A 55-year-old man undergoes emergent exploratory laparotomy and splenectomy following a motorcycle collision. Following surgery, he is found to have a traumatic brain injury requiring decompressive craniectomy and intracranial pressure monitoring. The patient then continues to have complications throughout his hospital course. Using the American College of Surgeons Trauma Quality Improvement Program guidelines, the surgical team has early and ongoing primary palliative care discussions to foster communication and determine goals of care for the patient. As the patient deteriorates, the surgical team continues meeting with the patient’s surrogate decision makers to discuss the best case and worst case scenarios regarding the patient’s prognosis and expected quality of life.
Disaster Falls : le nom d’un lieu perdu – des rapides sur la Green River entre l’Utah et le Colorado. Mais le nom, aussi, d’un événement tragique. A l’été 2008, lors d’un voyage organisé, le kayak dans lequel Stéphane Gerson naviguait avec son fils Owen chavira dans ces eaux froides. Après trois heures de recherches, on retira de l’eau le corps d’Owen. Il avait huit ans.
Au croisement du récit, de la chronique et de l’enquête, Disaster Falls entretisse les émotions du père, l’analyse de l’historien et la quête de sens. L’histoire hante le livre, que ce soit celle de ces rapides depuis leur découverte en 1869 ; celle de l’expérience du deuil parental (Shakespeare, Mallarmé, Hugo...) ou celle de catastrophes collectives qui, de la Shoah au 11-Septembre 2001, interfèrent également dans ce désastre familial.
Les derniers chapitres de Disaster Falls s’ouvrent à une autre vision de la mort. Deux ans après l’accident, le père de Stéphane Gerson, atteint d’un cancer inopérable, opte pour l’euthanasie en Belgique. Après avoir perdu un fils, l’auteur accompagne maintenant les derniers jours de son père. Autre filiation, autre mort – une mort acceptée, apaisée, faite sienne. "J’étais un vivant entre deux disparus."
Tiré du blog Tumblr "The last Message Received", créé par une adolescente de 16 ans, Emily Trunko, ce livre est "dédié à toutes les personnes qui, un jour, ont reçu un dernier message". Dans son introduction, Emily Trunko explique que le recueil de ces "derniers messages", messages de rupture amoureuse ou amicale pour certains, ou dernier message de cette "conversation légère dont tu ignores qu'elle précède une mort soudaine", a permis de fédérer une véritable communauté. Chaque dernier message choisi est accompagné de quelques lignes écrites par le destinataire, qui en retrace les circonstances.
Qu'il s'agisse de surmonter un deuil ou de prévenir un acte suicidaire, ce florilège de messages choisis ne laisse pas insensible et fait réfléchir à la portée de nos écrits. "Et si ce message était les derniers mots que mon destinataire lirait de moi ?" résonne alors comme un leitmotiv, une invitation à être plus prévenant et plus conscient des autres avant cet acte banal : cliquer sur "envoyer".
Importance: Previous studies have suggested that patients with cancer may be at an increased risk of death from unintentional injury, but to our knowledge, no large studies have examined the rates of death from unintentional injury among patients with cancer.
Objective: To characterize the incidence of death from unintentional injury among patients with cancer in the United States.
Design, Setting, and Participants: This retrospective cohort study included patients diagnosed with a first primary cancer between January 1, 1973, and December 31, 2015, identified from the Surveillance, Epidemiology, and End Results (SEER) program data. Comparisons with the general US population were based on mortality data collected by the National Center for Health Statistics. Analyses were performed from February 1, 2019, to August 15, 2019.
Main Outcomes and Measures: Rates and standardized mortality ratios (SMRs) of death from unintentional injury among patients with cancer.
