401
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Comtesse H, Rosner R. Prolonged grief disorder among asylum seekers in Germany: the influence of losses and residence status. Eur J Psychotraumatol 2019; 10:1591330. [PMID: 30988893 PMCID: PMC6450486 DOI: 10.1080/20008198.2019.1591330] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 02/07/2023] Open
Abstract
Background: Besides the high exposure to traumatic events, many refugees to Europe experienced tremendous interpersonal losses. Objective: The aim of this study was to investigate the rate and potential risk factors of prolonged grief disorder (PGD) in recently fled asylum seekers who lived in collective accommodations in Germany. Method: Three groups of asylum seekers from different countries (N = 99) completed the Traumatic Grief Inventory Self-Report Version (TGI-SR), Posttraumatic Stress Disorder Checklist-5 (PCL-5), and Patient Health Questionnaire depression module (PHQ-9). Individuals in Group 1 were waiting for asylum decisions (n = 29), Group 2 members were in appeal against rejected asylum claims (n = 32), and Group 3 members had been permitted temporary residence status (n = 38). Results: The loss of a loved person was reported by 92% of participants. The criteria for provisional PGD diagnosis according to Prigerson criteria were met by 20% of participants, 16% fulfilled the criteria for DSM-5 persistent complex bereavement disorder. Probable posttraumatic stress disorder (45%) and depression (42%) rates were high. The total number of lost nuclear family members and PTSD symptoms were associated with higher and temporary residence status was predicted lower PGD symptom levels. Conclusions: These results show that a substantial proportion of asylum seekers suffer from PGD. This points to the need to screen for problematic grief in the current refugee population in Europe.
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Affiliation(s)
- Hannah Comtesse
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, D-Eichstaett, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, D-Eichstaett, Germany
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402
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Hvidtjørn D, Prinds C, Bliddal M, Henriksen TB, Cacciatore J, O'Connor M. Life after the loss: protocol for a Danish longitudinal follow-up study unfolding life and grief after the death of a child during pregnancy from gestational week 14, during birth or in the first 4 weeks of life. BMJ Open 2018; 8:e024278. [PMID: 30580272 PMCID: PMC6318761 DOI: 10.1136/bmjopen-2018-024278] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION After the death of a child during pregnancy, birth or in the neonatal period, parents often experience feelings of guilt, disenfranchisement, feelings of betrayal by one's own body and envy of others. Such bereavement results in high rates of distress: psychologically, emotionally, physiologically and existentially. These data are collected using a national, longitudinal cohort to assess grief in mothers and their partners after the death of a child during pregnancy, birth or in the neonatal period. Our aim is to achieve a general description of grief, emotional health, and existential values after pregnancy or perinatal death in a Danish population. METHODS AND ANALYSIS The cohort comprises mothers and their partners in Denmark who lost a child during pregnancy from gestational week 14, during birth or in the neonatal period (4 weeks post partum). We began data collection in 2015 and plan to continue until 2024. The aim is to include 5000 participants by 2024, generating the largest cohort in the field to date. Parents are invited to participate at the time of hospital discharge or via the Patient Associations homepage. Data are collected using web-based questionnaires distributed at 1-2, 7 and 13 months after the loss. Sociodemographic and obstetric variables are collected. Validated psychometric measures covering attachment, continuing bonds, post-traumatic stress, prolonged grief, perinatal grief and existential values were chosen to reach our aim. ETHICS AND DISSEMINATION The study was approved by The Danish National Data Protection Agency (no. 18/15684, 7 October 2014). The results will be disseminated in peer-reviewed and professional journals as well as in layman magazines, lectures and radio broadcasts.
