Prolonged Grief and Functioning of Parents after the Hermosillo Day Care Fire

描述（由申请人提供）：拟议的项目将研究墨西哥埃莫西约ABC日托中心火灾对170名父母（母亲和父亲）的悲伤和功能的影响，他们的婴儿和幼儿在火灾发生时受到照顾。其中包括49名死亡儿童的父母，40名严重受伤的儿童，以及53名暴露在火灾中但相对安全的儿童。这些年轻的职业成年人都是在同一时间和最近经历了同样的可怕事件，而他们对此并没有责任，这一样本提供了一个令人信服的背景，可以用来研究丧亲之痛和长期悲伤的短期和长期后果，而不考虑创伤后应激障碍和重度抑郁症的后果。因此，拟议中的研究的主要目的是记录丧亲之痛和长期悲伤的独特功能后果。将全面评估功能结果，包括角色障碍和生活质量的措施;与配偶，家人和朋友的社会关系质量;养育/家庭压力;对精神卫生保健，自杀和酒精滥用的感知需求;以及身体健康问题和残疾。我们假设：（1）丧亲之痛对功能结果的影响超过创伤的影响;（B）悲伤对功能结果的影响超过创伤后应激障碍或重度抑郁症的影响;（3）丧亲之痛和悲伤的不良后果会随着时间的推移而越来越严重。仅限于一个时间点（第一年内或第一年以后）的评估将无法发现这种趋势，因此快速机制提供的快速审查对研究的科学目标至关重要。从CIAD调查人员编制的家长名单中招募，家长将在事件发生后8个月和20个月亲自接受采访。对于假设检验，我们将依赖于广义估计方程（GEE）的方法，这是一般线性模型的扩展，可容纳重复测量（时间1和2）和聚类数据（母亲和父亲）。本研究的第二个目的是探讨公共悲剧的社会动态如何影响症状和功能结果。大规模创伤造成的背景并没有充分了解对子女在交通事故等个别事件中死亡或受伤的父母的研究。不管是好是坏，每个父母在这种情况下的经历都被许多其他人分享。社会网络分析将提供个人联系和嵌入“父母社区”的措施。“将测试父母社区参与措施的线性和二次效应，同时控制其他社会支持措施和预测群体参与的因素。申请人之前在墨西哥（包括埃莫西约）进行的创伤和灾难研究为拟议的研究提供了便利。在过去的墨西哥灾害研究中，合作率非常高（87%）。当地的合作者，项目办公空间，并从家长的研究支持已经获得。 公共卫生相关性：这些结果将为研究和实践提供信息，以了解在涉及大规模死亡的创伤事件后，评估，治疗和研究长期悲伤障碍（PGD）作为一种不同于创伤后应激障碍（PTSD）的疾病是否重要。如果丧亲之痛和悲伤对功能没有独特的影响，那么在灾害的背景下，就很难认为这种区别对研究或治疗开发很重要。社交网络的结果可用于为旨在创建或与幸存者团体合作的个人和组织提供指导。

DESCRIPTION (provided by applicant): The proposed project would study the effects of the ABC Day Care Center fire in Hermosillo, Mexico on the grief and functioning of 170 parents (mothers and fathers) whose infants and toddlers were being cared for at the time of the blaze. This includes parents of 49 children who died, 40 children who were seriously injured, and 53 children who were exposed to the fire but escaped relatively unharmed. This sample of young working adults, all simultaneously and recently exposed to the same horrific event, for which they had no culpability, provides a compelling context in which to examine the shorter- and longer-term consequences of bereavement and prolonged grief, independent of the consequences that can be accounted for by posttraumatic stress and major depression. Thus the primary aim of the proposed study is to document the unique functional consequences of bereavement and prolonged grief. Functional outcomes will be assessed comprehensively, including measures of role impairment and quality of life; quality of social relationships with spouse, family, and friends; parenting/family stress; perceived need for mental health care, suicidality, and alcohol misuse; and physical health problems and disability. We hypothesize that (a) bereavement will have effects on functional outcomes over and above those that can be accounted for by trauma; (b) grief will show effects on functional outcomes over and above those that can be accounted for by PTSD or major depression; and (c) the adverse consequences of bereavement and grief will grow stronger over time. An assessment limited to only one time- point (within the first year or beyond the first year) would fail to detect such trends, making the expedited review provided by the RAPID mechanism essential to the scientific aims of the research. Recruited from a list of parents compiled by investigators at CIAD, parents would be interviewed in person at 8 and 20 months post- event. For hypothesis testing, we will rely on the method of Generalized Estimating Equations (GEE), an extension of the general linear model that accommodates repeated measurements (times 1 and 2) and clustered data (mothers and fathers). The secondary aim of the proposed study is to explore how the social dynamics of public tragedies influence symptom and functional outcomes. Mass trauma creates a context that is not fully informed by research on parents whose children died or were injured in individual events, such as vehicular accidents. For better or worse, the experience of each parent in this circumstance was shared by many others. Social network analysis will provide measures of individuals' linkages and embeddedness within the "community of parents." Linear and quadratic effects of parent-community participation measures will be tested while controlling for other measures of social support and factors that predict group participation. The proposed research is facilitated by the applicants' prior trauma and disaster research in Mexico, including Hermosillo. Cooperation rates in past Mexican disaster studies have been very high (87%). Local collaborators, project office space, and support for the research from parents have been obtained. PUBLIC HEALTH RELEVANCE: These results will inform research and practice about whether it is important to assess, treat, and study prolonged grief disorder (PGD) as a condition distinct from posttraumatic stress disorder (PTSD) in the aftermath of a traumatic event involving mass fatalities. If there are no unique effects of bereavement and grief on functioning, it becomes more difficult to argue that the distinction matters for research or treatment development, in the context of disasters. The social network results could be used to provide guidance for individuals and organizations that aim to create or work with survivor groups.