J Korean Med Sci.  2017 Jul;32(7):1173-1180. 10.3346/jkms.2017.32.7.1173.

Effects of Mental Health Support on the Grief of Bereaved People Caused by Sewol Ferry Accident

• Han H
• Noh JW
• Huh HJ
• Huh S
• Joo JY
• Hong JH
• Chae JH

• KMID: 2379614
• DOI: http://doi.org/10.3346/jkms.2017.32.7.1173

Abstract

Few studies have assessed the overall effects of multi-centered, complicated mental health support on the grief process. This study investigated the broader influence of mental health support provided practically to the bereaved family on the severity of complicated grief. Ninety-three bereaved family members of the Sewol ferry accident were recruited. Severity of complicated grief, post-traumatic stress disorder (PTSD) and depressive disorder was assessed through self-reporting questionnaire, inventory of complicated grief (ICG), PTSD Check List-5 (PCL-5) and Patient Health Questionnaire-9 (PHQ-9). We also included demographic, socioeconomic, health-related variables, and Functional Social Support Questionnaire (FSSQ), which affect the ICG score. Participants were divided into 4 groups based on the experience of psychotherapy or psychiatry clinic service before the accident and mental health support after the disaster. In univariate analysis, these 4 groups showed a significant difference in the mean ICG score (P = 0.020). Participants who received mental health support only after the Sewol ferry accident (group 2) showed a lower mean ICG score than those who received neither psychotherapy or psychiatry clinic service before the disaster nor mental health support after the accident (group 4). There was no significant correlation between the ICG score and other variables except for subjective health status measured 1 month after the disaster (P = 0.005). There was no significant difference in PCL-5 (P = 0.140) and PHQ-9 scores (P = 0.603) among groups, respectively. In conclusion, mental health support significantly reduced the severity of grief only in those participants who had not received any psychotherapy or psychiatry clinic service before the accident.

Keyword

Grief; Bereavement; Sewol Ferry; Disasters; Mental Health Services; Social Support

MeSH Terms

Bereavement
Depressive Disorder
Diagnostic Self Evaluation
Disasters
Grief*
Humans
Mental Health Services
Mental Health*
Psychotherapy
Stress Disorders, Post-Traumatic

Reference

1. Paik JW, Kim HS, Sim M, Lee HK, Woo YS, Chung C, Lee SH, Seok JH, Jeon HJ, Lee SM, et al. The Sewol Ferry accident and early mental health care response by volunteer activities of Korean Disaster Mental Health Committee and members of Korean Neuropsychiatric Association. J Korean Neuropsychiatr Assoc. 2015; 54:1–5.

2. Han H, Choi W, Huh S, Heo HJ, Chae JH. Understanding of complicated grief. Cognitive Behav Ther Korea. 2016; 16:383–401.

3. Meert KL, Shear K, Newth CJ, Harrison R, Berger J, Zimmerman J, Anand KJ, Carcillo J, Donaldson AE, Dean JM, et al. Follow-up study of complicated grief among parents eighteen months after a child’s death in the pediatric intensive care unit. J Palliat Med. 2011; 14:207–214.

4. Currier JM, Holland JM, Neimeyer RA. Sense-making, grief, and the experience of violent loss: toward a mediational model. Death Stud. 2006; 30:403–428.

5. Nakajima S, Ito M, Shirai A, Konishi T. Complicated grief in those bereaved by violent death: the effects of post-traumatic stress disorder on complicated grief. Dialogues Clin Neurosci. 2012; 14:210–214.

6. Wilson DM, Dhanji N, Playfair R, Nayak SS, Puplampu GL, Macleod R. A scoping review of bereavement service outcomes. Palliat Support Care. 2017; 15:242–259.

7. Wittouck C, Van Autreve S, De Jaegere E, Portzky G, van Heeringen K. The prevention and treatment of complicated grief: a meta-analysis. Clin Psychol Rev. 2011; 31:69–78.

8. Lee N, Sim K, Hahn S, Lee K, Sim M, Chae JH, Ahn H. A qualitative content analysis of reports of mental health service providers after the Sewol Ferry accident in Korea. Ment Health Soc Work. 2015; 43:116–144.

