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Groen SPN, Menninga MC, Cath DC, Smid GE. Let's talk about grief: Protocol of a study on the recognition and psychoeducation of prolonged grief disorder in outpatients with common mental disorders. Front Psychiatry 2022; 13:944233. [PMID: 36159934 PMCID: PMC9492871 DOI: 10.3389/fpsyt.2022.944233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recognition that the loss of a loved one may result in prolonged grief disorder (PGD) has gained broad attention recently. PGD may disturb daily functioning to such a degree that mental health treatment is required. Because PGD symptoms often resemble symptoms of common mental disorders (CMD) such as anxiety, depressive, and post-traumatic stress disorder, clinicians may not consider a PGD diagnosis. Moreover, cultural varieties in expression of PGD may complicate recognition. This study explores the prevalence of PGD among both natives and refugees with anxiety, depressive, or trauma- and/or stressor-related disorders as well as clinicians' awareness and knowledge of PGD symptoms. In addition, a psychoeducation module on PGD symptoms is developed through patient expert collaboration. METHODS Prevalence of PGD symptoms is investigated among 50 participants who are referred to outpatient clinics for anxiety, depression, or post-traumatic stress, using the Traumatic Grief Inventory-Self Report Plus (TGI-SR+) and the Bereavement and Grief-Cultural Formulation Interview (BG-CFI). Clinicians will be interviewed on knowledge (gaps) with respect to PGD symptoms. Finally, focus groups with patient experts are held to develop a psychoeducation module tailored to the patients' needs, norms and values. RESULTS This study will show prevalence of PGD among patients who are referred for anxiety, depression, and post-traumatic stress, awareness and knowledge of clinicians on PGD symptoms, and will offer patient expert informed psychoeducation. DISCUSSION Research on prevalence and recognition of PGD is vital. Study results of the prevalence of PGD will be compared to previous studies. Recognition of PGD as distinct disorder from CMDs requires clinicians' awareness of symptoms related to the loss of a loved one. Thereby, clinicians need to take cultural aspects related to death, bereavement and mourning into consideration. ETHICS AND DISSEMINATION The study protocol will be carried out in accordance with relevant guidelines and regulations. Exploratory research to assess the prevalence of PGD in patients suffering from CMDs will facilitate adequate diagnosis by increasing clinician's awareness of PGD symptoms. Tailored PGD psychoeducation, co-created by culturally diverse patient experts and clinicians will be made publicly available.
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Affiliation(s)
- Simon P N Groen
- De Evenaar Center for Transcultural Psychiatry Drenthe Mental Health Care, Beilen, Netherlands
| | - Marijke C Menninga
- De Evenaar Center for Transcultural Psychiatry Drenthe Mental Health Care, Beilen, Netherlands
| | - Daniëlle C Cath
- Department of Psychiatry, University Medical Center Groningen, Rob Giel Onderzoekscentrum, Groningen, Netherlands.,Drenthe Mental Health Care, Assen, Netherlands.,Department of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Geert E Smid
- Department of Humanist Chaplaincy Studies, University of Humanistic Studies, Utrecht, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands
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202
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Treml J, Brähler E, Kersting A. Prevalence, Factor Structure and Correlates of DSM-5-TR Criteria for Prolonged Grief Disorder. Front Psychiatry 2022; 13:880380. [PMID: 35664467 PMCID: PMC9159802 DOI: 10.3389/fpsyt.2022.880380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/28/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prolonged Grief Disorder (PGD) is now included in Section II of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR). To understand the health burden and then allocate economic and professional resources, it is necessary to provide epidemiological data for this new disorder. This is especially relevant since the new diagnostic criteria differ from its predecessors, which may affect the generalizability of previous findings. More information on the characteristics of people suffering from PGD is also beneficial to better identify individuals at risk. This study, therefore, aimed to estimate the prevalence of the new PGD criteria in a representative population-based sample, evaluate the factor structure, sociodemographic, and loss-related correlates of PGD caseness and explore possible predictors. METHODS Out of a representative sample of the German general population (N = 2,531), n = 1,371 (54.2%) reported to have experienced a significant loss throughout lifetime. Participants provided sociodemographic data and loss-related characteristics. PGD symptoms were measured using items from the German versions of the Prolonged Grief Scale (PG-13) and the Inventory of Complicated Grief (ICG), which could be matched to the DSM-5-TR criteria for PGD. RESULTS The conditional prevalence of PGD was 3.4% (n = 47). The most frequently reported symptoms were intense emotional pain and intense yearning or longing for the deceased. The confirmatory factor analysis confirmed a unidimensional model of PGD. Regression analysis demonstrated that time since the death, the relationship to the deceased, and unpreparedness for the death were significant predictors of PGD. CONCLUSION Although the prevalence of 3.4% using the new diagnostic criteria is lower than the prevalence previously suggested by a meta-analysis, PGD remains a substantial disorder in the general population. In particular, the loss of a partner or child increases the risk for PGD, as does unpreparedness for the death of a loved one. Clinicians should pay particular attention to these high-risk groups. Further clinical implications are discussed.
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Affiliation(s)
- Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Psychiatry and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
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203
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Dominguez-Rodriguez A, Herdoiza-Arroyo PE, Martínez Arriaga RJ, Bautista Valerio E, Mateu Mollá J, de la Rosa-Gómez A, Farfallini L, Hernández Jiménez MJ, Esquivel Santoveña EE, Ramírez-Martínez FR, Castellanos Vargas RO, Arzola-Sánchez CA, Arenas-Landgrave P, Martínez-Luna SC. Prevalence of Anxiety Symptoms and Associated Clinical and Sociodemographic Factors in Mexican Adults Seeking Psychological Support for Grief During the COVID-19 Pandemic: A Cross-Sectional Study. Front Psychiatry 2022; 13:749236. [PMID: 35370841 PMCID: PMC8964437 DOI: 10.3389/fpsyt.2022.749236] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/31/2022] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic is one of the greatest challenges in modern history, with more than four million confirmed deaths worldwide. To date, evidence regarding the psychological impact of the COVID-19 pandemic on grievers is scarce for developing countries such as Mexico. This study aimed to assess the levels of anxiety and associated concerns in a sample of Mexican adults bereaved during the COVID-19 outbreak. A cross-sectional study was conducted through the Duelo COVID (COVID Grief) platform, which is a self-guided online treatment. A total of 5,224 participants reported their anxiety, depression, sleep quality, avoidance, and arousal, prolonged grief symptoms, and medication consumption. Independent sample Mann-Whitney U-tests, chi-square tests, and Kruskal-Wallis tests, as well as multinomial logistic regression, were conducted. Results indicated that 90.4% of the participants reported clinical levels of anxiety, depression, and sleep affectations. The people who lost someone during the last 5 months scored higher in normal grief symptoms compared to the people whose loss was 6 months ago or more, and 9.8% of individuals reported the use of prescription medication, with anxiolytics and antidepressants being the most common. Females, younger respondents, unemployed people with a lower educational level, and participants who disclosed a recent suicide attempt were among those who reported medication consumption. Sleep problems were more frequent in older participants.
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Affiliation(s)
| | | | - Reyna Jazmin Martínez Arriaga
- Departamento de Clínicas de Salud Mental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Eduardo Bautista Valerio
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Anabel de la Rosa-Gómez
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Luis Farfallini
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
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204
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Abstract
Pandemics are complex events involving a range of stressors affecting mental health. The recent COVID-19 pandemic served as a catalyst, accelerating preexisting trends in clinical care such as the rise of e-health for rapidly and broadly disseminating psychological services. The process of adapting face-to-face clinical services to online formats occurred rapidly during COVID-19, underscoring the adaptability of clinicians to meet new challenges. However, COVID-19 also highlighted important shortcomings in clinical care, including planning deficiencies and shortages of clinicians with specialized training for treating various psychological problems (e.g., prolonged grief disorder). These problems and potential solutions are discussed.
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205
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Specht F, Vöhringer M, Knaevelsrud C, Wagner B, Stammel N, Böttche M. Prolonged grief disorder in Arabic-speaking treatment-seeking populations: Relationship with socio-demographic aspects, loss- and trauma-related characteristics, and mental health support. Front Psychiatry 2022; 13:933848. [PMID: 36186889 PMCID: PMC9520198 DOI: 10.3389/fpsyt.2022.933848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Prolonged grief disorder (PGD) has been included as a new diagnosis in the ICD-11 and is set to be included in the DSM-5-TR. To better identify vulnerable individuals, different factors associated with PGD have to be taken into account, but results regarding these factors remain equivocal. Moreover, few studies on PGD are available from Arabic-speaking populations and from different countries dealing with conflicts and wars. The objective was thus to examine PGD prevalence and associated characteristics in these populations. MATERIALS AND METHODS A total of N = 1,051 bereaved participants from Arabic-speaking populations completed the PG-13 as part of a screening procedure for an online mental health intervention. Multiple linear regression was conducted to examine associated factors for PGD symptom severity, and multiple logistic regression was applied to investigate associated factors for PGD according to PG-13 diagnostic criteria. RESULTS Of the participants, 18.8% (n = 198) met the PGD diagnostic criteria, at an average of about 6 years post-loss. The multiple linear regression yielded eight associated factors for PGD symptom severity (age, gender, number of losses, number of traumatic event types, relationship with the deceased, age at loss, impairment during first year post-loss, perceived social support), which explained 40.2% of the variance [F (17, N=1,033) = 40.82, p < 0.001, R 2 = 0.402]. The multiple logistic regression yielded five significant associations with PGD (gender, relationship with the deceased, number of lost persons, impairment during first year post-loss, perceived social support), which explained 33.0% (Nagelkerke R 2) of the variance in PGD according to PG-13 diagnostic criteria. DISCUSSION A substantial proportion of the participants met the PG-13 criteria for PGD, emphasizing that therapeutic services are indispensable in this population. The associated factors for PGD found in our Arab-speaking sample are largely consistent with those found in studies from other regions. The slightly differing numbers of associated factors between the linear and logistic regression underline that a continuous score reflects the continuum between normal and dysfunctional grieving, and therefore also a range of factors associated with PGD.
