Bereaved Families Research Articles

Complicated Grief, PTSD, and PTG in Bereaved Family: Moderating Effect of Resilience and Family Support

Despite the well-known negative ripple effect of the death of a loved one on the bereaved family, there is a lack of research that empirically examines the relationship between bereavement experience and the psychological adaptation process of the bereaved. Therefore, this study aimed to examine the relationship between complicated grief, posttraumatic stress disorder (PTSD), and posttraumatic growth (PTG) in the bereaved family. The results revealed that PTG of the bereaved could be promoted more effectively by an integrated intervention to promote personal competencies for resilience accompanied by strong family support compared to separate interventions of resilience and family support.

Unmet psycho-social needs of parents of children who die from cancer.

e24005 Background: Cancer is the leading disease-related cause of death for children in the United States, but there is limited data on the needs of caregivers who have lost a child to cancer, and few evidence-based bereavement interventions exist. Parents whose children die from cancer have increased rates of depression, anxiety, and health problems. Prior studies have shown that bereaved parents desire continued contact with their child’s medical team and to connect with parents who have had similar losses. Methods: This is a cross sectional survey of primary caregivers of pediatric patients who died from cancer and were cared for at a moderate size pediatric oncology program (50 new diagnoses per year) from 2010 to 2020. Participation was solicited by mail in English and Spanish. Research packets contained five surveys: Demographic Survey, The Needs Assessment for Family Caregivers Bereaved to Cancer, Quality of Life Survey (SF-36), Brief Grief Assessment, and Social Support Questionnaire (SSQ-6). Interested subjects also participated in a semi-structured, in-depth qualitative interview. Results: One hundred six potentially eligible families were identified. 27 families consented, 10 were without a known address, and 2 opted out. Twenty research packets and 9 interviews were completed, representing 19% of the population of interest and 23% of the invited population. The sample was diverse in gender, age, income, and education level, but not race. The greatest unmet needs were finding meaning in the death, personal wellness, and social activities. Caregivers reported good physical functioning but poor emotional well-being and fatigue. Complicated grief was most profound in the interference (grief interfering with life) and intrusion (images and thoughts of the child) domains. Quantity of social support correlated with satisfaction with social support (P = 0.02). Bereaved parents with greater unmet needs were found to have poorer quality of life in the following domains: energy/fatigue (P = 0.005), role limitations due to emotional problems (P = 0.01), pain (P = 0.01), and emotional well-being (P = 0.02). Greater unmet needs did not correlate to more complicated grief (P = 0.30) or satisfaction with social support (P = 0.08). Interview themes elicited were inadequate current bereavement services, necessary support for siblings, desired contact with the medical team, and connections to other bereaved caregivers. Conclusions: Findings support the need for implementation of more intensive evidence-based bereavement programs for families of children who died from cancer. The data suggests that interventions targeting emotional well-being and increased social supports, in the form of connections to the medical team and other bereaved families, will be the most efficacious in mitigating poor bereavement-related outcomes.

The Demographic Drivers of Grief and Memory After Genocide in Guatemala.

Mortality crises are relatively common demographic events, but we know little about how they affect local populations beyond excess mortality. I argue that using a kinship perspective to study mortality crises provides valuable insights into (1) how excess mortality affects the exposure to kin loss and (2) how family bereavement may contribute to the reproduction of historical memory in the long term. I explore these two processes using a unique genealogical database that records the complete demographic history of Rio Negro, a genocide-affected population in Guatemala, between 1982 and 2015. The analysis shows that deaths from the 1982 genocide were balanced by age, sex, and socioeconomic status. One third of the population were killed, but two thirds were left bereaved (the top 10% most affected individuals lost 30% of their nuclear family relatives and 23% of their extended family relatives). Notably, the proportion of the population related to a victim did not change between 1983 and 2015. The persistence of family bereavement can be interpreted as a prolongation of grief or as a driver of historical memory. These demographic dynamics have implications for the study of historical events beyond mortality crises.

