Abstract

Brazil has recorded a high percentage of homicides and deaths due to legal intervention. This article is part of a qualitative multiple case study about indirect victims who lost relatives to homicide perpetraded by security agents and police officers in Rio de Janeiro. Data were collected in four individual interviews with family members of people killed by police officers and three family members of police officers who were victims of homicide, and then subjected to thematic analysis. The testimonies revealed the major impacts of the loss of a family member on the indirect victim’s health, such as intense mental suffering and the negative impacts on human occupations such as work, leisure, health care, and sleep. Institutional support is limited in the face of the traumatic experience, whereas activist groups and entities tied to human rights advocacy are of great help in overcoming the pain of loss, especially for those who have lost their family members to the police. Further research is needed about the gaps between public facilities and policies and the needs of indirect victims.

Keywords:
Indirect Victims; Homicide; Human Occupation; Social Support; Coping Strategies

Introduction

Violence is a complex social phenomenon that varies over time and directly affects human life and health systems, since it demands resources from hospitals, emergency rooms, and outpatient clinics, in addition to harming people’s quality of life, causing damage to the physical and mental health of direct and indirect victims, and influencing the rate of potential years of life lost.

Among the expressions of violence, homicide is one of the most brutal, as it denies the basic right to life. It is defined as the destruction of human life by a person who intended to kill or injure another (Souza; Pinto; Ribeiro, 2020SOUZA, E. R.; PINTO, L. W.; RIBEIRO, A. P. Homicídio: Uma violência interpessoal que impede a vida. In: NJAINE, K. et al. (Org.). Impactos da Violência na Saúde. Rio de Janeiro: Fiocruz EAD/ENSP, 2020.).

Brazil has recorded high homicide rates. In 2018, there were a total of 57,956 homicide deaths, which represents 27.8 deaths per 100,000 inhabitants (Santiago; Nunes; Macena, 2021SANTIAGO, M. L. O; NUNES, R. A. L.; MACENA, R. H. M. Tendência temporal dos homicídios no Brasil no período de 2000-2019. Journal of Health and Biological Sciences, Fortaleza, v. 9. n. 1, p. 1-10, 2021. DOI: 10.12662/2317-3076jhbs.v9i1.4140.p1-10.2021
https://doi.org/10.12662/2317-3076jhbs.v... ). Although there has been a significant reduction in homicide deaths in the country since 2017 (with great inter- and intra-regional disparities), there has been an increase in the average annual percentage variations in deaths due to legal intervention in almost all regions, from 2000 to 2019 (Santiago Nunes; Macena, 2021SANTIAGO, M. L. O; NUNES, R. A. L.; MACENA, R. H. M. Tendência temporal dos homicídios no Brasil no período de 2000-2019. Journal of Health and Biological Sciences, Fortaleza, v. 9. n. 1, p. 1-10, 2021. DOI: 10.12662/2317-3076jhbs.v9i1.4140.p1-10.2021
https://doi.org/10.12662/2317-3076jhbs.v... ). Deaths cause by State agents are considered homicides in this article.

Many studies focus on homicide rates and the profile of the groups that are the agents and victims of these aggressions; however, research on the indirect victims of these daily tragedies in the country is less common. Indirect victims are the people, most often family members, related to the person who was killed. These people often experience serious psychological and physical harm (Hertz Prothrow-Stith; Chery, 2005HERTZ M. F.; PROTHROW-STITH, D.; CHERY, C. Homicide survivors: research and practice implications. American Journal of Preventive Medicine, v. 29, n. 5, p. 288-295, 2005. DOI: 10.1016/j.amepre.2005.08.027
https://doi.org/10.1016/j.amepre.2005.08... ) that needs to be made visible.

This article presents an excerpt from a broader comprehensive study entitled “Narrativas das vítimas indiretas: A voz de familiares de civis mortos por policiais e de policiais assassinados” (Narratives of indirect victims: The voice of family members of civilians killed by police officers and of murdered police officers), which focuses on the experiences of these people’s family members, taking the city of Rio de Janeiro as the empirical field. The aim was to identify and describe the impact of the traumatic event on the lives of the indirect victims. However, given the scope of the topic and the need for further theoretical and analytical development of some of the issues addressed in the mother study, in this article, we decided focus on the types of support received by the indirect victims after the loss of a family member and the strategies they adopted to overcome their pain and get on with their lives.

