Interventions for adult survivors of intrafamilial homicide: A review of the literature.

Individuals bereaved by intrafamilial homicide, in which the perpetrator and decedent were both members of the same family, experience an elevated risk for risk for mental health complications. Given the contextual complexity of intrafamilial homicide (IFH) and the negative sequalae this form of loss can engender, psychological interventions may assist survivors with adjustment on a number of fronts. This scoping review therefore addresses an important knowledge gap by summarizing the limited information on interventions specific to intrafamilial homicide survivors. Results failed to identify interventions specific to IFH bereavement, though interventions that may be deemed appropriate are highlighted and described. As such, this scoping review provides a practical synthesis of evidence-based and evidence-informed psychological interventions for traumatic loss that are applicable to and may hold promise for this vulnerable population. Recommendations for future research and best practices with intrafamilial homicide survivors are also discussed.

Behavioral activation is associated with post-disaster mental health: Secondary longitudinal analysis from a population-based study.

OBJECTIVE: Interventions in post-disaster environments may be accelerated by identifying protective behavioral factors adding incremental value to models of psychopathology using longitudinal methods. One protective behavior applicable to post-disaster contexts is behavioral activation (BA). BA is defined here as a behavioral pattern involving presence of valued activity engagement. While relevant post-disaster, the incremental value of BA behaviors in predicting longitudinal post-disaster outcomes is not well understood. We hypothesized that higher baseline engagement in behaviors consistent with a BA framework would predict decreased posttraumatic stress disorder (PTSD) symptom severity, depression symptom severity, and sleep disturbance approximately 3, 6, and 12 months after hurricane survivors completed baseline measures. METHODS: The current study is a secondary analysis from a randomized controlled trial of a disaster mental health digital intervention. Participants completed surveys at baseline and approximately 3, 6, and 12 months post-enrollment. Correlations and hierarchical regression analyses were calculated following data screening to predict PTSD symptom severity, depression symptom severity, and sleep disturbances. RESULTS: Controlling for alcohol use, prior trauma, displacement, and intervention condition, higher baseline BA consistently predicted less PTSD symptom severity, depression symptom severity, and sleep disturbances. CONCLUSION: Results suggest that post-disaster interventions should consider addressing BA. The study provides evidence that BA is potentially an important protective factor longitudinally predicting sleep disturbances and psychopathology after natural disasters.

Moving toward transdisciplinary approaches to addressing HIV and psychological trauma: Barriers and facilitators to building collaborations.

Most people living with HIV have experienced potentially traumatic events (e.g., physical assault, sexual assault, intimate partner violence) and, consequently, are at risk of trauma-related mental health difficulties, including posttraumatic stress disorder (PTSD). Yet, research and clinical efforts related to HIV and psychological trauma remain siloed. Guided by the four-phase model of transdisciplinary research, the current study explored barriers and facilitators to transdisciplinary HIV/trauma clinical and research collaborations to address the overlap between HIV and psychological trauma. This exploration represents an initial step in the development and conceptualization of a transdisciplinary team known as Team REACH (Resiliency, Engagement, and Accessibility for Comorbid HIV/PTSD), which seeks to address the overlap between HIV and psychological trauma. Barriers and facilitators were explored through individual qualitative interviews with 21 research and clinical staff members across two clinics within an academic medical center (i.e., an infectious diseases clinic and a trauma-focused specialty mental health clinic). The findings revealed a number of barriers, including a lack of awareness, time and funding concerns, and a lack of clarity regarding services or the division of responsibility. The results also highlight perceived facilitators for collaborations, such as existing infrastructure and relationships, shared goals, leadership support, knowledge of other agency activities, and staff/team buy-in. Recommendations for increased collaboration included ongoing communication, needs assessment and goal development, access to partners, and role establishment. These findings will guide the next steps in further developing transdisciplinary collaboration goals and have implications for increasing collaborative approaches to patient care and targeting processes to enhance team effectiveness for transdisciplinary goals.

Perceived Barriers and Facilitators to Treatment for Alcohol Misuse Among Survivors and Victim Service Professionals Following Sexual Assault and Intimate Partner Violence.

