This paper reviews the literature on the psychological consequences of sudden and violent losses, including disaster and military losses. It also reviews risk and resilience factors for grief and mental health and describes the effects and possible benefit of psychosocial interventions. The review shows gaps in the literature on grief and bereavement after sudden and violent deaths. Still, some preliminary conclusions can be made. Several studies show that a sudden and violent loss of a loved one can adversely affect mental health and grief in a substantial number of the bereaved. The prevalence of mental disorders such as post-traumatic stress disorder (PTSD), major depressive disorder (MDD), and prolonged grief disorder (PGD, also termed complicated grief) varies widely, however, from study to study. Also, mental health disorders are more elevated after sudden and violent losses than losses following natural deaths, and the trajectory of recovery seems to be slower. Several factors related to the circumstances of the loss may put the bereaved at heightened risk for mental distress. These factors may be differentially related to different outcomes; some increase the risk for PTSD, others for PGD. Given the special circumstances, bereavement following sudden and violent death may require different interventions than for loss from natural death. Recommendations for future research and clinical implications are discussed.

ResultsProfessionals such as police officers, firefighters and ambulance personnel often experience incidents that satisfy the stressor criterion for the PTSD diagnosis. Other professional groups such as health care professionals, train drivers, divers, journalists, sailors and employees in bank, post offices or in stores may also be subjected to work-related traumatic events. Work-related PTSD usually diminishes with time.Conclusions Mental health problems prior to the traumatic event and weak social support increase the risk of PTSD. Prevention of work-related PTSD includes a sound organizational and psychosocial work environment, systematic training of employees, social support from colleagues and managers and a proper follow-up of employees after a critical event.

Nine months post‐disaster, 134 rescuers involved in an off‐shore oil rig disaster were investigated by using a structured self report questionnaire to chart their experience of coping with disaster impact stressors and their mental and physical health 9 months after the disaster. Of the 134 rescuers, 24 were categorized as professional rescuers, 101 as non‐professionals and 9 could not be classified. Of the 212 victims, all oil rig workers, 89 (42%) were rescued. Seventy‐six percent of the rescuers reported they had been exposed to danger during the rescue operation, and 62% found the experience to be the worst ever. Eighty to ninety percent felt they had coped fairly well with the task, and severely disturbed coping was reported to be below 10% for decision‐making, ability to judge risk, capacity to function as leader, and finally ability to cooperate and act efficiently. For the non‐professionals, severe disturbance in ability to plan before acting was reported by 10% and moderate disturbance was reported by 38%. The frequency of emotional stress reactions during the rescue work can be assessed from the fact that 64% to 52% reported discouragement, restlessness, uncertainty, anxiety and irritation. The stressors inherent in this type of disaster seem to satisfy the DSM III stressor criterion for post‐traumatic stress disorder. Nine months after the disaster 24% reported their mental health to be poor due to the disaster impact, and only the most experienced rescuers had a low health risk compared to the others.

No abstract

The authors examined predictors of complicated grief (CG) in Norwegians 2 years after bereavement in the 2004 South-East Asian tsunami. A cross-sectional postal survey retrospectively covering disaster experiences and assessing CG according to the Inventory of Complicated Grief yielded 130 respondents (35 directly disaster-exposed and 95 not directly exposed), with 47.7% screening CG positive. They identified positive associations between CG and being female, losing a child or spouse, and time to death confirmation, and negative associations with previous losses, being employed, and receiving social support. Direct exposure did not increase CG risk. Support service providers should be aware of this high prevalence of severe, persistent grief.