Thus, the general objective of this article is to identify and describe the impacts on the health and occupations of indirect victims after homicide, and thus analyze the support received by the victims’ families from governmental (related to health, social assistance, justice, and public security) and non-governmental institutions; we also sought to understand what strategies were adopted by indirect victims to overcome the traumatic experience.

Material and methods

This is a qualitative case study, with an intentional sample, carried out in the city of Rio de Janeiro, historically marked by frequent conflicts between the police and the population, as well as between the police and criminal groups.

Individual interviews were carried out with four family members of people who were killed by police officers and three family members of police officers who were victims of homicides, with the criterion that the death had occurred at least two years before. This condition aimed to ensure distance from the violent event and, consequently, to reduce the emergence of more intense emotions in the interviewees. The interviews took place in the second half of 2019 and were interrupted in March 2020 due to the COVID-19 pandemic. All of the people interviewed were over 18.

The family members of homicide victims were accessed using the snowball technique, which is a useful method for researching groups that are difficult to access or study, or when there is no precision about their number. This method consists of a non-probabilistic sample that uses reference networks and referrals, useful for studying sensitive, private issues that therefore require the knowledge of people belonging to the target group or are recognized by them as informants for the study (Bockorni; Gomes, 2021BOCKORNI, B. R. S.; GOMES, A. F. A amostragem em snowball (Bola de neve) em uma pesquisa qualitativa no campo da administração. Revista de ciências empresárias da UNIPAR, Umuarama, v. 22, n. 1, p. 105-117, 2021.; Vinuto, 2014VINUTO, J. A amostragem em bola de neve na pesquisa qualitativa: um debate em aberto. Temáticas, Campinas, v. 22, n. 44, p. 203-220, 2014. DOI: 10.20396/tematicas.v22i44.10977
https://doi.org/10.20396/tematicas.v22i4... ).

The first step was to look for indications of people known to be participants/creators/organizers of associations that support police officer who were victims of violence and of social movements seeking justice for the deaths of family members by state security agents. Initially, these people were interviewed and referred to others who had gone through the same experience of loss, and so on in chains of reference. However, given the subject and the violent process experienced by these family members, it was difficult to get them to participate in the study.

The people who were invited claimed fear of retaliation, disbelief in institutions and the State, discouragement, and weariness at the painful and tiring process of seeking justice, and that they had already given interviews for other academic research. Based on these arguments, the search for other informants was widened: health service professionals who cared for people with these experiences and filmmakers who had made films with these people’s testimonies. Even so, some people who were referred refused to take part in the research, especially the family members of murdered police officers.

In qualitative research, data saturation is often used as a criterion for closing the sample, that is, “when no new elements are found and the addition of new information ceases to be necessary, since it does not alter the comprehension of the researched phenomenon” (Nascimento et al., 2018NASCIMENTO, L. C. N et al. Saturação teórica em pesquisa qualitative: relato de experiência na entrevista com escolares. Revista Brasileira de Enfermagem, Rio de Janeiro, v. 71, n. 1, p. 243-248, 2018. DOI: 10.1590/0034-7167-2016-0616
https://doi.org/10.1590/0034-7167-2016-0... , p. 244; our translation). However, Fontanella et al. (2011FONTANELLA, B. J. B. et al. Amostragem em pesquisas qualitativas: proposta de procedimentos para constatar saturação teórica. Cadernos de Saúde Pública, Rio de Janeiro, v. 27, n. 2, p. 389-394, 2011. DOI: 10.1590/S0102-311X2011000200020
https://doi.org/10.1590/S0102-311X201100... ) point out that there are difficulties in objectively verifying and explaining the saturation process, and state that, in non-probabilistic samples, the definition of saturation is based on the researcher’s empirical experience, guided by theoretical knowledge about the object of study.

