Abstract
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.
Highlights
In response to the death of a loved one, many people experience acute emotional distress and symptoms of mental health disorders, which generally decrease over time
The current study introduced and evaluated the effects of an outreaching model of care following bereavement through homicide and examined whether baseline symptom severity and functional impairment and their changes during treatment varied as a function of sociodemographic- and homicide-related characteristics, having a history of mental health problems and treatment-related characteristics
Prevalence of severe symptoms across disorders and general functional impairment at baseline was high, adding to the body of literature describing the broad range of detrimental effects of homicide on the mental health of homicide survivors [e.g., [13]]
Summary
In response to the death of a loved one, many people experience acute emotional distress and symptoms of mental health disorders, which generally decrease over time. In recent literature on pathological grief reactions, PGD [1] is referred to as persistent complex bereavement disorder (PCBD), a condition identified for further study in the DSM-5 [American Psychiatric Association (APA) [2]]. Every homicide is estimated to affect the lives of approximately 7 to 10 close relatives [7, 8], as well as those of numerous friends, neighbors, and co-workers. Those affected are often referred to as “homicide survivors” [9]. Homicide survivors are typically underrepresented in media coverage, research reports, and government funds, that tend to focus on perpetrators [7, 10]
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