In our prospective study, 168 adolescents exposed directly or indirectly to the same traumatic event-a fatal school bus accident-in which seven students were killed instantly, were assessed for post-traumatic stress, depression and grief symptoms at 2- and 18-months post-accident. Prevalence rates of likely PTSD and depression were noted across all types of physical proximity exposure: 77.6% and 48.1% respectively in the indirectly exposed group, 79.4% and 47.1% respectively in the directly in-the-area exposed group, and 77.8% and 42.1% respectively in the directly in-bus exposed group. One-fifth experienced high and unremitting levels of grief symptoms over time ("persistent grief"); 17% with initially high levels of grief symptoms showed a decrease at 18 months but were still within the low medium range ("towards recovery"); 39% with initially medium/high grief symptoms reported low levels of grief at the follow-up ("recovery"); and 23% of the participants experienced grief symptoms that remained persistently low ("resilient"). The absence of both PTSD and depression at 18 months predicted adjustment to loss, whereas the absence of depression at 18 months predicted a recovering course of grief. The findings highlight the impact of high levels of post-traumatic stress and depression symptoms on the long-term persistent grief outcome.
Keywords: Grief; PTSD; adolescents; depression; peer loss; road-traffic accident.