The researcher considers that there is empirical saturation when they see that they already have the data needed to answer their research questions; and that there is theoretical saturation when the field no longer provides new elements that help to deepen the theorizing (Fontanella et al., 2011FONTANELLA, B. J. B. et al. Amostragem em pesquisas qualitativas: proposta de procedimentos para constatar saturação teórica. Cadernos de Saúde Pública, Rio de Janeiro, v. 27, n. 2, p. 389-394, 2011. DOI: 10.1590/S0102-311X2011000200020
https://doi.org/10.1590/S0102-311X201100... ). We believe that both criteria were met in this study.

The interviews were conducted by a trained researcher, digitally recorded, and transcribed, and they lasted an average of 90 minutes. Only one participant did not allow the recording, and the interview was recorded later. Most of the interviews took place in a closed room, in privacy, and at the location requested by the interviewees, to ensure the confidentiality of the conversation. The interview covered the following topics: the interviewee’s own life trajectory; the conditions that enabled the violent death to occur; the affective, psychological, social, and financial impacts of the death for the interviewee; the support received from institutions/social networks; and the strategies used to overcome the traumatic experience. These last two are the focus of this article.

The material collected was subjected to content analysis, thematic modality, as recommended by Gomes (2015GOMES, R. A Análise de dados em pesquisa qualitativa. In: MINAYO, M. C. S; DESLANDES, S. F; GOMES, R (Org.). Pesquisa Social: Teoria, Método e Criatividade. Petrópolis, Rio de Janeiro: Vozes, 2015. p. 79-108). This approach consists of the discovery of the “nuclei of meaning that make up the communication and whose presence or frequency of appearance can mean something for the chosen analytical objective” (Gomes, 2015GOMES, R. A Análise de dados em pesquisa qualitativa. In: MINAYO, M. C. S; DESLANDES, S. F; GOMES, R (Org.). Pesquisa Social: Teoria, Método e Criatividade. Petrópolis, Rio de Janeiro: Vozes, 2015. p. 79-108, p. 92, our translation). The data went through the following phases of analysis: (1) pre-analysis: corresponds to the floating reading; (2) exploration of the material, with successive readings for coding the interviews, considering the meanings and recurrences of the statements; (3) treatment of the results, inference, and interpretation: moment in which the categorization and description of the data occurs (Gomes, 2015GOMES, R. A Análise de dados em pesquisa qualitativa. In: MINAYO, M. C. S; DESLANDES, S. F; GOMES, R (Org.). Pesquisa Social: Teoria, Método e Criatividade. Petrópolis, Rio de Janeiro: Vozes, 2015. p. 79-108).

Each participant received a code containing a fictitious name followed by an indication of belonging to one of the groups studied (G1: group of family members of people killed by police officers; G2: group of family members of police officers killed).

The research was submitted to the research ethics committee of the Sergio Arouca National School of Public Health (ENSP), Oswaldo Cruz Foundation (Fiocruz), and approved under opinion n. 3.443.421.

In order to take care of possible risks to participants, contacts of health services or reference professionals were identified and provided in case participants experienced any discomfort or psychological stress during the interview.

Results and discussion

Seven people were interviewed, six women and one man; four are indirect victims of police action, that is, they have had their children killed/injured by security agents, and the other three interviewees were family members of police officers killed because they were police officers. They all live in the municipality of Rio de Janeiro, the same city where the violence was perpetrated against their family members.

Chart 1 shows information such as fictitious names, age, gender, ethnicity, place of residence, degree of kinship with the person who was killed, and the year of death. The ages of the indirect victims range from 41 to 71 years and those of their dead family members range from 2 to 51 years; half of them self-declare as black; only one person lives in the southern zone of Rio de Janeiro, whereas the others live in peripheral and working-class communities or neighborhoods. The data are presented according to whether they belong to group 1 or group 2.

The thematic analysis of the interviews was organized into three categories: (1) violence and the impacts on the health and occupations of indirect victims; (2) support received from governmental and non-governmental institutions; and (3) strategies adopted by indirect victims to overcome the traumatic experience.

Violence and the impacts on the health and occupations of indirect victims

All interviewees, whether indirect victims of police killings or of killed police officers, reported deterioration or worsening in their general health status after the homicides, with similar symptoms among the female participants and the only male interviewee.

