Historical Trauma and Grief
An Intervention Project
Related to Place
1Gyda
Swaney, PhD
1Ke Wu, PhD
2Patricia A. Holkup, PhD, RN
2Emily Matt Salois, MSW, ACSW
1University
2Montana
of Montana, Missoula
State University College of Nursing, Bozeman
American Indigenous Research Association
Salish Kootenai College, Pablo, MT
October 10-11, 2014
Introduction
CBPR & Indigenous research approaches
Underlying issue related to health disparities

Impact of widespread grief
Goals of project

Develop and pilot an intervention to address historical
trauma and grief (quantitative)

Elicit a description of community members’ experiences
of grief (qualitative)
The Intervention:
A 3-Day Grief Retreat
An Indigenous ceremony to honor
historical trauma and grief
Intervention



Day 1: BELONGING

Birth/Infancy/Discovery

Introduction, virtues, telling the HT
story, signs and symptoms of
unresolved and disenfranchised grief.
Day 2: MASTERY

Adolescence/Faith/Personal Growth

Exploration of
intergenerational/current family
situations and dynamics, work on
Circle of Grief (chronological
identification of losses & positive
lessons).
Day 3: INDEPENDENCE

Adult/Autonomy/Freedom/Recovery

Identification of relationships with
the losses, letter writing exercise.
Brendtro, Brokenleg, & Van Bockern, 1990;
DeRoche & Malatare, 2010
What is the effect of the Grief Retreat on participants’
expression of grief, resilience/coping skills, psychological
wellbeing, and experience of historical trauma?
(N = 50, F=26; M=24)
Table 1. Data collection schedule
Table 1. Data collection schedule (Groups I – IV)
Pre
Time 1
1st
Demographic
Grief History Questionnaire
Historical Trauma
Historical Loss Scale (HLS)
Historical Loss Associated Symptoms Scale (HLASS)
Traumatic Grief
Inventory of Traumatic Grief (ITG)
day
Post
Time 2
Grief Retreat
(Intervention)
Measures
Grief Retreats 5-6 (N = 37, F=18; M=19)
Measures
1 month after
Note: References for instruments included at the end
Pre
Time 1
1st day
Demographic
Grief History Questionnaire
Grief Question:
1.
Have you experienced another death?
Qualitative Questions:
1.
What was helpful?
2.
What do you wish was included?
Historical Trauma
Historical Loss Scale (HLS)
Historical Loss Associated Symptom Scale (HLASS)
Traumatic Grief
Inventory of Traumatic Grief (ITG)
Resilience/Coping
Brief COPE Inventory (BC)
Brief Resilience Scale (BRS)
Inventory of Support Evaluation List (ISEL)
Psychological
Kessler-6 (K-6)
Positive and Negative Affect Schedule (PANAS)
Approximate time to complete the packet
Time 2
1 day >
Post
Time 3
1 mo >
Time 4
3 mo >
35 min
40 min
50 min
Grief Retreat (Intervention)
Grief Retreats 1-4
50 min
Demographics






N = 87 (female = 44; male = 43)
Live alone (yes = 20.7%; no = 79.3%)
Employed (yes = 43.7%; no = 56.3%)
Education

