This article was downloaded by: [University of Rochester]On: 27 August 2013, At: 00:55Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

Death StudiesPublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/udst20

Stress, coping, and mentalhealth outcomes following anatural disaster: Bereavedfamily members and friendscomparedShirley A. Murphy aa University of Washington, SeattlePublished online: 14 Aug 2007.

To cite this article: Shirley A. Murphy (1986) Stress, coping, and mental healthoutcomes following a natural disaster: Bereaved family members and friendscompared, Death Studies, 10:5, 411-429, DOI: 10.1080/07481188608252840

To link to this article: http://dx.doi.org/10.1080/07481188608252840

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all theinformation (the “Content”) contained in the publications on our platform.However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness,or suitability for any purpose of the Content. Any opinions and viewsexpressed in this publication are the opinions and views of the authors, andare not the views of or endorsed by Taylor & Francis. The accuracy of theContent should not be relied upon and should be independently verified withprimary sources of information. Taylor and Francis shall not be liable for anylosses, actions, claims, proceedings, demands, costs, expenses, damages,and other liabilities whatsoever or howsoever caused arising directly orindirectly in connection with, in relation to or arising out of the use of theContent.

This article may be used for research, teaching, and private study purposes.Any substantial or systematic reproduction, redistribution, reselling, loan,sub-licensing, systematic supply, or distribution in any form to anyone isexpressly forbidden. Terms & Conditions of access and use can be found athttp://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

w w w w w w m w w w w w w w w w w w w w m w m w w w w w w m w w w m w w w m w w w w w m w

STRESS, COPING, AND MENTAL HEALTH OUTCOMES FOLLOWING A NATURAL DISASTER:

BEREAVED FAMILY MEMBERS AND FRIENDS COMPARED

w m w w w m w w m w m w m w m w m w w w m m m m m m c o w m w w w m m w w w w w w w m m w m

SHIRLEY A. MURPHY

University of Washington, Seattle

A longitudinal exploratory design was used to assess levels of stress, self-efiicaqy, social support, health status, and recovery one and three years followinp a disaster. Study participants were 31 relatives and 18 friends of deceased disaster victims. Data were collected by questionnaires and interviews and were analyzed by multiva- riate statistics. Results indicate that relatives’ scores in two of the three health outcome measures were significantb higher than friends. Only four of the 49 partici- pants reported full recovery three years postdisaster. Otportunities for innovative interventions as well as advancing theory development for practice are discussed.

Introduction

The death of a valued person precipitates a major life crisis for most individuals. Toynbee (1976) asserts that death is a dyadic event in which there are always “two parties to the suffering that death in- flicts; and in the apportionment of this suffering, the survivor takes the brunt” (p. 332). Toynbee’s observation, published nearly a dec- ade ago, is supported by a report released in the Fall of 1984 by the National Institutes of Mental Health. This report, a survey of pre- vious research on reactions to death, cited two factors that led to the

Data analyses for this study were funded by the American Nurses’ Foundation. Appre- ciation is expressed to Barbara J . Stewart, Marie Beaudet, and Susan Miller of the Oregon Health Sciences University for statistical consultation and assistance with data analyses.

Death Studies, 10:411-429, 1986 411 Copyright 0 1986 by Hemisphere Publishing Corporation

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

412 S. A . Murphy

conclusion that bereavement is a major public health problem. Each year, eight million Americans experience the death of a close family member, and among these newly bereaved there are about 35,000 deaths. Others may develop serious illnesses thought to be precipi- tated by a progression of unresolved grief, depression, and sup- pressed immunity (Bartrop, Lockhurst, Lazarus, Kiloh, & Penny, 1977; Schleifer, Keller, Camerino, Thornton, & Stein, 1983).

Overwhelmingly, research and clinical interventions have fo- cused on the bereavement course of women following the deaths of their husbands. Several recent publications summarize widows’ grief processes, role strains, social adaptation, negative health outcomes, and mortality rates (Ball, 1976-1977; Demi, 1978; Glick, Weiss, & Parkes, 1974; Hauser, 1983; Stroebe & Stroebe, 1983; Vachon, Lyall, Rogers, Freedman-Letofsky, & Freeman, 1980).

A less established line of bereavement inquiry concerns family members other than widows. Investigators have just begun to study widowers, maternal responses to fetal and infant death, and parent and sibling responses following the deaths of children in families (Da- vies, 1983; Gallagher, Breckenridge, Thompson & Peterson, 1983; Stroebe & Stroebe, 1983; Williams & Nikolaisen, 1982).