In group 1, two interviewees reported that pre-existing health conditions worsened after the death of family members. Although the interviewees reported the impact of the violence they experienced on their health, they stressed that this impact extended to other people, such as neighbors, friends and, above all, other close family members. For every fatal victim, three to seven people are estimated to suffer intensely from the loss (Soares; Miranda; Borges, 2006SOARES, G. A. D.; MIRANDA, D; BORGES, D. As vítimas ocultas da violência na cidade do Rio de Janeiro. 4. ed. Rio de Janeiro: Civilização Brasileira, 2006.; Souza; Pinto; Ribeiro, 2020SOUZA, E. R.; PINTO, L. W.; RIBEIRO, A. P. Homicídio: Uma violência interpessoal que impede a vida. In: NJAINE, K. et al. (Org.). Impactos da Violência na Saúde. Rio de Janeiro: Fiocruz EAD/ENSP, 2020.). These people also had their health badly affected, as we can see in the following statements:

Whereas some of the people interviewed reported a worsening of preexisting conditions, others reported that, after a few months, they were diagnosed with hypertension, diabetes, or had health problems such as aneurysm and facial paralysis. Similar reports were described by Costa et al. (2017COSTA, D. H. et al. Homicídios de jovens: Os impactos da perda em famílias de vítimas. Physis: Revista de Saúde Coletiva, Rio de Janeiro, v. 27, n. 3, p. 685-705, 2017. DOI: 10.1590/S0103-73312017000300016
https://doi.org/10.1590/S0103-7331201700... ) and Costa, Njaine, and Schenker (2017COSTA, D. H.; NJAINE, K.; SCHENKER, M. Repercussões do homicídio em famílias das vítimas: uma revisão da literatura. Ciência & Saúde Coletiva , Rio de Janeiro, v. 22, n. 9, 2017. DOI: 10.1590/1413-81232017229.18132016
https://doi.org/10.1590/1413-81232017229... ). Despite not being able to establish a direct relationship between the homicide of the family member and the onset/aggravation of chronic diseases, the statements suggest a worsening in their general health status.

Common to all the interviews was the statement of intense mental suffering accompanied by depressive symptoms, such as insomnia, lack of appetite, suicidal ideation, as well as aggressive behavior, compulsion for food or shopping, and startle at stimuli that resemble gunshots. The following statement exemplifies some of these characteristics:

Symptoms of depression and anxiety are frequently cited in the literature by people who have lost a family member in a violent way (Connolly; Gordon, 2014CONNOLLY, J.; GORDON, R. Co-victims of Homicide: A Systematic Review of the Literature. Trauma, Violence, & Abuse, v. 16, n. 4, p. 494-505, 2014. DOI: 10.1177/1524838014557285
https://doi.org/10.1177/1524838014557285... ), with many developing symptoms related to post-traumatic stress disorder (PTSD) or having the condition altogether, with the incidence of this rate being approximately 23% (Hertz; Prothrow-Stith; Chery, 2005HERTZ M. F.; PROTHROW-STITH, D.; CHERY, C. Homicide survivors: research and practice implications. American Journal of Preventive Medicine, v. 29, n. 5, p. 288-295, 2005. DOI: 10.1016/j.amepre.2005.08.027
https://doi.org/10.1016/j.amepre.2005.08... ).

The same symptoms and health conditions were reported by the interviewees who had their family police officer killed, especially with regard to mental suffering. Two interviewees said they had depressive symptoms or depression, and one said she had panic disorder, which had a negative impact even on her work:

This withdrawn behavior, characterized by difficulty socializing and considered an alienation from social relationships that reduces the support network, is reported in studies as an outcome of the violence suffered by that family nucleus (Connolly; Gordon, 2014CONNOLLY, J.; GORDON, R. Co-victims of Homicide: A Systematic Review of the Literature. Trauma, Violence, & Abuse, v. 16, n. 4, p. 494-505, 2014. DOI: 10.1177/1524838014557285
https://doi.org/10.1177/1524838014557285... ), which directly affects the social participation of the indirect victim in their daily relationships.