Changes in Cultural Values of Ma'pasilaga Tedong (Case Study on Death Services in Lembang Sarambu, Buntu Pepasan District, North Toraja Regency

This paper describes the socio-cultural changes that occur in the Lembang Sarambu community, Buntu Pepasan District, North Toraja, in the ma'pasilaga tedong tradition, along with the factors that influence the occurrence of these social changes. The method used in this research is the descriptive qualitative method, with data collection techniques of observation, interviews, and documentation. The results in this study are the values contained in the ma'pasilaga tedong tradition, namely 1) cultural values, ma'pasilaga tedong is a tradition that has been passed down from generation to generation to perfect the implementation of the rambu solo ceremony; 2) the value of customs, the Toraja people believe that the buffalo is a sacred animal; 3) moral values, in the ma'pasilaga tedong tradition, the buffalo that will be competed are buffalo that have certain criteria, such as the buffalo that will be competed must be the buffalo that will be sacrificed for the corpse; 4) social values, namely the tradition of ma'pasilaga tedong cannot be carried out if there is no solo sign ceremony'. The values that have changed in the ma'pasilaga tedong tradition are: 1) moral values, where the ma'pasilaga tedong tradition which originally aimed to comfort the bereaved family and as a form of empathy for the bereaved family has now become a gambling arena for ma'pasilaga tedong ; 2) and the initial social value of ma'pasilaga tedong was only done in one day, namely when there was a rambu solo' ceremony, but now it has been carried out for days even though the rambu solo' ceremony is not held. With the factor of cultural changes that occur caused by internal factors; population and discoveries and external factors; war and other cultural influences.

The Children Left Behind: The Need for Public Policies to Meet the Needs of Children Orphaned by COVID-19

COVID-19 has had a huge impact on the social, cultural, economic, education, tourism, trade and other sectors in Indonesia. Of all of these, health and humanitarian issues are those most highlighted. This research involved a literature search of books, journal articles and manuscripts of government regulations. Discussing the death rate from COVID-19 is not only a question of how many people have lost their lives in Indonesia due to contracting the disease, but also of the conditions and survival of the families left behind, especially children who have lost their parents due to COVID-19. The psychological aspects of the families of COVID-19 victims have often been neglected. As yet, the Government still largely focuses on the sick or dead and has not paid much attention to the bereaved families, especially children, who are in dire need of assistance. In Indonesia, there are 11,045 children who have become orphans, fatherless, or motherless because their parents or caregivers died due to COVID-19.1 This raises concerns regarding how their clothing, food and shelter needs can be met, along with their needs related to the rights to education, physical and psychological health, and security and safety. Therefore, procedures, coordination, schemes for protecting children’s rights, and mitigation actions involving public policies must notice and meet the needs of children who have lost their parents due to the COVID-19 pandemic.
 Keywords: COVID-19, children, assistance, public policy

A Scoping Review of Interventions for Family Bereavement Care during the COVID-19 Pandemic.

The death of a loved one is a major stressor, and bereaved people are at a higher risk of negative health effects. This risk is higher during the COVID-19 pandemic, which raises the need for understanding existing bereavement support interventions. This scoping review aimed to map and summarize findings from the existing literature regarding bereavement support interventions (i.e., psychosocial and psychotherapeutic interventions) for family carers of people who died of COVID-19. The Arksey and O’Malley methodological framework was used. Five databases—Medline, PubMed, CINAHL, Scopus, and Web of Science—were searched for articles available from the inception of COVID-19 pandemic (March 2020) to January 2022, following the PRISMA guidelines. Among the 990 studies identified, only seven met this study’s inclusion criteria. The analysis comprised three key topics: types of support programmes and bereavement interventions; tools used to measure the outcomes; and evidence of the impacts of the interventions. All studies analysed included interdisciplinary interventions, commonly developed in clinical settings. Support for recently bereaved individuals can entail cognitive behavioural therapy strategies and other tools to educate, guide, support, and promote healthy integration of loss. To mitigate the effects of non-normative family bereavement, we recommend a systematic approach and coordination between organizational settings, including access to informal and professional support, in order to find hope while navigating the aftermath of COVID-19.

The invisible body work of ‘last responders’ – ethical and social issues faced by the pathologists in the Global South

ABSTRACT This paper utilises empirical data to explore the value of ‘body work’ performed by last responders charged with the duty of dead body management, with a focus on the Global South. While frontline staff work to save lives, little is known about the experiences and roles of those who care for the dead in global health in times of crises and even during normal times. This paper discusses ethical and socio-cultural challenges pathologists face in ‘working on the bodies of others’ while conducting any form of post-mortem procedures – necessary for ascertaining and recording the causes of death. Identifying and reporting the cause of death have significant public health benefits and provide closure for bereaved families. Despite the foregoing, the pathology field does not attract funding from governments or donors, and it is overlooked compared to other disciplines. Autopsy procedure bears social stigma – as it is associated with body mutilation and therefore disrespecting the dead; certain cultural beliefs or taboos about impurity and death persist, further raising some social and ethical tensions. As a result, the dearth of autopsy procedures contributes to the cause of death uncertainty in global health.

