Assessing and Treating Childhood Traumatic Loss

This study explores exposure to community violence (CV) and traumatic loss and their relation to posttraumatic stress disorder (PTSD) and grief symptoms among Guatemalan aid workers. Out of 135 workers surveyed, 79% reported that someone close to them had died, and 33% reported a loss that was rated as traumatic. The average number of lifetime incidents of CV reported was 13, and the highest was 32. In all, 36% of the sample reported symptoms that meet criteria for PTSD.Those participants who reported a traumatic loss also reported significantly higher complicated grief (CG) scores, and those who reported a traumatic human-perpetrated loss also reported significantly higher levels of hyperarousal PTSD symptoms than those who reported a traumatic loss that was nonhuman perpetrated.

Background: When traumatic events and losses intersect in the form of traumatic loss, these events can trigger both posttraumatic stress disorder and pathological grief. Objective: This systematic review investigates which characteristics differentiate between the development of the respective disorders or are associated with comorbidity. Method: A systematic literature search using Medline, PubMed, APA PsycInfo and Web of Science yielded 46 studies which met the inclusion criteria. In these studies, PTSD was assessed using 17 and pathological grief using 16 different validated instruments. In the quality assessment, 12 studies were classified as average, 30 as above average, and 4 as excellent. The investigated risk factors were categorized into 19 superordinate clusters and processed using narrative synthesis. Results: The relationship to the deceased, mental health issues, and religious beliefs seem to be associated specifically with pathological grief symptoms compared to PTSD symptoms. Social support and social emotions emerged as significant correlates and potential risk factors for both PTSD and pathological grief. Included studies had mainly cross-sectional designs. Conclusions: Differentiating factors between pathological grief and PTSD appear to exist. The results should be considered within the limitations of the heterogeneity of the included studies and the research field. There is a lack of studies (1) using a longitudinal study design, (2) starting data collection early following the traumatic loss, (3) using standardized, up-to-date measurement instruments and (4) including comorbidity in their analyses. Further research is urgently needed for more accurate (acute) screenings, prognoses, and interventions following traumatic loss.

Introduction:Significant traumatic bone loss in developed countries occurs in a high proportion of open fractures ranging from 11.4% to 40%. However, literature from developing countries such as Uganda scarcely documents the prevalence and patterns of traumatic bone loss. Direct trauma and iatrogenic factors have been associated with traumatic bone loss as possible etiologies.Objective:The study was aimed at establishing the prevalence and patterns of traumatic bone loss following open long bone fractures, and identifying factors associated with traumatic bone loss among patients presenting to Mulago Hospital within 24 hours of sustaining the injury up to completion of the initial fracture debridement, reduction, and fixation.Methodology:It was a prospective cohort study conducted at Mulago Hospital. A total of 136 open long bone fractures were registered and physically examined for traumatic bone loss. Patients who consented were recruited consecutively to participate in the study. Data on the patients’ sociodemographics and fracture patterns were collected using pretested questionnaires and analyzed using Stata version 12.Results:From 123 patients, a total of 136 open long bone fractures were registered. The prevalence of traumatic bone loss following open long bone fractures was 26.5%. Of the 36 open long bone fractures with traumatic bone loss, the more common pattern (61.1%) was significant traumatic bone loss (≥ 2.5 cm long). Commercial motorcycle riders (22.0%) and traders (20.3%) were the most common occupations associated with open long bone fractures. Gunshot injuries were the leading cause of traumatic bone loss in open long bone fractures.Conclusion:Our setting has a high prevalence of traumatic bone loss among open long bone fractures with the majority occurring in Gustilo type IIIB injuries of the tibia. The likelihood of traumatic bone loss is higher in open fractures caused by gunshots.

In the literature on grief and loss, it is noticed that the quest or the reconstruction of meaning after a traumatic loss of significant others has a crucial impact on successfull coping with this traumatic experience. Existing research proves that traumatic loss strongly shatters the system of meaning of a trauma survivor, and thus it becomes harder to integrate this experience into the self structures or personal memory. This relation between quest or the reconstruction of meaninng and difficulties to cope with traumatic loss is a multidimensional process. Authors investigating it frequently get quite controversial results. However, it is necessary to combine and compare studies made in this field and to summarize the knowledge of quest or reconstruction of meaning having or not an impact on coping with traumatic loss. There, several problematic aspects emerge. One of the basic ones is that there are some attempts to generalize the process of grief after traumatic and other very different losses and the role of quest or reconstruction of meaning in this process. The problems may arise because different researchers have different attitudes and theoretical approaches to the meaning as such, use different concepts and definitions, e.g., if the concept finding meaning and quest of meaning means the same; regarding the problem of definitions, authors chose too distinct methods in their studies. During the last twenty years when attention to the quest or reconstruction of meaning after a traumatic loss is under investigation, there are quite a lot of results found, a huge variety of knowledge in this field; thus, it is needed to be able to generalize it. A more clear view to the quest or the reconstruction of meaning after a traumatic loss is important not only to scientists but also to practicians dealing with people surviving a traumatic loss of significant others as well. In this article, the main trends of researching the quest or reconstruction of meaning after a traumatic loss and the difficulties in comparing and generalizing the results of these different studies are discussed.

