The UK National Homicide Therapeutic Service: a retrospective naturalistic study among 929 bereaved individuals

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

Predicting transitions between longitudinal classes of post-traumatic stress disorder, adjustment disorder and well-being during the COVID-19 pandemic:protocol of a latent transition model in a general Dutch sample

BACKGROUND: A growing body of literature shows profound effects of the COVID-19 pandemic on mental health, among which increased rates of post-traumatic stress disorder (PTSD) and adjustment disorder (AD). However, current research efforts have largely been unilateral, focusing on psychopathology and not including well-being, and are dominated by examining average psychopathology levels or on disorder absence/presence, thereby ignoring individual differences in mental health. Knowledge on individual differences, as depicted by latent subgroups, in the full spectrum of mental health may provide valuable insights in how individuals transition between health states and factors that predict transitioning from resilient to symptomatic classes. Our aim is to (1) identify longitudinal classes (ie, subgroups of individuals) based on indicators of PTSD, AD and well-being in response to the pandemic and (2) examine predictors of transitioning between these subgroups. METHODS AND ANALYSIS: We will conduct a three-wave longitudinal online survey study of n≥2000 adults from the general Dutch population. The first measurement occasion takes place 6 months after the start of the pandemic, followed by two follow-up measurements with 6 months of intervals. Latent transition analysis will be used for data analysis. ETHICS AND DISSEMINATION: Ethical approval has been obtained from four Dutch universities. Longitudinal study designs are vital to monitor mental health (and predictors thereof) in the pandemic to develop preventive and curative mental health interventions. This study is carried out by researchers who are board members of the Dutch Society for Traumatic Stress Studies and is part of a pan-European study (initiated by the European Society for Traumatic Stress Studies) examining the impact of the pandemic in 11 countries. Results will be published in peer-reviewed journals and disseminated at conferences, via newsletters, and media appearance among (psychotrauma) professionals and the general public

Psychopathology in a treatment-seeking sample of homicidally bereaved individuals:Latent class analysis

Background: Violently bereaved individuals are at increased risk of developing severe and comorbid disorders. Comorbidity may increase psychiatric symptom severity and suicide risk and decrease psychosocial functioning compared with having one disorder. We aimed to identify subgroups of individuals with similar symptom patterns, describe prevalence rates and overall levels of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) per class, and explore associations between class membership and personal and homicide related variables. Methods: We investigated the comorbidity of symptoms of PGD, PTSD, MDD, and GAD in a sample of 923 treatment-seeking homicidally bereaved individuals by deploying latent class analysis. Results: Three subgroups were identified: (i) a moderate distress, low depression class (12.4%), (ii) a high distress, moderate depression class (42.7%), and (iii) a high distress and high depression class (45.0%). Prevalence rates and total scores of the questionnaires followed the pattern of iii ≥ ii ≥ i (ps ≤ .001). Being female and having experienced prior life stress distinguished between all classes (ps ≤ .05). Limitations: The data-driven analytic approach and reliance on self-reported routine outcome monitoring data limit the generalizability and validity of the study. Strengths include the large sample size and the inclusion of four measures in a treatment-seeking, violently bereaved sample. Conclusions: Classes were most clearly distinguishable based on symptom severity, indicating high comorbidity following bereavement by homicide. This argues for an integrated treatment that targets different complaints simultaneously rather than successively

Predicting transitions between longitudinal classes of post-traumatic stress disorder, adjustment disorder and well-being during the COVID-19 pandemic: protocol of a latent transition model in a general Dutch sample

Stress and Psychopatholog

Prevalence matters : The influence of socio-demographic and loss-related variables on the development of prolonged grief disorder

A meta-analysis is currently being conducted on pro-longed grief disorder (PGD) following unnatural losses.Preliminary results indicate a much higher prevalencethan the prevalence of PGD following natural losses. Inaddition, other loss-related variables may be associatedwith PGD prevalence. This symposium aims to illustratethe clinical implications of these‘prevalence matters’bypresenting two studies of large help-seeking samples ofbereaved individuals. The first study is based on datafrom 942 Western homicidally bereaved individuals. Thesecond study examined data from 2404 Arabic speakingbereaved individuals. The third study introduces a cultu-rally-sensitive online assessment measure of PGD forSwiss, Japanese and Chinese bereaved individuals

