Factors associated with posttraumatic stress severity and treatment response in a retrospective, naturalistic sample of homicidally bereaved children and young people

Background: Research on the mental health of homicidally bereaved children and young people is scarce. Despite the importance of timely referral of those at risk of developing severe mental health problems, few convincing risk factors have been identified. The effectiveness of current treatment models is unclear.

Objective: This study examined factors associated with posttraumatic stress (PTS)symptom severity and treatment response in a naturalistic sample of homicidally bereaved children and young people who received traumatic grief-focused cognitive behavioural therapy (TGF-CBT); and assessed whether PTS-symptoms decreased between the start and termination of treatment.

Method: Data was used from 222 children and young people aged between 8 and 25, who had completed therapy by July 2017, and for whom either start – or end scores on PTS-symptoms, or both, were available. PTS-symptoms were measured with the Children's Revised Impact of Event Scale-8 (CRIES-8). We explored associations of personal and loss-related variables with baseline symptom levels and symptom reduction during treatment, using latent growth modelling.

Results: PTS-symptoms decreased significantly from pre- to posttreatment and with a large effect size. Higher age was associated with early treatment discontinuation. Female sex was associated with higher baseline scores, and having lost a parent or sibling with lower baseline scores. Higher baseline scores were associated with larger symptom reduction during treatment.

Conclusions: TGF-CBT shows promise in reducing PTS-symptoms following homicidal bereavement, regardless of the individual differences in personal or loss-related characteristics included in this study. However, it is important to recognize the uniqueness of children and young people confronted with homicidal loss, and to tailor treatment to their individual needs and developmental stage. More research on risk and protective factors for adverse mental health outcomes and response to treatment in children and young people bereaved by homicide is urgently needed.

HIGHLIGHTS

• Traumatic grief-focused cognitive behavioural therapy shows promise in reducing mental health complaints in children and young people following homicidal bereavement, resulting in a significant decrease of posttraumatic stress symptoms with a large effect size in the current study.
• It is important to recognize the uniqueness of children and young people confronted with homicidal loss, and to tailor treatment to their individual needs and developmental stage.
• More research on risk and protective factors for adverse mental health outcomes and response to treatment in children and young people bereaved by homicide is urgently needed.