A bereavement population that has not been studied are close friends of persons who die. Several recent publications have de- scribed the benefits of close social bonds. According to Phillips & Fischer (1 3), non-kin relationships are especially rewarding because they are freely chosen and therefore are likely to be based on value similarity. Similarly, adult confidant relationships have been shown to buffer the effects of stress on illness, whereas the absence of confi- dants led to high levels of psychological symptoms under stressful circumstances (Miller & Ingram, 1976). Burke and Weir (1977) and Weiss (1974) maintain that most persons require both a principal attachment figure and a network of friends with whom to share com- mon interests, promote self-esteem, and obtain a sense of purpose. Yet studies examining bereavement responses of close friends have not been conducted or published.

Additional factors not yet widely studied, may also contribute to bereavement stress. Among these are: (u) the mode of death, ( b ) multiple, simultaneous deaths in a family, (c) the appraisal of the death event, that is, devastating, threatening, or challenging, (6) the relationship between the deceased and bereaved prior to death, that

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

Disaster EJects 413

is, valued, ambivalent, (e) coping skills, and v) perceptions of social support. Only one published study has incorporated variables from all of these categories (Cowan & Murphy, 1985).

This paper reports the results of an exploratory study that com- pared a group of close relatives and a group of close friends of per- sons who died following the volcanic eruption of Mt. St. Helens in southwestern Washington in May of 1980. These data were part of a comprehensive longitudinal study conducted one and three years postdisaster that assessed levels of stress, self-efficacy, social support, health status, and perceived recovery. Study findings have important implications for practitioners because disasters expose normal popu- lations to catastrophic losses whose effects may be underestimated. Moreover, past studies have shown that disaster victims are reluctant to seek help to resolve personal and family conflicts that may result (Lindy, Grace, & Green, 1981; Silver & Wortman, 1980).

Conceptual Basis of the Study

Five theoretical constructs guided the study design and analysis: the magnitude of loss experienced as a result of an uncontrollable event, the appraisal of loss and perceived stress, the coping strategies and social resources available, passage of time, and health outcomes and perceived recovery.

Magnitude of Loss

A disaster may produce several levels or magnitudes of loss, such as bereavement] surviving a life-threatening evacuation, and/or prop- erty destruction. The effects of these losses may vary in both inten- sity and duration and are dependent upon demographic characteris- tics of victims, concurrent negative events, and other factors. The death of a significant other is consistently viewed as the most aversive of stressful life events (Holmes & Rahe, 1967; Sarason, Johnson, & Seigel, 1978). Weisman (1973) suggests untimely death (unexpected] premature, and violent) has more devastating effects on bereaved persons than does timely (expected, accepted) death. Bugen (1977) asserts that the more central (important) the deceased/bereaved rela- tionship prior to death, the more intense and prolonged the grieving process will be.

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

414 S. A . Murphv

Appraisal of Loss and Perceived Stress

Following a catastrophic event, individuals cognitively appraise the situation to determine personal demands, constraints, and resources available. According to Hyman and Woog (1982) it is the perception of the event as stress-producing, rather than the event itself, which is the crucial factor in illness onset. Hartsough (1985) differentiates agent (disaster)-produced stress (e.g., death of family members) from response (official and social agency)-produced stress (e.g., interviews by the mass media) and argues that both are potential sources of stress for disaster victims,

Coping Strategies and Social Responses

A major intrapersonal resource may be self-efficacy, or one’s belief in the ability to effect outcomes. According to Bandura (1977), self- efficacy involves judgements about how well one can organize and carry out courses of behavior necessary to cope with prospective situ- ations involving ambiguous, unpredictable and stressful elements in the environment. Whether a person engages in trying to cope and how long he/she will persist in coping, depends on the belief, or expectation one has at the outset. Tests of the theory have been sup- ported with heart attack victims and patients with chronic obstructive pulmonary disease; but self-efficacy has not been examined in disas- ter victims.

House recently defined social support as “an interpersonal trans- action involving one or more of the following: (a) emotional concern (liking, love, empathy); (b) instrumental aid (goals and services); (c) information (about the environment); and (d) appraisal (informa- tion relevant to self-evaluation)” (p. 39). Numerous investigators have reported that the importance of relationships with confidants act either as antecedents that reduce the likelihood of illness, or as buffers that lessen the impact of negative life events.

Passage of Time

Passage of time is thought to mediate the effects of loss and stress on health and social adjustment, but the precise role that time plays is

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

Disaster Eflects 415

unclear. It is an important variable in disaster recovery because of disaster victims; reluctance to seek help (Lindy, et al., 1981).