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Affiliation(s)
- Freya Specht
- Research Department, Center ÜBERLEBEN, Berlin, Germany
| | - Max Vöhringer
- Research Department, Center ÜBERLEBEN, Berlin, Germany
| | | | - Birgit Wagner
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Nadine Stammel
- Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Maria Böttche
- Research Department, Center ÜBERLEBEN, Berlin, Germany.,Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
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206
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Lenferink LIM, Sveen J, Maccallum F. Editorial: Consequences and aftercare of a traumatic loss of a loved one. Front Psychiatry 2022; 13:1111000. [PMID: 36684027 PMCID: PMC9850152 DOI: 10.3389/fpsyt.2022.1111000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Affiliation(s)
- Lonneke I M Lenferink
- Department of Psychology, Health and Technology, Faculty of Behavioural Management and Social Sciences, University of Twente, Enschede, Netherlands.,Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Josefin Sveen
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.,Department of Women's and Children's Health, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Fiona Maccallum
- School of Psychology, The University of Queensland, St. Lucia, QLD, Australia
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207
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Valid measurement of DSM-5 persistent complex bereavement disorder and DSM-5-TR and ICD-11 prolonged grief disorder: The Traumatic Grief Inventory-Self Report Plus (TGI-SR+). Compr Psychiatry 2022; 112:152281. [PMID: 34700189 DOI: 10.1016/j.comppsych.2021.152281] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/22/2021] [Accepted: 10/15/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION When grief reactions after bereavement are so intense that they impair daily functioning, a diagnosis of disturbed grief may apply. Slightly differing criteria-sets for disturbed grief are included in the ICD-11, the DSM-5, and its forthcoming text revision, DSM-5-TR. We examined psychometric properties of a new self-report measure, the 22-item Traumatic Grief Inventory-Self Report Plus (TGI-SR+), that assesses these criteria sets for Persistent Complex Bereavement Disorder (PCBD) as per DSM-5, and Prolonged Grief Disorder (PGD) as defined in ICD-11 and DSM-5-TR. MATERIAL AND METHODS We examined the: i) factor structure, ii) internal consistency, iii) temporal stability, iv) convergent validity, v) known-groups validity, vi) probable caseness, and vii) optimal clinical cut-off scores in two Dutch bereaved samples. Sample 1 consisted of 278 adults, bereaved by various causes. Sample 2 included 270 adults who lost loved ones in a traffic accident. RESULTS We found support for a 3-factor PCBD model, 1-factor DSM-5-TR model, and 1-factor ICD-11 PGD model. The DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD items demonstrated good internal consistency and temporal stability. Associations between disturbed grief symptoms and posttraumatic stress and depression levels supported convergent validity. Associations between demographic/loss-related variables and disturbed grief symptoms supported known-groups validity. Optimal clinical cut-offs for the TGI-SR+ total score were ≥ 75, ≥71, and ≥ 75 for probable caseness of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD, respectively. DISCUSSION While replication of our findings in diverse bereaved samples is needed, we conclude that the TGI-SR+ is a reliable and valid measure to assess symptoms of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD.
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208
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Lechner-Meichsner F, Mauro C, Skritskaya NA, Shear MK. Change in avoidance and negative grief-related cognitions mediates treatment outcome in older adults with prolonged grief disorder. Psychother Res 2022; 32:91-103. [PMID: 33818302 PMCID: PMC8490492 DOI: 10.1080/10503307.2021.1909769] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective: The present study investigated the role of the two theoretically derived mediators in the treatment of Prolonged Grief Disorder (PGD). Mediators were changes in avoidance and maladaptive cognitions. An additional hypothesis tested whether these candidate mediators are specific to CBT-based Complicated Grief Treatment (CGT) compared to Interpersonal Therapy (IPT). Method: We performed secondary analyses with assessment completers (n = 131) from a randomized-controlled trial with older adults with PGD. Patients received 16 sessions of CGT or IPT. Outcomes were treatment response and reductions in grief symptoms and grief-related related impairment. Results: Reductions in avoidance between baseline and week 16 mediated reductions in grief symptoms and grief-related impairment. Reductions in maladaptive grief-related cognitions over the same period mediated treatment response, reductions in grief symptoms and grief-related impairment. There were no significant treatment-mediator interactions. We could not establish that mediators changed before the outcomes. Conclusion: Results are consistent with theoretical models of PGD, including the CGT treatment model. Despite different therapeutic procedures, we found no significant interaction effect, but CGT produced larger effects. Future research needs to establish a timeline of change through the use of multiple measurements of mediators and outcomes.Trial registration: ClinicalTrials.gov identifier: NCT01244295.
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209
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Bovero A, Pidinchedda A, Clovis F, Berchialla P, Carletto S. Psychosocial factors associated with complicated grief in caregivers during COVID-19: Results from a preliminary cross-sectional study. DEATH STUDIES 2021; 46:1433-1442. [PMID: 34957925 DOI: 10.1080/07481187.2021.2019144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic has changed how end-of-life ceremonies are performed, affecting grief processing and bereavement experiences. In this study, caregivers of patients who died with COVID-19 during the first wave of the pandemic were asked to complete an online survey designed to detect psychosocial factors associated with the presence of complicated grief (CG). The results show CG present in 48.4% of caregivers. The marital and cohabitant status during lockdown, the perceived sense of guilt and depression levels were significantly associated with the presence of CG, whereas attendance at the funeral and social support were found to be significant protective factors.
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Affiliation(s)
- Andrea Bovero
- Clinical Psychology Unit, University Hospital sA.O.U. Città della Salute e della Scienza di Torino", Torino, Italy
| | - Alexa Pidinchedda
- Clinical Psychology Unit, University Hospital sA.O.U. Città della Salute e della Scienza di Torino", Torino, Italy
| | - Federica Clovis
- Clinical Psychology Unit, University Hospital sA.O.U. Città della Salute e della Scienza di Torino", Torino, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Sara Carletto
- Clinical Psychology Unit, University Hospital sA.O.U. Città della Salute e della Scienza di Torino", Torino, Italy
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
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210
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Kapoor S, Thakkar J. Learn to Live Again. Am J Hosp Palliat Care 2021; 39:1121-1123. [PMID: 34889657 DOI: 10.1177/10499091211055902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The COVID-19 pandemic has claimed more than 4.5 million lives so far throughout the world. These sudden, unnatural, and unexpected deaths have led to complicated grief reactions as families did not get time to prepare for death. I describe the experience of my family in India during the disastrous second wave of the pandemic. The experience of many such families of COVID-19 casualties is like a horror story that will continue to scare them each day of their life. These families have already suffered a serious and long-lasting harm and are at greater risk of suffering from prolonged grief disorder, post-traumatic stress disorder, depression, emotional distress, adult separation disorder, and generalized anxiety disorder for a long period of time. Creating support groups, empowering primary-care physicians to help and counsel their patients, providing them access to cognitive behavioral therapy, help with opening up and venting out some of their feelings, and training to develop resilience are some of the measures to help our grieving patients.
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Affiliation(s)
- Sumit Kapoor
- Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, 2013Montefiore Medical Center, Bronx, NY, USA
| | - Jyotsana Thakkar
- Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, 2013Montefiore Medical Center, Bronx, NY, USA
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211
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Zuelke AE, Luppa M, Löbner M, Pabst A, Schlapke C, Stein J, Riedel-Heller SG. Effectiveness and Feasibility of Internet-Based Interventions for Grief After Bereavement: Systematic Review and Meta-analysis. JMIR Ment Health 2021; 8:e29661. [PMID: 34889769 PMCID: PMC8701663 DOI: 10.2196/29661] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although grief and its symptoms constitute a normal reaction to experiences of loss, some of those affected still report elevated levels of distress after an extended period, often termed complicated grief. Beneficial treatment effects of face-to-face therapies, for example, grief counseling or cognitive behavioral therapy against complicated grief, have been reported. Evaluations of internet- and mobile-based interventions targeting symptoms of grief in bereaved individuals with regard to objective quality criteria are currently lacking. OBJECTIVE We aim to conduct a systematic review and meta-analysis on the effectiveness and feasibility of internet- and mobile-based interventions against symptoms of grief after bereavement. METHODS We conducted systematic literature searches of randomized controlled trials or feasibility studies published before January 9, 2020, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, in PubMed, PsycINFO, Web of Science Core Collection, and the Cochrane Library. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations system. We further assessed aspects of feasibility and rated quality of interventions using criteria suggested by an expert panel on mental health care (German Association for Psychiatry, Psychotherapy, and Psychosomatics). A random-effects meta-analysis was conducted to assess between-group effect sizes. RESULTS In total, 9 trials (N=1349) were included. Of these, 7 studies were analyzed meta-analytically. Significant effects were found for symptoms of grief (g=0.54, 95% CI 0.32-0.77), depression (g=0.44, 95% CI 0.20-0.68), and posttraumatic stress (g=0.82, 95% CI 0.63-1.01). Heterogeneity was moderate for grief and depression (I2=48.75% and 55.19%, respectively) and low for posttraumatic stress symptoms (I2=0%). The overall quality of evidence was graded low (grief and depression) to moderate (posttraumatic stress). User satisfaction with the interventions was high, as was the quality of the interventions assessed using objective quality criteria. CONCLUSIONS Internet- or mobile-based interventions might constitute an effective treatment approach against symptoms of grief in bereaved adults. However, the small sample sizes and limited number of studies included in the review warrant further investigation. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42012002100; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131428.
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Affiliation(s)
- Andrea E Zuelke
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Christine Schlapke
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
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212
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Harrison O, Windmann S, Rosner R, Steil R. Inclusion of the other in the self as a potential risk factor for prolonged grief disorder: A comparison of patients with matched bereaved healthy controls. Clin Psychol Psychother 2021; 29:1101-1112. [PMID: 34822735 DOI: 10.1002/cpp.2697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/09/2022]
Abstract
Pathological grief has received increasing attention in recent years, as about 10% of the bereaved suffer from one kind of it. Pathological grief in the form of prolonged grief disorder (PGD) is a relatively new diagnostic category which will be included into the upcoming ICD-11. To date, various risk and protective factors, as well as treatment options for pathological grief, have been proposed. Nevertheless, empirical evidence in that area is still scarce. Our aim was to identify the association of interpersonal closeness with the deceased and bereavement outcome. Interpersonal closeness with the deceased in 54 participants (27 patients suffering from PGD and 27 bereaved healthy controls) was assessed as the overlap of pictured identities via the inclusion of the other in the self scale (IOS scale). In addition to that, data on PGD symptomatology, general mental distress and depression were collected. Patients suffering from PGD reported higher inclusion of the deceased in the self. By contrast, they reported feeling less close towards another living close person. Results of the IOS scale were associated with PGD severity, general mental distress and depression. Inclusion of the deceased in the self is a significant statistical predictor for PGD caseness.