Results: A total of 8 271 020 patients with cancer were included in this study (50.2% female; mean [SD] age, 63.0 [15.7] years). Among them, 40 599 deaths from unintentional injury were identified. The rates of death from unintentional injury were 81.90 per 100 000 person-years among patients with cancer and 51.21 per 100 000 person-years in the corresponding US general population. The SMR of death from unintentional injury was 1.60 (95% CI, 1.58-1.61). Higher rates of death from unintentional injury were associated with increasing age at diagnosis (=80 years; rate ratio [RR], 2.91; 95% CI, 2.84-2.98; P < .001), male sex (RR, 1.69; 95% CI, 1.66-1.73; P < .001), American Indian or Alaskan Native population (RR, 1.48; 95% CI, 1.30-1.68; P < .001), and being unmarried (RR, 1.23; 95% CI, 1.18-1.28; P < .001). Rates of death from unintentional injury were the highest in patients with cancers of the liver (200.37 per 100 000 person-years), brain (175.04 per 100 000 person-years), larynx (148.78 per 100 000 person-years), and esophagus (144.98 per 100 000 person-years). The SMRs were the highest in the first month after cancer diagnosis.
Conclusions and Relevance: This study found that the incidence of death from unintentional injury among patients with cancer was significantly higher than that in the general population in the United States. The rates of death from unintentional injury varied by age, sex, race/ethnicity, marital status, cancer site, disease stage, and time since diagnosis. The findings suggest that death from unintentional injury among patients with cancer requires further attention and that initiatives to identify patients at risk and to develop targeted prevention strategies should be prioritized.
C'est l'histoire d'un jeune homme de 17 ans, Parker Santé. Depuis le décès de son père il y a 5 ans, il n'a pas prononcé un mot. Pendant que ses camarades de classe postulent à l'université, lui sèche les cours du lycée et traîne dans les hôtels chics de San Francisco pour parfaire sa technique de pickpocket. Un jour, il rencontre Zelda Toth aux cheveux argentés. Il dérobe de l'argent dans son sac à main. Mais il est très surpris, elle ne le dénonce pas et lui dit qu'elle n'en aura bientôt plus l'utilité. Le livre décrit leur cheminement commun pour redonner goût à la vie l'un à l'autre.
The study investigated the traumatic impact of the Dana 2012 plane crash in Lagos, Nigeria. Using a cross-sectional survey, the roles of quality of life (QoL) and impact of event were examined against death anxiety of the proximate inhabitants of the crash site. Result showed significant influence of QoL on death anxiety, with higher QoL participants manifesting higher levels of death anxiety. However, impact of the crash event and demographic indicators such as age, sex, pilot preference, and belief-in-life after death did not influence death anxiety of participants. It can be concluded from these results that the perception of higher QoL has a profound influence on death anxiety of people reminiscing mortality reminders no matter their age, sex, beliefs, and life preferences. It is recommended that anxious death-related experiences be prevented in all spheres of life in pursuit of safety and sound mental health of the people.
BACKGROUND: The objective of this study was to determine whether severity and severity change of coexisting psychiatric symptoms might affect change of complicated grief (CG) regarding the Sewol ferry disaster.
METHODS: Data from a cross-sectional survey were obtained 18 months (Time 1) and 30 months (Time 2) after the disaster. We ascertained sociodemographic variables and variables obtained from self-reporting questionnaires (i.e., CG, depression, anxiety, post-traumatic stress disorder [PTSD], insomnia, embitterment, and suicidal risk) among 56 bereaved family members.
RESULTS: Severity of other psychiatric symptoms at Time 1 had no effect on change of CG at Time 2. However, changes in severity of PTSD over a year affected change of CG.
CONCLUSION: It is important to evaluate changes in severity of PTSD and its treatment during management of CG, especially when it involves bereaved families experiencing a traumatic accident.
This article presents qualitative data to explore the experience of farming family members faced with accidental or suicide death and understand how this is experienced within the farming context. Individual semistructured interviews were conducted with 25 members of Australian farming families bereaved by suicide or accidental death. Qualitative data was thematically analyzed. Three interconnected themes were identified: acceptance of risk, normalization of death, pragmatic behavior patterns and connection to place. Bereavement and reconstruction of meaning following suicide or accidental death for farming families is influenced by the cultural, social, geographical, and psychological contexts of farming families. This article challenges traditional conceptions of suicide and accidental death as necessarily experienced as “violent” or “traumatic,” bereavement as experienced similarly across western cultures, and the reaction to suicide or accidental death as one that challenges people’s understanding of their world and leaves them struggling to find a reason why the death occurred.