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Affiliation(s)
- Dorte Hvidtjørn
- University of Southern Denmark and Odense University Hospital, Research Unit for Gynecology and Obstetrics, Institute of Clinical Research, Odense, Denmark
- Unit for Perinatal Loss, Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Christina Prinds
- University of Southern Denmark and Odense University Hospital, Research Unit for Gynecology and Obstetrics, Institute of Clinical Research, Odense, Denmark
- Midwifery College, University College South Denmark, Esbjerg, Denmark
| | - Mette Bliddal
- OPEN Odense Patient Data Explorative Network, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Tine Brink Henriksen
- Perinatal Epidemiology Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Joanne Cacciatore
- School of Social Work, Arizona State University, Tempe, Arizona, USA
| | - Maja O'Connor
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
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403
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Trajectories of prolonged grief one to six years after a natural disaster. PLoS One 2018; 13:e0209757. [PMID: 30576369 PMCID: PMC6303052 DOI: 10.1371/journal.pone.0209757] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 12/12/2018] [Indexed: 11/29/2022] Open
Abstract
Background The long-term trajectories of prolonged grief are poorly understood. The aims were to examine the course of grief among bereaved disaster survivors up to six years post loss and factors predicting worse bereavement outcome. A third aim was to explore differences in grief indicators between trajectories. Methods Bereaved Swedish tourists who survived the 2004 Indian Ocean tsunamis responded to surveys including the Inventory of Complicated Grief 1 to 6 years after the disaster. Latent growth mixture modeling was used to identify longitudinal trajectories of grief. Multinomial logistic regression analysis was used to examine predictors of class membership. Results Three trajectories were identified: resilient (41% of the sample), recovering (48%), and chronic (11%). The strongest predictor of chronic grief was the loss of one’s child. When examining grief indicators, the chronic trajectory was characterized by not accepting the loss, while yearning was common in all trajectories. Conclusions This study highlights the importance of considering how traumatically bereaved individuals can be affected by loss for several years after a disaster, especially after losing one’s child. An inability to accept the loss, more so than yearning, appears to characterize bereaved survivors at risk of a chronic trajectory of grief.
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404
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Bussolari C, Habarth JM, Phillips S, Katz R, Packman W. Self-Compassion, Social Constraints, and Psychosocial Outcomes in a Pet Bereavement Sample. OMEGA-JOURNAL OF DEATH AND DYING 2018; 82:389-408. [PMID: 30514184 DOI: 10.1177/0030222818814050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated self-compassion in the context of grief following the death of a companion animal in a recently bereaved sample (N = 431). We addressed social contexts and individual differences focusing on how psychosocial outcomes vary as a function of social constraints, as well as individual differences in self-compassion and use of continuing bonds (CB). We observed that self-compassion related to the frequency of engagement in CB. Self-compassion also moderated relationships between grief severity and depression as well as social constraints and depression. We recommend future research on self-compassion training and psychosocial outcomes, especially for those experiencing social constraints or disenfranchised grief.
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Affiliation(s)
- Cori Bussolari
- Department of Counseling Psychology, University of San Francisco, CA, USA
| | | | | | | | - Wendy Packman
- Psychology Department, Palo Alto University, CA, USA
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405
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Kokou-Kpolou K, Megalakaki O, Nieuviarts N. Persistent depressive and grief symptoms for up to 10 years following perinatal loss: Involvement of negative cognitions. J Affect Disord 2018; 241:360-366. [PMID: 30144719 DOI: 10.1016/j.jad.2018.08.063] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/08/2018] [Accepted: 08/12/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Perinatal loss is known to be associated with a heightened risk of mental health complications. However, the psychological mechanisms underlying the perinatal grief process are less well documented. We hypothesized that negative cognitions are associated with post-perinatal loss symptomatology, and vary according to whether the death occurs before or after birth. METHODS We adopted a cross-sectional design to assess demographics, variables related to the death, five types of negative cognitions (about the self, world, life, future, and self-blame), prolonged grief, and depressive symptoms. The sample included 98 perinatally bereaved mothers with a mean age of 33.9 years. RESULTS When we controlled for demographics and variables related to the death, hierarchical linear regression showed that maladaptive cognitions about life, the future and the world were associated with prolonged grief symptoms, whereas only maladaptive cognitions about the world were associated with depressive symptoms. Significant interaction effects confirmed that cognitions about the world were associated with increased depressive symptoms when the death occurred after the birth, and cognitions about life when it occurred before the birth. LIMITATIONS The cross-sectional design precluded causal conclusions. However, the sample size was relatively representative and limited to perinatally bereaved mothers. CONCLUSIONS Different negative cognitions are involved in persistent depressive versus grief symptoms following perinatal loss, and vary depending on the type of loss. These results will serve to enhance perinatal grief interventions.
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Affiliation(s)
| | - Olga Megalakaki
- Department of Psychology, Picardy Jules Verne University, Amiens, France
| | - Nicolas Nieuviarts
- Department of Psychology, Picardy Jules Verne University, Amiens, France
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406
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Abstract
A relevant proportion of deaths by suicide have been attributed to other causes that produce the number of suicides remains hidden. The existence of a hidden number of cases is explained by the nature of the problem. Problems like this involve violence, and produce fear and social shame in victims' families. The existence of violence, fear and social shame experienced by victims favours a considerable number of suicides, identified as accidents or natural deaths. This paper proposes a short time discrete compartmental mathematical model to measure the suicidal risk for the case of Spain. The compartment model classifies and quantifies the amount of the Spanish population within the age intervals (16, 78) by their degree of suicide risk and their changes over time. Intercompartmental transits are due to the combination of quantitative and qualitative factors. Results are computed and simulations are performed to analyze the sensitivity of the model under uncertain coefficients.
