Between trauma and grief in psychosocial crisis intervention and beyond. An integrative biopsychosocial framework model of traumatic loss

**_Background_**: Traumatic losses are among the most frequent and critical life events. Despite their profound impact, to the best of our knowledge, no studies to date have commenced immediately following a death event to investigate the phenomenology of PTSD and PGD after traumatic losses. We defied the challenges of this complex acute setting and collected data immediately after the loss as well as six months later.<br /><br /> **_Objectives and methods_**: The dissertation is based on six articles that are presented in a narrative synthesis of the current state of research. We conducted systematic reviews to capture the existing research on risk factors following traumatic loss (Articles 1 and 2). Futhermore, we collected empirical data to examine the symptomatology of PTSD and PGD in the acute phase immediately after the death event (Article 3), identified risk and maintaining factors of PTSD and PGD acutely and after six months (Article 4), and examined promoting factors of posttraumatic growth following traumatic loss (Article 6). Data from Articles 3, 4, and 6 were collected in cooperation with psychosocial crisis intervention teams immediately after loss events (T1, N = 142) and six months later (T2, N = 42). Variables assessed included sociodemographic and loss-related characteristics, PTSD, PGD, depression, generalized anxiety, life satisfaction, posttraumatic cognitions, social acknowledgment, and self-disclosure. Additionally, we examined a second sample having experienced potentially traumatic losses in the context of terrorism (Article 5). Participants were Iraqi internally displaced persons (IDPs; N = 199) who fled their hometowns due to the ISIS conflict and reported having lost an important person within the past 5 years. We investigated whether affected individuals could be assigned to distinct classes at symptom-cluster levels of PTSD and PGD and which risk factors are associated with the respective classes.<br /><br /> **_Results_**: Both samples were strongly affected. The sample in the psychosocial crisis intervention faced types of death with mostly traumatic circumstances, a close relationship to the deceased, direct exposure to the death event or corpse, and a short time since the loss. The sample in the terror context in Iraq was often affected by sudden or violent deaths as well as ongoing conflicts and displacement. We identified dissociation as a specific risk factor for PTSD (Articles 1 and 4) and a close relationship to the deceased as a specific risk factor for PGD (Articles 1, 2, and 4). Social support emerged as one of the largest risk factors for both disorders (Articles 1 and 2) and as a promoting factor for posttraumatic growth (Article 6). Persistent distress due to separation in the terror context is associated with increased comorbidity (Article 5). At the symptom pattern level immediately after the loss, symptoms of PTSD and PGD showed distinct patterns even in this acute phase within a few hours to days after the loss, except for avoidance behavior, where both disorders overlapped. Additionally, three central symptoms were identified for PTSD (nightmares, avoidance of reminders, and hypervigilance) and two for PGD (disturbing memories of the deceased person and yearning). Based on the narrative synthesis and Articles 1-6, we derived an integrative biopsychosocial framework model that encompasses risk factors, etiology, response or symptom patterns, and interplay of PTSD and PGD. The core elements are the two differentiating axes for PTSD and PGD following traumatic losses, each representing opposing disturbances in temporal autobiographical integration: in PTSD, the past intrudes upon the present due to a failure to contextualize the traumatic event as having occurred in the past; in PGD, by contrast, the loss is not mentally integrated into the future, which impedes adaptive processes. This explains the cardinal symptoms of the persistent threat to life in PTSD (traumatic distress) and the persistent preoccupation and longing in PGD (separation distress). Both disorders are associated with avoidance, intrusion, (neuro-)physiological, and cognitive symptoms that closely interact with each other.<br /><br /> **_Implications_**: The framework model and its underlying results from the articles offer a solid foundation for deriving implications for both research and practice based on the identified risk factors and symptom patterns in the field of acute psychosocial crisis intervention (e.g., early screening, early intervention, triage) and long-term help (e.g., specific and transdiagnostic treatment). However, the dissertation also highlights that research on traumatic loss is still in its infancy, so future research must address improvements regarding earlier data collection, longitudinal designs, larger sample sizes, and consistent current measurement instruments to adequately address this complex field.<br /><br /> **_Conclusions_**: This dissertation is a first but important step towards improving support for people in their darkest hours in the context of traumatic losses and beyond. To the best of our knowledge, this is the first investigation to gather data on PTSD and PGD immediately after traumatic losses, shedding light on a previously almost unexplored area. Given the frequency of traumatic losses, their immense impacts, and the suffering of the bereaved, further research in this area is imperative. The integrative biopsychosocial risk model can serve as a foundation for further research and practice.

Level thesis:degree_level

thesis.doctoral

Grantor dc:publisher

Universität Bielefeld

Year

2025

Author dc:creator

• Jann, Philipp

Repository record source_url

https://pub.uni-bielefeld.de/record/3006319

OAI identifier oai:identifier

oai:pub.uni-bielefeld.de:3006319