Traumatic Loss Research Articles

CLINICAL, EPIDEMIOLOGICAL, AND NOSOLOGICAL CHARACTERISTICS OF INJURED INDIVIDUALS WITH MASSIVE BLOOD LOSS

Severe mechanical trauma is one of the major medical and social issues in modern society, resulting in more than 5.8 million deaths worldwide each year. The leading potentially preventable cause of death in such cases is massive, uncontrolled blood loss. Objective: to study and analyze the clinical, epidemiological, and nosological characteristics of injuries, as well as age, sex, and peculiarities of traumagenesis, in order to enhance the effectiveness of emergency medical care for victims with traumatic blood loss, in accordance with the standards of evidence-based medicine. Results. The study found that trauma cases leading to massive blood loss occur more frequently in males (78.4% men vs. 21.6% women). The largest proportion of male victims are aged 21 to 30 years (21.8%). Most injuries resulted from domestic incidents (29.3%), road traffic accidents (21.2%), and criminal acts (19.2%). The most common injury types were stab wounds (40.1%) and direct blows (23.3%). In terms of injury localization, the upper limb was most commonly affected (21.9%), followed closely by the lower limb (21.6%). Individuals injured in hostilities predominantly sustained mine-blast injuries, often associated with multifactorial combined injuries. Conclusions: The clinical-epidemiological and nosological characteristics of victims with massive traumatic blood loss indicate distinct risk groups based on age, sex, type, and mechanism of injury. It has established that these clinical and epidemiological features significantly influence both the outcome of the traumatic process and the effectiveness of emergency medical care.

Resilience and Loss During the Iron-Swords War: The Importance of Coping Strategies

The unprecedented events on October 7th in Israel, characterized by little actual and perceived control over the sources of the stress, have affected virtually every household in Israel, either due to the economic and social consequences of the ensuing war or experiencing the loss of relatives and friends. The current study examined the association between traumatic loss of close friends/relatives and resilience during the initial stages of the Iron-Swords war and explored the moderating role of coping strategies for this link. Data were collected from 286 participants (age range 19-82) who completed online scales assessing loss, resilience, and coping strategies during the first weeks of the Iron-Swords war. Results demonstrated a negative association between emotion-focused coping and resilience, as well as a positive association between problem-focused coping and resilience. Moreover, coping strategies moderated the loss-resilience link, which was significant only for individuals reporting low levels of both problem-focused and emotion-focused coping. Our findings support the claim that relying on at least one dominant coping strategy (i.e., problem-focused coping/emotional-focused coping/both) is efficient to reserve resilience levels at times of adversity. The findings of the current study, based on data collected in the first weeks of the Iron-Swords war, highlight the value of different coping styles in preserving individual resilience as a protective factor against stress during adversity.

The Grief Networks of Traumatic and Nontraumatic Deaths: Comparing Earthquake- and Illness-Related Losses.

Traumatic death is a risk factor for prolonged grief. Network analysis offers a perspective for understanding traumatic bereavement at a symptom interaction level. This study estimates regularized partial correlation grief networks for bereavement due to earthquake (n = 818) and illness (n = 237), using symptoms from the Inventory of Complicated Grief (ICG) as the nodes. Difficulty in accepting death and loneliness were highly central nodes in both networks. Trust difficulties and longing for the deceased exhibited high centrality in the earthquake-bereaved sample but not in the illness-bereaved sample. The earthquake bereavement network was characterized by high connectivity and a diversity of central symptoms. These results provide insights into understanding the severity of grief after a traumatic loss. Although promoting the integration of the reality of loss and alleviating loneliness is important, it might also be worth considering the role of post-loss interpersonal trust and the distress associated with longing for the deceased for traumatic bereavement.

Personal Pilgrimage Aids in Processing of Traumatic Grief in Survivors of Parent Suicide

A twenty-six-year-old female suffers traumatic loss after her father’s suicide. Client has endured approximately four months of complicated grief to date. She experiences, among other things, preoccupation with the end story, intense sorrow, sleeplessness, and appetite issues. Embarking on a series of 45-minute weekly sessions just two weeks prior, Client and I have thus far addressed her grief through re-membering exercises and an experiential therapy tactic called the Personal Pilgrimage.