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407
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Abstract
Major depression is a common illness that severely limits psychosocial functioning and diminishes quality of life. In 2008, WHO ranked major depression as the third cause of burden of disease worldwide and projected that the disease will rank first by 2030.1 In practice, its detection, diagnosis, and management often pose challenges for clinicians because of its various presentations, unpredictable course and prognosis, and variable response to treatment.
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Affiliation(s)
- Gin S Malhi
- Department of Academic Psychiatry, Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia; CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - J John Mann
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University, New York, NY, USA
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408
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Quero S, Molés M, Campos D, Andreu‐Mateu S, Baños RM, Botella C. An adaptive virtual reality system for the treatment of adjustment disorder and complicated grief: 1‐year follow‐up efficacy data. Clin Psychol Psychother 2018; 26:204-217. [DOI: 10.1002/cpp.2342] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/08/2018] [Accepted: 10/08/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Soledad Quero
- Departamento de Psicología Básica, Clínica y PsicobiologíaUniversitat Jaume I Castellón Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERON)Instituto Salud Carlos III Madrid Spain
| | - Mar Molés
- Departamento de Psicología Básica, Clínica y PsicobiologíaUniversitat Jaume I Castellón Spain
| | - Daniel Campos
- Departamento de Psicología Básica, Clínica y PsicobiologíaUniversitat Jaume I Castellón Spain
| | - Sabrina Andreu‐Mateu
- Departamento de Psicología Básica, Clínica y PsicobiologíaUniversitat Jaume I Castellón Spain
| | - Rosa M. Baños
- Departamento de Personalidad, Evaluación y Tratamientos PsicológicosUniversidad de Valencia Valencia Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERON)Instituto Salud Carlos III Madrid Spain
| | - Cristina Botella
- Departamento de Psicología Básica, Clínica y PsicobiologíaUniversitat Jaume I Castellón Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERON)Instituto Salud Carlos III Madrid Spain
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409
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Camacho D, Pérez-Nieto MÁ, Gordillo F. Cause of Death and Guilt in Bereavement: The Role of Emotional Regulation and Kinship. JOURNAL OF LOSS & TRAUMA 2018. [DOI: 10.1080/15325024.2018.1485277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Dulce Camacho
- Director of Alaia Association, Clinical Psychologist, Madrid, Spain
| | | | - Fernando Gordillo
- Department of Psychology, Camilo José Cela University, Madrid, Spain
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410
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Rosner R, Pfoh G, Kotoučova M, Comtesse H. Integrative kognitive Verhaltenstherapie für die anhaltende Trauerstörung: Vorstellung eines Behandlungsmanuals. VERHALTENSTHERAPIE 2018. [DOI: 10.1159/000489509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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411
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Boelen PA, Lenferink LIM, Nickerson A, Smid GE. Evaluation of the factor structure, prevalence, and validity of disturbed grief in DSM-5 and ICD-11. J Affect Disord 2018; 240:79-87. [PMID: 30059938 DOI: 10.1016/j.jad.2018.07.041] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/01/2018] [Accepted: 07/14/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Persistent complex bereavement disorder (PCBD) is a disorder of grief included in DSM-5 Section 3. Prolonged Grief Disorder (PGD) is a disorder of grief that will enter the forthcoming ICD-11. This study evaluated the factor structure, prevalence, and validity of disturbed grief as per DSM-5 and ICD-11. METHODS With data from a community sample (N =512), we used confirmatory factor analysis (CFA) to evaluate the fit of different factor models for PCBD and PGD, determined diagnostic rates for probable PCBD and PGD, and used sensitivity/specificity analyses to evaluate the performance of individual items as indicators of PCBD and PGD. We calculated associations of PCBD-caseness and PGD-caseness with concurrently assessed symptoms of posttraumatic stress disorder (PTSD) and depression and, in a subset of 280 participants, with these same symptoms assessed one year later, to examine concurrent and predictive validity of PCBD and PGD. RESULTS For PCBD-symptoms, a three-factor model with distinct factors of separation distress, reactive distress, and social/identity disruption fit the data well; for PGD-symptoms a two-factor model with distinct separation distress symptoms and additional symptom (e.g., guilt, anger, blame) yielded acceptable model fit. Overall, items evidenced strong sensitivity and negative predictive power, and relatively poor specificity and positive predictive power. The prevalence of probable DSM-5 PCBD (6.4%) was significantly lower than the prevalence of ICD-11 PGD (18.0%). Both PCBD and PGD were significantly associated with concurrent overall grief, depression, and PTSD; PCBD but not PGD was associated with symptoms one year beyond baseline. LIMITATIONS Limitations include our reliance on self-reported data and symptoms of PCBD and PGD being derived from two questionnaires. CONCLUSIONS Findings provide preliminary evidence for the validity of both the PCBD and PGD constructs, albeit that prevalence rates of both constructs and predictive validity differ-which needs further scrutiny.
