Traumatische rouw bij nabestaanden na geweldsmisdrijven: diagnostiek en behandeling

Volgens het Nederlandse Centraal Bureau voor de Statistiek (2022) is 5,4% van alle overlijdens in Nederland in 2020 (9030 van 168.678) het uiteindelijke gevolg van uitwendige (“niet-natuurlijke”) doodsoorzaken. Het gaat hierbij om ongevallen (71,2%, 6433), zelfdoding (20,2%, 1823) moord en doodslag (1,2%, 107), overig geweld (7,1%, 639) en gebeurtenissen opzet onbekend (0,3%, 28). Bij nabestaanden is het risico op traumatische rouw na een dergelijk ’traumatisch’ verlies sterk verhoogd vergeleken met een verlies door ziekte van een dierbare. Herkenning en behandeling van traumatische rouw, die veelal gepaard gaat met intens lijden en beperkingen in functioneren, is van groot belang; behandeling kan leiden tot aanzienlijke klachtenreductie, ook langere tijd na het verlies

Traumatische rouw bij nabestaanden na geweldsmisdrijven: diagnostiek en behandeling

Volgens het Nederlandse Centraal Bureau voor de Statistiek (2022) is 5,4% van alle overlijdens in Nederland in 2020 (9030 van 168.678) het uiteindelijke gevolg van uitwendige (“niet-natuurlijke”) doodsoorzaken. Het gaat hierbij om ongevallen (71,2%, 6433), zelfdoding (20,2%, 1823) moord en doodslag (1,2%, 107), overig geweld (7,1%, 639) en gebeurtenissen opzet onbekend (0,3%, 28). Bij nabestaanden is het risico op traumatische rouw na een dergelijk ’traumatisch’ verlies sterk verhoogd vergeleken met een verlies door ziekte van een dierbare. Herkenning en behandeling van traumatische rouw, die veelal gepaard gaat met intens lijden en beperkingen in functioneren, is van groot belang; behandeling kan leiden tot aanzienlijke klachtenreductie, ook langere tijd na het verlies

Prolonged Grief Disorder in Section II of DSM-5:A Commentary

The American Psychiatric Association (APA) has proposed to change the position of disturbed grief in DSM-5, replacing criteria for Persistent Complex Bereavement Disorder (PCBD), currently in Section III (APA, 2013), for criteria for Prolonged Grief Disorder, to be moved into Section II (APA, 2020). In our view, it is a welcome step if criteria for DSM-5 PGD are added to Section II, as disordered grief would then be recognized as a formal DSM diagnosis. We also have some concerns about the DSM-5 PGD proposal, that we hope can be allayed in the process toward the appearance of the revised DSM-5. These concerns are articulated in this letter

Expert medico-legal reports: The relationship between levels of consistency and judicial outcomes in asylum seekers in the Netherlands

Introduction: If asylum applicants need to prove that they have been persecuted in their home country, expert judgment of the psychological and physical consequences of torture may support the judicial process. Expert medico-legal reports can be used to assess whether the medical complaints of the asylum seeker are consistent with their asylum account. It is unclear which factors influence medical expert judgement about the consistency between an asylum seeker’s symptoms and story, and to what extent expert medico-legal reports are associated with judicial outcomes. Methods: We analysed 97 medico-legal reports on traumatised asylum seekers in the Netherlands. First, we evaluated the impact of trauma-related and other variables on experts’ judgments of the consistency of symptoms and story. Second, we evaluated the effect of experts’ judgments of symptom-story consistency on subsequent judicial outcomes. Results: Gender, receipt of mental health care and trauma-related variables were associated with symptomstory consistency. Positive asylum decisions were predicted by expert judgments about the presence of physical signs and symptoms of torture, and ill-treatment and their consistency with the refugee’s story, but not psychological symptoms. Conclusion: These results suggest that standardised procedures for the documenting of medical evidence by independent experts can improve judicial decision quality and the need to improve psychological and psychiatric assessments

Cognitive therapy and EMDR for reducing psychopathology in bereaved people after the MH17 plane crash:Findings from a randomized controlled trial

