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.
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.