Postdisaster Health Outcomes

The recovery period following a disaster involves numerous stressful activities including grieving, adjusting to role changes such as wid- owhood and single parent status, moving, cleaning, and repairing property, and preparing lengthy reports associated with loss. A num- ber of past studies have suggested that these stressful activities have led to negative health outcomes. In summary, several assumptions guided the exploratory analyses: (a) both kin and non-kin whose re- lationships are severed by untimely death are likely to experience an intense and prolonged grief, (6) disaster death is likely to be ap- praised as extremely stressful which might have an impact on health status, and (c) both self-efficacy and social support are likely to be altered during the course of disaster bereavement.

In the current study, l$e stress was defined as concurrent negative life events that occurred during the past year as well as those result- ing from the disaster and ongoing or daily hassles encountered. Cop- ing was defined as the way disaster stress was managed and consisted of both the belief in one’s ability to effect outcomes (self-efficacy), and the use of interpersonal resources (social support). Mental health outcome was defined as the levels of mental distress study subjects reported one and three years following the disaster.

Method

Sample

Sixty persons were declared dead or missing and presumed dead as a result of the volcanic eruption. Nine of these persons were either children or adults whose whereabouts could not be limited to the eruptive area the morning of the disaster. Of the remaining 51 adult deceased, 20 were confirmed dead and 31 were presumed dead. Thus the sample pool from which potential bereaved subjects could be drawn was small and finite. To assure a representative sample of adequate size for analyses, a close family member and close friend

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

416 S. A . Murphy

for each deceased disaster victim were recruited as subjects. “Close- ness” was measured by asking bereaved study subjects to rate the importance of the deceased person on a 1 to 9 Likert scale, with the number 1 designated as “not close,” “not important,” and the num- ber nine designated ass “very close,” “very important.” Only sub- jects who rated closeness of the deceased person at seven or above were included in the study.

In 1981, 39 family members and 30 friends participated. In 1983, 31 family members and 18 of these same friends continued in the study. Names of relatives of confirmed deceased disaster victims were obtained from death certificates whereas names of relatives of those presumed dead were obtained from a list of persons who gave court testimony required for processing provisional death certificates. Name of bereaved close friends were obtained primarily from rela- tives. Eighty percent of all deceased victims were represented in the study in 1981.

The bereaved family members and friends were similar in age, but dissimilar on other demographic variables. Upon entry into the study, the mean age of family members was 38 years compared to friends’ mean age of 40.5 years. Eighty-seven percent of the relatives were female compared to 56 percent of the friends. Friends were somewhat better educated and held higher paying jobs than relatives. Family members’ relationships to the deceased were as follows: wid- ows 16 percent, mothers 19 percent, daughters 48 percent, sons 10 percent, and sibling 6 percent. The remaining 37 percent of the bereaved group were close friends. The bereaved participants’ resi- dential geographic proximity to the eruptive area ranged from within a 25-mile radius of Mt. St. Helens to ten additional U.S. cities and extended to two Canadian provinces.

Measures

Instruments for the disaster study were selected from standardized measures having adequately established levels of reliability and valid- ity as well as a potentially wide range of scores. By using measures that are highly sensitive to relatively small differences among individ- uals on measured attributes, the sample size can be somewhat smaller than in studies in which measurement cannot be as well controlled. Measures of stress were the Life Experiences Survey and

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

Disaster Effects 417

the Hassles Scale. Measures of intra and inter-personal support were Coppel’s Self-Efficacy Scale and Index of Social Support. The men- tal health measuers were scales of the Symptom Checklist-90-R. Only the recovery measures were investigator-developed.

The L@ Experiences Survey. This scale developed by Sarason, Johnson, and Siege1 (1978) is a 47-item multidimensional scale which permits respondents to verify the occurrence of objective indicators of stress and subjectively rate these indicators as positive or negative. Validity has been shown through significant correlations with other stress- related measures and a test-retest reliabilities were .56 and .88 (72~345) (Sarason et al., 1978).

The Hassles Scale. Measurement of subjects’ daily stresses were ob- tained with this 11 7-item scale that describes ways in which persons may perceive feeling “hassled” (Lazarus & Cohen, 1977). Respon- dents select and rate hassles for both persistence and irritability (1- somewhat, 2-moderate, 3-extreme). Test-retest correlation coeffi- cients ranged from .48 to .79 (p< .OOl) between frequency of hassles and psychological symptoms measured by the Symptom Checklist (n= 100) (Folkman & Lazarus, 1980).