6th Grade or less = 1.1%

Partial High School = 4.6%

High School Diploma/GED = 21.8%

Partial College = 34.5%

Completed College = 21.8%

Graduate/professional training = 12.6%

Other = 2.3%
Organized Religion (yes = 62.4%; no = 37.6%)
Tribal traditional spiritual practices: (yes = 67.8%; no = 32.2%)
Grief History: Number of Deaths per
Participant in Past 5 Years
22
14%
37
24%
N = 155
M = ~5
Range = 1-20
14
9%
51
33%
31
20%
Preliminary Results
MEASURE
Groups 5 & 6
Historical Loss Scale
(Developed for Native Americans)
Participants thought more about Historical Loss
[T1 (M = 44.67) – T2 (M = 47.33) – T3 (M = 41.0) – (T4 (M =
34.78); p = .033, eta = .328, n = 9]
Historical Loss Associated Symptom Scale
(Developed for Native Americans)
NSF
Anxiety/Depression (T1 – T3, p = .06, eta = .273, n = 9)
Anger/Avoidance (NSF)
Brief COPE Inventory
Coping/Planning (NSF)
Acceptance (NSF)
Humor (NSF)
Religion (NSF)
Support (NSF)
Distraction/Venting (NSF)
Denial/Self-Blame (NSF)
Substance Use [T1 – T3, p < .038 and T1 – T4, p < .05]
Behavioral Disengagement (NSF)
M
SD
N
T1
5.30
2.49
10
T2
4.80
1.93
10
T3
3.10*
1.73
10
T4
3.40*
1.84
19
Brief Resilience Scale
NSF
Overall, the participants’ scores demonstrated resilience
(M = 20.143 – 19.143, n = 7)
Preliminary Results (continued)
Interpersonal Support
Evaluation List
Appraisal [T1 (M = 22.3) – T2 (M = 18.2), p < 0.05; n = 10]
Tangible (NSF)
Self-Esteem Support (NSF)
Belonging Support [T1 – T2, p = .135, eta = .256]
The Intervention had an impact on participants’ feelings of
support and belonging while in the group
Kessler-6 Scale
Psychological Distress decreased significantly when in
group, then increased (but not significantly)
[T1 (M = 19.8) – T2 (M = 22.5), n = 10, p < .05, eta = .403]
Positive and Negative
Affect Schedule
Positive Affect stayed essentially the same (n = 8)
Negative Affect DECREASED initially and then returned to
baseline at 3 month follow-up (n = 9)
NSF
Brief Resilience Scale
NSF
Overall, the participants’ scores demonstrated resilience
(M = 20.143 – 19.143, n = 7)
Preliminary Assessment of the
Inventory of Traumatic Grief
Question: Can the ITG be used with Native American
populations?
Inventory of Traumatic Grief (ITG)
Developed for Euro/American populations
Two domains: Separation & traumatic distress
Focus: Grief related to loss of a significant other
ITG culturally vetted:
• Relevance and offensiveness
• Slight modifications made
• Noted: ITG focuses on one death; Native Americans often experience frequent,
multiple, and layered deaths
Convergent validity (ITG & HLASS)
Conclusion: Statistical significance suggests measurement of the same construct, grief,
but low r values may represent differing domains in the larger grief construct.
Inventory of Traumatic Grief
N = 87; M = 57.94; SD = 25.64; Range = 0 - 150
Cut Score is 90
10 (of the 87 participants, 11%) scored above 90
Emerging Model: Grief and Resilience
GRIEF
Individual
Family
Tribal
Community
GRIEF is experienced on
multiple levels
Traditional
Homelands
Grief begins a process
that is met with multiple
levels of RESILIENCE
RESILIENCE
Presentation References
Brendtro, L.K., M. Brokenleg, and S. Van Bockern, Reclaiming youth at risk: Our hope
for the future. 1990, Bloomington, IN: Solution Tree.
DeRoche, M.L. and M. Malatare, Historical trauma and the grief life cycle, in Alberta
Delegated First Nations Agencies: Best Practices Symposium "Nii stow a tsi maan:
Raising Our Children". 2010: Edmonton, Alberta, Canada.
References for Instruments
Historical Loss Scale & Historical Loss Associated Symptoms Scale
Walls, M.L. and L.B. Whitbeck, Distress among Indigenous North Americans:
Generalized and culturally relevant stressors. Society and Mental Health, 2011.
1(2): p. 124-136.
Walls, M.L. and L.B. Whitbeck, The intergenerational effects of relocation policies on
Indigenous families. Journal of Family Issues, 2012. 33(9): p. 1272-1293.
Whitbeck, L.B., et al., Conceptualizing and measuring historical trauma among