Loss is a commonly experienced traumatic event among children. Although the experience of loss can potentially lead to posttraumatic stress symptoms (PTSS), little is known about PTSS levels after traumatic loss versus other traumatic events. We investigated data from a randomized controlled trial (RCT) on trauma-focused cognitive behavioral therapy (TF-CBT) versus a waitlist condition for children with PTSS. In a secondary analysis, we compared participants who reported traumatic loss as their index event (n = 23) to those who reported the two most frequently reported index events in the RCT: sexual abuse (SA; n = 59) and physical violence (PV; n = 55). The index event was rated according to the participants' most distressing traumatic event reported on the Clinician-Administered PTSD Scale for Children and Adolescents. Participants who experienced traumatic loss reported fewer PTSS and better general functioning than those who reported SA. A subgroup RCT (n = 19) revealed TF-CBT to be highly effective in reducing PTSS in cases of traumatic loss, d = 1.69. The effect sizes for PTSS indicated that all three trauma groups benefited from TF-CBT. In the waitlist group, PTSS symptoms improved for SA and PV, ds = 0.76 and 0.98, respectively, but not for traumatic loss, d = 0.23. These findings suggest that TF-CBT is a feasible and promising treatment for children who experience PTSS after traumatic loss. The results are limited by the post hoc quality of the analyses and lack of a measure of grief in the RCT.

This article takes a sociocultural approach to examining creative responses to a traumatic death and loss and their contribution to further understanding of grief, identity, and continuing bonds. Based on qualitative interviews with family members bereaved after a drug- or alcohol-related death, the article explores how, in circumstances which threaten identity and continuity of being, grief may find expression through public and private creativity. Indeed, such creativity was apparent despite negative cultural representations of such deaths invalidating the grief of those left behind, who may suffer profound guilt, isolation, and disturbing memories. While interviewees reported such negative effects, psychologically considered symptomatic of complicated grief disorder, they also conveyed creative responses to negative stereotypes, rebuilding identities, and continuing bonds. These responses, through which interviewees communicated both vulnerability and resilience, revealed a complex and nuanced picture of grief following traumatic loss.

Introduction: Segmental loss of bone after traumatic injury can be managed with primary amputation or attempted limb salvage with bony regeneration. We aimed to describe our experience of treating traumatic bone loss at a tertiary level one trauma center and propose an approach to help in the treatment of these patients. Methods: Ten patients were identified via a search of the hospital's medical records covering a 5-year period. Each patient was then retrospectively reviewed with injury factors, treatment options, and final outcomes. Each patient was treated based on an anatomic approach developed by the unit to manage segmental bone loss. Results: Of the patients who underwent bony regeneration, we had four distal tibial fractures: three in the upper limb and one distal femoral fracture. Both primary amputation patients had tibial fractures. The mean bone loss was 88.5 mm. We employed bone transport in four cases, Masquelet in two, a free vascularized fibular graft and soft-tissue flap in one instance, and a combination of free vascularized fibula graft and Masquelet in another case. All patients achieved union, although the mean time to union in smokers was 1403 days, compared to 499 days in nonsmokers. Complications included three returns to theater for bone grafting and three recurrent soft-tissue infections. Post regeneration, the patients had a mean Short Form-36 score of 54.2, and most of the patients were “very satisfied” with the outcome of their surgeries. Conclusion: The regeneration of bone after traumatic loss is onerous on patients, is demanding for clinicians, and requires significant health resources. It should only be considered with appropriate patient buy-in and in the absence of contraindications.