Survivors of sexual assault (SA) and intimate partner violence (IPV) report high rates of alcohol misuse and often receive services from community agencies. We conducted a qualitative study to examine barriers and facilitators to treatment for alcohol misuse after experiences of SA/IPV among survivors (N = 13) and victim service professionals (VSPs; N = 22) at community-based agencies using semi-structured interviews and focus groups. Survivors discussed seeking treatment for alcohol misuse when alcohol is being used to cope with SA/IPV-related distress and when alcohol use becomes problematic. Survivors identified that stigma and acknowledgment of alcohol misuse are individual-level barriers and facilitators to treatment. System-level factors were also described including having access to treatment and sensitive providers. VSPs also discussed individual (e.g., stigma) and system (e.g., availability and quality of services) level barriers and facilitators to treatment for alcohol misuse. Results indicated several unique barriers and facilitators to treatment for alcohol misuse following SA/IPV.

Predictors of Stigma, Guilt, and Shame among Adults Bereaved by Fatal Overdose.

With the spectacular rise of US overdose deaths, bereavement for these affected families has become a matter of increasing concern. Qualitative research has highlighted the role of stigmatization as well as guilt and shame among this population. However, the magnitude and pre-death predictors of stigmatization, guilt, and shame have yet to be assessed quantitatively. In the current study, we assess the magnitude of stigmatization, guilt, and shame among 115 adults bereaved by overdose by drawing comparisons with 185 adults bereaved by suicide. Results revealed no significant differences regarding overall levels of stigmatization, guilt, and shame between the overdose and suicide bereaved. Among the overdose bereaved, regression models indicated a number of pre-death factors associated with stigmatization, guilt, and shame, such as the frequency of the decedent's drug use, family drug use severity, and interpersonal conflict between the bereaved and the decedent. Implications and future directions for research are discussed.

Development and psychometric validation of the Dying Imagery Scale-Revised.

Survivors of sudden death losses frequently experience vivid imagery associated with the events surrounding their loved one's death. This paper describes the development and psychometric validation of the Dying Imagery Scale-Revised (DIS-R), a 15-item measure assessing three forms of death imagery, including Reenactment, Remorse, and Revenge imagery. The first study details the development of the DIS-R in a sample of suddenly bereaved college students. The second study examines the validity and reliability of the DIS-R among suddenly bereaved adults. Results suggest that the measure is psychometrically sound and may provide clinically useful information for bereavement counselors.

Interventions for child and adolescent survivors of intrafamilial homicide: A review of the literature.

The nature of intrafamilial homicide is complex and traumatic. Child survivors are at significant risk for maladjustment, including negative psychological sequela, grief complications, and contextual challenges associated with the homicide. Thus, children may benefit from services addressing specific psychosocial challenges following intrafamilial homicide. In this paper, we review the literature to identify trauma- and grief-informed interventions implemented for youth following violent bereavement. Given limited research on this vulnerable population, we discuss interventions that show promise for child survivors, exploring specific needs, challenges, and potential implications of these interventions for treating children and families experiencing intrafamilial homicide bereavement.

Substance Use Prevention Programming for Adolescents and Young Adults: A Mixed-Method Examination of Substance Use Perceptions and Use of Prevention Services.

BACKGROUND: Although substance use problems are highly prevalent among adolescents and emerging adults, this population does not regularly receive substance use prevention programming in their communities. Low perceived risk of substance use, which is linked to actual behavior, may contribute to low rates of engagement in community prevention efforts for substance use. To examine this, the current study used a mixed methods approach to: (1) examine the relationship between engagement in prevention education and substance use; and, (2) analyze qualitative data on education programs offered in the community to help identify strengths and gaps in prevention resources. Method: Quantitative and qualitative data were collected from adolescents (age 13-18) and young adults (age 19-25) living in the Southeast, recruited from local schools and community events to participate in a preventive intervention focused on prevention of HIV, substance use, and other risky behaviors. Prior to engagement in this intervention, self-report questionnaires were completed by adolescents assessing: substance use, perceived risk, and engagement in substance use education classes. Focus groups were also conducted with adolescents recruited from a local high school and young adults recruited from local colleges to obtain additional information about engagement in education programs. Results: Regarding perceived risk, 71.8% of adolescents reported moderate to great risk in having five or more drinks once or twice a week and 43% of adolescents reported moderate to great risk in smoking cannabis once or twice a week. Forty-four percent of adolescents had talked to one of their parents about the dangers of tobacco, alcohol, or drug use in the past year. Further, 18% of adolescents had been to a class or program on prevention of alcohol and other drug abuse in the past month and 50.7% had heard, read, or watched an advertisement about prevention of substance use in the past year. Qualitative results Eight overarching themes, each with its own sub-themes, emerged from the participant's responses during the focus groups. Each is described below with representative quotes provided throughout for illustrative purposes. Conclusions: Findings revealed several gaps in resources identified by adolescents and young adults that are needed to adequately address substance use, which provide important next steps for substance use prevention among youth.