Self-Efficicacy. The Self-Efficacy Scale is a series of 22 statements that measures beliefs about the ability of one’s behavior to produce de- sired outcomes (Coppel, 1980). Internal consistency reliability was .91 (coefficient alpha), and test-retest reliability r - .68 to r 5 .73. A principal components factor analysis of the scale yielded four factors that accounted for 63 percent of the total variance (Coppel, 1980).

The Symptom Checklist-90-R. Measures of mental health were ob- tained by the SCL-90-R, a self-report 90-item checklist developed by Derogatis (1977). Respondents rate each item on a five-point scale of distress from “not at all” (0) to “extremely” (4). Current point in time distress is reflected by scores on three global indices of distress and nine symptom subscales. Derogatis (1977) suggests the Global Severity Index (GSI) compiled by scores on all 90 items is the most meaningful single indicator of distress. The nine subscales of the SCL are: depression, somatization, anxiety, hostility, interpersonal sensitivity, obsessive-compulsive (lack of concentration), paranoia

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

418 S. A . Murphy

(suspiciousness), phobic anxiety (fear), and psychotism (alienation). The SCL-90-R has an extensive history of psychometric develop- ment. Moreover, two measures of reliability for the SCL-90-R were established for the current study. For the GSI, the internal consist- ency reliability was Y = .97. Stability coefficients between the two data collection periods were r = .66 for the bereaved group ($5 -01). Subscale reliabilities are reported elsewhere (Kiger & Murphy, in press). The GSI scale and the depression and somatization subscales were selected for analysis in this study because of their reliabilities and clinical relevance.

Recouery. Two investigator-developed items assessed recovery. The first was, (‘as of today, how well do you feel you have recovered from the effects of your loss?” (1 =not at all, 9=completely). The second item was “if you have completely recovered, how long after the di- saster did it take to feel recovered?” Subjects selected one of five time periods-6 to 11 months, 12 to 17 months, 18 to 23 months, 24 to 29 months, 30 to 36 months.

Procedure

Data collection procedures were identical for both time periods. Let- ters were mailed to potential participants explaining the nature and purpose of the study. DHHS guidelines were followed regarding written informed consent, confidentiality, and freedom to withdraw. Data were collected approximately 11 and 35 months postdisaster. The study measures were assembled in three random orders and mailed to persons who agreed to participate. Structured telephone or personal interviews were conducted with the same 30 bereaved per- sons (20 relatives and 10 friends), following return of the question- naires in both 1981 and 1983.

Data Analysis

The within-bereaved group analyses repeated here followed analyses that compared the bereaved, property loss and control groups re- ported elsewhere (Murphy, 1984; Murphy, in press). Results of the three group comparisons indicated that the bereaved group reported the highest rates of overall mental distress and depression and the

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

Disaster Effects 419

lowest rates of recovery. Therefore, within bereaved group analyses were of interest.

Each person’s set of scores were regarded as independent obser- vations for statistical analysis. It was assumed that even though both relatives and friends were bereaved as a result of the same disaster death, their responses would be independent since each participant was unique. For example, one relativelfriend pair might be a 55- year-old mother and a 35-year-old male friend, whereas another relative/friend pair might be a 40-year-old widow and 45-year-old male friend. To check on the assumption of independence of observa- tions, Pearson correlations were computed for each pair of subjects for each of the study measures. The results were all non-significant, appearing not to produce a sampling bias. This sampling methodol- ogy is described in detail elsewhere (Murphy & Stewart, 1985-1986).

Longitudinal data from the measures of stress, support and health, were analyzed by two-way analysis of variance. The bereaved subjects, grouped by their kin or non-kin relationships with the de- ceased, comprised two levels of one factor, and repeated measures of data collected approximately one and three years postdisaster, com- prised the two levels of the second factor. Interview data were sub- jected to theme analysis extracted from verbatim notes made at the time of each interview.

Results

Stress, Support and Health Data

No significant main effects were found for either measure of stress on the between-groups factor, however, both measures were statistically significant on the repeated measures factor, indicating that stress lev- els decreased significantly between the two data collection periods for both groups. No significant main effects were found for either sup- port variable on either factor. These results can be interpreted to mean that there were not statistically significant differences between family members and friends regarding how they rated their self- competencies to bring about desired outcomes, nor did the two groups differ in how they perceived their support systems. Moreover, neither aspect of support changed significantly between data collec-

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

420 S. A. Murphy

tion periods. In contrast, results for the SCL-90-R Global Severity Index, and the depression and somatization subscales of the SCL-90- R, indicated that all F ratios for between and within group sources of variation were significant except for the between group ratio on the somatization dependent variable (see Figure 1). These results can be interpreted to mean that for overall severity and depression, family members’ scores were significantly higher than friends, even though scores on these measures had decreased significantly between the two data collection periods. Table 1 shows means and standard deviations for the two study groups.