Linking Objects for Traumatic Companion Animal Loss

A thirty-seven-year-old female suffers traumatic loss when a pack of urban coyotes attacks, mutilates, and kills her 12-year-old pocket beagle, Boogie. Female client endures problematic grief seven-plus months in nature. Among many other symptoms, she experiences intense sorrow, preoccupation with the deceased, and functional impairment. Client and I have been addressing her grief through a series of weekly, 90-minute sessions. In this fourth session, I introduce and articulate the experiential concept of linking objects.

Person-specific emotional dynamics: a story of a traumatic loss

The impact of traumatic loss on an individuals’ mental health is a critical area of study. While most research has focused on general grief patterns, the unique trajectories of trauma survivors have been understudied. This research utilizes a high-resolution dataset from a single individual over several years, including a period of unexpected tragedy. Using person-specific dynamic modeling and network analysis, the study examines the psychological processes related to traumatic loss. The results reveal a complex distress trajectory and emotional variability with increasing resilience over time. Findings suggest that traumatic loss can induce strongly interconnected emotional networks, typically linked to vulnerability to psychological disorders. Yet, a heightened correlation within a network representing both positive and negative aspects could indicate the emergence of adaptive coping strategies. The study emphasizes that analyzing emotional inertia and variability separately provides a holistic clinical perspective and deepens the understanding of diverse psychological states and affective dynamics. This research underlines the benefits of investigating individual experiences and stresses the need for idiographic approaches in trauma and grief studies. Future research utilizing high-resolution data from multiple individuals may provide a more comprehensive understanding of the diverse trajectories of grief and inform the future of personalized intervention and care.

Listening to the conversations of our bodies: Somatic intersubjectivity in psychotherapy

ABSTRACT This article explores the opportunities for client and therapist when somatic therapies and psychotherapy are brought together. Through a case study I illustrate how understandings and interventions from Intersubjective Self Psychology, Somatic Experiencing®, and Integral Somatic Psychology™ all supported the client’s emergence from profoundly somatised childhood traumatic loss, allowing them to restore thwarted developmental processes, rebuild affect tolerance, process their grief, and inhabit their life in new ways. I explicate how a deeply embodied psychotherapeutic relationship, where the conversations between the client and therapist’s bodies are held at the centre of the therapeutic relationship, can support reducing client re-traumatisation in therapy, meet early developmental needs, re-link affective layers allowing somatic and psychological (re)integration. I also explore the impact on, and possibilities for, the therapist of combining somatics and psychotherapeutic principles and techniques.

Meaning-making in psychotherapy after traumatic loss: therapists’ perspectives

ABSTRACT Sudden, unexpected loss can be particularly devastating for the bereaved as they struggle to make sense of their loss. We interviewed 11 therapists who specialized in loss/trauma about how each of them helped one client make meaning after a traumatic loss. Data, analyzed using Consensual Qualitative Research (CQR), revealed that the traumatic loss had negatively impacted clients’ relationships, mental health, and beliefs/religion/spirituality; therapists utilized a range of interventions to facilitate meaning-making, including supporting clients through the grief process, as well as helping them experience/regulate emotion and change their narratives around the loss; clients made meaning in diverse ways that could be broadly categorized under meaning-as-comprehensibility and meaning-as-significance; and clients experienced positive adjustment (in mental health, relationships, etc.) through the meaning-making work. Implications for counseling psychology research and practice are discussed.

The Role of Complicated Grief in Health Inequities in American Indian Communities

