Postdisaster morbidity of the bereaved. A possible role for preventive psychiatry?

Immediately following a rail disaster in Sydney, Australia, on January 18, 1977, in which 83 people were killed, an attempt was made to organize a preventive psychiatry outreach program for the relatives of the bereaved and the survivors. Bereavement counseling was offered to all families considered to be at risk for development of postbereavement morbidity. A follow-up study was performed 15 to 18 months later to assess the level of functioning of the bereaved relatives. The next of kin of 36 victims (43 per cent of the total number killed) were interviewed and filled in questionnaires (general health, Goldberg's General Health Questionnaire, loss, and social support). They included 15 widows, nine widowers, 11 mothers, and eight fathers who had lost children. The trends were for the bereaved spouses to have done better than bereaved parents; the widowers to have done better than the widows; those with a supportive network to have done better than those without one; those who saw the body to have done better than those who did not; and, in addition, there was a tendency for those who had bereavement counseling to do better than those who had no such intervention. Examples are given of several types of outcome, and conclusions are drawn about the results and the difficulties of implementing and evaluating such a program.