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Affiliation(s)
- Octavia Harrison
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Sabine Windmann
- Department of Cognitive Psychology II, Goethe University Frankfurt, Frankfurt, Germany
| | - Rita Rosner
- Department of Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany.,Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Marburg, Germany
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213
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Jopp DS, Lampraki C, Meystre C, Znoj H, Brodbeck J. Professional Support After Partner Loss: Likelihood and Correlates of Help-Seeking Behavior. Front Psychol 2021; 12:767794. [PMID: 34887814 PMCID: PMC8649630 DOI: 10.3389/fpsyg.2021.767794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Intimate partner loss in later life can be one of the most stressful events in adulthood. Individuals who struggle to adapt to the new life conditions may need support from a mental health professional. However, less is known about the likelihood to seek professional help after separation, divorce, or bereavement in later life and associated factors. This study investigated professional help-seeking (PHS) for partner loss after a long-term marriage in separated, divorced, and bereaved individuals and examined the extent to which specific person and event-related variables, as well as depressive symptoms, increase its likelihood. The data were derived from the LIVES "Intimate Partner Loss Study." The self-administered questionnaires were completed by 388 adults. PHS was higher after separation (57%) and divorce (49%), compared to widowhood (18%). Higher likelihood of PHS was associated with separation and divorce, female gender, having someone to count on, loss unexpectedness, needing more time to overcome the loss, and more depressive symptoms. Informing individuals unlikely to seek help (e.g., males, bereaved, and individuals with no confidant) about PHS benefits may facilitate adaptation to partner loss.
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Affiliation(s)
- Daniela S. Jopp
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- LIVES Center, Swiss Centre of Expertise in Life Course Research, Lausanne, Switzerland
| | - Charikleia Lampraki
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- LIVES Center, Swiss Centre of Expertise in Life Course Research, Lausanne, Switzerland
| | - Claudia Meystre
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- LIVES Center, Swiss Centre of Expertise in Life Course Research, Lausanne, Switzerland
| | - Hansjörg Znoj
- LIVES Center, Swiss Centre of Expertise in Life Course Research, Lausanne, Switzerland
- Institute of Psychology University of Bern, Bern, Switzerland
| | - Jeannette Brodbeck
- LIVES Center, Swiss Centre of Expertise in Life Course Research, Lausanne, Switzerland
- Institute of Psychology University of Bern, Bern, Switzerland
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214
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Colvin C, Ceide M. Review of Grief Therapies for Older Adults. CURRENT GERIATRICS REPORTS 2021; 10:116-123. [PMID: 34812404 PMCID: PMC8600102 DOI: 10.1007/s13670-021-00362-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 10/26/2022]
Abstract
Purpose of Review The objective of this review is to provide background on common theories of grief, describe the impact of grief on older adults and to introduce various modalities that are currently used and/or being researched for treatment. The objective is also to condense information and identify what has been found beneficial versus what has been found lacking. A brief examination of overlap of other disorders is done. It also will suggest what further research is necessary on this subject, and highlight what research is being done during the COVID-19 Pandemic. Findings The latest research of grief primarily involves refining the definitions of grief. More concrete definitions of grief will help for better screening tools, and thus target interventions more appropriately. There is considerable need for applying it to the unique and real-world COVID-19 pandemic. Summary Grief disorders are relatively common and the symptoms overlap other disorders. Since the treatments differ, identifying grief disorders is important, especially in the elderly who are more susceptible to grief disorders. Therapy improves grief better than medications, but medications will help with any co-occurring disorders. No clear superior therapy has been identified but research continues. The pandemic has highlighted the need to refine the definitions of grief disorders and to treat them effectively.
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Abstract
This article reviews the current state of knowledge and promising new directions concerning the psychology of pandemics. Pandemics are disease outbreaks that spread globally. Historically, psychological factors have been neglected by researchers and health authorities despite evidence that pandemics are, to a large extent, psychological phenomena whereby beliefs and behaviors influence the spreading versus containment of infection. Psychological factors are important in determining (a) adherence to pandemic mitigation methods (e.g., adherence to social distancing), (b) pandemic-related social disruption (e.g., panic buying, racism, antilockdown protests), and (c) pandemic-related distress and related problems (e.g., anxiety, depression, posttraumatic stress disorder, prolonged grief disorder). The psychology of pandemics has emerged as an important field of research and practice during the coronavirus 2019 (COVID-19) pandemic. As a scholarly discipline, the psychology of pandemics is fragmented and diverse, encompassing various psychological subspecialties and allied disciplines, but is vital for shaping clinical practice and public health guidelines for COVID-19 and future pandemics. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Steven Taylor
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada;
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216
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Sekowski M, Prigerson HG. Conflicted or close: Which relationships to the deceased are associated with loss-related psychopathology? BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:510-526. [PMID: 34724233 DOI: 10.1111/bjc.12344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/16/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Prior studies have shown that pre-loss closeness and conflict with a deceased person are associated with the severity of symptoms of prolonged grief and/or depression. Nevertheless, mechanisms underlying these relationships are not well understood. We propose a theoretical model in which past closeness and conflict are related to prolonged grief and depression via concrete and symbolic continuing bonds (CB). The aim of our study was to test this model in a sample of bereaved family members. METHODS Individuals (N = 244) who had lost a family member from 0.5 to 8.0 years before the survey completed the Quality of Relationships Inventory-Bereavement Version, the Continuing Bonds Scale, the Prolonged Grief Disorder-13 scale, and the Patient Health Questionnaire-9. RESULTS The findings partially confirmed our model. Closeness was positively and moderately associated with symptoms of prolonged grief but not with symptoms of depression. Conflict was positively and weakly associated with symptoms of depression and prolonged grief. All of these relationships were only partially mediated by concrete/maladaptive and symbolic/adaptive CB. CONCLUSIONS The differences in the relationship of past closeness and conflict to prolonged grief and depression symptoms suggest that inter- and intrapersonal mechanisms of prolonged grief and depressive symptoms may be distinct. If future, especially longitudinal studies, confirm our model, CB would be a possible target for interventions for bereaved persons who had a close and/or conflicted relationship with a deceased family member and experience loss-related psychopathology. PRACTITIONER POINTS Continuing bonds (CB) are a potential target of interventions for bereaved persons who had a close and/or conflicted relationship with a deceased family member and experience symptoms of prolonged grief and/or depression. Internalization of the capacity to care for yourself and feel autonomous in a safe and stable therapeutic relationship may lead to increased self-confidence, promote working through past experiences in the relationship with the deceased, and gradual reduction of concrete forms of CB. Increasing awareness and acceptance of emotional experiences may contribute to the appreciation of past relationship with a deceased person and the growth of symbolic forms of CB. Future research should focus on verifying the effectiveness of the attachment-informed therapeutic approach to working with CB.
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Affiliation(s)
- Marcin Sekowski
- Department of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Live Care, Weill Cornell Medicine, New York City, New York, USA.,Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York City, New York, USA
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217
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Pattison NA, White C, Lone NI. Bereavement in critical care: A narrative review and practice exploration of current provision of support services and future challenges. J Intensive Care Soc 2021; 22:349-356. [PMID: 35154374 PMCID: PMC8829769 DOI: 10.1177/1751143720928898] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
This special article outlines the background to bereavement in critical care and scopes the current provision and evidence for bereavement support following death in critical care. Co-authored by a family member and former critical care patient, we aim to draw out the current challenges and think about how and where support can be implemented along the bereavement pathway. We draw on the literature to examine different trajectories of dying in critical care and explore how these might impact bereavement, highlighting important points and risk factors for complicated grief. We present graphic representation of the critical junctures for bereavement in critical care. Adjustment disorders around grief are explored and the consequences for families, including the existing evidence base. Finally, we propose new areas for research in this field.
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Affiliation(s)
- Natalie A Pattison
- East and North Herts NHS Trust, Hertfordshire, UK; University of Hertfordshire, Hertfordshire, UK; the Florence Nightingale Foundation, London, UK
| | | | - Nazir I Lone
- University of Edinburgh School of Molecular Genetic and Population Health Sciences, Edinburgh, UK
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218
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Harris CB, Brookman R, O’Connor M. It's not who you lose, it's who you are: Identity and symptom trajectory in prolonged grief. CURRENT PSYCHOLOGY 2021; 42:11223-11233. [PMID: 34720547 PMCID: PMC8536249 DOI: 10.1007/s12144-021-02343-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 10/31/2022]
Abstract
The death of a loved one has been associated with a range of emotional and cognitive impacts, with up to 10% of the bereaved population experiencing a prolonged grief reaction. Direct investigation of the role of self-identity in the maintenance of grief symptoms is limited and has not discriminated between relationship type. This longitudinal study investigated the differences in grief symptoms over time depending on relationship to the deceased person (partner or adult child), as well as the association between long-term grief symptoms and identity, attachment, and cognitive interdependence. Data from bereaved partners and adult children in The Aarhus Bereavement Study at two- and 18-months post-bereavement were included in this study. They completed questionnaires measuring their grief symptoms at both time points, a measure of attachment at Time 1, and measures of the interdependence of their pre- and post-loss identity with the deceased, their cognitive interdependence, and everyday memory retrieval failures at Time 4. Compared with adult children, bereaved partners experienced more intense grief symptoms at both time points. Regression analysis identified that over and above immediate grief symptoms, key predictors of prolonged grief symptoms were a merged post-bereavement identity with the deceased, younger age, and everyday memory retrieval difficulties. Relationship type and pre-bereavement identity contributed to initial but not prolonged grief symptoms. We discuss these findings in terms of the role of interdependence in prolonged grief.