Complicated grief is both a cause and a consequence of health inequities in Native (American Indian/Alaska Native [AI/AN]) communities. Given disproportionately high rates of physical (e.g., cancer, diabetes, and heart disease) and mental health problems (e.g., substance use disorder, posttraumatic stress disorder) in Native communities, it is common for AI/AN people to suffer many losses each year. Experiences of traumatic or repeated losses may lead to the development of maladaptive grief, often known as complicated grief. The aim of the current study was to understand the perspectives of community members on grief and its connection with health inequities among AI people who have experienced the loss of a person with whom they were close. Using a community-based participatory research framework, we conducted semi-structured interviews with 12 AI adults from a rural reservation community. The ages of the participants ranged from 32 to 80 years ( M = 54.33, SD = 14.46) and women ( n = 7, 58.3%) and men ( n = 5, 41.7%) were included. The participants reported many barriers to healthy grieving and linked chronic, complicated grief with the development of multifaceted health problems, which were seen as exacerbating health disparities and leading to additional losses and grief. While coping with loss was difficult, many people were able to heal from extraordinary losses through community support and cultural practices. Future research with AI/AN communities is needed to develop, implement, and evaluate culturally responsive therapeutic grief treatments. There is also a pressing need to address current physical and mental health inequities to reduce the mortality rate and, thus, complicated grief in AI/AN communities.

Family Communication With Children and Adolescents Post Parental Loss in Road Traffic Accidents: A Qualitative Study

Background: Traumatic parental loss during childhood and adolescence can have long-lasting effects on the developmental trajectory of youngsters. While there is some literature on the advantages of positive family communication fostering better adjustment in bereaved children and adolescents, patterns of family communication post parental loss have not received much attention. An understanding of these patterns can pave the way for more holistic interventions in this vulnerable group. Aim: The aim of the study was to explore parental loss-related communication in families of children and adolescents who have lost a parent to a road traffic accident. Method: The study was carried out in a tertiary hospital setting in Bengaluru. The sample comprised of 24 children and 17 surviving parents. The study employed a qualitative research design. Semi-structured in-depth interviews were conducted with surviving parents/caregivers and the children/adolescents. The interviews were analysed by using inductive thematic analysis. Results: The themes generated from the semi-structured interviews highlighted patterns of communication in parentally bereaved families. Four major themes emerged from the semi-structured interviews – mode of getting to know about the death, disclosure regarding the death, discussion regarding the death and individual needs related to communication. Conclusions: Communication regarding parental loss as a result of road traffic accidents in the family context seems to be desirable and may enable healthy grieving in youngsters. Short-term interventions aimed at enhancing family communication patterns following traumatic parental loss need to be developed in the Indian context.

Freeze-dried porous collagen scaffolds for the repair of volumetric muscle loss injuries.

Volumetric muscle loss (VML) injuries are characterized by the traumatic loss of skeletal muscle resulting in permanent damage to both tissue architecture and electrical excitability. To address this challenge, we previously developed a 3D aligned collagen-glycosaminoglycan (CG) scaffold platform that supported in vitro myotube alignment and maturation. In this work, we assessed the ability of CG scaffolds to facilitate functional muscle recovery in a rat tibialis anterior (TA) model of VML. Functional muscle recovery was assessed following implantation of either non-conductive CG or electrically conductive CG-polypyrrole (PPy) scaffolds at 4, 8, and 12 weeks post-injury by in vivo electrical stimulation of the peroneal nerve. After 12 weeks, scaffold-treated muscles produced maximum isometric torque that was significantly greater than non-treated tissues. Histological analysis further supported these reparative outcomes with evidence of regenerating muscle fibers at the material-tissue interface in scaffold-treated tissues that was not observed in non-repaired muscles. Scaffold-treated muscles possessed higher numbers of M1 and M2 macrophages at the injury while conductive CG-PPy scaffold-treated muscles showed significantly higher levels of neovascularization as indicated by the presence of pericytes and endothelial cells, suggesting a persistent wound repair response not observed in non-treated tissues. Finally, only tissues treated with non-conductive CG scaffolds displayed neurofilament staining similar to native muscle, further corroborating isometric contraction data. Together, these findings show that CG scaffolds can facilitate improved skeletal muscle function and endogenous cellular repair, highlighting their potential use as therapeutics for VML injuries.

Timely tibiotalar fusion after utilization of Masquelet technique guided by in-hospital 3D printing

The following report describes a case of a 24-year-old female who presented with a traumatic open trimalleolar ankle fracture withsevere distal tibial bone loss. She was submitted to a staged acute Masquelet technique, where the in-hospital 3D printing was utilizedto guide the shaping and sizing of the antibiotic cement spacer and, subsequently, the bone allograft utilized two months later duringtibiotalar fusion. Adequate bony consolidation was achieved at the 7-week follow-up, and the patient was able to bear weight at 12weeks fully. Level of Evidence V; Therapeutic studies; Case Report.

