questionnaire as well as the Impact of Event Scale (IES). The results showed that a majority of the children had been exposed to armed combat, with displaced children significantly more exposed to destruction of home and school as well as to acts of violence, and loss of family members, than the non-displaced children. Regarding the IES scores, displaced children had significantly higher scores for the total score and for the intrusion and avoidance subscales. For girls the total score and intrusion score were significantly higher than for boys. Different exposure factors were significantly related to the IES scores, especially for the intrusion subscale of the IES.

Fear of flying in civil aviation personnel.

Included in a multi-faceted questionnaire concerning the work environment within a commercial airline were questions on flight anxiety and exposure for critical incidents. A total of 1,147 respondents were included in the sample. Results show that 9.2% of the aircrew members feel anxious or afraid of flying monthly or more often. The cockpit crewmembers were less anxious than the cabin crewmembers, and female cabin crewmembers were more anxious than male. Aircrew who had experienced critical situations and had not sufficiently worked through their experiences, reported more anxiety than those with adequate work-through. We recommend that the cabin crewmembers be provided with better information on how the flight deck operates, and that more stable work crews and co-training of cabin and cockpit crewmembers be facilitated. A formal debriefing routine after critical incidents is advised. Personnel with flight anxiety should be offered help to reduce their fear level.

Parental grief following the death of an infant--a follow-up over one year.

The course of parental bereavement during the first year following an infant's death was investigated. Also, the differences in mothers' and fathers' reactions, the differences according to the mothers' occupational role, and the similarities in couples' reactions were studied. From a total sample of 59 families, 13 families answered their questionnaires at all three time points (1, 6 and 13 months), 22 families responded at two time points, and 37 families responded at some point following the loss. Measures relating to anxiety, depression, bodily discomfort, general well being and impact of event were used at the three time points. The results showed that grief, as measured by the different inventories, decreased over time. The decrease was most evident from 6 to 13 months, and most prominent in women. A considerable number of the parents were still actively dealing with the loss all through the first year of bereavement. In most couples the mother reported most distress. Mothers were significantly more depressed than fathers at all time points, and mothers also had significantly higher anxiety and lower general health at 1 and 13 months, and intrusive scores of 1 and 6 months. Women at home evidenced more grief at all three time points than women employed outside the home. A high or low score in one spouse was more strongly correlated with a similar score in the other at 1 and 13 months, than at 6 months. The implications for counselling of parents, with special emphasis on the employment situation of the mother, is emphasized.

Parental reactions to the loss of an infant child: a review.

This article examines methodological problems, and describes and evaluates commonly explored variables regarding research on the effect of an infant's death on the family. The components of parents' and siblings' grief reactions, and the similarities and differences in parental grief are reviewed. The research shows marked differences between mothers' and fathers' reactions--the grief reactions in mothers being stronger and more prolonged. Different explanations for this are put forward. The effect of different types of loss as well as the effect of the child's life span before death are also reviewed and discussed. Further knowledge is needed to single out the influence of these factors' on the families' reactions. It is concluded that the death of an infant makes the family prone to develop short-term and/or long-term problems in their adaptation to the loss. An integrated effort by health professionals is needed to develop systematic ways of helping families to cope with the death of a child.