The 3 Wishes Program Improves Families’ Experience of Emotional and Spiritual Support at the End of Life

BackgroundThe end-of-life (EOL) experience in the intensive care unit (ICU) is emotionally challenging, and there are opportunities for improvement. The 3 Wishes Program (3WP) promotes the dignity of dying patients and their families by eliciting and implementing wishes at the EOL.AimTo assess whether the 3WP is associated with improved ratings of EOL care.Program DescriptionIn the 3WP, clinicians elicit and fulfill simple wishes for dying patients and their families.Setting2-hospital academic healthcare system.ParticipantsDying patients in the ICU and their families.Program EvaluationA modified Bereaved Family Survey (BFS), a validated tool for measuring EOL care quality, was completed by families of ICU decedents approximately 3 months after death. We compared patients whose care involved the 3WP to those who did not using three BFS–derived measures: Respectful Care and Communication (5 questions), Emotional and Spiritual Support (3 questions), and the BFS-Performance Measure (BFS-PM, a single-item global measure of care).ResultsOf 314 completed surveys, 117 were for patients whose care included the 3WP. Bereaved families of 3WP patients rated the Emotional and Spiritual Support factor significantly higher (7.5 vs. 6.0, p = 0.003, adjusted p = 0.001) than those who did not receive the 3WP. The Respectful Care and Communication factor and BFS-PM were no different between groups.DiscussionThe 3WP is a low-cost intervention that may be a feasible strategy for improving the EOL experience.

Did the Quality of ICU End-of-Life Care Suffer During the COVID-19 Pandemic? (GP710)

Outcomes1. Learn the components of the Bereaved Family Survey and what it measures2. Describe whether there were changes in end-of-life care ratings after the pandemic startedImportanceGiven strained resources and visitation restrictions, families might have perceived lower-quality end-of-life (EOL) care during the COVID-19 pandemic.Objective(s)We compared families’ ratings of EOL care before and during the COVID-19 pandemic.Method(s)Next-of-kin (NOKs) of patients who died in the ICUs of a two-hospital healthcare system between July 2019 and April 2021 were asked to complete a modified Bereaved Family Survey (BFS). We compared care quality reports for patients who died before and during the pandemic using single-item questions and two measures derived from the BFS: Respectful Care and Communication (5 items, alpha = 0.82) and Emotional and Spiritual Support (3 items, alpha = 0.77). Multivariable regression was used to adjust for demographic and clinical characteristics.ResultsOf 1,029 patients who died in the ICU during the study period, 133 of 388 (34%) NOKs completed the survey before the pandemic and 181 of 639 (28%) during the pandemic. Among those for whom surveys were received, pandemic decedents had higher sequential organ failure assessment score on ICU admission (8.0 vs 6.0, p < 0.01), fewer palliative care consultations (28% vs 40%, p = 0.03), and fewer advance directives (30% vs 44%, p < 0.01) than decedents before the pandemic. In multivariate analysis, NOKs of pandemic decedents more frequently reported that they were notified of impending death (90.6% vs 79.7%, p < 0.01). There was no difference in the global rating of EOL care (63.2% vs 63% rating it as excellent, p = 0.59) or Emotional and Spiritual Support or Respectful Care and Communication factors.Conclusion(s)Despite visitation restrictions, the modified BFS did not detect a difference in families’ overall ratings of quality of EOL care in the ICU among decedents before and during the pandemic.ImpactOur study shows that the quality of EOL care can be preserved during periods of stress such as the COVID-19 pandemic.

Bereaved Family ‘Involvement’ in (Prisoner) Death Investigations: Whose ‘Satisfaction’?