A Baseline Model of PTSD From the ACES Cohort.

Post-traumatic stress disorder (PTSD) is a primary military psychiatric condition with complex etiology including strong genetic and/or environmental influences. Environmental influences and demographics can play a role in supporting underlying genetic traits for clinical utility evaluation as risk modifying factors. We are undertaking an IRB approved study to evaluate polygenic scores of PTSD risk in the adverse childhood experience and serotonin (ACES) transporter cohort. Baseline demographic characteristics and statistical modeling of 291 active duty service members from ACES cohort were used and excluded individuals with traumatic brain injury-induced loss of consciousness, pre-deployment PTSD or anxiety disorder, and pre-deployment prescription of antidepressants or psychoactive medications. Summary of categorical and numerical variables were evaluated using chi-square and t-test, respectively. We model PTSD risk and associated scores using linear and logistic regressions. The ACES subset was 79.1% males, multi-ancestry, and mean age of 38.3 years. Most PTSD individuals received behavioral therapy (89.6%) and/or prescribed antidepressants (67%) had higher scores in ACES, combat exposure scales, PTSD checklist military version, neurobehavioral symptom inventory, Pittsburg sleep quality index, insomnia severity index, and composite autonomic symptom score surveys and were less likely to expect future deployment. A positive correlation between age, total months deployed, ACES, CES, PCL-M, and positive-PTSD diagnosis were consistent but not in older individuals, who were more likely and frequently deployed although increasing risk for combat exposure. Demographic characteristics of the ACES cohort fit a coherent model of risk for PTSD to evaluate polygenic scores. Additional research is merited to understand PTSD effects on these confounding factors.

Modified Masquelet technique : Technique of the induced membrane in the course of time

The reconstruction of long bone defects as aresult of primary traumatic, secondary infection or tumor-related loss of substance continues to represent asurgical challenge. Callus distraction via segment transport, vascularized bone transfer and the induced membrane technique (IMT) are established methods of reconstruction. In recent decades IMT has experienced increasing popularity due to its practicability, reproducibility and reliability. At the same time, the original technique has undergone numerous modifications. The results are correspondingly heterogeneous. This overview is intended to explain the basic principles of IMT and to provide an overview of the various modifications and their complications.

Risk Factors for Plate Infection, Exposure, and Removal in Mandibular Reconstruction.

Mandibular plate reconstruction (MPR) is often indicated after tumor ablation, osteoradionecrosis excision, and traumatic bone loss to restore oral functionality and facial cosmetics. There are limited analyses identifying risk factors that lead to plate infection (PIn), exposure, and removal ("plate complications"). Retrospective cohort study. Academic tertiary medical center. Patients who underwent MPR from 2013 to 2022 were identified. Risk factors for plate complications were analyzed based on demographic, clinical, intraoperative, and postoperative factors. Multivariable analysis was conducted with logistic regression. Survival analysis was conducted with a Cox model. Of the 188 patients analyzed, 48 (25.5%) had a plate complication [infection: 22 (11.7%); exposure: 23 (12.2%); removal: 35 (18.6%)]. Multivariate analysis revealed predictive associations between at least 1 plate complication and the following variables: smoking status, soft tissue defect size, number of plates, average screw length, and various postoperative complications. Other associations approached the threshold for significance. Prior and adjuvant radiation therapy, type of free flap, stock versus custom plates, and perioperative antibiotic prophylaxis regimens were not associated with plate complications. No plate complication was independently associated with lower overall survival. PIn (hazard ratio, HR: 7.99, confidence interval, CI [4.11, 15.54]) and exposure (HR: 3.56, CI [1.79, 7.08]) were independently associated with higher rates of plate removal. Plate complications are relatively common after MPR. Smoking history, specific disease characteristics, hardware used during surgery, and postoperative complications may help identify higher-risk patients, but additional larger-scale studies are needed to validate our findings and resolve discrepancies in the current literature.