Griffin a choisi de quitter Théo, son premier amour parti à l'autre bout du pays pour ses études. Les deux garçons s'aiment toujours et sont restés en contact. Griffin était convaincu qu'ils formeraient à nouveau un couple un jour, même quand Théo se met à fréquenter Jackson. Malheureusement, tout vole en éclats à la mort de Théo, laissant derrière lui un garçon qui a bien du mal à vivre dans un monde où il n'est plus.
Inspiré de l’histoire vraie de la princesse Haya Bint Al Hussein de Jordanie.
Haya perd sa mère à l’âge de 3 ans dans un accident d’hélicoptère. Sa joie de vivre s’envole avec le décès de sa maman. Ce sont les chevaux qui vont commencer à lui redonner le sourire, et surtout Bree (Bint Al Reeh "La fille du Vent"), une pouliche orpheline que son père lui offre pour ses 6 ans, lors de sa fête d’anniversaire.
Avec elle Haya va retrouver goût à la vie et réussir à se construire malgré la perte de sa mère.
Un joli récit émouvant qui nous fait suivre Haya sur les chemins qu’elle emprunte pour surmonter la perte de sa mère. Chemins qui ne sont pas faciles car Haya grandit dans l’ombre de sa mère absente. Elle lui écrit d’ailleurs régulièrement pour lui faire part de ses doutes, de ses joies, de ses angoisses, de ses fiertés…Jusqu’au jour où Haya réalise qu’elle a surmonté sa peine et qu’elle garde le souvenir de sa mère.
The current study applied the Conservation of Resources (COR) disaster theory to explain suicide proneness after the Deepwater Horizon oilrig explosion. We had 213 residents in affected areas with complete measures of resource stability, distress, and coping 18 months after the disaster. Overall, 10% expressed clinically elevated suicide proneness. The COR model had excellent fit that accounted for 41% of inter-individual differences in suicide proneness. Aligned with theory, residents lacking resources who experienced distress and coped by avoidance were more suicide-prone. Fostering resource stability and constructive coping after catastrophe may help reduce suicide proneness and prevent suicide in disaster-impacted citizens.
OBJECTIVE: After the Sewol ferry disaster, bereavement with suicidal ideation was a critical mental health problem that was accompanied by various neuropsychological symptoms. This study examined the frontal alpha asymmetry (FAA), heart rate variability (HRV), and several psychological symptoms in bereaved family members (BFM) after the Sewol ferry disaster.
METHODS: Eighty-three BFM after the Sewol ferry disaster were recruited. We assessed FAA, HRV, and psychological symptoms, including depression, post-traumatic stress, post-traumatic growth factor, anxiety, grief, and positive resources, between BFM with the presence and absence of current suicidal ideation.
RESULTS: Compared to BFM without suicidal ideation, BFM with suicidal ideation showed a higher FAA with right dominance. Significant differences in psychological symptoms were observed between the groups. In BFM with suicidal ideation, the low: high frequency (LF:HF) ratio correlated with social resources and support.
CONCLUSION: The FAA and LF:HF ratio may be biomarkers that represent the pathological conditions of BFM with suicidal ideation. If researched further, they may shed light on the interaction between bereavement with suicidal ideation and social resources for therapeutic intervention.
Fatal work incidents result in an array of government responses, and in countries such as the United Kingdom and Australia, this may include the holding of coronial inquests. A common theme from the scant literature is that family members have a strong need to know how and why their loved one died. The inquisitorial nature of inquests suggests potential in uncovering this information, although little is known about families' experiences with these proceedings. Interviews with 40 bereaved relatives explored their views and experiences of inquests. Findings suggest that families, often frustrated with other investigative processes, want inquests to provide a better understanding of how and why the death occurred, uncover any failings/responsibilities, and thereby move closer to a sense of justice being obtained for the deceased. Families identified problems perceived to impair the process and where improvements could be made to secure a more effective and meaningful institutional response to the fatality.