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Affiliation(s)
- Celia B. Harris
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Australia, Locked Bag 1797, Penrith, NSW 2214 Australia
| | - Ruth Brookman
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Australia, Locked Bag 1797, Penrith, NSW 2214 Australia
| | - Maja O’Connor
- Unit for Bereavement Research, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé 11, Building 1351, 319, 8000 Aarhus C, Denmark
- Unit for Psycho-Oncology and Health Psychology, Department of Oncology, Aarhus University Hospital and Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- The Danish National Center for Grief, Copenhagen, Denmark
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219
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Pinheiro P, Gonçalves MM, Nogueira D, Pereira R, Basto I, Alves D, Salgado J. Emotional processing during the therapy for complicated grief. Psychother Res 2021; 32:678-693. [PMID: 34663184 DOI: 10.1080/10503307.2021.1985183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Prior research, mainly conducted on depression, observed that clients' improved capability to process their emotions predicted better therapeutic outcomes. The current comparative study aimed to investigate whether emotional processing was related to therapeutic change in complicated grief. METHOD We analyzed two contrasting cases (good or poor outcome) treated with grief constructivist therapy. In both cases we investigated the association of emotional processing (Experiencing Scale) to (1) therapeutic outcome (Inventory of Complicated Grief), and (2) change in the type of grief-related emotions (Emotions Episodes). RESULTS The session-by-session growth of clients' emotional processing and the change of grief-related emotions were qualitatively explored throughout both cases. Compared with the poor outcome case, the good outcome case achieved more improvement in the ability to process emotions. Such improvement occurred alongside a deeper change in the type of grief-related emotions aroused, from maladaptive to more adaptive responses. CONCLUSION Our findings suggest that a higher emotional processing capability may be associated with the transformation of grief-related maladaptive emotions and with the improvement of complicated grief condition.
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Affiliation(s)
- Patrícia Pinheiro
- School of Psychology, University of Minho, Braga, Portugal.,Department of Social and Behavior Sciences, University of Maia, Maia, Portugal
| | | | - Daniela Nogueira
- Department of Social and Behavior Sciences, University of Maia, Maia, Portugal
| | - Rui Pereira
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Isabel Basto
- Department of Social and Behavior Sciences, University of Maia, Maia, Portugal.,Center for Psychology at the University of Porto, University of Porto, Porto, Portugal
| | - Daniela Alves
- School of Psychology, University of Minho, Braga, Portugal
| | - João Salgado
- Department of Social and Behavior Sciences, University of Maia, Maia, Portugal.,Center for Psychology at the University of Porto, University of Porto, Porto, Portugal
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220
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Kokou-Kpolou CK, Adansikou K, Park S, Hajizadeh S, Iorfa SK, Cénat JM. Prolonged grief and posttraumatic growth among middle-aged and older widowed persons: A latent class analysis and testing for the role of social support. DEATH STUDIES 2021; 46:1401-1413. [PMID: 34554058 DOI: 10.1080/07481187.2021.1978115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Evidence has shown that symptoms of grief co-occur with posttraumatic growth following loss. Using latent class analysis among a Togolese sample of middle-aged/older widowed persons, we identified three classes along their experiences of grief-growth interaction (combined grief/growth, predominantly growth, and low-medium growth classes). The combined grief/growth class members were more likely to have lost their spouses recently and to report greater marital relationship satisfaction with their spouse before their death. The perceived social support from family was predictive of the predominantly growth class membership. The findings provide a nuanced understanding of grief, which is dominated by psychopathology and negative outcomes.
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Affiliation(s)
| | | | - Sunyoung Park
- Graduate School of Psychology, California Lutheran University, Thousand Oaks, California, USA
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221
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Demarchi L, Pawluski JL, Bosch OJ. The brain oxytocin and corticotropin-releasing factor systems in grieving mothers: What we know and what we need to learn. Peptides 2021; 143:170593. [PMID: 34091013 DOI: 10.1016/j.peptides.2021.170593] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/17/2021] [Accepted: 05/31/2021] [Indexed: 12/15/2022]
Abstract
The bond between a mother and her child is the strongest bond in nature. Consequently, the loss of a child is one of the most stressful and traumatic life events that causes Prolonged Grief Disorder in up to 94 % of bereaved parents. While both parents are affected, mothers are of higher risk to develop mental health complications; yet, very little research has been done to understand the impact of the loss of a child, stillbirth and pregnancy loss on key neurobiological systems. The emotional impact of losing a child, e.g., Prolonged Grief Disorder, is likely accompanied by dysregulations in neural systems important for mental health. Among those are the neuropeptides contributing to attachment and stress processing. In this review, we present evidence for the involvement of the brain oxytocin (OXT) and corticotropin-releasing factor (CRF) systems, which both play a role in maternal behavior and the stress response, in the neurobiology of grief in mothers from a behavioral and molecular point of view. We will draw conclusions from reviewing relevant animal and human studies. However, the paucity of research on the tragic end to an integral bond in a female's life calls for the need and responsibility to conduct further studies on mothers experiencing the loss of a child both in the clinic and in appropriate animal models.
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Affiliation(s)
- Luisa Demarchi
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, 93053 Regensburg, Germany.
| | - Jodi L Pawluski
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S, 1085 Rennes, France.
| | - Oliver J Bosch
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, 93053 Regensburg, Germany.
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222
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Rabow MW, Huang CHS, White-Hammond GE, Tucker RO. Witnesses and Victims Both: Healthcare Workers and Grief in the Time of COVID-19. J Pain Symptom Manage 2021; 62:647-656. [PMID: 33556494 PMCID: PMC7864782 DOI: 10.1016/j.jpainsymman.2021.01.139] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 01/03/2023]
Abstract
Heathcare Workers (HCWs) recognize their responsibility to support the bereaved loved ones of our patients, but we also must attend to our own professional and personal grief in the COVID-19 pandemic. COVID-19 grief is occurring in the setting of incomplete grief, disenfranchised grief, fractured US governmental leadership, and evidence of great mistrust, systemic racism, and social injustice. In the intensity and pervasiveness of COVID-19, HCW fears for themselves, their colleagues, and their own loved ones are often in conflict with professional commitments. Even at the dawn of promising national and global vaccination programs, significant HCW morbidity and mortality in COVID-19 has already become clear, will continue to grow, and these effects likely will last far into the future. Given the risks of complicated grief for HCWs in the setting of COVID-19 deaths, individual HCWs must put every effort into their own preparation for these deaths as well as into their own healthy grieving. Equally importantly, our healthcare systems have a primary responsibility both to prepare HCWs and to support them in their anticipatory and realized grief. Special attention must be paid to our HCW trainees, who may have not yet developed personal or professional grief management strategies and are coming into healthcare practice during a time of great disruption to both teaching and clinical care.
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Affiliation(s)
- Michael W Rabow
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, CA.
| | - Chao-Hui S Huang
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | | | - Rodney O Tucker
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
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223
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Lenferink LIM, Boelen PA, Smid GE, Paap MCS. The importance of harmonising diagnostic criteria sets for pathological grief. Br J Psychiatry 2021; 219:473-476. [PMID: 31718725 PMCID: PMC8387857 DOI: 10.1192/bjp.2019.240] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Five diagnostic criteria sets for pathological grief are currently used in research. Studies evaluating their performance indicate that it is not justified to generalise findings regarding prevalence rates and predictive validity across studies using different diagnostic criteria of pathological grief. We provide recommendations to move the bereavement field forward.
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Affiliation(s)
- Lonneke I. M. Lenferink
- Postdoctoral Researcher, Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen; and Postdoctoral Researcher, Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, The Netherlands,Correspondence: Lonneke I. M. Lenferink.
| | - Paul A. Boelen
- Professor, Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University; Professor, ARQ National Psychotrauma Centre; and Clinical Psychologist, Foundation Centrum ‘45, The Netherlands
| | - Geert E. Smid
- Psychiatrist, ARQ National Psychotrauma Centre; Psychiatrist, Foundation Centrum ’45; and Professor, University of Humanistic Studies, The Netherlands
| | - Muirne C. S. Paap
- Assistant Professor, Department of Inclusive and Special Needs Education, Faculty of Behavioural and Social Sciences, University of Groningen; Assistant Professor, Department of Child and Family Welfare, Faculty of Behavioural and Social Sciences, University of Groningen, The Netherlands; and Researcher, Department of Research and Development, Clinic Mental Health and Addiction, Oslo University Hospital, Norway
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224
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Bryant RA, Edwards B, Creamer M, O'Donnell M, Forbes D, Felmingham KL, Silove D, Steel Z, McFarlane AC, Van Hooff M, Nickerson A, Hadzi-Pavlovic D. Prolonged grief in refugees, parenting behaviour and children's mental health. Aust N Z J Psychiatry 2021; 55:863-873. [PMID: 33124446 DOI: 10.1177/0004867420967420] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Many refugees experience bereavement, and as a result they suffer elevated rates of prolonged grief disorder. Evidence also indicates that elevated rates of psychological disturbance in refugee children can be associated with parental mental health. This study examined the extent to which prolonged grief disorder in refugees is associated with their parenting behaviour and in turn with their children's mental health. METHODS This study recruited participants from the Building a New Life in Australia prospective cohort study of refugees admitted to Australia between October 2013 and February 2014. The current data were collected in 2015-2016 and comprised 1799 adults, as well as 411 children of the adult respondents. Adult refugees were assessed for trauma history, post-migration difficulties, harsh and warm parenting, probable prolonged grief disorder and posttraumatic stress disorder. Children were administered the Strengths and Difficulties Questionnaire. The current analyses on bereaved refugees comprise 110 caregivers and 178 children. RESULTS In this cohort, 37% of bereaved refugees reported probable prolonged grief disorder. Path analysis indicated that caregivers' grief was directly associated with children's emotional difficulties. Caregiver warmth was associated with reduced emotional problems in children of refugees with minimal grief but associated with more emotional problems in caregivers with more severe grief. More harsh parenting was associated with children's conduct problems, and this was more evident in those with less severe grief. CONCLUSION Severity of prolonged grief disorder is directly linked to refugee children's mental health. The association between parenting style, grief severity and children's mental health highlights that managing grief reactions in refugees can benefit both refugees and their children.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Ben Edwards
- Centre for Social Research and Methods, The Australian National University, Canberra, ACT, Australia
| | - Mark Creamer
- Phoenix Australia, The University of Melbourne, Carlton, VIC, Australia
| | - Meaghan O'Donnell
- Phoenix Australia, The University of Melbourne, Carlton, VIC, Australia
| | - David Forbes
- Phoenix Australia, The University of Melbourne, Carlton, VIC, Australia
| | - Kim L Felmingham
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Derrick Silove
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Zachary Steel
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Alexander C McFarlane
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, SA, Australia
| | - Miranda Van Hooff
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, SA, Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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225
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Grief Reactions and Grief Counseling among Bereaved Chinese Individuals during COVID-19 Pandemic: Study Protocol for a Randomized Controlled Trial Combined with a Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179061. [PMID: 34501650 PMCID: PMC8431533 DOI: 10.3390/ijerph18179061] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022]
Abstract
COVID-19 has caused nearly 4.3 million deaths all around the world. People who have experienced loss during this special period may find it difficult to adapt to life after loss, and may even suffer from prolonged grief disorder or other mental health problems. However, there is a huge gap of grief research in China, with almost no comprehensive grief intervention training system or very few professional grief consultants. Considering the large number of bereaved individuals who are suffering from grief and other mental health problems, it is significant to develop a suitable and effective intervention protocol immediately. This article illustrates a study protocol initiated by a Chinese university to investigate the mental health of bereaved individuals during the COVID-19 pandemic and train grief counselors to provide grief counseling to the bereaved, as well as to evaluate the effectiveness of the grief counseling. The method is as follows: (1) 300 psychological counselors will be recruited to attend the grief counseling training. Assessments will be conducted at three time points: baseline (T0), after the basic training (T1), and after the advanced training (T2); (2) 500 bereaved Chinese will be recruit to join the online survey and will be assessed at two time points with a six-month interval; and (3) a two-armed (grief counseling versus wait-list controls) RCT (random control trials) will be conducted with 160 bereaved individuals. Assessments will be conducted at three time points: before randomization (baseline, T0), at the post-counseling (T1), and three months after the post-counseling (T2). Primary outcomes will be assessed by the Prolonged Grief Questionnaire (PG-13), the 20-item PTSD Checklist for DSM-5 (PCL-5), the Depression Anxiety and Stress Scale (DASS-21), and the Posttraumatic Growth Inventory (PTGI). This research will help develop grief research and grief counseling in China, as well as provide professional mental health services for individuals who may suffer from grief-related disorders in the future.