These narratives indicate that the burden of suffering experienced by the indirect victims, in addition to causing illness, has led to a disruption or weakening in the occupations performed by these people. Occupations are understood as daily activities carried out individually or collectively that give meaning and purpose to life (Gomes; Teixeira; Ribeiro, 2020GOMES, M. D.; TEIXEIRA, L.; RIBEIRO, J. Enquadramento da Prática da Terapia Ocupacional: Domínio & Processo 4ª Edição. 2021. Versão Portuguesa de Occupational Therapy Practice Framework: Domain and Process 4th Edition (AOTA, 2020). Leiria: Politécnico de Leiria, 2021. DOI: 10.25766/671r-0c18
https://doi.org/10.25766/671r-0c18... ). Examples of occupations include self-care activities, instrumental activities of daily living, rest, sleep, education, work, leisure, and social participation.

The most diverse statements of these indirect victims point to this restriction and weakening of their various occupations, such as: not being able to sleep properly; having difficulty interacting with people, as well as working and studying; limiting leisure activities; and neglecting self-care.

One aspect that contributes to explaining the burden of illness that culminates so abruptly in occupations is that the family members’ grief is often not recognized and legitimized by public opinion. This is most clearly seen among the interviewees in group 1, whose relatives were killed by public security agents. In these cases, due to the excessive delay in a judicial resolution of the case, mourning becomes a never-ending process that changes family ties with great impact on these people (Araújo; Sousa; Silva, 2022ARAÚJO, V. S., SOUZA, E. R., SILVA, V. L. M. “Eles vão certeiros nos nossos filhos”: adoecimentos e resistências de mães de vítimas de ação policial no Rio de Janeiro, Brasil. Ciência & Saúde Coletiva, Rio de Janeiro, v. 27, n. 4, p. 1327-1336, 2022. DOI: 10.1590/1413-81232022274.06912021
https://doi.org/10.1590/1413-81232022274... ). This process of prolonged mourning, which causes enormous suffering, can also be observed in the people who have had their police family members murdered.

Indirect victims can often experience isolation due to feelings of powerlessness, lack of security, and sadness, which directly affects their engagement and motivation to carry out their daily tasks. According to Hammel (2020HAMMELL, K. W. Ações nos determinantes sociais de saúde: avançando na equidade ocupacional e nos direitos ocupacionais. Cadernos Brasileiros de Terapia Ocupacional, São Carlos, v. 28, n. 1, p. 378-400, 2020. DOI: 10.4322/2526-8910.ctoARF2052
https://doi.org/10.4322/2526-8910.ctoARF... ), giving people the opportunity to engage in old or new occupations in their social support networks should be seen as a basic human right, even though they often experience social helplessness, a condition that occurs both due to the lack of information about the judicial process and the lack of support from institutional facilities that could help them (Costa et al., 2017COSTA, D. H. et al. Homicídios de jovens: Os impactos da perda em famílias de vítimas. Physis: Revista de Saúde Coletiva, Rio de Janeiro, v. 27, n. 3, p. 685-705, 2017. DOI: 10.1590/S0103-73312017000300016
https://doi.org/10.1590/S0103-7331201700... ; Souza; Pinto; Ribeiro, 2020SOUZA, E. R.; PINTO, L. W.; RIBEIRO, A. P. Homicídio: Uma violência interpessoal que impede a vida. In: NJAINE, K. et al. (Org.). Impactos da Violência na Saúde. Rio de Janeiro: Fiocruz EAD/ENSP, 2020.).

Governmental and non-governmental support received by the victims’ families

Based on previous studies that described social helplessness as a recurrent condition among indirect victims (Araújo; Souza; Silva, 2022ARAÚJO, V. S., SOUZA, E. R., SILVA, V. L. M. “Eles vão certeiros nos nossos filhos”: adoecimentos e resistências de mães de vítimas de ação policial no Rio de Janeiro, Brasil. Ciência & Saúde Coletiva, Rio de Janeiro, v. 27, n. 4, p. 1327-1336, 2022. DOI: 10.1590/1413-81232022274.06912021
https://doi.org/10.1590/1413-81232022274... ; Costa et al., 2017COSTA, D. H. et al. Homicídios de jovens: Os impactos da perda em famílias de vítimas. Physis: Revista de Saúde Coletiva, Rio de Janeiro, v. 27, n. 3, p. 685-705, 2017. DOI: 10.1590/S0103-73312017000300016
https://doi.org/10.1590/S0103-7331201700... ), we sought to investigate whether there was support from government institutions for these family members. Examples of government institutions include health, social assistance, justice, and public security agencies, which, to a greater or lesser extent, are involved in events of this nature.