American Indian people. American Journal of Community Psychology, 2004. 33(3/4):
p. 119-130.
Whitbeck, L.B., et al., Depressed affect and historical loss among North American
Indigenous adolescents. American Indian and Alaska Native Mental Health Research,
2009. 16(3): p. 16-41.
Inventory of Traumatic Grief
Boelen, P.A., et al., Reliability and validity of the Dutch version of the Inventory of
Traumatic Grief (ITG). Death Studies, 2003. 27: p. 227-247.
Jacobs, S.C., C. Mazure, and H. Prigerson, Diagnostic criteria for traumatic grief.
Death Studies, 2000. 24: p. 185-199.
Jacobs, S.C. and H.G. Prigerson, Psychotherapy of traumatic grief: A review of
evidence for psychotherapeutic treatments. Death Studies, 2000. 24: p. 479-495.
Prigerson, H.G., et al., Traumatic grief as a risk factor for mental and physical
morbidity. American Journal of Psychiatry, 1997. 154(5): p. 616-623.
Prigerson, H.G., et al., Influence of Traumatic Grief on suicidal ideation among young
adults. American Journal of Psychiatry, 1999. 156(12): p. 1994-1995.
Prigerson, H.G., et al., Prolonged grief disorder: Psychometric Validation of criteria
proposed for DSM-V and ICD-11. PLoS Med 2009. 6(8).
Prigerson, H.G. and S.C. Jacobs, Traumatic grief as a distinct disorder: A rationale,
consensus criteria and a preliminary empirical test, in Handbook of bereavement
research: Consequences, coping, and care, M.S. Stroebe, et al., Editors. 2001,
American Psychological Association Press: Washington, DC. p. 613-645.
Prigerson, H.G., et al., Inventory of complicated grief: A scale to measure
maladaptive symptoms of loss. Psychiatry Research, 1995. 59: p. 65-79.
Prigerson, H.G., et al., Consensus criteria for traumatic grief: A preliminary
empirical test. British Journal of Psychiatriy, 1999. 174: p. 67-73.
Prigerson, H.G., et al., Traumatic Grief: A case of loss-induced trauma. American
Journal of Psychiatry, 1997. 154(7): p. 1003-1009.
Inventory of Traumatic Grief (cont.)
Shear, K., et al., Traumatic grief treatment: A pilot study. American Journal of
Psychiatry, 2001. 158(9): p. 1506-1508.
Shear, K., et al., Treatment of complicated grief. Journal of the American Medical
Association, 2005. 293(21): p. 2601-2608.
Shear, K., et al., Screening for complicated grief among project liberty service
recipients 18 months after September 11, 2001. Psychiatric Services, 2006. 57(9): p.
1291-1297.
Shear, K. and K. Smith-Caroff, Traumatic loss and the syndrome of complicated grief.
PTSD Research Quarterly, 2002. 13(1): p. 1-7.
Brief COPE
Carver, C. S. (1997). You want to measure coping but your protocol's too long: Consider
the Brief COPE. International Journal of Behavioral Medicine, 4(1), 92-100.
Hobfoll, S., Jackson, A., & Hobfoll, I. (2002). The impact of communal-mastery versus
self-mastery on emotional outcomes during stressful conditions: A prospective study
of Native American women. American Journal of Community Psychology, 30(6), 853871.
Hobfoll, S., & Schroder, K. (2001). Distinguishing between passive and active prosocial
coping: Bridging inner-city women's mental health and aids risk behavior. Journal of
Social and Personal Relationships, 18(2), 201-217.
Brief Resilience Scale
Long, C., & Nelson, K. (1999). Honoring diversity: The reliability, validity, and utility
of a scale to measure Native American resilience. Journal of Human Behavior in the
Social Environment, 2(1-2), 91-107.
Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Jennifer, B. (2008).
The brief resilience scale: Assessing the ability to bounce back. International
Journal of Behavioral Medicine, 15, 194-2000.
Windle, G., Bennett, K. M., & Noyes, J. (2011). A methodological review of resilience
measurement scales. Health and Quality of Life Outcomes, 9(8).
Interpersonal Support Evaluation List
Cohen, S., & Hoberman, H. M. (1983). Positive events and social supports as buffers of
life change stress. Journal of Applied Social Psychology, 13(2), 99-125.