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226
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From virtual to real healing: a critical overview of the therapeutic use of virtual reality to cope with mourning. CURRENT PSYCHOLOGY 2021; 42:8697-8704. [PMID: 34429574 PMCID: PMC8376294 DOI: 10.1007/s12144-021-02158-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 12/29/2022]
Abstract
In recent years, virtual reality (VR) has been effectively employed in several settings, ranging from health care needs to leisure and gaming activities. A new application of virtual stimuli appeared in social media: in the documentary ‘I met you’ from the South-Korean Munhwa Broadcasting, a mother made the experience of interacting with the avatar of the seven-year-old daughter, who died four years before. We think that this new application of virtual stimuli should open a debate on its possible implications: it represents contents related to grief, a dramatic and yet natural experience, that can have deep psychological impacts on fragile subjects put in virtual environments. In the present work, possible side-effects, as well as hypothetical therapeutical application of VR for the treatment of mourning, are discussed.
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Psychometric properties of the German version of the Depressive and Anxious Avoidance in Prolonged Grief Questionnaire (DAAPGQ). PLoS One 2021; 16:e0254959. [PMID: 34375341 PMCID: PMC8354469 DOI: 10.1371/journal.pone.0254959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/06/2021] [Indexed: 11/19/2022] Open
Abstract
The Depressive and Anxious Avoidance in Prolonged Grief Questionnaire (DAAPGQ) was developed to measure depressive and anxious avoidance behaviors, which, according to cognitive-behavioral models, are supposed to play an important role in the development and maintenance of prolonged grief. The present study aimed to develop a German version of the DAAPGQ and evaluate its psychometric properties and validity within a representative sample of the German general population (N = 2531). The German-language DAAPGQ was developed using a forward-backward translation procedure. Then, a subsample of individuals who reported having lost a significant other (N = 1371) of a representative sample was assessed with the German DAAPGQ, along with information on sociodemographic characteristics, prolonged grief symptom severity (PG-13), general anxiety (GAD-2) and depression (PHQ-2). The factor structure of the DAAPGQ was evaluated using confirmatory factor analyses, reliability by calculating internal consistency on subscale level and convergent validity by correlations between DAAPQG subscale sores with PG-13, GAD-2 and PHQ-2 sum scores. As expected, a two-factor model with correlated latent variables showed good fit to the data, replicating findings from the original version. Internal consistency was high for both subscales (Cronbach’s α .86 and .95, respectively). Convergent validity was established by theoretically expected and statistically significant positive correlations of DAAPGQ subscales with symptom severity of prolonged grief, depression, and anxiety and negative correlations with time since loss. Furthermore, the addition of depressive and anxious avoidance significantly improved the prediction of prolonged grief symptom severity over sociodemographic and loss-related information. In sum, our results suggest that the German-language DAAPGQ is a reliable and valid measure of depressive and anxious avoidance and a useful tool to improve our knowledge on the role of avoidance in prolonged grief. We also provide descriptive data to improve the applicability of the DAAPGQ for individual diagnostics.
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228
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Selman L. Covid grief has cracked us open: how clinicians respond could reshape attitudes to bereavement-an essay by Lucy Selman. BMJ 2021; 374:n1803. [PMID: 34376385 DOI: 10.1136/bmj.n1803] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Lucy Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, UK
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El Sayed S, Gomaa S, Aboelfotoh S, El Wasify M. Pandemic Grief Scale in detection of grief reaction among physicians in COVID-19 era. MIDDLE EAST CURRENT PSYCHIATRY 2021. [PMCID: PMC8328533 DOI: 10.1186/s43045-021-00130-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Physicians are considered one of the most vulnerable groups who might develop pandemic grief during this critical time of COVID-19 infection, and this grief reaction might have deleterious effects on their life. This cross-sectional observational online study aimed to investigate the pandemic grief reaction among physicians and its burden on their aspects of life. Results Socio-demographic characteristics of 900 physicians were collected. The Pandemic Grief Scale (PGS) was used to detect the grief reaction among them and also Patient Health Depression Questionnaire-9 (PHQ-9) was used to evaluate the depressive manifestations. Sheehan Disability Scale was considered to investigate the burden of this grief on different aspects of life. The study revealed high mean score of Pandemic Grief Scale: 11.12 ± 2.34; the mean score of Sheehan Disability Scale was 17.63 ± 5.17, and the mean score of Patient Health Depression Questionnaire-9 was 19.89 ± 4.27. Conclusion Pandemic grief is commonly experienced by the physicians during this COVID-19 era due to sudden loss of loved one or the cases themselves. This pandemic grief has drastic effect on domains of physicians’ life.
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230
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Boelen PA. Symptoms of prolonged grief disorder as per DSM-5-TR, posttraumatic stress, and depression: Latent classes and correlations with anxious and depressive avoidance. Psychiatry Res 2021; 302:114033. [PMID: 34134030 DOI: 10.1016/j.psychres.2021.114033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/22/2021] [Indexed: 11/30/2022]
Abstract
Bereavement may precipitate significant mental health problems. Prolonged grief disorder (PGD) is included in section 2 of the forthcoming DSM-5 text-revision (DSM-5-TR). Research using earlier criteria of disordered grief showed that bereaved people may have distinct symptom patterns-including high, low, and comorbid symptomatology. Building on that work, we used latent class analysis to identity subgroups of bereaved individuals based on their endorsement of symptoms of PGD (per DSM-5-TR), posttraumatic stress, and depression. We also examined if class-membership was associated with socio-demographic and loss-related variables and anxious and depressive avoidance behaviors. Self-reported data were available from 436 people, mostly women, mostly bereaved by the death of their partner or child. Three subgroups were identified, evidencing low symptom levels (34.2%), predominantly PGD symptoms (38.7%), and high symptom levels (27%), respectively. Shorter time since loss, lower education, loss of a partner, and unnatural/violent deaths increased chances of inclusion in the high symptoms class. Anxious and depressive avoidance were lowest in the low symptoms class, higher in the PGD class, and strongest in the high symptoms class. Findings show that PGD per DSM-5-TR is a distinct condition and underscore that reducing avoidance behaviors is important in the treatment of post-loss psychopathology.
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Affiliation(s)
- Paul A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, PO Box 80140, 3508 TC Utrecht, the Netherlands; ARQ National Psychotrauma Centre, Nienoord 5, NL-1112 XE Diemen, the Netherlands.
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231
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Tay DL, Thompson C, Jones M, Gettens C, Cloyes KG, Reblin M, Thomas Hebdon MC, Beck AC, Mooney K, Ellington L. "I Feel All Alone Out Here": Analysis of Audio Diaries of Bereaved Hospice Family Caregivers During the COVID-19 Pandemic. J Hosp Palliat Nurs 2021; 23:346-353. [PMID: 33660671 PMCID: PMC8243771 DOI: 10.1097/njh.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The COVID-19 pandemic has dramatically changed social life. This secondary qualitative analysis aimed to better understand the impact of the pandemic on bereaved hospice family caregivers' experiences of social connection and isolation in a time of social distancing and general anxiety. Six caregivers in 3 states recorded audio diaries (N = 59) between March 13 and May 15, 2020. Caregivers were, on average, 56.80 years old (SD, 14.22; range, 32-67 years old) and consisted of spouses (n = 2), adult children (n = 3), and a sibling (n = 1). Using NVIVO 12, caregiver diaries were coded for (1) "social connection" (n = 23), defined as being able to access or seeking informal or formal social support networks; (2) "isolation" (n = 17), defined as being unable or reluctant to access informal or formal social support networks, or feeling alone; and (3) "bereavement processes" (n = 147), informed by the dual process model of bereavement (restoration and loss-oriented stressors). Content analysis revealed that caregivers were able to connect with others despite physical distancing expectations, expressed loneliness and grief while in isolation, and described moving on in the face of uncertainty. Findings provide insight into how caregivers experienced bereavement during the initial period of the pandemic and highlight implications for hospice bereavement services.