Novel Application of Skills for Psychological Recovery as an Early Intervention for Violent Loss: Rationale and Case Examples.

This article describes a novel application of Skills for Psychological Recovery (SPR)-a brief, early intervention developed by the National Center for Posttraumatic Stress Disorder and the National Child Traumatic Stress Network-for families grieving the violent death of a loved one. Drawing on conservation of resources theory, SPR incorporates cognitive-behavioral skills-building modules to help survivors cope with trauma-related distress and posttrauma resource loss. The authors describe the intervention and illustrate the use of SPR for violent loss by presenting data from two cases involving a suicide survivor and a homicide survivor. Implications for future research are discussed.

Web-based CBT for the prevention of anxiety symptoms among medical and health science graduate students.

Medical and health science graduate students report greater anxiety problems than the general population, but they are less likely to seek treatment due to cultural and logistical barriers. One preventative approach that overcomes these barriers is web-based cognitive behavioral therapy (webCBT). It is unknown whether webCBT is effective for preventing anxiety escalation within this population. A randomized controlled trial was conducted, comparing the effects of webCBT versus a control group (CG). Medical university students (n=594; Mage=27; 67% female; 80% Caucasian) completed online baseline measures and four assigned online activities. Measures were re-administered after approximately three months. There was a small interaction effect between time of assessment and treatment condition. Anxiety severity was lower in the webCBT (M[SD]=2.88[3.36]) versus CG condition (M[SD]=3.69 [3.35]) at follow-up. This effect was moderate for students with mild, versus minimal, anxiety at baseline. The proportion of students with possible anxiety disorder was lower in the webCBT (4.5%) versus CG (8.5%) condition, and the proportion of mildly anxious students with a clinically significant increase in symptoms was lower in the webCBT (10%) versus CG (20%) condition. WebCBT may aid in preventing anxiety escalation in this population, particularly for at-risk students who report mild anxiety symptoms.

Module-based comprehensive approach for addressing heterogeneous mental health sequelae of violent loss survivors.

Significant strides have been made in the trauma and grief fields to address the unique needs of those who have lost a loved one to violent death. Several treatment techniques have been found to be effective for symptoms of trauma and grief that are prevalent among violent loss survivors including restorative retelling and cognitive behavioral strategies. Current interventions either are tailored for a specific mental health problem or are more universal in nature for grief related to violent loss. This paper presents an evidence-based and guided modular approach for responding to the myriad potential mental health needs of violent loss survivors. A comprehensive module-based structured intervention for violent loss survivors, which specifically targets several common mental health difficulties following traumatic loss, may offer clinicians a thorough and flexible approach guided by clinical assessment to address the distinctive and common issues violent loss survivors often face.

Introduction to the special section: Integrative approaches for treating violent loss survivors.

Survivors of sudden, traumatic death are at risk for a variety of bereavement-related mental health problems, including posttraumatic stress disorder, depression, and prolonged grief disorder. Because these conditions often cooccur, traumatic grief interventions are generally designed to be transdiagnostic, integrative treatments that combine techniques designed to treat a wide range of mood and anxiety symptoms. In this special section, expert clinicians and researchers present a series of papers describing new, integrative treatment models for violently bereaved children and adults and also describe ways that integrative treatments can be enhanced using peer support.

Introduction to the special section: Creative applications of Restorative Retelling.