9. Gyeonggi-do Ansan-si Integrated Disaster Metal Health Support Team (KR). Disaster Mental Health Support for 14 Days after the Sewol Ferry Accident. Suwon: Gyeonggi Provincial Mental Health Center;2014.

10. Ogrodniczuk JS, Joyce AS, Piper WE. Changes in perceived social support after group therapy for complicated grief. J Nerv Ment Dis. 2003; 191:524–530.

11. Prigerson HG, Maciejewski PK, Reynolds CF 3rd, Bierhals AJ, Newsom JT, Fasiczka A, Frank E, Doman J, Miller M. Inventory of complicated grief: a scale to measure maladaptive symptoms of loss. Psychiatry Res. 1995; 59:65–79.

12. Hoge CW, Riviere LA, Wilk JE, Herrell RK, Weathers FW. The prevalence of post-traumatic stress disorder (PTSD) in US combat soldiers: a head-to-head comparison of DSM-5 versus DSM-IV-TR symptom criteria with the PTSD checklist. Lancet Psychiatry. 2014; 1:269–277.

13. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16:606–613.

14. Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the patient health questionnaire (PHQ-9): a meta-analysis. CMAJ. 2012; 184:E191–E196.

15. Broadhead WE, Gehlbach SH, de Gruy FV, Kaplan BH. The Duke-UNC functional social support questionnaire. Measurement of social support in family medicine patients. Med Care. 1988; 26:709–723.

16. Burke LA, Neimeyer RA, McDevitt-Murphy ME. African American homicide bereavement: aspects of social support that predict complicated grief, PTSD, and depression. Omega (Westport). 2010; 61:1–24.

17. Bonanno GA, Wortman CB, Lehman DR, Tweed RG, Haring M, Sonnega J, Carr D, Nesse RM. Resilience to loss and chronic grief: a prospective study from preloss to 18-months postloss. J Pers Soc Psychol. 2002; 83:1150–1164.

18. Boelen PA, de Keijser J, van den Hout MA, van den Bout J. Treatment of complicated grief: a comparison between cognitive-behavioral therapy and supportive counseling. J Consult Clin Psychol. 2007; 75:277–284.

19. Reynolds CF 3rd, Miller MD, Pasternak RE, Frank E, Perel JM, Cornes C, Houck PR, Mazumdar S, Dew MA, Kupfer DJ. Treatment of bereavement-related major depressive episodes in later life: a controlled study of acute and continuation treatment with nortriptyline and interpersonal psychotherapy. Am J Psychiatry. 1999; 156:202–208.

20. Rosner R, Bartl H, Pfoh G, Kotoučová M, Hagl M. Efficacy of an integrative CBT for prolonged grief disorder: a long-term follow-up. J Affect Disord. 2015; 183:106–112.

21. Shear K, Frank E, Houck PR, Reynolds CF 3rd. Treatment of complicated grief: a randomized controlled trial. JAMA. 2005; 293:2601–2608.

22. Smid GE, Kleber RJ, de la Rie SM, Bos JB, Gersons BP, Boelen PA. Brief eclectic psychotherapy for traumatic grief (BEP-TG): toward integrated treatment of symptoms related to traumatic loss. Eur J Psychotraumatol. 2015; 6:27324.

23. Weissman MM, Markowitz JC, Klerman GL. Comprehensive Guide to Interpersonal Psychotherapy. New York, NY: Basic Books;2000.

24. Zygmont M, Prigerson HG, Houck PR, Miller MD, Shear MK, Jacobs S, Reynolds CF 3rd. A post hoc comparison of paroxetine and nortriptyline for symptoms of traumatic grief. J Clin Psychiatry. 1998; 59:241–245.

25. Hensley PL, Slonimski CK, Uhlenhuth EH, Clayton PJ. Escitalopram: an open-label study of bereavement-related depression and grief. J Affect Disord. 2009; 113:142–149.

26. Simon NM, Shear MK, Fagiolini A, Frank E, Zalta A, Thompson EH, Reynolds CF 3rd, Silowash R. Impact of concurrent naturalistic pharmacotherapy on psychotherapy of complicated grief. Psychiatry Res. 2008; 159:31–36.