Recovery Data

Only four of the 49 subjects, two relatives and two friends, reported they had fully recovered three years postdisaster. Relatives’ recovery times were 12 to 17 months and 30 to 36 months respectively. Friends rated recovery times at 12 to 17 months and 24 to 29 months respective1 y.

Interview Data

Two questions from each collection period regarded bereavement stress, coping, and recovery and were examined to compare re- sponses to disaster death according to kin and non-kin status. The first question at Time 1 was, “what were some of the changes you had to make as a result of your loss?” Two major themes evolved in family members responses: adjusting to sudden role change and cop- ing with grief, loss, and intense loneliness.

One young woman responded, “I have lost my entire family over a nine-month period; you can’t believe the financial mess I am in and what I have been called on to do.” A brother responded, “I had to move to this state to take care of my elderly parents since my brother was killed by the disaster. My mother died six weeks after my brother’s death and my father is now hospitalized with a stroke. The move has been hard on my adolescent children.” The pain of testify- ing at the presumptive death hearings was a stressor mentioned by several respondents.

Coping with the unexpected and unusual loss was difficult for those who experienced the deaths of multiple family members, par-

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

4.0

1.4 .9

.8

.7

.6

.5

.4

.3

.2

R F

4.0

1.5

I .4

1.3

1.2

1.1

1 .o

.9

.7

.6

.5

.4

.3

.2 .a

T2

SCL-

90-R

GLOB

AL S

EVER

ITY

INDE

X

Betw

een

SS F

4.6

2*,

df

48

Wit

hin

SS F

20.

19**

* d

f 49

T1

7.2

SCL-

90-R

DEPR

ESSI

ON S

UB-S

CALE

Betw

een

SS F

6.09

* df

48

Wit

hin

SS F

21.

66**

*, d

f 49

4.0

1.4

1.3

1.2

1.1

1 .o

.9

.8

.7

.6

.5

.4

.3

.2

T1

T2

SCL-

90-

R

SOMATI ZA

TI ON

SUB

- SCA

LE

Betw

een SS F

2.2

6,

df

48

With

in SS

F 15

.06*

**

df

49

TI =

1981

, T2

=

1983

, R

= R

elat

ives

, F

= Fr

iend

s le

L

N

FIG

UR

E 1

. M

enta

l he

alth

out

com

es, r

elat

ives

and

fri

ends

com

pare

d us

ing

2 X

2 a

naly

sis

of v

aria

nce

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

TA

BL

E 1

. M

eans

and

Sta

ndar

d D

evia

tion

s on

Stre

ss, S

uppo

rt, a

nd H

ealth

Out

com

e V

aria

bles

for

Fam

ily M

embe

rs a

nd F

rien

ds I

and

3 Y

ears

Pos

t-D

isas

ter

~ ~~

~

Fam

ily m

embe

rs (n =

3 1)

1981

19

83

1981

19

83

Intim

ate

frie

nds (n

- 18

)

Stud

y m

easu

res

Mea

n S

.D.

Mea

n S

.D.

Mea

n S

.D.

Mea

n S

.D.

Neg

ativ

e ex

peri

ence

s 15

.03

Has

sles

13

8.42

So

cial

sup

port

51

.74

Self

-eff

icac

y 76

.91

Ove

rall

dist

ress

1.

04

Dep

ress

ion

1.51

So

mat

izat

ion

.90

~~

~

10.7

0 6.

97

117.

50

74.3

0 13

.15

49.5

8 11

.69

72.5

5 .5

8 .6

7 .6

3 .9

4 .6

0 .5

7

~~

~

6.80

11

.61

51.6

0 11

9.22

12

.38

55.7

8 13

.47

78.5

6 .4

5 .6

7 .5

5 1.

03

.49

.66

~ 11.0

4 7.

72

9.05

86

.74

83.6

1 86

.32

13.3

0 56

.56

13.3

3 13

.69

78.5

6 9.

22

.51

.46

.42

.69

.6

.62

.55

.39

.37

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

Disaster Eflects 423

ticularly young persons, who lost both parents. Some dreamed of their parents coming home; others became upset when they saw cars resembling those belonging to their parents. Others reported family disputes, especially in situations where the deceased had been di- vorced and remarried, and grandparents from one side of the family were not well acquainted with children from the other side. Friends reported assisting family members in come cases, but the predomi- nant theme among non-kin was coping with the loss. Many friends commented on the loss of extremely talented persons whom they felt were both friends and role models to them.