Restorative Retelling is a structured, group-based intervention for violent loss survivors. Preliminary evidence supports the effectiveness of Restorative Retelling as a tertiary intervention for bereavement-related mental health problems. Providers delivering treatments like Restorative Retelling, however, should recognize that many survivors will likely encounter a number of barriers to care that can make engaging in structured, time-intensive interventions rather difficult. In this special section, we introduce a series of articles by expert clinicians and researchers describing creative applications of the restorative retelling model that simultaneously aim to mitigate known barriers to care and promote engagement in violent loss treatment.

Survivors' perspectives on a modular approach to traumatic grief treatment.

Understanding survivors' perspectives on treatment is important in a patient-centered approach to developing interventions for traumatic loss. Focus groups were conducted with 23 motor vehicle crash, suicide, and homicide survivors. Survivors' attitudes toward a modular treatment for traumatic loss were assessed. This study also sought to explore survivors' perspectives on the acceptability of existing evidence-based practice elements in the treatment of bereavement-related mental health problems. Qualitative analyses suggest that survivors liked a modular treatment approach and agreed that existing practice elements could be useful in addressing bereavement-related concerns. Implications for developing a modular treatment package for traumatic loss are discussed.

The Relationship Between Experiences With the Criminal Justice System and Mental Health Outcomes Among Survivors of Homicide.

Homicide survivors are at increased risk for mental health disorders, including depression, posttraumatic stress disorder (PTSD), and complicated grief (CG). Accordingly, this survey study examined how satisfaction with the criminal justice system (CJS) was associated with depression, PTSD, and CG among 47 homicide survivors. It also examined how satisfaction with specific aspects of the CJS related to satisfaction with the overall CJS. Satisfaction with the overall CJS was uniquely associated with depression (odds ratio [OR] = 2.32; 95% confidence interval [CI] [1.16, 4.66]) while satisfaction with the police department was uniquely associated with CG (OR = 2.14; 95% CI [1.02, 4.47]). Satisfaction with having input into the CJS process and satisfaction with efforts devoted by the CJS to apprehend the perpetrator were uniquely related to satisfaction with the overall CJS (ß = .49, p = .003 and ß = .40, p = .007, respectively).

Associations between motor vehicle crashes and mental health problems: data from the National Survey of Adolescents-Replication.

Motor vehicle crashes (MVCs) are a leading cause of physical injuries and mortality among children and adolescents in the United States. The purpose of this study was to examine associations between having an MVC and mental health outcomes, including posttraumatic stress disorder (PTSD), depression, and drug and alcohol misuse in a nationally representative sample of adolescents. A sample of 3,604 adolescents, aged 12-17 years, was assessed as part of the 2005 National Survey of Adolescents-Replication (NSA-R) study. Data were weighted according to the 2005 U.S. Census estimates. Within this sample, 10.2% of adolescents reported having at least 1 serious MVC. The prevalence of current PTSD and depression among adolescents having an MVC was 7.4% and 11.2%, respectively. Analyses revealed that an MVC among adolescents aged 15 years and younger was independently associated with depression (OR = 2.17) and alcohol abuse (OR = 2.36) after adjusting for other risk factors, including a history of interpersonal violence. Among adolescents aged 16 years and older, an MVC was associated only with alcohol abuse (OR = 2.08). This study was the first attempt to explore adverse mental health outcomes associated with MVCs beyond traumatic stress symptoms among adolescents in a nationally representative sample.

Child sexual abuse prevention training for childcare professionals: an independent multi-site randomized controlled trial of Stewards of Children.

Given the significant rates and deleterious consequences of childhood sexual abuse (CSA), identifying effective primary prevention approaches is a clear priority. There isa growing awareness that childcare professionals (e.g.,teachers, childcare personnel, clergy) are in a unique position to engage in prevention efforts due to high accessibility to children and expertise in child development. However, CSA prevention programs targeting childcare professionals have received insufficient attention. The goal of this study was toc on duct an independent multi-site controlled evaluation of an existing CSA prevention program, Stewards of Children, offered through both in-person and web-based formats. This study included 352 childcare professionals recruited from children's advocacy centers across three states. Participants were randomly assigned to one of three conditions: (1) inperson training, (2) web-based training, or (3) waitlist control. Dependent variables included CSA knowledge, CSA attitudes,and self-reported CSA preventive behaviors. Results indicated that Stewards impacted knowledge, attitudes, and preventive behaviors. No differences were found between training modalities (i.e., in-person versus web-based) on knowledge and preventive behaviors. Results indicate that brief trainings for childcare professionals may impact CSA prevention efforts.