Towards an integrated conceptualization of traumatic grief

Recently, the diagnoses Persistent Complex Bereavement Disorder (PCBD) and prolonged grief disorder (PGD) have been included in DSM-5 and ICD-11, respectively. However, there is an ongoing discussion about which concepts and which criteria best describe the phenomenon of disturbed, complicated or traumatic grief. In this symposium, we will discuss several studies that offer different perspectives on the conceptualization of this condition. In the first presentation the difference in factor structure, prevalence and validity of disturbed grief in DSM-5 and ICD-11 will be discussed. Furthermore, the symposium covers presentations about the influence of culture on the nature and assessment of (disturbed) grief symptoms, symptoms predicting problematic grief trajectories and variables associated with alleviation of disturbed grief symptoms during traumatic grief-focused CBT for homicidally bereaved people. At the end, participants will be up-to-date on the recent scientific discussions about the conceptualization of traumatic grief

Prevalence and predictors of psychiatric disorders in a large help-seeking sample of homicidally bereaved persons

Background: Literature on grief reactions in the after-math of a homicide is scarce and inconclusive, oftendescribing small and heterogenous (sub)samples, yield-ing varying results. Method: Data of 942 individuals who are bereaved due to homicide were analysed. Data wereobtained from ASSIST Trauma Care UK, a specialistThird Sector (Not-for-Profit) Organization providingspecialist therapeutic intervention to homicide survivors.Measures included questionnaires assessing symptomsof PTSD, PGD, anxiety and depression, as well as socio-demographic and homicide related characteristics. Results: Prevalence rates of PTSD, PGD and clinicallyrelevant anxiety and depression were generally quitehigh. Status of the judicial process was one of the vari-ables rendering people prone to elevated distress.Conclusions: This study provides insight into the preva-lence and correlates of grief-related disorders followingbereavement through homicide. Information obtainedcan inform the improvement of treatment options

Different glomerulopathies accompanying non-small-cell lung cancer

PubMedID: 16021324The coexistence of lung cancer and glomerular lesion is not commonly reported. Malignancy-related glomerulopathy is commonly membranous glomerulonephritis. Other glomerulopathies are seldom reported. We report two cases presenting with non-small-cell lung cancer, acute renal failure and nephrotic syndrome secondary to membranoproliferative glomerulonephritis and amyloidosis. © The Mount Sinai Journal of Medicine

Risk and protective factors for symptom reduction following traumatic grief focused CBT

Background: Although it appears evident that emotional consequences of homicidal loss merit clinical attention, options for both preventative and curative treatments are scarce. To date, few studies have examined treatments specifically targeting emotional problems of homicidally bereaved individuals. Objective: To offer a preliminary evaluation of the potential effects of a traumatic grief-focused outreaching model of care. Method: Pre- and post-treatment data were obtained from 942 individuals who underwent traumatic-grief focused CBT provided by ASSIST Trauma Care UK designed specifically for homicide survivors. Baseline levels of PTSD, prolonged grief disorder, anxiety, depression and general functioning as well as change scores were estimated using latent growth models in Amos. Sociodemographic, therapy and homicide related characteristics were included as predictors. Results: A significant decline in scores was found on all measures, and effects were found on sociodemographic, therapy and homicide related characteristics, both on op baseline levels and change scores. Conclusions: The shown impact of several predictors on baseline and change scores underlines the importance to tailor treatment to the specific needs associated with individual and homicide related characteristics following a homicide

Plasma homocysteine level and 677C -> T mutation on the MTHFR gene in patients with venous thromboembolism

WOS: 000275575500003PubMed ID: 20429317Background: The aim of this study was to evaluate the role of plasma total homocysteine level and 677C -> T mutation on the methylene tetrahydrofolate reductase (MTHFR) gene in the development of venous thromboembolism. Methods: Thirty-six (18 male, 18 female and mean+SD; 48.3 +/- 15.5 years) patients with venous thromboembolism and 25 healthy adults (13 male, 12 female and mean SD; 46.8 +/- 9.2 years) were included in the study. Fasting plasma total homocysteine level was determined by a high performance liquid chromatography. 677C -> T mutation on the MTHFR gene in peripheral blood was detected by Real Time-PCR method. Results: The level of plasma total homocysteine (18.5 +/- 10.6 mu mol/L) was significantly higher in patients with venous thromboembolism than in the control group (11.0 +/- 4.7 mu mol/L) (p=0.015). 677C -> T mutation on the MTHFR gene heterozygosity was higher in the patient group than in the control group [13 (36.1%) and 2 (8%) respectively] but this difference was not significant (p=0.07). Conclusion: It is thought that a high plasma total homocysteine may cause venous thromboembolism (Tab. 2, Ref. 21). Full Text (Free, PDF) www.bmj.sk