The second question at Time 1 asked subjects to discuss any positive, growth-producing effects that may have resulted from the disaster deaths. The overwhelming theme among relatives was, “there haven’t been any.” The few exceptions can be noted in the following comments: “I’ve grown up and I needed to” (daughter). “I’ve learned I’m a strong person” (son). “I have a stronger belief in a life hereafter” (sibling). “Our family has gotten closer” (son). In contrast, by one-year postdisaster, friends’ responses were far more positive and are reflected in the following comments: “This was both the worst and the best thing that ever happened to me.” “I have become much more present-oriented. I enjoy today, period.” “I’ve taken out a will.” “My own work has advanced. I’m a better artist because of my friend’s death. I have felt a real need to uphold his high standards.”

At Time 2, 3 years postdisaster, the first interview question was “What bothers you now about your loss?” The major theme among relatives was the lack of resolution: “It was a senseless death, a con- tinuation of grief-holidays, birthdays, and May 18 are dreaded, empty days.” “I miss them-that’s the bottom h e . ” “I’m better now that I have a routine-I’m beginning to get a purpose to my life again.” “There is nothing like it, but I’ve learned to go on-no recovery, just adjustment.” “My dreams are more neutral now-I dream of earlier happier times.” “I feel cheated. My only son is gone-I’ll never have grandchildren.” “I still vacillate between an- ger and loneliness-the danger was not made known. The deaths were preventable.” “I am still going through belongings-an emo- tionally loaded task.” “I have a serious drug problem.”

The second question at Time 2 asked participants what they did to promote their recoveries. More subjects had sought professional

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

424 S. A. Murphy

help (n - 6) between the two data collection periods than one year postdisaster (n - 3). “Seeking counseling has helped. I still need to talk about it and I can’t continue to unload on my friends. This way I have permission to continue to work through.” “Finding a good bereavement counselor is a discouraging process. After two unsuc- cessful tries, I started going around interviewing them to find some- one comfortable enough to help me. It’s the only way.” Several sub- jects reported reading current best sellers on grief and bereavement but most were disappointed with the quality of materials found in libraries and bookstores.

Discussion

The most important study findings are reflected in health outcomes. Being a family member of a deceased disaster victim resulted in higher levels of overall mental distress and depression than did being a close friend. The significant main effects of the repeated measures factor across all three mental health outcomes suggests that time had an important ameliorating effect. The repeated measures findings are consistent with findings in the comprehensive study-that even though bereaved subjects reported lower levels of mental distress over time, they were statistically significantly higher than those of both the control group and the SCL-90-R normative group. The slow patterns of recovery are consistent with health data and suggest the recovery period may be longer than commonly accepted among both professional helpers and the general population.

Similarly, the interview data suggest clear differences between kin and non-kin responses to the death of an important other and support statistical findings. By one year postdisaster, friends could articulate their positive as well as the negative effects of their losses, and by three years postdisaster, appeared to have made considerable progress toward the resolution of loss and were desirous of putting the past behind. These findings may account for the 58 percent attri- tion rate in the friends sub-sample. In contrast, interview data sug- gest that family members were experiencing somewhat intense and prolonged grief responses, although mental health status improved significantly between 198 1 and 1983.

The absence of significant differences between relatives and

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

Disaster Effects 425

friends on the stress measures over time may be explained by the fact that the two groups gave similar ratings on concurrent life events and hassles. Neither the Life Experiences Survey nor the Hassles Scale are context-specific. These instruments may not have been optimal measures of the stressful encounter.

The lack of significant main effects on either factor on the self- efficacy measure is a positive finding that supports the notion that self-mastery is a relatively stable trait in adults. The lack of signifi- cant main effects on either factor on the social support measure could also be regarded as an indication that support remained stable over time or that new supports had been established by the time of data collection. In one sense, the current findings can be regarded as contradictory to the typical patterns of support during bereavement. Glick et al. (1974) and others have reported a reduction in support. Moreover, the quantitative findings reported here do not reflect change in support patterns away from peer to family support and friendship concerns described by several young women (daughters of deceased disaster victims).

Implications for Clinicians

A criterion for study participation was that each family member and friend report a central relationship with the deceased disaster victim. By three years postdisaster, friends were apparently able to loosen this close bond, whereas family members were not. Whether family members could benefit from the bereavement process experienced by friends is an interesting question. Based on differences in levels of overall mental distress, depression, somatization, and recovery, friends may be appropriate persons to promote recovery in family members in much the same way (Barrett (1978), Silverman (1981), and Vachon et al. (1980) established widow-to-widow therapy groups.