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232
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Treml J, Schmidt V, Nagl M, Kersting A. Pre-loss grief and preparedness for death among caregivers of terminally ill cancer patients: A systematic review. Soc Sci Med 2021; 284:114240. [PMID: 34303292 DOI: 10.1016/j.socscimed.2021.114240] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cancer is one of the most common causes of death. The period of time between receiving a terminal diagnosis of cancer and the death of a loved one has been operationalized as pre-loss grief and, more recently, as preparedness for death. Originally, grief before loss was thought to have positive effects on the bereavement outcome, but some studies have revealed contradictory findings. This systematic review investigates definitions and measurement tools of pre-loss grief and preparedness for death, as well as the associations of both constructs with caregiver characteristics, pre-loss psychological aspects and post-loss adjustment among caregivers of people living with terminal cancer. METHODS PubMed/Medline, PsycINFO and Web of Science were searched for studies published up until October 2020. Quantitative empirical studies from peer reviewed journals were included if a measurement tool for pre-loss grief or preparedness for death was used and if they focused on adult caregivers of adult people with cancer in an end-of-life trajectory and were excluded when they were not written in English or were descriptive/qualitative studies. Quality assessment of all studies was performed. RESULTS Most studies used convenience samples and had a mean number of 725 participants. Overall, 16,326 participants in 35 articles were included and narratively synthesized. High levels of pre-loss grief, as well as low levels of perceived preparedness for death, were associated with poor post-loss adjustment (e.g., prolonged grief, depressive symptoms, etc.). CONCLUSIONS Caregivers with high levels of pre-loss grief and low levels of preparedness for the death of their loved one would benefit from targeted support for post-loss adjustment. Results are limited by an inconsistent operationalization of both constructs.
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Affiliation(s)
- Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Viktoria Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Michaela Nagl
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
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233
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Wu EX, Collins A, Briggs S, Stajduhar KI, Kalsi A, Hilliard N. Prolonged Grief and Bereavement Supports Within a Caregiver Population Who Transition Through a Palliative Care Program in British Columbia, Canada. Am J Hosp Palliat Care 2021; 39:361-369. [PMID: 34259023 PMCID: PMC8847765 DOI: 10.1177/10499091211030442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the prevalence of prolonged grief disorder (PGD), and self-reported resilience among bereaved caregivers within a palliative care program that serves a large region of the Lower Mainland in British Columbia, Canada. Additionally, to discern effective bereavement supports utilized by caregivers following the loss of a loved one. METHODS A descriptive study using both quantitative and qualitative methods. Sociodemographic information (n = 427) was collected from bereaved caregivers 3 months after their loss. PGD and resilience were prospectively assessed 12 months post-loss using the prolonged grief scale (PG-13, n = 212) and brief resilience scale (BRS, n = 215), respectively. A qualitative thematic analysis was conducted on responses to the open-ended question on what bereavement services or activities caregivers found helpful in coping with the loss of a loved one. RESULTS Of the 212 individuals that completed the PG-13, 4.7% met diagnostic criteria for PGD, 27.4% were moderate risk, and 67.9% were low risk for PGD. Of the 215 caregivers that completed the BRS, 48.4% had low resilience, 51.6% had normal resilience, and 0% had high resilience. The major themes of formal supports, informal supports, and self-care activities emerged from caregiver comments regarding effective bereavement supports. CONCLUSION The incidence of PGD in caregivers is low within the Fraser Health Palliative Care program. Bereaved caregivers mainly utilize existing social networks and activities to cope with their loss. Focusing on a community-based approach to supports may improve bereavement experiences and lower rates of prolonged grief.
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Affiliation(s)
- Elizabeth X Wu
- Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Collins
- Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Palliative Medicine, Fraser Health Authority, British Columbia, Canada
| | - Shelley Briggs
- Department of Palliative Medicine, Fraser Health Authority, British Columbia, Canada
| | - Kelli I Stajduhar
- School of Nursing & Institute on Aging and Lifelong Health, University of Victoria, British Columbia, Canada
| | - Asha Kalsi
- Health Information Science University of Victoria, Victoria, British Columbia, Canada
| | - Neil Hilliard
- Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Palliative Medicine, Fraser Health Authority, British Columbia, Canada
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234
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Xu X, Wen J, Skritskaya NA, Zou X, Mauro C, Wang J, Shear MK. Grief-related beliefs in shidu parents with and without prolonged grief disorder: Psychometric properties of a Chinese version of the Typical Beliefs Questionnaire. Clin Psychol Psychother 2021; 29:512-523. [PMID: 34235799 DOI: 10.1002/cpp.2641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 12/17/2022]
Abstract
The Typical Beliefs Questionnaire (TBQ) assesses common grief-related cognitions, which demonstrated satisfactory psychometric properties in a treatment-seeking sample with prolonged grief disorder (PGD). Chinese shidu parents (bereaved parents over the age of 49 who have lost their only child) are at a high risk of PGD. The current study aimed to examine psychometric properties of the Chinese version of the TBQ (TBQ-C) in a community sample of shidu parents with and without PGD, to compare this to the original validation clinical sample in the United States bereaved of any close relationship and to consider its use as a clinical tool. We examined the rate of positive endorsement, factor structure, internal consistency and validity of the TBQ-C in 310 community-based shidu parents (including 102 who met the criteria for PGD). Results showed that the rate of positive endorsement for each item ranged from 7.2% to 48.6% among non-PGD participants and from 20.6% to 92.2% among PGD participants. Confirmatory factor analysis indicated that the original five-factor structure fit both the non-PGD and PGD shidu parents. The TBQ-C showed acceptable internal consistency and satisfactory convergent and concurrent validity in both groups. It had good discriminant validity and can be helpful in distinguishing shidu parents with and without PGD. The TBQ-C can be used to investigate common grief-related beliefs that may be problematic for both shidu parents with and without PGD.
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Affiliation(s)
- Xin Xu
- Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Jun Wen
- Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Beijing, China
| | | | - Xinyan Zou
- Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Christine Mauro
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jianping Wang
- Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - M Katherine Shear
- Center for Complicated Grief, Columbia School of Social Work, New York, NY, USA
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235
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Tur C, Campos D, Herrero R, Mor S, López-Montoyo A, Castilla D, Quero S. Internet-delivered Cognitive-Behavioral Therapy (iCBT) for Adults with Prolonged Grief Disorder (PGD): A Study Protocol for a Randomized Feasibility Trial. BMJ Open 2021; 11:e046477. [PMID: 34230018 PMCID: PMC8261880 DOI: 10.1136/bmjopen-2020-046477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/11/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Grief is an emotional reaction to the loss of a loved one with a natural recovery. Approximately 10% of people who lose a loved one develop prolonged grief disorder (PGD). Internet-based and computer-based interventions (ie, internet-delivered cognitive-behavioural therapy, iCBT) are a cost-effective alternative that makes it possible to reach more people with PGD. The main aim of this study is to assess the feasibility of a new iCBT-called GROw-for PGD. As a secondary objective, the potential effectiveness of GROw will be explored. METHODS AND ANALYSIS This study is a two-arm feasibility randomised trial. A total of 48 adults with PGD who meet the eligibility criteria will be randomised to the experimental group (iCBT: GROw) or the active control group (face-to-face CBT treatment). The treatment is organised sequentially in eight modules in the iCBT format and 8-10 sessions in the face-to-face format, and both formats have the same therapeutic components. There will be five assessment points with qualitative and quantitative evaluations: screening, baseline, after the intervention, 3-month follow-up and 12-month follow-up. Consistent with the objectives, the measures are related to the feasibility outcomes for the main aim of the study (participant adherence, expectations and satisfaction with the treatment, preferences, alliance and utility) and psychological and mental health outcomes for secondary analyses (symptoms of grief, symptoms of depression, symptoms of anxiety, affectivity, quality of life, work and social adaptation, post-traumatic growth, purpose in life, mindfulness and compassion). ETHICS AND DISSEMINATION The Ethics Committee of the Universitat Jaume I (Castellón, Spain) granted approval for the study (CD/002/2019). Dissemination will include publications and presentations at national and international conferences. TRIAL REGISTRATION NUMBER NCT04462146.
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Affiliation(s)
- Cintia Tur
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Daniel Campos
- Department of Psychology and Sociology, University of Zaragoza, Huesca, Spain
| | - Rocio Herrero
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Sonia Mor
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Alba López-Montoyo
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Diana Castilla
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
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236
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Wittkowski J, Scheuchenpflug R. Evidence on the Conceptual Distinctness of Normal Grief From Depression. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2021. [DOI: 10.1027/2512-8442/a000077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: The distinctness of grief from depression has been the subject of a long scholarly debate, even influencing definitions of diagnostic criteria. Aims: This study aims at clarifying the issue by a multifaceted analysis of data from a large German sample. Method: A community sample of 406 bereaved persons answered the Wuerzburg Grief Inventory (WGI), a multidimensional grief questionnaire designed to measure normal grief in the German language, and the General Depression Scale – Short Version (GDS-S), a self-report depression scale. Data were analyzed by factor analysis to identify structural (dis-)similarities of the constructs, and analysis of variance (ANOVA) to identify the influence of the factors relationship to the deceased, type of death, and time since loss on grief measures and depression scores. Results: Factor analysis clustered items referring to grief-related impairments and depression into one factor, items referring to other dimensions of grief on separate factors, however. Relationship to the deceased influenced the grief measures impairments and nearness to the deceased, but not depression scores if controlled for impairments. Type of death showed specific effects on grief scores, but not on depression scores. Time since loss influenced grief scores, but not depression scores. Limitations: The analysis is based on a self-selected community sample of grieving persons, self-report measures, and in part, on cross-sectional data. Conclusion: Factor analysis and objective data show a clear distinction of dimensions of grief and depression. The human experience of grief contains a sense of nearness to the lost person, feelings of guilt, and positive aspects of the loss experience in addition to components resembling depression.
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Affiliation(s)
- Joachim Wittkowski
- Institute of Psychology, Julius-Maximilians-Universität of Würzburg, Germany
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237
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Sekowski M, Prigerson HG. Associations between interpersonal dependency and severity of prolonged grief disorder symptoms in bereaved surviving family members. Compr Psychiatry 2021; 108:152242. [PMID: 33979631 DOI: 10.1016/j.comppsych.2021.152242] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/27/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Several studies have shown that interpersonal dependency is a risk factor for prolonged grief disorder (PGD), a disorder that has been recently approved by the American Psychiatric Association Assembly for inclusion in the Diagnostic and Statistical Manual of Mental Disorders-5-Text Revision (DSM-5-TR). Nevertheless, it remains unclear whether this relationship is independent of depression, which may also be related to both loss and interpersonal dependency. Furthermore, anaclitic dependency (maladaptive and immature) compared to relatedness (more adaptive and mature) dependency, and the relationships between these types of dependency and PGD, have not been examined. The aim of the present study was to determine how anaclitic and relatedness dependency are associated with PGD symptom severity, controlling for depressive symptom severity, over and above potential sociodemographic and loss-related confounder variables. METHODS Participants (N = 241) bereaved after the death of a family member from 0.5 to 8 years before the survey (M = 3.36, SD = 2.02) completed the Depressive Experiences Questionnaire, the Patient Health Questionnaire-9, and the Prolonged Grief Disorder-13 scale (PG-13). RESULTS A hierarchical regression analysis confirmed that anaclitic dependency is positively associated with PGD symptom severity, even when controlling for depression severity and other potential confounder variables. There was no significant association between relatedness dependency and PGD. CONCLUSIONS To assess the risk of PGD in individuals bereaved after the death of a family member, it is important to assess anaclitic dependency.
