Locked in grief: a qualitative study of grief among family members of missing persons in southern Sri Lanka

BMC Psychology - 2021
Amila Isuru1, Padmakumara Bandumithra2, Shehan Williams3
1Department of Psychiatry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
2District General Hospital, Hambantota, Sri Lanka
3Department of Psychiatry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka

Tóm tắt

Abstract Introduction The psychological and social issues experienced by family members of missing persons are different from normal grief following the death of a loved one. The term “Ambiguous loss” describes this psychological phenomenon. Ambiguous loss acts as a barrier to adjusting to grief, leading to symptoms of depression and intra and interpersonal relational conflicts. An in-depth phenomenological understanding of this subjective experience is important. Method A qualitative study was conducted among close family members of persons who had gone missing during the civil conflict and the 2004 tsunami in southern Sri Lanka following formal ethical approval from an university ethics review committee. Purposive and snowballing sampling methods were used to recruit the participants. Theoretical sample saturation was achieved with 24 family members of missing persons. Responders were mothers, fathers, wives, husbands, and siblings of missing individuals. In-depth interviews were recorded with the help of a semi-structured guide, after informed consent. The recordings were transcribed and coded by three independent investigators. The investigators through consensus arrived at the phenomenological themes and grounded them through reflexivity. The triangulation process involved cross-checking observational notes made by the interviewers and consulting the interviewees. Results We interviewed 24 first degree relatives of missing individuals. Twenty-one of the interviewees were unsure about the fate of the missing individual, while three of them believed the missing individual to be dead. Of the 24 missing individuals, 20 were males and 18 had gone missing in civil conflicts and 6 in the Indian Ocean Tsunami. Six predominant phenomenological themes were identified. Those were lack of closure, hope, guilt, helplessness, perpetual suffering, and an emotional vacuum. These phenomenological experiences are highlighted by the interviewees through a range of utterances that hold profound cultural, social and emotional significance of unresolved and vacillating grief. Conclusion The highlighted phenomenology of grief in surviving family members of those who go missing following traumatic events demands a response from health and social services in every country that experiences disaster. The surviving loved one is ‘locked in grief’ indefinitely and future research on evidence-based interventions to overcome this predicament is warranted.

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Tài liệu tham khảo

Sri Lanka: Report released on needs of families of missing persons | International Committee of the Red Cross. [cited 2021 Apr 4]. https://www.icrc.org/en/document/sri-lanka-families-missing-persons.

Sri Lanka: Report released on needs of families of missing persons | International Committee of the Red Cross. [cited 2020 Jun 21]. https://www.icrc.org/en/document/sri-lanka-families-missing-persons.

Hollifield M, Hewage C, Gunawardena CN, Kodituwakku P, Bopagoda K, Weerarathnege K. Symptoms and coping in Sri Lanka 20–21 months after the 2004 tsunami. Br J Psychiatry. 2008;192(01):39–44.

Boss P. Ambiguous loss research, theory, and practice: reflections after 9/11. J Marriage Fam. 2004;66(3):551–66. https://doi.org/10.1111/j.0022-2445.2004.00037.x.

Boss P. Ambiguous loss in families of the missing. Lancet. 2002;360(SUPPL 1):s39–40.

Persons ED, Processes E. The first Asian conference on psychosocial work in the search for enforced disappeared persons. In: Exhumation processes and the struggle for justice and T; 2010. pp. 38–40.

International Committee of the Red Cross. Sri Lanka: Report released on needs of families of missing persons | International Committee of the Red Cross. 2016 [cited 2020 Jun 21]. https://www.icrc.org/en/document/sri-lanka-families-missing-persons.

Crettol M, La Rosa A-M. The missing and transitional justice: the right to know and the fight against impunity. Int Rev Red Cross. 2006;88(862):355.

Bernard V. The disappeared and their families: when suffering is mixed with hope. Int Rev Red Cross. 2017;99(905):475–85.

Isuru A, Hewage SN, Bandumithra P, Williams SS. Unconfirmed death as a predictor of psychological morbidity in family members of disappeared persons. Psychol Med. 2019;49(16):2764–71.

Lenferink LIM, de Keijser J, Wessel I, de Vries D, Boelen PA. Toward a better understanding of psychological symptoms in people confronted with the disappearance of a loved one: a systematic review. Trauma Violence Abus. 2019;20(3):287–302.

Ball HA, Siribaddana SH, Kovas Y, Glozier N, McGuffin P, Sumathipala A, et al. Epidemiology and symptomatology of depression in Sri Lanka: a cross-sectional population-based survey in Colombo District. J Affect Disord. 2010;123(1–3):188–96.

Wayland S, Maple M, McKay K, Glassock G. Holding on to hope: a review of the literature exploring missing persons, hope and ambiguous loss. Death Stud. 2016;40(1):54–60. https://doi.org/10.1080/07481187.2015.1068245.

Holmes L. The experiences of, and impacts on, the families of missing people. Rep Res Summary.(1020419):10–3.

Parr H, Stevenson O, Woolnough P. Search/ing for missing people: families living with ambiguous absence. Emot Sp Soc. 2016;19:66–75. https://doi.org/10.1016/j.emospa.2015.09.004.

Kajtazi-Testa L, Hewer CJ. Ambiguous loss and incomplete abduction narratives in Kosovo. Clin Child Psychol Psychiatry. 2018;23:333–45. https://doi.org/10.1177/1359104518755221.

Robins S. An assessment of the needs of families of the missing in Nepal. Ssrn. 2009.

Bowlby J. Attachment and loss. Loss sadness and depression. New York; 1980.

Barakovic D, Avdibegovic E, Sinanovic O. Posttraumatic stress disorder in women with war missing family members. Psychiatr Danub. 2014;26(4):340–6.

International Committee of the Red Cross. Living with uncertainty. Needs of the families of missing persons in Sri Lanka. 2016.

Boss P. Ambiguous loss theory: challenges for scholars and practitioners. Fam Relat. 2007;56(2):105–11. https://doi.org/10.1111/j.1741-3729.2007.00444.x.

Bryant RA. Prolonged grief. Curr Opin Psychiatry. 2014;27(1):21–6.

Dewhirst P, Kapur A. The disappeared and invisible revealing the enduring impact of enforced disappearance on women the disappeared and invisible. 2015 [cited 2019 Jan 31]. www.ictj.orgII.

Yakinthou C. Living with the shadows of the past: the impact of disappearance on wives of the missing in Lebanon. 2015.

Somasundaram D. Collective trauma in northern Sri Lanka: a qualitative psychosocial-ecological study. Int J Ment Health Syst. 2007;1:1–27.

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