It can be observed in the statements of the two groups studied that the State, here understood as government institutions, provided little support to indirect victims. This little or no institutional support is offset by strong support from informal or non-governmental social support networks, as emphasized by the group who had their family member killed or injured by police officers, especially with regard to the support provided by activist movements of mothers who are indirect victims of violence and groups that claim for human rights.

The social support network can integrate family ties, friends, and people from the community, and includes positive aspects that provide support in times of crisis and often mitigate factors that cause stress (Costa, 2009COSTA, L. G. A rede de apoio social de jovens em situação de vulnerabilidade social e o uso de drogas. 2009. Dissertação (Mestrado em Psicologia) - Universidade Federal do Rio Grande do Sul, Porto Alegre, 2009.). The higher the level of social support, the greater the possibility of a person developing adaptive strategies to deal with adverse situations in everyday life (Costa, 2009COSTA, L. G. A rede de apoio social de jovens em situação de vulnerabilidade social e o uso de drogas. 2009. Dissertação (Mestrado em Psicologia) - Universidade Federal do Rio Grande do Sul, Porto Alegre, 2009.; Pizzinato et al., 2018PIZZINATO, A. et al. Análise da rede de apoio e do apoio social na percepção de usuários e profissionais da proteção social básica. Estudos de Psicologia, Natal, v. 23, n. 2, p. 145-156, 2018. DOI: 10.22491/1678-4669.20180015
https://doi.org/10.22491/1678-4669.20180... ).

The support mentioned by the interviewees include: the mutual exchanges of mothers who organize collectively in activist groups; gestures of solidarity from the community itself to the indirect victims, expressed by donating utensils or testifying about the crime at the police station; and by other family members taking in the mothers.

Three interviewees reported that the support of other mothers who were indirect victims of violence and some political organizations, represented here by the activism of social movements, especially those engaged in these movements, were an important source of support and care:

Araújo, Souza, and Silva (2022ARAÚJO, V. S., SOUZA, E. R., SILVA, V. L. M. “Eles vão certeiros nos nossos filhos”: adoecimentos e resistências de mães de vítimas de ação policial no Rio de Janeiro, Brasil. Ciência & Saúde Coletiva, Rio de Janeiro, v. 27, n. 4, p. 1327-1336, 2022. DOI: 10.1590/1413-81232022274.06912021
https://doi.org/10.1590/1413-81232022274... ) report that there are several groups of mothers in Brazil who are demanding justice; however, in this study, it can be seen that the groups, in addition to being organized for activism, function as a space for welcoming, to share a pain that can only be experienced by another mother. This mutual help and exchange allow them to take up new occupations and thus give their lives a new meaning.

Gestures of solidarity from the family and community with the situation were mentioned by three interviewees. This support is seen as something very significant for the mothers, because these attitudes made many cases go to court, due to the testimony of neighbors who were witnesses or because the community itself helped with other resources to care for the family.

At least two other participants also reported having received support and care from their families to console them in the face of the difficulties experienced as a result of their bereavement, although it is important to mention that the way in which each family provides support varies greatly. Family reorganization after loss, in certain circumstances, allows values such as solidarity and bonding to emerge in the emotional repertoire of many of these indirect victims (Domingues; Dessen; Queiroz, 2015DOMINGUES, D. F; DESSEN, M. A.; QUEIROZ, E. Luto e enfrentamento em famílias vitimadas por homicídio. Arquivos Brasileiros de Psicologia, Rio de Janeiro, v. 67, n. 2, p. 61-74, 2015.). This happened in some cases, according to the statement:

Arlete was the only interviewee in group 1 who mentioned the work of the police station in her son’s case in a positive light:

In group 2, only one interviewee reported having received religious support, which came from a close person:

The other people interviewed, although they claimed to have a religion, did not mention any support of this nature.