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Affiliation(s)
- Marcin Sekowski
- Department of Psychology, The Maria Grzegorzewska University, ul. Szczesliwicka 40, 02-353 Warsaw, Poland.
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Live Care, 321 Lasdon House, 420 East 70(th) Street, Weill Cornell Medicine, NY, New York 10021, United States of America; Department of Medicine, Division of Geriatrics and Palliative Medicine, Baker Pavilion 14(th) Floor, East 68(th) Street, Weill Cornell Medicine, NY, New York 10021, United States of America.
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238
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Eisma MC, Franzen M, Paauw M, Bleeker A, Aan Het Rot M. Rumination, worry and negative and positive affect in prolonged grief: A daily diary study. Clin Psychol Psychother 2021; 29:299-312. [PMID: 34170063 PMCID: PMC9291980 DOI: 10.1002/cpp.2635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 11/22/2022]
Abstract
After bereavement, a significant minority experiences severe, persistent, and disabling grief, termed prolonged grief or complicated grief. Prolonged grief treatments may be enhanced by improving understanding of malleable risk factors in post‐loss psychological adaptation. Repetitive negative thought (e.g., rumination, worry) constitutes such a risk factor. Rumination and worry are both theorized to be maladaptive through interrelations with affect, yet this assumption has not been systematically investigated in the bereaved. We aimed to fill this gap in knowledge with a baseline survey and 10‐day daily diary investigation among a bereaved sample. Survey between‐subject analyses (N = 113) demonstrated that trait rumination and worry, trait negative affect and prolonged grief symptoms are positively related to each other and negatively related with trait positive affect. Within‐subject multilevel analyses of diaries (N = 62) demonstrated that trait rumination and trait worry relate positively to daily negative affect and negatively to daily positive affect. Daily rumination and worry showed similar relationships with daily negative and positive affect. A stronger relationship emerged between daily rumination and daily negative affect in people with higher prolonged grief symptom levels. Findings consistently support interrelations between repetitive negative thought, affect, and prolonged grief symptoms. Rumination appears particularly detrimental in people with severe grief reactions. Results align with research demonstrating the effectiveness of targeting repetitive negative thought in prolonged grief treatments. Additionally, our study demonstrates the potential feasibility and usefulness of using daily diaries to study behaviours of relevance to post‐loss adaptation in everyday life.
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Affiliation(s)
- Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Minita Franzen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Mabel Paauw
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Anke Bleeker
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Marije Aan Het Rot
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
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239
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Plews-Ogan E, Keywan C, Morris SE, Goldstein RD. The parental role before and after SIDS. DEATH STUDIES 2021; 46:2316-2326. [PMID: 34101544 DOI: 10.1080/07481187.2021.1936296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Role confusion is a prominent constituent symptom of Prolonged Grief Disorder in parents after their infants die from sudden infant death syndrome (SIDS). We interviewed 31 parents of SIDS infants 2-5 years post-loss examining the parental role before death, at the time of loss, and in bereavement. Thematic analysis found disruption of the role and re-imagined responsibilities for their child's physical security, emotional security, and meaning. Tasks within these domains changed from concrete and apparent to representational and self-generated. Parents in bereavement locate ongoing, imperative parental responsibilities, particularly asserting their child's meaningful place in the world and in their family.
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Affiliation(s)
- Erin Plews-Ogan
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Christine Keywan
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sue E Morris
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Richard D Goldstein
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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240
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Bryant RA, Bawaneh A, Giardinelli L, Awwad M, Al‐Hayek H, Akhtar A. A prevalence assessment of prolonged grief disorder in Syrian refugees. World Psychiatry 2021; 20:302-303. [PMID: 34002523 PMCID: PMC8129832 DOI: 10.1002/wps.20876] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | - Ahmad Bawaneh
- Jordan Country OfficeInternational Medical CorpsAmmanJordan
| | | | - Manar Awwad
- Jordan Country OfficeInternational Medical CorpsAmmanJordan
| | | | - Aemal Akhtar
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia,Clinical, Neuro and Developmental PsychologyVrije UniversiteitAmsterdamThe Netherlands
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241
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Szuhany KL, Malgaroli M, Miron CD, Simon NM. Prolonged Grief Disorder: Course, Diagnosis, Assessment, and Treatment. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:161-172. [PMID: 34690579 PMCID: PMC8475918 DOI: 10.1176/appi.focus.20200052] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Losing a loved one is one of life's greatest stressors. Although most bereaved individuals navigate through a period of intense acute grief that lessens with time, approximately 10% will develop a prolonged grief condition. This review provides an overview of the course of grief and describes risk factors for developing prolonged grief disorder. The evolution of the prolonged grief disorder diagnosis, including the latest criteria sets for ICD-11 and DSM-5, as well as common comorbid conditions and differential diagnosis are discussed. Clinically useful self-report and clinician-rated measures for assessing symptom constructs and overall prolonged grief disorder severity, evidence-based psychotherapies (such as complicated grief treatment), as well as evidence about pharmacologic approaches are presented. Finally, the authors discuss important future directions, including a potential increase in prolonged grief disorder cases due to the COVID-19 pandemic.
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Affiliation(s)
- Kristin L Szuhany
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Matteo Malgaroli
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Carly D Miron
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Naomi M Simon
- Department of Psychiatry, New York University Grossman School of Medicine, New York
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242
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Fernández-Alcántara M, Kokou-Kpolou CK, Cruz-Quintana F, Pérez-Marfil MN. Editorial: New Perspectives in Bereavement and Loss: Complicated and Disenfranchised Grief Along the Life Cycle. Front Psychol 2021; 12:691464. [PMID: 34113302 PMCID: PMC8185040 DOI: 10.3389/fpsyg.2021.691464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
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243
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Carlsson N, Alvariza A, Bremer A, Axelsson L, Årestedt K. Symptoms of Prolonged Grief and Self-Reported Health Among Bereaved Family Members of Persons Who Died From Sudden Cardiac Arrest. OMEGA-JOURNAL OF DEATH AND DYING 2021; 87:66-86. [PMID: 34011206 PMCID: PMC10064453 DOI: 10.1177/00302228211018115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sudden cardiac arrest is common and is one of the leading causes of death in the western world, and the sudden loss following cardiac arrest may have a significant impact on bereaved family members' health. Therefore, the aim of this study was to describe symptoms of prolonged grief and self-reported health among bereaved family members of persons who died from sudden cardiac arrest, with comparisons between spouses and non-spouses. This was a cross-sectional observation study with 108 adult family members who completed a questionnaire. A fifth of the family members reported prolonged grief, and problems with self-reported health were common, especially regarding anxiety. Spouses reported more problems with prolonged grief and self-reported health compared with non-spouses. The risk of these family members developing prolonged grief and health problems should be recognized, and professional support should be offered.
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Affiliation(s)
- Nina Carlsson
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,Department of Internal Medicine, Region Kalmar County, Kalmar, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Anders Bremer
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,Department of Ambulance Service, Region Kalmar County, Kalmar, Sweden
| | - Lena Axelsson
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,The Research Section, Region Kalmar County, Kalmar, Sweden
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244
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Huang M, Habermas T. Narrating ambiguous loss: Deficiencies in narrative processing and negative appraisal of consequences. J Clin Psychol 2021; 77:2147-2166. [PMID: 34004016 DOI: 10.1002/jclp.23146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 11/16/2020] [Accepted: 03/28/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare narrative coping with physical and psychological ambiguous loss (AL) and definite loss in terms of distancing (vs. narrative immersion), meaning-making, and subjective biographical consequences. METHODS Thirty adults who had lost a parent to death, to going missing, or to Alzheimer disease (N = 90, 67 females; mean age 36.73 years, SD = 7.27; mean time since loss 9.0 years) narrated two loss-related and three control memories. RESULTS Individuals with AL were not more immersed in the loss experience, but less successful in finding meaning and in evaluating the loss and its consequences positively compared to those with a definite loss. These group differences were not due to differences in depression, posttraumatic stress disorder, and protracted grief. CONCLUSIONS Ambiguity of loss renders meaning-making and coherently narrating loss more difficult, leading to more negative affect, suggesting interventions that help narrating loss coherently in a self-accepting way.
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Affiliation(s)
- Manxia Huang
- Institute of Applied Psychology, China University of Geosciences, Wuhan, China.,Department of Psychology, Goethe University Frankfurt, Frankfurt a. M., Germany
| | - Tilmann Habermas
- Department of Psychology, Goethe University Frankfurt, Frankfurt a. M., Germany
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245
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Rosner R, Comtesse H, Vogel A, Doering BK. Prevalence of prolonged grief disorder. J Affect Disord 2021; 287:301-307. [PMID: 33812243 DOI: 10.1016/j.jad.2021.03.058] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/27/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prolonged grief is a disorder (PGD) characterized by severe and disabling grief reactions for an extended period of time after the loss of a significant person. ICD-11 and DSM-5-TR differ substantially in individual criteria. OBJECTIVE Estimation of the respective prevalence of PGDICD-11 and PGDDSM-5-TR and the frequency with which single symptoms of prolonged grief occur in the general population. METHODS Out of a representative sample of the German general population (N=2498), n = 914 reported a significant loss and prolonged grief symptoms based on the extended version of the self-reported Prolonged Grief Disorder-13+9 (PG13+9). Sociodemographic and loss-related characteristics were collected. RESULTS The probable prevalence of PGDICD-11 was 1.5% and that of PGDDSM-5-TR was 1.2% in the general sample. Among bereaved persons (n=914), the prevalence of developing PGDICD-11 was 4.2% and that of PGDDSM-5-TR was 3.3%. Diagnostic agreement between the two criteria-sets was very high and did not increase after heightening the accessory symptom threshold for PGDICD-11. Difficulties accepting the loss was the most frequent single symptom (14-25%) and grief-related impairment was common (10-16%). Over 60% of participants with a probable PGD diagnosis utilized health care services. LIMITATIONS Results are based on self-reported data. The PG13+9 was not designed to assess grief symptoms according to ICD-11 and DSM-5-TR diagnostic criteria. CONCLUSIONS Prolonged grief according to ICD-11 and DSM-5-TR is a notable disorder in the general population. Among bereaved persons, single symptoms of prolonged grief are relatively frequent and cause substantial degrees of impairment.