Cohen, S., Mermelstein, R., Kamarck, T., & Hoberman, H. M. (1985). Measuring the
functional components of social support. In I. G. Sarason & B. R. Sarason (Eds.),
Social support: Theory, research and applications (pp. 73-94): NATO ASI Series:
Series D: Behavioral and Social Sciences, No 24.
Kessler-6
Furukawa, T. A., Kessler, T., Andrews, G., & Andrews, S. (2003). The performance of the K6
and K10 screening scales for psychological distress in the Australian national survey of
mental health and well-being. Psychological Medicine, 33, 357-362.
Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S.-L. T., . . .
Zaslavsky, A. M. (2002). Short screening scales to monitor population prevalences and
trends in non-specific psychological distress. Psychological Medicine(32), 959-976.
Kessler, R. C., Barker, P.R., Colpe, L.J., Epstein, J.F., Gfroerer, J.C., Hiripi, E., Howes,
M.J., Normand, S.T., Manderscheid, R.W., Walters, E.E., Azslavsky, A.M. (2003). Screening
for serious mental illness in the general population. Archives of General Psychiatry, 60,
184-189.
Kessler, R. C., Green, J.G., Gruber, M.J., Sampson, N.A., Bromet, E., Cuitan, M., Furukawa,
T.A., Gureje, O., Hinkov, H., Hu, C., Lara, C., Lee, S., Mneimneh, Z., Myer, L., OakleyBrown, M., Posada-Villa, J., Sagar, R., Viana, M.C., Zaslavsky, A.M. (2010). Screening for
serious mental illness in the general population with the K6 screening scale: Results from
the WHO World Mental Health (WMH) survey initiative. International Journal of Methods
in Psychiatric Research, 19(Si[[;e,emt 1), 4-22.
Manson, S. M., Jiang, L., Zhang, L., Beals, J., Acton, K.J., Roubideaux, Y., SDPI Healthy
Heart Demonstration Project,. (2011). Special diabetes program for Indians: Retention in
cardiovascular risk reduction. The Gerontologist, 51(S1), S21-S32.
Mitchell, C. M., Beals, J. (2011). The utility of the Kessler Screening Scale for Psychological
Distress (K6) in two American Indian communities. Psychological Assessment, 23(3), 752761.
Kessler-6 (cont.)
Parker, T., Maviglia, M.A., Lewis, P.T., Gossage, J.P., May, P.A. (2010). Psychological distress
among Plains Indian mothers with children referred to screening for Retal Alcohol
Spectrum Disorders. Substance Abuse Treatment, Prevention, and Policy, 5(22), 22-30.
Wittchen, H. (2010). Editorial: Screening for serious mental illness: methodological studies
of the K6 screening scale. International Journal of Methods in Psychiatric Research,
16(Supplement 1), 1-3.
Positive and Negative Affect Schedule
Crawford, J. R., & Henry, J. D. (2004). The Positive and Negative Affect Schedule (PANAS):
Construct validity, measurement properties and normative data in a large non-clinical
sample. British Journal of Clinical Psychology, 43, 245-265.
Thompson, E. R. (2007). Development and validation of an internationally reliable shortform of the Positive and Negative Affect Schedule (PANAS). Journal of Cross-Cultural
Psychology, 38(2), 227-242.
Watson, D., Clark, L. A., & Tellegen, A., . (1988). Development and validation of brief
measures of positive and negative affect: The PANAS Scales. Journal of Personality and
Social Psychology, 54 (6), 1063-1070.
Acknowledgements
Mary Louise DeRoche, MSH, LAC
Melveena Malatare, MA, LAC
Annie Belcourt, PhD
InPsych Research Team
Ann Douglas, MA; Ciara Hansen, MA; Desiree Pierre-Fox, MA; Ennis Vaile, MA; Georgie Ferguson,
MA; Jennie Fretts, MA; Maegan Rides at the Door, MEd; Matthew Croxton, MA;
Raquel Arouca, PhD; Vernon Grant, MS; William Shunkamolah, PhD
Maria Yellow Horse Brave Heart, PhD
Ray Daw, MA
This project was supported by a grant from the National Institute of General Medical Sciences (8 P20 GM103474-11) from the National Institutes of Health. The
content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of General Medical Sciences or
the National Institutes of Health
Lemlmtš
Thank you!
QUESTIONS?
gyda.swaney@umontana.edu
ke.wu@umontana.edu
pholkup@montana.edu
emilymatt@bresnan.net