A duty to investigate deaths in detention is enshrined within international legislation including Article 2 of the European Convention on Human Rights (ECHR). A core purpose of these investigations, following UK case law, is that bereaved families ‘have the satisfaction of knowing that lessons learned […] may save the lives of others.’ We highlight the striking absence of evidence illustrating the ‘satisfaction’ of bereaved families, utilising a case study of prisoner death investigations undertaken by the Prisons and Probation Ombudsman (PPO) and Coroners in England and Wales. Drawing on data from semi-structured interviews with 26 stakeholders, we explore what may produce familial ‘satisfaction’ and question who is satisfied by prisoner death investigations. Our analysis demonstrates that bereaved family ‘satisfaction’ was regularly spoken about by investigators and invoked to legitimise investigations despite limited evidence thereof. In conclusion, we highlight how the Ombudsman and Coroners should reconsider their practices to better satisfy families and manage expectations.

‘The human toll’: Highlighting the unacknowledged harms of prison suicide which radiate across stakeholder groups

Internationally, prisoner mortality rates are up to 50% above those in the community. Although prisoner deaths are frequent and have significant implications across a broad range of stakeholder groups, these harms are rarely acknowledged. We address this by presenting original data from semi-structured interviews with 19 senior Prison Service staff (representing 8 prisons and 11 regions) and 16 Ombudsman investigators in England and Wales. These professional groups have received limited consideration in previous research. Without negating implications for bereaved families and other prisoners, we demonstrate that scholars have grasped neither the impacts of prisoner deaths on investigators, nor the extent of the harms experienced through investigations. All stakeholders benefit from reducing prisoner suicides, but death investigations do not enable stakeholders’ ‘shared ground’ to be mobilised. Currently, death investigations compound the harms of deaths.

Facilitators and barriers in using comics to support family caregivers of patients receiving palliative care at home: A qualitative study

Background: Family caregiving at home is highly important for people receiving palliative treatment, but also a complex experience, subject to implicit social expectations. This study empirically explored the claim that comics benefit palliative care practice, through evaluating a graphic novel’s value as an aid in supportive conversations with family caregivers. Aim: To identify facilitators and barriers in using Naasten (Loved ones), a Dutch research-based graphic novel about family caregivers providing care at the end-of-life. Design: Qualitative study, following thematic content analysis. Setting/participants: Three focus groups with family caregiver consultants, palliative care volunteers, and healthcare professionals (total N = 23) who supported family caregivers; and individual telephone interviews with family caregivers to whom the book was presented (N = 4). Results: Barriers and facilitators related to: (1) the family caregiver, (2) impact on the family caregiver, (3) impact on the conversation between the person who provides support and the family caregiver, (4) their relationship, and (5) the person who provides support. Naasten was reported as recognizable and supportive, and powerful in raising emotions, awareness and conversation. Barriers concerned the book’s impact due to its style and guidance of a conversation, and doubts about its surplus-value. Conclusions: Emotionally impactful comics may support bereaved family caregivers, but should be introduced with care among current family caregivers, for example, ensuring a right fit, introduction, and follow-up—while taking into account a caregiver’s individual situation, needs, abilities, and affinity with the medium. Comics are preferably used in educational settings, contributing to professional awareness and tailored support of family caregivers.

Bereaved Family Members' Perspectives of Good Death and Quality of End-of-Life Care for Malignant Pleural Mesothelioma Patients: A Cross-Sectional Study.

Objective: This study investigated whether malignant pleural mesothelioma (MPM) patients achieved good deaths and good quality of end-of-life care compared with other cancer patients from the perspective of bereaved family members in Japan. Methods: This cross-sectional study was part of a larger study on the achievement of good deaths of MPM patients and the bereavement of their family members. Bereaved family members of MPM patients in Japan (n = 72) were surveyed. The Good Death Inventory (GDI) was used to assess the achievement of good death. The short version of the Care Evaluation Scale (CES) version 2 was used to assess the quality of end-of-life care. The GDI and CES scores of MPM patients were compared with those of a Japanese cancer population from a previous study. Results: MPM patients failed to achieve good deaths. Only 12.5% of the MPM patients were free from physical pain. The GDI scores of most of the MPM patients were significantly lower than those of the Japanese cancer population. The CES scores indicated a significantly poorer quality of end-of-life care for the MPM patients than the Japanese cancer population. The total GDI and CES scores were correlated (r = 0.55). Conclusions: The quality of end-of-life care for MPM patients remains poor. Moreover, MPM patients do not achieve good deaths from the perspective of their bereaved family members.