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Affiliation(s)
- Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.
| | - Hannah Comtesse
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.
| | - Anna Vogel
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Bettina K Doering
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
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246
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Grauerholz KR, Berry SN, Capuano RM, Early JM. Uncovering Prolonged Grief Reactions Subsequent to a Reproductive Loss: Implications for the Primary Care Provider. Front Psychol 2021; 12:673050. [PMID: 34054675 PMCID: PMC8149623 DOI: 10.3389/fpsyg.2021.673050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction There is a paucity of clinical guidelines for the routine assessment of maladaptive reproductive grief reactions in outpatient primary care and OB-GYN settings in the United States. Because of the disenfranchised nature of perinatal grief reactions, many clinicians may be apt to miss or dismiss a grief reaction that was not identified in the perinatal period. A significant number of those experiencing a reproductive loss exhibit signs of anxiety, depression, or post-traumatic stress disorder. Reproductive losses are typically screened for and recorded numerically as part of a woman’s well-visit intake, yet this process often fails to identify patients emotionally troubled by a prior pregnancy loss. Materials and Methods A summative content analysis of 164 recent website blogs from female participants who self-reported having experienced a miscarriage or abortion in their lifetime was conducted. The narratives were reviewed for details regarding the time span between the pregnancy loss and the composition of the blog post. The stories were analyzed for subsequent relationship problems and detrimental mental health conditions. Maladaptive reactions were contrasted for those that indicated a greater than 12 months’ time-lapse and those who had not. Results More than a third (39.6%) of the women reported in the narrative that at least one year or more had passed since experiencing the miscarriage or abortion. For those women, the median time span between the loss and composing the blog was 4 years with a range of 47 years. Mental health conditions attributed to the reproductive loss by those who reported longer bereavement times included subsequent relationship problems, substance misuse, depression, suicidal ideation, and PTSD. The percent of reported maladaptive issues was more than double (136.9% vs. 63.6%) for those who reported that a year or more had passed since the loss of the pregnancy. Discussion Grief reactions following the loss of a pregnancy may be prolonged or delayed for several months which can contribute to adverse biopsychosocial outcomes. Recognition and treatment of maladaptive grief reactions following a pregnancy loss are critical. Screening methods should be enhanced for clinicians in medical office settings to help identify and expedite the appropriate mental health assistance.
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Affiliation(s)
| | - Shandeigh N Berry
- Life Perspectives, San Diego, CA, United States.,Department of Nursing, College of Arts and Sciences, St. Martin's University, Lacey, WA, United States
| | - Rebecca M Capuano
- Life Perspectives, San Diego, CA, United States.,Blue Ridge Women's Center, Roanoke, VA, United States
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247
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Kustanti CY, Chu H, Kang XL, Liu D, Pien LC, Jen HJ, Shen STH, Chen JH, Chou KR. Evaluation of the performance of instruments to diagnose grief disorders: A diagnostic meta-analysis. Int J Nurs Stud 2021; 120:103972. [PMID: 34098452 DOI: 10.1016/j.ijnurstu.2021.103972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/26/2021] [Accepted: 04/27/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Prolonged or complicated grief disorder occurs in 9.8% of bereaved adults and can progress into adverse health effects if left unresolved. Evidence on the appropriate and specific diagnostic instrument for the assessment of prolonged or complicated grief disorders is lacking. OBJECTIVE The purpose of this study was to evaluate the performance of the most widely used instruments to diagnose grief disorders, including The Inventory of Complicated Grief, The Inventory of Complicated Grief - Revised, and the Prolonged Grief Disorder-13. DESIGN Diagnostic meta-analysis. DATA SOURCES PubMed, EMBASE, CINAHL, Medline, Scopus, Web of Science, and Cochrane were searched up to July 1, 2020. METHODS We included studies evaluating the sensitivity and specificity of grief disorders diagnostic tools against the comparator tests in individuals who experienced the loss of a family member. A diagnostic meta-analysis of pooled sensitivity and specificity, likelihood ratios, and area under curve were performed with a random-effect and hierarchical model. RESULTS In the current study, 3540 participants were involved. The six studies of the Inventory of Complicated Grief had pooled sensitivity of 0.93 (95% confidence interval: 0.87 to 0.97) and specificity of 0.96 (95% confidence interval: 0.92 to 0.98). The positive likelihood ratio was 23.4 (95% confidence interval: 11.2 to 49.0) and the negative likelihood ratio was 0.07 (95% confidence interval: 0.04 to 0.14) with area under curve value at 0.96 (95% confidence interval: 0.97 to 0.99). For Prolonged Grief Disorder-13, the three included studies' pooled sensitivity was 0.51 (95% confidence interval: 0.42 to 0.60), and the pooled specificity was 0.96 (95% confidence interval: 0.93 to 0.98). The Inventory of Complicated Grief-Revised evaluation could not be performed as only two articles from the same study were identified in this meta-analysis. CONCLUSIONS The Inventory of Complicated Grief is a highly recommend instrument to differentiate the case of grief disorders. Nurses and health care professionals can use the Inventory of Complicated Grief in the diagnosis of prolonged or complicated grief disorders due to its high sensitivity and specificity values. Further evaluations are needed for the use of Prolonged Grief Disorder-13 and Inventory of Complicated Grief-Revised. REGISTRATION The study is registered with the Open Science Framework (https://osf.io/bs8n6/?view_only=109e76e59efb4d7699153f62564f57ed). Tweetable abstract: Inventory of Complicated Grief is a highly recommend instrument with high sensitivity and specificity for diagnosing grief disorders.
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Affiliation(s)
- Christina Yeni Kustanti
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Bethesda Yakkum Health Science Institute, Yogyakarta, Indonesia
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing, University of Pennsylvania, United States
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Li-Chung Pien
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Shu-Tai H Shen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jin-Hua Chen
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan; Statistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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248
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de Feijter M, O'Connor MF, Arizmendi BJ, Ikram MA, Luik AI. The longitudinal association of actigraphy-estimated sleep with grief in middle-aged and elderly persons. J Psychiatr Res 2021; 137:66-72. [PMID: 33657460 DOI: 10.1016/j.jpsychires.2021.02.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/26/2021] [Accepted: 02/17/2021] [Indexed: 11/27/2022]
Abstract
Most people experience grief after a loss, about 10% develop complicated grief, often accompanied by sleep complaints. Yet, the role of objectively estimated poor sleep remains unclear. Therefore, we assessed the cross-sectional and longitudinal association of actigraphy-estimated sleep with grief. We included 1,776 participants (mean age: 61.8 ± 8.9 years, 55% women) of a prospective population-based cohort. Of 1,471 participants (83%) repeated measures of grief were available (median follow-up 6 years, inter quartile range 5.6-6.3). At baseline, sleep was objectively estimated using actigraphy (mean duration 6.0 ± 0.8days). At baseline and follow-up, participants were asked about significant losses and completed the Dutch Inventory of Complicated Grief (17 items, cut-off ≥22). At baseline 1,521 (86%) participants experienced no grief, 44 (2%) acute grief (<6 months, any grief score), 158 (9%) non-complicated grief (≥6 months, grief score<22), and 53 (3%) complicated grief (≥6 months, grief score≥22). In those indicating any grief (n = 255), low sleep efficiency (B = -0.16, 95%CI = -0.30;-0.02), long sleep onset latency (B = 0.07, 95%CI = 0.01; 0.14), and long wake after sleep onset (B = 0.06, 95%CI = 0.01; 0.10) were cross-sectionally associated with more grief symptoms. Over time, those with a short total sleep time (OR = 0.59, 95%CI = 0.39; 0.91), low sleep efficiency (OR = 0.95, 95%CI = 0.91; 0.99), long sleep onset latency (OR = 1.02, 95%CI = 1.00; 1.04), and long wake after sleep onset (OR = 1.02, 95%CI = 1.00; 1.03) at baseline more often experienced complicated grief than non-complicated grief at follow-up. This study suggests that objectively estimated poor sleep is associated with grief over time. Poor sleep might not only accompany grief, but also be a risk factor for developing complicated grief after a loss.
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Affiliation(s)
- Maud de Feijter
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | | | - Brian J Arizmendi
- Department of Psychology, University of Arizona, USA; Department of Psychology, Phoenix VA Health Care System, USA
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
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249
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Gravesen JD, Birkelund R. The discursive transformation of grief throughout history. Nurs Philos 2021; 22:e12351. [PMID: 33894104 DOI: 10.1111/nup.12351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/23/2021] [Accepted: 04/03/2021] [Indexed: 11/30/2022]
Abstract
In recent decades, the phenomenon of grief, when you lose a loved one, has been the subject of exploration and discussion among researchers. Because of this, prolonged grief is now recognized as a possible mental disorder as the latest version of the diagnosis manual; 'International Classification of Diseases' (ICD-11) being published in 2018 is featuring a new diagnosis called 'prolonged grief disorder'. The commencement of this new disorder indicates a shift in the way grief is being articulated why the notion of rupture from the French philosopher Michel Foucault is applied as a philosophical approach in this paper. A Foucault-inspired discourse analysis has been prepared and by considering the issue historically and tracing how the concept of grief has been articulated in different time periods throughout history, the aim is to map out the discursive transformation that has taken place and to gain insight into how the societal context has supported and enabled this transformation. This paper takes a historical look back from the 1800s to present and identifies when changes can be observed in the way grief is being articulated. These changes or ruptures are identified in the work of Søren Aabye Kierkegaard, Sigmund Freud and Margaret Stroebe & Henk Schut who all must be assumed to have contributed significantly to how grief is perceived in various historical time periods. The discourse analysis identifies how prominent thinkers have articulated grief in each period and how today's perception of grief, as a possible mental disorder, both relates to these prominent thinkers but also reflects dominant societal values and ideologies.
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Affiliation(s)
| | - Regner Birkelund
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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250
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Co-occurrence of prolonged grief symptoms and symptoms of depression, anxiety, and posttraumatic stress in bereaved adults: A systematic review and meta-analysis. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100140] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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