Work

Unmasking and Addressing COVID-19–Related Maladaptive Grief Reactions Among Suicidal Youth: Pilot Evidence for an Enhanced Psychiatry Emergency Room Safety Preventive Intervention

Year: 2024

Type: article

Abstract: Objective The coronavirus pandemic has resulted in catastrophic levels of mortality among parents and caregivers worldwide. This study explored the benefit of a grief-enhanced trauma-informed safety preventive intervention in enhancing parental support, ameliorating maladaptive grief and posttraumatic stress reactions, and reducing suicidal risk among youth who have experienced a COVID-19–related death of a parent/relative. Method This retrospective cohort study included youth with COVID-19–related maladaptive grief and posttraumatic stress disorder (PTSD) reactions and suicidality who received either reminder-focused positive psychiatry with suicide prevention (RFPP-S) (n = 62) or treatment as usual (TAU) (n = 62) at a large county psychiatric emergency room (PER). Clinical assessments were administered at baseline, day 2, and postdischarge weeks 1 and 4. Results The prevalence of youth with PTSD and suicidality presenting at the PER was 61%; 40% had COVID-19–related PTSD, of whom 90% also had maladaptive grief reactions. On day 2, a significant reduction was noted in maladaptive grief reactions and PTSD symptoms, reactivity to trauma and loss reminders, guilt feelings, negative affectivity, and avoidance in youth receiving RFPP-S, but not in TAU youth ( p = .001). RFPP-S, but not TAU, was associated with a significant reduction in Columbia–Suicide Severity Rating Scale scores, decreased length of stay, and rapid acute crisis stabilization ( p = .001). A substantial increase in well-being, engagement, connectedness with caregivers, resilience and adaptability, posttraumatic growth, and enhanced coping skills was found in RFPP-S youth ( p < .05), but not in TAU youth. Postdischarge follow-up was significantly enhanced in RFPP-S youth (100%) compared with TAU youth (32%). RFPP-S, but not TAU, was associated with no readmissions for suicidality postdischarge, sustained reduced maladaptive grief reactions and PTSD symptoms, and reduced reactivity to trauma/loss reminders at 1-month follow-up. Conclusion This study suggests the feasibility and potential effectiveness of providing a grief-enhanced trauma-informed safety preventive intervention in a PER. This intervention was associated with reducing severity of maladaptive grief and posttraumatic stress reactions, improving mental well-being and youth–caregiver interactions, and promoting safety and acute crisis stabilization. Parental/PER therapeutic support has promise as an important public health strategy for this population of grieving suicidal youth. Plain language summary COVID-19–related maladaptive grief and posttraumatic stress reactions are prevalent among adolescents with suicidality who visited the psychiatry emergency room. The authors investigate the role of grief-enhanced trauma-informed safety preventive intervention for youth with COVID-19-related maladaptive grief and posttraumatic stress in a psychiatric emergency room setting. The authors found that such intervention in the psychiatric emergency room setting was associated with a robust reduction in maladaptive grief and posttraumatic stress reactions, reactivity to trauma and loss reminders, and suicidality, and resulted in rapid stabilization of acute crisis and favorable clinical outcomes. The authors conclude that parental and emergency room therapeutic intervention holds promise for COVID-19–related grieving suicidal youth. Diversity & Inclusion Statement We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Source: JAACAP Open

DOI: 10.1016/j.jaacop.2024.10.001

Authors: Naser Ahmadi, Julie B. Kaplow, Alan Steinberg, James T. McCracken, Steven J. Berkowitz, Robert S. Pynoos