Survivors of Homicide: Mental Health Outcomes, Social Support, and Service Use Among a Community-Based Sample.

This study aims to explore rates of bereavement-related mental health outcomes and diagnostic comorbidity along with the associations between mental health outcomes, perceived social support, knowledge of services, and service use among a diverse sample of 47 survivors 2 years post loss. Findings are consistent with prior studies in that homicide is associated with an overlapping of significant symptom presentation of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and complicated grief (CG). Lack of grief-specific social support was demonstrated to be associated with PTSD and MDD but not with CG. Although a significant number of survivors reported poor mental health outcomes, a limited number were using services.

Prevalence and Co-Occurrence of Psychiatric Conditions Among Bereaved Adults.

Importance: Rates of grief-related psychiatric conditions, such as prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD), among bereaved adults in the US are largely unknown due to limited studies that leverage national samples. Objective: To assess risk factors for and prevalence rates and co-occurrence of PGD, PTSD, and MDD among bereaved adults in the US. Design, Setting, and Participants: Data for this survey study were collected from a large US panel sample between October 10 and 28, 2022, using a web-based survey. Participants were aged 18 years or older and were proficient in English. Data analysis was conducted between March and June 2023. Main Outcomes and Measures: Probable psychiatric conditions were assessed with validated measures that used conservative cutoff scores, duration, and impairment criteria. These measures included the revised Prolonged Grief Disorder scale for PGD, the PTSD Checklist for DSM-5 for PTSD, and the Patient Health Questionnaire-9 for MDD. Data were analyzed using basic descriptives and logistic regression. Results: A total of 2034 adults (n = 1529 and 505 in the bereaved and comparison groups, respectively) completed the study. Respondents had a mean (SD) age of 40.7 (15.9) years; the majority were women (1314 [64.6%]) and had at least some college experience (1394 [68.5%]). With regard to race and ethnicity, 392 respondents (19.3%) were Black, 138 (6.8%) were Hispanic, and 1357 (66.7%) were White. Among bereaved adults, 312 (20.4%), 518 (33.9%), and 461 (30.2%) met criteria for a presumptive diagnosis of PGD, PTSD, and MDD, respectively. Comorbidities were common, with 441 participants (28.8%) meeting criteria for at least 2 co-occurring disorders. Comorbid PGD, PTSD, and MDD were more common than any 2 co-occurring or isolated disorders; the presence of co-occurring conditions was more likely among respondents who reported a traumatic loss. Age and educational attainment were associated with the risk of psychiatric conditions; less time since the index death, loss of a psychologically close other, and a traumatic loss experience were associated with increased risk of PGD, PTSD, and MDD or their co-occurrence. Conclusions and Relevance: In this study, the majority of bereaved adults did not meet presumptive criteria for PGD, PTSD, or MDD. Nevertheless, PGD, PTSD, and MDD were highly prevalent and comorbid, particularly among those who experienced traumatic loss. These findings underscore the need for integrated psychological care that leverages transdiagnostic mechanisms of evidence-based practice.

The relationship between knowledge and child and caregiver distress during the medical examination for child sexual abuse.

When child sexual abuse is suspected, a child sexual abuse-related medical examination is recommended to ensure the child's well-being. While the extant research has sought to identify factors influencing child distress during this examination, only recently have studies began examining variables that may be directly associated with the child or with the medical setting. Knowledge of the child sexual abuse-related medical examination is one medical-related variable that has been implicated in child and caregiver distress during the examination. The current study contributes to the existing literature by investigating associations among examination knowledge in relation to caregiver and child anxiety at the time of a child sexual abuse-related medical examination, taking into account ethnicity, past child abuse, injury to child as result of abuse, and caregiver response to disclosure. Sixty-eight children and their nonoffending caregiver were assessed. Results indicated that understanding of the examination and caregiver response to disclosure were significantly associated with caregiver and child anxiety.