Black gives way to blue: Understanding and treating traumatic grief in families following fatal traffic accidents

Abstract

Each year, road traffic accidents cause the deaths of 1.19 million people worldwide (World Health Organization, 2023). Beyond these numbers, such sudden and violent losses profoundly affect bereaved families. For children and parents, the death of a loved one can abruptly shatter a sense of safety and trust. While many gradually adjust, a substantial minority experience enduring grief-related difficulties that disrupt daily life. These may take the form of prolonged grief disorder (PGD), depression, or posttraumatic stress disorder (PTSD). In this dissertation, the term traumatic grief is used as an umbrella concept for these psychological difficulties following a traumatic loss. PGD was officially recognized in 2022 in both the DSM-5-TR and ICD-11. It is defined by persistent yearning or preoccupation with the deceased, alongside symptoms such as disbelief, identity disruption, and emotional numbness. Building on this recognition, the purpose of this dissertation was threefold: (1) to develop and validate an age-appropriate assessment tool for PGD symptoms in children and adolescents; (2) to examine grief responses in parents who lost a child in a road traffic accident, and the role of parental reactions in children’s outcomes; and (3) to design an internet-based cognitive behavioral therapy (iCBT) program for bereaved youth. For the first aim, the Traumatic Grief Inventory – Kids – Clinician-Administered (TGI-K-CA) was developed with grief experts and bereaved youth. The 16-item interview is the first tool tailored to assess PGD in children and adolescents. Psychometric testing showed acceptable reliability and validity, though some items functioned less well than expected, warranting further study. The second aim focused on parents. Among 148 bereaved parents, two patterns of grief reactions were found: most reported high PGD and moderate PTSD, while a smaller group showed moderate PGD with low PTSD. Mothers and parents with high self-directed anger were more likely to fall into the severe pattern. A mixed-method observational study with 20 parent–child dyads further showed that critical parenting was linked to higher child depression and PTSD, whereas positive, loss-specific responses were associated with lower depression and better quality of life. These findings underline the importance of parenting styles and ways of discussing loss for children’s outcomes. The third aim addressed the development of an iCBT program. Input from children, parents, grief professionals, and eHealth experts emphasized the need for brief, user-friendly sessions, therapist involvement, parental participation, and positive language. Online interventions show promise in lowering barriers to care, though their effectiveness and acceptability require further evaluation. In sum, this dissertation advances understanding of traumatic grief in families affected by road traffic accidents. It introduces the first clinician-administered tool for PGD symptoms in children and adolescents, identifies risk patterns in bereaved parents and links between parental reactions and child outcomes, and presents an internet-based CBT program. Together, these contributions represent a step toward more accessible, family-centered, and evidence-based care for bereaved families coping with traumatic loss.