The lack of resolution among bereaved family members is incon- sistent with expectations held by professionals and the general public. However, since the residences of study participants are widely dis- persed, outreach services and public information may also be ways to reach some persons whose mental distress scores and self-rated recov- eries suggest they could benefit from intervention.

Next, participants’ reports .of dissatisfaction with professional

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

426 S. A. Murphy

counselors must be addressed. Persons in this study were distressed by the apparent discomfort of professionals in discussing traumatic death experiences; yet past studies have documented the need of victims to verbalize over and over their perceptions, including self- blame (Lindemann, 1944; Melick, Logue & Frederick, 1982). The apparent lack of skill in helping clients has been pointed out by oth- ers. Silver and Worman (1980) have warned that professionals are likely to underestimate the impact of unpredicted and uncontrollable events. In a study of the delivery of mental health services following disasters, Baisden and Quarantelli (1981) found that professionals provided information rather than clinical interventions. These defi- cits are likely to be due to insufficient clinical preparation and experi- ence in loss, grief, and bereavement counseling.

Implications for Theory Developnzent for Clinical Practice

Bugen’s model of grief appeared to be supported in the current study. Grief was indeed intense and prolonged for family members and is reflected in both statistical and interview data. The Bugen model needs further testing. If supported empirically, the theory has important implications for clinical practice.

Limitations and Future Directions

The major limitation was the small sample size. The family member subgroups of widows, mothers, adult children, and siblings were too small for comparative analyses. Since little is known about the be- reavement transition among these persons, an important goal for future studies is to obtain samples of sufficient size to carry out these analyses-an important task in the case of the current study.

In summary, study subjects for the foregoing analyses were grouped according to relationships with deceased disaster victims by which they were initially recruited. Methods of obtaining representa- tive and adequate-sized samples from potentially high risk bereaved persons have had limited discussion in the literature. The selection of two bereaved persons for each deceased disaster victim lessened a potential sampling dilemma. Study findings revealed significant dif- ferences between bereaved family members and friends’ health status

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

Disaster Effects 427

as the result of a natural disaster, although levels of distress were significantly lower three years postdisaster compared to one year postdisaster.

References

Baisden, B., & Quarantelli, E. (1981). The delivery of mental health services in community disasters. An outline of research findings. Journal of Community

Ball, J. (1976-1977). Widow’s grief The impact of age and mode of death. O m e p ,

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 19 1-2 15.

Barrett, C. J . (1978). Effectiveness of widows’ groups in facilitating change. Jour- nal of Consulting and Clinical Psychology, 46, 20-31.

Bartrop, R. W. Lockhurst, E., Lazarus, L., Kiloh, L. G., & Penny, R. (1977). Depressed lymphocyte function after bereavement. Lancet, 1, 834-836.

Bugen, L. (1977). Human grief: A model for prediction and intervention. American Journal of Orthopsychiatry, 47, 196-206.

Burke, R., & Weir, T. (1977). Marital helping relationships: Moderators between stress and well-being. The Journal of Psychology, 95, 121-130.

Coppel, D. (1980). The relationship of perceived social support and serf-e&ag to major and minor stresses. Unpublished doctoral dissertation, University of Washington, Seattle.

Cowan, M. E., & Murphy, S. A. (1985). Identification of post disaster bereave- ment risk predictors. Nursing Research, 34, 71-75.

Davies, M. B. (1983). Behavioral responses of children to the death of a sibling. Unpublished doctoral dissertation. the University of Washington, Seattle.

Demi, A. S. (1978). Adjustment to widowhood after a sudden death: Suicide and non-suicide survivors compared. Communicating Nursing Research, 11, 91-94.

Derogatis, L. (1977). SCL-90-R: Administration scoring, C3 procedures manual. Balti- more: Clinical Psychometrics Research.

Folkman, S., & Lazarus, R. S. (1980). An analysis of coping in middle-aged community sample. Journal of Health and Social Behavior, 21, 219-239.

Gallagher, D. E., Breckenridge, J . N. , Thompson, L. W., Peterson, J. A. (1983). Effects of bereavement on indicators of mental health in elderly widows and widowers. Journal of Gerontology, 38, 565-571.

Glick, I . , Weiss, R., & Parkes, C . (1974). Thefirst year of bereavement. New York: John Wiley & Sons.

Green, B. L. (1982). Assessing levels of psychological impairment following disas- ter. The Journal of Nervous and Mental Disease, 170, 544-552.

Hartsough, D. M. (1985). Measurement of the psychological effects of disaster.

Psychology, 9, 195-203.