An evaluation of the associations among posttraumatic stress disorder, depression, and complicated grief in active duty military personnel with traumatic loss.

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.

Traumatic experience and loss: A brief therapy with a traumatized refugee boy and his parents in exile.

In this paper, the author portrays the psychoanalytic therapy with a twelve-year-old refugee boy and his parents, prior to which the boy had been traumatised by the deaths of both his brothers in the civil war. In 2015 he had travelled with his father to Austria, where he was warmly received in a small community. The author examines how this child reacted to the traumatising experiences, as well as which resilience factors played a role in overcoming them. The psychoanalytic process is illuminated in a detailed analysis of the therapy sessions, which created a space for overcoming the helplessness, mourning the loss and furthering the integration process of the identity, disturbed after the traumatic experiences.

Grief Accompanied by Suicidal Thoughts After Traumatic Loss in Adolescent: A Case Report

Grief is a normal process that occurs following the irreversible loss of a loved one. This process, characterized by painful experiences, varies widely and is influenced by numerous factors, including the identity of the deceased, the circumstances of their death, the individual characteristics of the bereaved, and the availability of support systems. The suddenness and violence of a loss can disrupt the normal grieving process, leading to the manifestation of traumatic symptoms. This phenomenon, referred to as “traumatic grief” in the literature, is associated with an increased risk of various psychiatric disorders, including major depression, anxiety disorders, and post-traumatic stress disorder. The death of a parent represents a profound loss for an adolescent, complicating their coping mechanisms and significantly impacting their psychological well-being. Parental loss alone is a significant risk factor for suicidal behavior in adolescents. When a parent’s death is traumatic, it can further exacerbate this risk, leading to suicidal thoughts and behaviors by disrupting the normal grief process, even in adolescents who were previously mentally healthy. This article presents the diagnosis and treatment of a 17-year-old girl who exhibited active suicidal thoughts and behaviors after her father was killed with a firearm. The objective of this case report is to explore the atypical grief symptoms that can follow traumatic losses during adolescence and to assess the effectiveness of holistic approaches that combine supportive psychotherapy with pharmacotherapy in treating such cases.

The Effect of Life Stages on the Experience of Those Who Have Received an Unexpected and Violent Death Notification: A Qualitative Study.

How individuals are informed of the traumatic loss of a loved one can influence their grieving process and quality of life. This qualitative study aimed to explore, through thematic analysis, how life stages might influence the experience and feelings of those who have received communication of a traumatic death from police officers or healthcare professionals. Recruited through social networks and word of mouth, 30 people participated in the study. Subjects were divided into three groups according to age (Group 1: ten participants aged between 20 and 35 years; Group 2: ten participants aged between 45 and 55 years; and Group 3: ten participants aged 60 and over). Participants completed an ad hoc questionnaire online. Atlas.ti software 8 was used to perform thematic analysis. The three age groups had the following four key themes in common: (a) emotional reactions; (b) subjective valuation of the notification; (c) support; and (d) needs. Subtle differences emerged between age groups; yet the quality of the reactions and main themes did not vary greatly between the groups considered. The communication of an unexpected and violent death seems to provoke rather similar effects in survivors of different life stages. A few differences were noted in sub-themes (increased need for professional training in younger recipients; absence of suicidal ideation in older adults); perhaps quantitative designs could provide further details in future investigations.

The gift of peer understanding and suicide bereavement support groups: A qualitative study

There is a growing recognition and need for more studies on groups practices and processes to develop greater insight into the helpful elements that may be distinctive to bereavement peer support groups for traumatic loss such as, suicide. Using a qualitative descriptive design, focus groups and individual interviews were conducted online and face-to-face with a purposive sample of 27 participants in Ireland and in Denmark, who were bereaved by suicided and were attending peer bereavement support groups. Data were analyzed through Thematic Analysis. The findings suggest that the group provided a safe place where people felt and nurtured a deep emotional connection, a place where people trusted themselves and others to speak the unspoken and to tell and re-tell their story without fear of consequence as well as a place where they learnt to process their loss. Findings are discussed and recommendations based on the findings are proposed.