Experiencing a sudden/violent loss of a significant other is a risk factor for developing persistent complex bereavement disorder (PCBD), depression, and/or posttraumatic stress disorder (PTSD). Cognitive therapy (CT) combined with eye movement desensitization and reprocessing (EMDR) might be an effective treatment for bereaved people with PCBD, depression, and/or PTSD symptoms after sudden/violent loss. We tested the effects of CT + EMDR versus waitlist controls in disaster-bereaved people. In a multicenter randomized controlled trial, changes in self-rated PCBD, depression, and PTSD levels were compared between an immediate treatment and waitlist control group in 39 Dutch people who experienced loss(es) in the disaster with flight MH17, using multilevel modeling. Associations between reductions in symptom levels and reductions in maladaptive cognitive- behavioral variables were examined using regression analyses. The immediate treatment group showed a significantly stronger decline in depression (Hedges' g = 0.61) compared with waitlist controls (Hedges' g = 0.15). No significant between-groups differences were found in PCBD and PTSD levels. Symptom reductions were correlated with reductions in maladaptive cognitive- behavioral variables. Although CT + EMDR coincided with symptom reductions associated with reductions in negative cognitions and avoidance behaviors, more research with larger samples is needed to further examine the effectiveness of CT + EMDR in bereaved people after sudden/violent loss

Acute grief after deaths due to COVID-19, natural causes and unnatural causes:An empirical comparison

Background: There are now over 800,000 registered deaths due to the COVID-19 pandemic worldwide. Researchers have suggested that COVID-19 death characteristics (e.g., intensive care admission, unexpected death) and circumstances (e.g., secondary stressors, social isolation) will precipitate a worldwide increase of prolonged grief disorder (PGD) and persistent complex bereavement disorder (PCBD). Yet, no study has investigated this. Since acute grief is a strong predictor of future pathological grief, we compared grief levels among people recently bereaved due to COVID-19, natural, and unnatural causes. Methods: People bereaved through COVID-19 (n = 49), natural causes (n = 1182), and unnatural causes (n = 210), completed self-report measures of demographic and loss-related characteristics and PGD and PCBD symptoms. Results: COVID-19 bereavement yielded higher symptom levels of PGD (d = 0.42) and PCBD (d = 0.35) than natural bereavement (but not unnatural bereavement). Effects held when limiting analyses to recent losses and those who participated during the pandemic. Expectedness of the death explained this effect. Limitations: Limitations include using a convenience sample and self-report measures. Conclusions: Higher grief levels occur among people bereaved due to COVID-19 compared to people bereaved due to natural loss. We predict that pandemic-related increases in pathological grief will become a worldwide public health concern

Online cognitive–behavioural therapy for traumatically bereaved people:study protocol for a randomised waitlist-controlled trial

Introduction The traumatic death of a loved one, such as death due to a traffic accident, can precipitate persistent complex bereavement disorder (PCBD) and comorbid post-traumatic stress disorder (PTSD) and depression. Waitlist-controlled trials have shown that grief-specific cognitive–behavioural therapy (CBT) is an effective treatment for such mental health problems. This is the first study that will examine the effectiveness of online CBT (vs waitlist controls) in a sample exclusively comprised of people bereaved by a traumatic death. Our primary hypothesis is that people allocated to the online CBT condition will show larger reductions in PCBD, PTSD and depression symptom levels at post-treatment than people allocated to a waitlist. We further expect that reductions in symptom levels during treatment are associated with reductions of negative cognitions and avoidance behaviours and the experience of fewer accident-related stressors. Moreover, the effect of the quality of the therapeutic alliance on treatment effects and drop-out rates will be explored. Methods and analysis A two-arm (online CBT vs waiting list) open-label parallel randomised controlled trial will be conducted. Participants will complete questionnaires at pretreatment and 12 and 20 weeks after study enrolment. Eligible for participation are Dutch adults who lost a loved one at least 1 year earlier due to a traffic accident and report clinically relevant levels of PCBD, PTSD and/or depression. Multilevel modelling will be used. Ethics and dissemination Ethics approval has been received by the Medical Ethics Review Board of the University Medical Center Groningen (METc UMCG: M20.252121). This study will provide new insights in the effectiveness of online CBT for traumatically bereaved people. If the treatment is demonstrated to be effective, it will be made publicly accessible. Findings will be disseminated among lay people (eg, through newsletters and media performances), our collaborators (eg, through presentations at support organisations), and clinicians and researchers (eg, through conference presentations and scientific journal articles). Trial registration number NL7497