7, 307-333.

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

428 S. A . Murphy

In J. Laube & S. A. Murphy (Eds.), Perspectives on disaster recovery, 22-60. East Norwalk: Appleton-Century-Crofts.

Hauser, M. J. (1983). Bereavement outcome for widows. Journal of Psychosocial Nursing and Mental Health Services, 21, 23-3 1 .

Hofmes, T., & Rahe, R. (1967). The social readjustment rating scale. Journal of Psychosomatic Research, 11, 2 13-2 18.

Hyman, R., & Woog, P. (1982). Stressful life events and illness onset: A review of critical variables. Research in Nursing and Health, 5, 155-163.

Kiger, J. A., & Murphy, S. A. (in press). A longitudinal reliability assessment of the SCL-90-R using a disaster bereaved sample. Wstern Joumal of Nursing Research.

Lazarus, R., & Cohen, J. (1977). The hassles scale. Stress and coping project, University of California.

Lindemann, E. (1944). Symptomatology and management of acute grief. American Journal of Psychiatry, 144, 141-148.

Lindy, J., Grace, M., Green, B. (1981). Survivors: Outreach to a reluctant popu- lation. American Journal of Orthopsychiatry, 51, 468-478.

Melick, M. E. (1985). The health of postdisaster populations: A review of litera- ture and case study. In J. Laube & S. A. Murphy (Eds.), Perspective on disaster recovery, 179-209. East Norwalk: Appleton-Century-Crofts.

Melick, M. E., Logue, J., Frederick, A. (1982). Stress and disaster. In E. Gold- berger & s. Breznitz (Eds.), Handbook OfSfress. New York: Free Press.

Miller, P. & Ingram, J. (1976). Friends, confidants, and symptoms. Social Psychia-

Murphy, S.A. (1984). Stress levels and health status of victims of a natural disas- ter. Research in Nursing and Health, 7, 205-2 15.

Murphy, S. A. (in press). Health and recovery status of natural disaster victims one and three years later. Research in Nursing and Health.

Murphy, S . A,, Stewart B. J. (1985-1986). Linked pairs of subjects: A method for increasing the sample size in a study of bereavement. Omega, 16, 141-153.

Phillips, S. L., & Fischer, C. S. (1984). Measuring social support networks in general populations. In B. S. Dohrenwend & B. P. Dohrenwend (Eds.), Stress-

ful lqe events and their contexts, VoI. 2 . New Brunswick, N. J . : Rutgers University Press.

Rabkin, J., & Struening, E. (1976). Life events, stress, and illness. Science, 194,

Sarason, I., Johnson, J., & Siegel, J. (1978). Assessing the impact of life changes: Development of the life experiences survey. Journal of Consulting and Clinical

Schleifer, S. J., Keller, S. E., Camerino, M., Thornton, J. L., & Stein, M. (1983). Suppression of lymphocyte stimulation following bereavement. Journal .f the American Medical Association, 250, 374-377.

Silver, R., & Wortman, C. (1980). Coping with undesirable life events. In J. . Garber & M. Seligman (Eds.), Human helplessness: Theoiy and applications. New

Silverman, P. R. (1981). Helping womm cope with grief. Beverly Hills: Sage Publica-

try, 11, 51-58.

101 3- 1020.

Psychology, 46, 932-946.

York: Academic Press.

tions.

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3

Disaster Effects 429

Stroebe, M. S., & Stroebe, W. (1983). Who suffers more? Sex differences in health risks of the widowed. Psychological Bulletin, 93, 279-301.

Toynbee, A. (1976). The relation between life and death, living and dying. In E. S. Shneidman (Ed.) , Death: Current Perq?ectives, (pp. 324-332). Palo Alto: Mayfield Publishing Co.

Vachon, M., Lyall, W. A . , Rogers, J., Freedman-Letofsky, K., & Freeman, S. J. (1980). A controlled study of self-help intervention for widows. American Jour- nal ofPsychiat9, 137, 1380-1384.

Weisman, A. (1973). Coping with untimely death. Psychiatv, 36, 336-379. Weiss, R. (1974). The provisions of social relationships. In 2. Rubin (Ed.), Doing

unto others. Englewood Cliffs: Prentice-Hall. Williams, R. A , , & Nikolaisen, S. M. (1982). Sudden infant death syndrome:

Parents’ perceptions and responses to the loss of their infant. Research in Nurs- ins and Health, 5, 55-61.

Received November 15, 1985

Dow

nloa

ded

by [

Uni

vers

ity o

f R

oche

ster

] at

00:

55 2

7 A

ugus

t 201

3