ABSTRACTBackgroundIn response to extreme life events, individuals may experience not only distress but also positive transformation, known as posttraumatic growth (PTG). Only a few studies have investigated PTG following traumatic loss. This is the first study to investigate promotive factors—loss‐related, intrapersonal and interpersonal factors—immediately after the loss and 6 months later.MethodsA total of 36 participants (58% female, Mdn = 49 years) were invited by psychosocial crisis intervention teams. Data collection took place immediately after a traumatic loss (T1) and 6 months later (T2). Various sociodemographic, loss‐related, intrapersonal (e.g., symptomatic distress, posttraumatic cognitions) and interpersonal (e.g., social acknowledgement, self‐disclosure) variables were investigated. Sociodemographic and loss‐related variables were compared using inferential statistical group comparisons with regard to PTG. Multiple logistic regressions compared intrapersonal versus interpersonal factors to predict PTG at 6 months.ResultsParticipants were strongly affected by their level of exposure and the sudden or violent death circumstances of their close relatives. Among the sociodemographic and loss‐related characteristics, no association was found with PTG. Lower levels of acute symptomatic distress predicted higher PTG. After 6 months, interpersonal factors significantly predicted PTG, whereas intrapersonal variables showed no more association with PTG.ConclusionsThe results suggest that there is a complex relationship between intrapersonal and interpersonal factors and PTG immediately following traumatic losses as well as 6 months later, which can only partially be related to the existing literature. Further research in this important field is urgently needed to support individuals after traumatic losses.

ABSTRACTBackground: Confrontation with a traumatic (e.g. disaster-related) loss is a risk factor for the development of psychopathology, including symptoms of prolonged grief (PG), posttraumatic stress (PTS), and depression. Although interventions have been developed for reducing post-loss psychopathology, more research into the effectiveness of treatment is needed to improve care for bereaved persons. Cognitive therapy (CT) and eye movement desensitization and reprocessing (EMDR) have been shown to be effective in trauma-exposed populations. We hypothesize that CT and EMDR are also effective in reducing symptoms among people exposed to traumatic loss.Objective: In this article we describe the rationale of a randomized controlled trial (RCT) to examine (1) treatment effects of CT and EMDR for reducing PG, PTS, and depression among traumatically bereaved people, and (2) the associations between improvements in PG, PTS, and depression symptoms on the one hand and tentative mechanisms of change, including a sense of unrealness, negative cognitions, avoidance behaviour, and intrusive memories, on the other hand.Method: A two-armed (intervention versus waiting list controls) RCT will be conducted. Participants will be asked to fill in questionnaires prior to treatment, during treatment, and one, 12, and 24 weeks post-treatment. Potential participants are people who have lost one or multiple significant other(s) in the Ukrainian plane disaster in 2014 with clinically significant levels of self-rated PG, PTS, and/or depression. Multiple regression, including analysis of covariance, and multilevel regression analyses will be used.Discussion: There is a need for treatment for psychopathology following traumatic loss. Strengths of this study are the development of a treatment that targets grief and trauma-related complaints and the examination of potential mechanisms of change in CT and EMDR. Bereaved people, clinicians, and researchers could benefit from the results of this study.

Types of interpersonal loss through death, such as suicide bereavement, are associated with increased suicide risk. Quantification of suicide risk is less understood across the spectrum of traumatic (e.g., violent) and natural loss, representing a significant literature gap that could be addressed to inform the assessment of and intervention on suicide risk in bereaved adults. A web panel of 2,034 adult participants was administered via Qualtrics to gather data on suicide risk across loss types in bereaved individuals. Loss groups included (a) anticipated medical causes, (b) sudden medical causes, (c) car crash, (d) suicide, (e) homicide, and (f) fatal overdose. We also included individuals reporting no significant loss. Individuals with an anticipated medical loss reported the lowest suicide risk, with the highest risk reported by individuals experiencing suicide or homicide loss. Adjusting for perceived social support, individuals reporting an anticipated medical loss had lower suicide risk relative to suicide and homicide loss, while individuals with a sudden medical loss reported lower suicide risk than suicide loss. Individuals endorsing suicide loss described higher suicide risk than the no-loss group, and individuals in the homicide loss group reported higher suicide risk relative to the no-loss condition. Suicide risk was most elevated in traumatic loss conditions, particularly homicide and suicide loss groups. Results inform assessment and intervention surrounding bereaved individuals and suggest that individuals experiencing specific types of traumatic loss (i.e., suicide and homicide loss) are at the highest suicide risk and therefore may warrant additional screening and clinical attention. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background. In the world literature only a few cases of medial ankle reconstruction after its traumatic loss were described. The authors have not found similar cases in the Russian-language literature.
 The aim of the study is to show a rare clinical case of a patient with a traumatic defect of the medial ankle and to describe the method of its reconstruction.
 Case presentation. A 52-year-old patient suffered a motorcycle injury resulting in an open fracture of the medial ankle with bone fragment loss. The patient was taken to a medical facility where he underwent primary surgical treatment with wound suturing. Three months later, the reconstruction of the medial ankle with a free iliac crest autograft, medial ankle osteosynthesis and deltoid ligament plasty were carried out at N.N. Priorov National Medical Research Center of Traumatology and Orthopedics. In the postoperative period, immobilization of the ankle joint was performed for 4 weeks followed by the active development of motions and partial weight bearing 8 weeks after the surgery. The AOFAS score 12 months after the reconstruction was 93 points. According to CT scans, complete autograft integration was achieved and no signs of instability of the ankle joint were observed. The patient was satisfied with the performed surgical treatment.
 Conclusion. The most optimal method of treatment in case of traumatic defect of the medial ankle is its reconstruction with a free iliac crest autograft. This allows us to form a graft of required parameters and shape, minimizing the risk of postoperative complications.