This study aims to identify parenting experiences after the death of a child. Using interpretive phenomenological analysis, we mapped the experiences of 16 parents with school-aged surviving children after the death of their sibling to the 2014 Sewol ferry disaster in South Korea. Interviews illuminate five master themes of parenting surviving children following a child’s death: (a) parental anxiety, (b) conflicts and obstacles in the parent-child relationship, (c) changes in parenting style, (d) striving to support children’s grief, and (e) seeking outside help for parenting. Implications for supporting grieving parents and their children are discussed in light of the findings.
BACKGROUND: Previous latent trajectory studies in adult bereaved people have identified individual differences in reactions postloss. However, prior findings may not reflect the complete picture of distress postloss, because they were focused on depression symptoms following nonviolent death. We examined trajectories of symptom-levels of persistent complex bereavement disorder (PCBD), depression, and posttraumatic stress disorder (PTSD) in a disaster-bereaved sample. We also investigated associations among these trajectories and background and loss-related factors, psychological support, and previous mental health complaints.
METHODS: Latent class growth modeling was used to identify distinct trajectories of PCBD, depression, and PTSD symptoms in people who lost loved ones in a plane disaster in 2014. Participants (N = 172) completed questionnaires for PCBD, depression, and PTSD at 11, 22, 31, and 42 months postdisaster. Associations among class membership and background and loss-related variables, psychological support, and previous mental health complaints were examined using logistic regression analyses.
RESULTS: Two PCBD classes emerged: mild (81.8%) and chronic (18.2%) PCBD. For both depression and PTSD, three classes emerged: mild (85.6% and 85.2%), recovered (8.2% and 4.4%), and chronic trajectory (6.2% and 10.3%). People assigned to the chronic PCBD, depression, or PTSD class were less highly educated than people assigned to the mild/recovered classes.
CONCLUSIONS: This is the first latent trajectory study that offers insights in individual differences in longitudinal symptom profiles of PCBD, depression, and PTSD in bereaved people. We found support for differential trajectories and predictors across the outcomes.
Posttraumatic stress disorder (PTSD), which is caused by a major traumatic event, has been associated with autonomic nervous function. However, there have been few explorations of measuring biological stress in the victims' family members who have been indirectly exposed to the disaster. Therefore, this longitudinal study examined the heart rate variability (HRV) of the family members of victims of the Sewol ferry disaster. We recruited 112 family members of victims 18 months after the disaster. Sixty-seven participants were revisited at the 30 months postdisaster time point. HRV and psychiatric symptoms including PTSD, depression and anxiety were evaluated at each time point. Participants with PTSD had a higher low frequency to high frequency ratio (LF:HF ratio) than those without PTSD. Logistic regression analysis showed that the LF:HF ratio at 18 months postdisaster was associated with a PTSD diagnosis at 30 months postdisaster. These results suggest that disrupted autonomic nervous system functioning for longer than a year after trauma exposure contributes to predicting PTSD vulnerability. Our finding may contribute to understand neurophysiologic mechanisms underlying secondary traumatic stress. Future studies will be needed to clarify the interaction between autonomic regulation and trauma exposure.
The Traumatic Grief Inventory Self-Report version (TGI-SR) is an 18-item self-report measure. It was designed to assess symptoms of Persistent Complex Bereavement Disorder (PCBD) included in Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 and Prolonged Grief Disorder (PGD) proposed by an international group of experts in grief. The research in this article used data from a bereaved patient sample and people who lost loved ones in the Ukrainian airplane crash in July 2014. Findings indicated that the TGI-SR is a reliable and valid tool to assess disturbed grief in research and to identify people needing a more comprehensive assessment of their grief in clinical settings.