Determinants of alcohol use among the youth in the Bosomtwe District, Ashanti Region- Ghana

Background: Alcohol consumption accounts for major health related morbidity and mortality in the world with more than 3 million deaths and increasing global disease burden. The use of alcohol among the youth is very crucial due to prolonged complications established throughout the entire life of the individual. Objectives: This study aims to determine the factors that influence alcohol use among the youth in the Bosomtwe district of Ashanti Region, Ghana. Method: A cross- sectional study design was used for this study. The sample size estimated was 383 using the StatCalc tool on Epi Info 7, for the estimated population size with a 5% error margin. P-value of £0.05 was considered statistically significant at 95% confidence interval. Responses were collected from participants who consented to the study. The participant selection was dependent on the eligibility criteria for the study. The data was processed and analyzed with STATA 14. Chi- squared analysis was done to establish association between the independent and dependent variables. Results: 51.7% of the participants from the Bosomtwe district had consumed alcoholic beverage before with 71.86% currently consuming alcoholic beverage. Majority (63.70%) of the participants knew alcohol had adverse effect on the various organs of the human body. 50.51% were introduced to alcohol use by their peers with 51.51% of them being influenced by their peers on the choice of alcoholic beverage. Most of the participants (45.45%) consumed alcoholic beverage due to the content displayed during advertisement with 66.16% being influenced to consume alcoholic beverage following bereaved family member or friend. Almost 70% of the participants consumed their first alcoholic drink between the age of 20-24years. Majority (64.14%) of the participants consumed alcohol just for fun. The significant factors influencing alcohol use in the study were educational status of the participants, gender, information gathered about alcoholic beverages and during bereavement. There were significant association between information regarding alcohol use, policies on alcohol consumption, bereavement of family members and current alcohol consumption with p-values of 0.008, 0.019 and 0.001 respectively. Conclusion: More than 70% of the participants in the Bosomtwe district were currently consuming alcoholic beverage with 53.55% of them engaging in binge drinking. Most of the participants had suffered some complications following alcohol use. There is the need for appropriate interventions in this area to reduce the morbidity and mortality related to alcohol use.

Does 'Time Heal all Wounds?' The Prevalence and Predictors of Prolonged Grief Among Drug-Death Bereaved Family Members: A Cross-Sectional Study.

Despite rising rates of drug-related deaths (DRDs), the consequences of DRDs for bereaved family members are scarcely investigated. This study aimed to estimate the prevalence of prolonged grief (PG) symptoms in bereaved family members after DRDs, identify predictors of PG and examine whether symptom levels decrease with time. A cross-sectional design based on survey data from parents (n = 93), siblings (n = 78), children (n = 24) and other family members (n = 39) was conducted (n = 234). Descriptive analyses, a multivariate linear regression, and ANOVA were performed. 60 family members (26%) suffered from high levels of PG symptoms after DRDs (parents 31.2%, siblings 21.8%, children 20.9%). The strongest associations were found between a high level of symptoms and 'months since the loss', 'suicidal thoughts' and 'withdrawal from others'. The ANOVA analyses showed that time does not always 'heal all wounds', and the bereaved who lost one to 2years ago had the highest level of PG symptoms.

Amplified Cardiopulmonary Recordings: Music Therapy Legacy Intervention with Adult Oncology Patients and Their Families—A Preliminary Program Evaluation

Background: Amplified cardiopulmonary recording (ACPR) is a unique music therapy intervention implementing recorded heartbeats with meaningful music. Although its clinical application has grown, there is limited research on the acceptability and usage by bereaved families. Objective: The research objective was to understand the frequency recipients engaged with ACPR after their loved one died. Design: A survey was undertaken with relatives of 191 adult patients who had participated in ACPR. Setting/Subjects: Bereaved loved ones of adult oncology patients who received care at the Norton Cancer Institute in Louisville, Kentucky, USA. Results: Out of the 191 participants, 73% of family members responded, 49% reported listening to their recording frequently, 31% listened to the recording at least once after receiving it, and 20% reported never listening. Conclusions: ACPR appears to have moderate acceptability and usage among bereaved family members, especially when created in the context of ongoing music therapy treatment. We recommend that this process-based music therapy intervention be studied further and offered proactively.