Loss, stress and readjustment: The structure of coping with bereavement and disability

Between 44% and 87% of active duty service members and veterans who deployed following the September 11, 2001, terrorist attacks know someone who was killed or seriously injured in combat. Considering the high frequency and known impact of traumatic loss, it is important to understand if and how traumatic loss may impede posttraumatic stress disorder (PTSD) treatment progress in military personnel. Additionally, experiencing a traumatic loss elevates the risk of developing prolonged grief disorder (PGD), which is associated with higher levels of PTSD symptoms, more functional impairment, and more lifetime suicide attempts among military personnel. Given what is known about the association between PGD and PTSD in treatment-seeking service members and veterans, it is also important to understand whether grief-related symptom severity negatively impacts PTSD treatment response. The current study examined associations among traumatic loss, complicated grief, depressive symptoms, and PTSD treatment response among military personnel (N = 127) who participated in variable-length cognitive processing therapy (CPT). There was no direct, F(2, 125) = 0.77, p =.465, or indirect, β =.02, p =.677, association between a traumatic loss index event and PTSD treatment response compared with other trauma types. Prior assessments of depressive symptom severity were directly related to PTSD at later assessments across two models, ps <.001-p =.021 Participants with a traumatic loss index trauma demonstrated significant reductions in complicated grief, depressive symptoms, and PTSD following CPT, ps <.001, ds = -0.61--0.83. Implications, study limitations, and suggestions for future research are presented.

ON THE MORNING OF September 11, 2001, people the world over were riveted by breaking news of seemingly impossible events: simultaneous terrorist attacks, using three hijacked commercial airliners, on the World Trade Center in New York City and the Pentagon in Washington, D.C. As America awoke to the devastating reports on television and radio, the drama continued to unfold, until a fourth jetliner filled with passengers crashed into the earth in rural Pennsylvania, apparently falling short of its intended political target. In the subsequent hours, days, and weeks, the terrible cost of the terrorist acts continued to mount, with a death toll exceeding 3,000 people, who only hours before the attacks had begun their day’s work or travel unaware that it would be their last. Some of the losses touched Americans with particular poignancy, such as the tragic deaths of hundreds of New York City firefighters and police officers struggling in and around the damaged towers to evacuate survivors, who themselves were buried in the rubble of the collapsing structures. As the grim day ended, a nation and world community mourned the terrible loss of life. Immediate images and subsequent reports of the attacks symbolized both the personal and universal dimensions of catastrophe: scenes of individuals falling from windows 100 stories above the earth, contributing to mortality statistics tallying the deaths of citizens of more than 80 nations literally spanning the globe. And these deaths were only the most evident and anguishing of an unforeseeable range of losses—of health, livelihood, security, and much else—that would ripple through families, businesses, communities, and whole cultures in the months and years to come. The traumatic losses entailed by this attack draw attention to the frailty of human life, as well as the obvious and less than obvious impact of loss of life on survivors. This issue of Innovations focuses on the immediate and long-term effects of bereavement. Although untimely and violent deaths pose special challenges for the bereaved, even the anticipated death of a loved one can shake our emotional world, and produce surprising aftershocks. The emotional impact of such losses can be compounded by the misunderstanding, blame, or simple inattention of other people in institutional care settings, the family, workplace or community, adding a burden of private anguish, secrecy, or shame for those whose mourning is “hurried up,” disallowed, trivialized, or unrecognized by those around them.

Daily emotional experiences may vary depending on a stressor's intensity or source. The present study aimed to examine the interaction between traumatic loss, daily uplifts, and daily subjective age predicting daily negative affect. Results from a 14-day daily diary study of 440 US adults aged 50-85 showed that daily increases in uplifts were associated with decreases in negative affect, especially for those who reported a traumatic loss when they also experienced increases in subjective age. Based on our study, daily events and perceptions can have a considerable impact on daily functioning and may serve as important mechanisms after a traumatic loss. Although traumatic losses may impact individuals differently, incorporating daily uplifts, based on available resources and capacities, may foster daily emotional well-being.