The indirect victims in group 2, like those in group 1, also received little institutional support, with family support being the main support mentioned. The support that family members of killed police officers receive appears to be more limited than that provided to victims in group 1, since they are able to rely on activists, politicians, family members, and the community.

This last statement shows that the perpetuation of stigma towards indirect victims is continuously lived out by these family members, which undermines the provision of formal and informal social support, given that many of these victims end up not receiving support of any kind (Souza; Pinto; Ribeiro, 2020SOUZA, E. R.; PINTO, L. W.; RIBEIRO, A. P. Homicídio: Uma violência interpessoal que impede a vida. In: NJAINE, K. et al. (Org.). Impactos da Violência na Saúde. Rio de Janeiro: Fiocruz EAD/ENSP, 2020.).

The Unified Social Support System and the Unified Health System were not mentioned directly in the interviews. Health care by a professional psychologist was mentioned briefly in a few interviews and without any further information about where the care was provided and how it began. A study by Costa, Njaine, and Souza (2020COSTA, D. H; NJAINE, K.; SOUZA, E. R.. Apoio institucional a famílias de vítimas de homicídio: análise das concepções de profissionais da saúde e assistência social. Trabalho, Educação e Saúde, Rio de Janeiro, v. 18, n. 3 e00282114, 2020. DOI: 10.1590/1981-7746-sol00282
https://doi.org/10.1590/1981-7746-sol002... ) mentions that health and social support professionals are often not very active when it comes to assisting victims of violence; many of these professionals work in precarious facilities, with limited material and human resources, and experience a sense of powerlessness when dealing with this issue and public. Many of them have experienced violence of this and other kinds and therefore feel fragile when dealing with the cases they see, in addition to the lack of training on the subject in the facilities. Another important point highlighted in this study is that, in their own professional work, there is a perpetuation of the stigma of being black or brown, poor, living in peripheral communities, whose dead family members are symbolically associated with criminality, in relation to deaths by homicide, even though different professionals have different experiences and approaches when confronted with these cases (Costa; Njaine; Souza, 2020COSTA, D. H; NJAINE, K.; SOUZA, E. R.. Apoio institucional a famílias de vítimas de homicídio: análise das concepções de profissionais da saúde e assistência social. Trabalho, Educação e Saúde, Rio de Janeiro, v. 18, n. 3 e00282114, 2020. DOI: 10.1590/1981-7746-sol00282
https://doi.org/10.1590/1981-7746-sol002... ).

Strategies adopted by indirect victims to overcome the traumatic experience

Faced with the traumatic experience and the limited institutional support, we investigated the possible strategies adopted by family members to cope with the suffering they went through. It was observed that the support of other mothers and social movements struggling for justice proved to be an important support at the time of the loss. Continuing in political activism and the struggle for justice emerged from the statements as one of the main strategies adopted by the victims to deal with the loss. This occurred in both groups, but it was predominant among family members who had their children killed by police officers.

According to Araújo, Souza, and Silva (2022ARAÚJO, V. S., SOUZA, E. R., SILVA, V. L. M. “Eles vão certeiros nos nossos filhos”: adoecimentos e resistências de mães de vítimas de ação policial no Rio de Janeiro, Brasil. Ciência & Saúde Coletiva, Rio de Janeiro, v. 27, n. 4, p. 1327-1336, 2022. DOI: 10.1590/1413-81232022274.06912021
https://doi.org/10.1590/1413-81232022274... ), activism can be interpreted as a search for moral reparation in the face of public opinion, since these indirect victims are often labeled as “mothers of criminals.”

The struggle for justice, against impunity or, as many have mentioned, the “need to give a voice” to the murdered family member, to not to let them be forgotten, it emerges as an effort not to erase family histories. Despite the suffering from always reliving the pain and trauma of the loss, these activities fuel them with the liberating and therapeutic strength and courage to keep fighting for justice, (Vianna; Farias, 2011VIANNA, A.; FARIAS, J. A guerra das mães: dor e política em situações de violência institucional. Cadernos Pagu, Campinas, n. 37, p. 79-116, 2011. DOI: 10.1590/S0104-83332011000200004
https://doi.org/10.1590/S0104-8333201100... ), not just for their case, but for that of all the other mothers who have had their children killed. The following statement exemplifies this:

The engagement in political activism for some participants was and continues to be so significant that it generated opportunity and motivation for one of them to attend college:

Social support can be divided into three major spheres: emotional, which is based on relationships of trust and sharing feelings; instrumental, which includes help with tasks and cases of illness; and informational, which consists of advice and guidance (Pizzinato et al., 2018PIZZINATO, A. et al. Análise da rede de apoio e do apoio social na percepção de usuários e profissionais da proteção social básica. Estudos de Psicologia, Natal, v. 23, n. 2, p. 145-156, 2018. DOI: 10.22491/1678-4669.20180015
https://doi.org/10.22491/1678-4669.20180... ). The social support network set up among indirect victims who have had their children killed by security agents is organized in a movement in which, at the same time that they engage in activism and provide support to fragile mothers or fathers, they seek to contribute to the collective organization, in a continuous cycle that generates new meaning to the daily lives of these people.

This engaged care from one indirect victim to another ends up constituting a co-occupation, in other words, a practice shared by several people, with active participation in an interactive and reciprocal relationship.

A second aspect, although less mentioned in the statements, was the investment in individual occupations, centered on self-care, health management, and leisure activities to overcome pain and health problems. Among the activities mentioned are going to the gym, taking walks, or doing leisure activities, and getting involved in religious activities.

Among the women who had their police family members killed, one interviewee reported that she had tried to set up an organization that would bring together the families of police officers who had survived violence, so that it could function as an organization that these mothers could rely on.

However, this participant reports that the police are very resistant to accepting any kind of initiative in this direction:

The words of this mother, whose daughter was brutally murdered, carry a great significance, as they elucidate the fragility of the State in protecting its own personnel (Duarte, 2019DUARTE, E. N. P. M. O Risco não cessa quando o turno termina: Um estudo sobre a morte de policiais militares fora do serviço. 2019. 112 f. Dissertação (Mestrado em Segurança Pública) - Universidade Federal do Pará, Belém, 2019.). When a homicide occurs, the State often neglects the victim’s family members. The following statement exemplifies a case in which the police husband was shot (shortly before the police son-in-law was lethally wounded in a confrontation) and received psychological assistance, but no other family members were included:

The report above reinforces the invisibility of indirect victims of violence who are not even recognized as victims, and do not receive any kind of support from institutions (Kamimura, 2009KAMIMURA, A. A efetivação dos direitos humanos: o desafio do direito no atendimento interdisciplinar a vítimas de violência. 2009. 191 f. Dissertação (Mestrado em Direito) - Faculdade de Direito, Universidade de São Paulo, São Paulo, 2009.). The other people interviewed in group 2 reported that religious activities, physical exercise, and the mutual support of their families were important activities in their daily lives in order to get up and overcome the trauma.

Final considerations

This study focused on the impact of homicide on indirect victims, analyzing the support they received in the face of fatality, and the strategies they used to overcome the traumatic event. All the participants interviewed reported worsening of their general health, marked by intense mental suffering, which impacted negatively on daily activities related to work, leisure, health care, sleep, etc.

One support mentioned by people who had children killed by security agents was that of activist groups or human rights organizations. This activism, in which many were directly or indirectly involved, enabled them to rearrange new occupations in terms of social participation, since they began to share activities with other people who had experienced the same trauma, involved in similar activities, and with similar experiences, which can be interpreted as a collective strategy to overcome the pain of losing a family member. Other forms of support and strategies were mentioned; however, the State is largely absent in providing support to these family members. This indicates the importance of future studies seeking to better understand this “gap” between State agencies and policies and indirect victims, in order to adopt or improve public programs and policies.

Notably, few studies have sought to analyze from a comprehensive point of view the strategies adopted to try to overcome the loss and pain, and to get on with life in different groups (family members of people killed by police officers and family members who had their police family members killed), which is an important contribution of this study. In addition, the results reinforce the need to implement policies that protect citizens and families, which promote equity and inclusion for those who have historically been the most vulnerable, excluded, and discriminated against. Policies that result in benefits for society as a whole, that go beyond the police-oriented view with which the issue is restrictively and traditionally dealt with.

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