The impact of death rattle on bereaved families: not the sound itself, but the resonance with their feelings.

This study aimed to explore (i) the consistency between physician-rated and bereaved family-perceived intensity of death rattle, (ii) the relationship between intensity of death rattle and the bereaved family's distress and (iii) the bereaved family's experience and feelings related to suctioning for death rattle. We used matched data for deceased patients from a prospective cohort study of cancer patients admitted to a palliative care unit, and their bereaved families from a nationwide questionnaire survey in Japan. The intensity of death rattle using Back's score was evaluated prospectively by physicians and retrospectively by bereaved families. In total, 1122 bereaved families answered (response rate: 66.7%). Of these, 297 reported the development of death rattle. The maximum intensity of death rattle evaluated by physicians and perceived by bereaved families was poorly correlated (Spearman correlation coefficient 0.188, P=0.082). The optimal cut-off point of Back's score for detecting high-level distress was 1/2, with a low accuracy of prediction (area under the curve 0.62). More than 70% of bereaved families indicated suctioning reduced the intensity of death rattle, made patients comfortable and themselves relieved, whereas a similar proportion felt patients were in distress during suctioning. Families who felt suctioning was gently performed and discussed well whether to do suctioning with health care providers felt less needs for improvement. Bereaved family-perceived intensity of death rattle did not correlate to physician-evaluated intensity, and the intensity of death rattle itself seemed to poorly correlate to family distress. Gently performed suctioning based on sufficient discussion with families can help reduce family-perceived patient discomfort.

“That Little Bit of Time”: Transition-to-Hospice Perspectives from Hospice Staff and Bereaved Family (S531)

“That Little Bit of Time”: Transition-to-Hospice Perspectives from Hospice Staff and Bereaved Family (S531)

Factors associated with the decision to offer memory making in end-of-life: A survey of healthcare professionals in adult intensive care.

Report experiences and behaviour influences with healthcare professionals' decision to and experiences of offering memory making during end-of-life care in the adult acute population. Little is known about healthcare professionals' experiences offering memory making during adult acute end-of-life care. Survey. Registered nurses, medical practitioners and social workers employed at a single tertiary referral adult intensive care, where memory making had been implemented nearly two years prior were invited to participate between June and August 2017. Reporting adheres to the STROBE checklist. Ninety-six valid surveys (75% response rate: 75 registered nurses, 19medical practitioners, and 2social workers) were analysed with 67 participants reporting experience offering memory making. Highest overall agreement scores included believing families value memory making and the offer of memory making being beneficial. Enablers were described as organisational supports, personal qualities and good interpersonal relationships. Barriers identified included the intensive care environment, workload, inexperience offering/facilitating memory making, being afraid to offer, lack of resources and legality concerns. Compared with non-experienced participants, experienced participants reported higher level of confidence and comfort offering memory making, pride in their ability, ability to spend time supporting families and had observed colleagues offering memory making. Experienced participants were less likely to be afraid to offer, be limited by the family's behaviours, report lack of resources or be time limited to offer memory making. Findings identify elements needed for the development and support for offering memory making to assist bereaved families in adult acute care including role modelling, support to reduce negative emotions, workload assistance and leadership/organisational support. Discoveries have important implications in addressing evidence gaps regarding behaviour influences linked to the decision to offer memory making. Findings inform development and sustainability to integrate memory making as routine end-of-life care intervention in adult acute care.

Analyzing The Grief of Naomi in The Book of Ruth

This article analyzed the grief of Naomi in the book of Ruth by using the six stages of grief by Elisabeth Kübler-Ross and David Kessler. Although Naomi could be an inadequate model in dealing with her grief, her attitude resonates with many people in dealing with their griefs. It makes this study is noteworthy. This article analyzed how Naomi dealt with her grief in the six stages of grief, namely: denial, anger, bargaining, depression, acceptance, and finding the meaning and then take the implication for the ministry during the pandemic of Covid-19. The study showed that anger and depression are visible in the story of Naomi. Acceptance is not explicit. There is no denial, bargaining, and finding the meaning stages in Naomi’s grief. She was still struggling with her grief, although she could accept the new situation with the marriage of Ruth and Boaz and the birth of Obed. Today many people struggle with grief during this pandemic. Therefore, it is essential to pay attention to vaccines and medication and notice the need for psychological help and therapy for the bereaved families.