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Affiliation(s)
- Paul A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, The Netherlands; Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE, Diemen, The Netherlands.
| | - Lonneke I M Lenferink
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, The Netherlands; Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | | | - Geert E Smid
- Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE, Diemen, The Netherlands; Foundation Centrum '45, Nienoord 5, 1112 XE, Diemen, The Netherlands
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412
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Reardon DC. The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. SAGE Open Med 2018; 6:2050312118807624. [PMID: 30397472 PMCID: PMC6207970 DOI: 10.1177/2050312118807624] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/26/2018] [Indexed: 12/26/2022] Open
Abstract
The abortion and mental health controversy is driven by two different perspectives regarding how best to interpret accepted facts. When interpreting the data, abortion and mental health proponents are inclined to emphasize risks associated with abortion, whereas abortion and mental health minimalists emphasize pre-existing risk factors as the primary explanation for the correlations with more negative outcomes. Still, both sides agree that (a) abortion is consistently associated with elevated rates of mental illness compared to women without a history of abortion; (b) the abortion experience directly contributes to mental health problems for at least some women; (c) there are risk factors, such as pre-existing mental illness, that identify women at greatest risk of mental health problems after an abortion; and (d) it is impossible to conduct research in this field in a manner that can definitively identify the extent to which any mental illnesses following abortion can be reliably attributed to abortion in and of itself. The areas of disagreement, which are more nuanced, are addressed at length. Obstacles in the way of research and further consensus include (a) multiple pathways for abortion and mental health risks, (b) concurrent positive and negative reactions, (c) indeterminate time frames and degrees of reactions, (d) poorly defined terms, (e) multiple factors of causation, and (f) inherent preconceptions based on ideology and disproportionate exposure to different types of women. Recommendations for collaboration include (a) mixed research teams, (b) co-design of national longitudinal prospective studies accessible to any researcher, (c) better adherence to data sharing and re-analysis standards, and (d) attention to a broader list of research questions.
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413
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Killikelly C, Bauer S, Maercker A. The Assessment of Grief in Refugees and Post-conflict Survivors: A Narrative Review of Etic and Emic Research. Front Psychol 2018; 9:1957. [PMID: 30405474 PMCID: PMC6204364 DOI: 10.3389/fpsyg.2018.01957] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/21/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Prolonged grief disorder (PGD) is a new mental health disorder that will be recognized by the World Health Organization’s disorder classification, the ICD-11, in 2018. Current assessment measures of PGD are largely based on North American and European conceptualizations of grief (etic i.e., from the perspective of the observer). However, research is emerging from communities outside of the Global North, in particular, conflict-exposed communities, exploring local models (emic i.e., from within the cultural group), assessment measures and symptoms of grief. Several reviews have found that refugees have higher rates of mental illness, defined by etic standards as depression, post-traumatic stress disorder (PTSD), anxiety disorders and psychotic symptoms. Yet, presently there are no reviews documenting the assessment of PGD in refugees and post conflict survivors. Method: This narrative review will provide an overview of studies that assess grief in refugees to (1) identify current assessment measures of grief in refugees (i.e., type and frequency of questionnaires used, whether Global North-based, etic, or locally developed, emic, and the level of cultural adaptation) and (2) to document the variety and rate of grief symptoms identified with Global North standard measures and/or local measures (i.e., the endorsement of standard symptom items and the identification of culturally specific symptoms of grief). Results: This review revealed 24 studies that assessed disordered grief in refugee or post conflict samples. Studies were heterogeneous in their assessment methods; the majority (n = 17) used an etic approach, four used a combined etic/emic approach, and three used a predominantly emic approach. The rate of disordered grief was high depending on cultural adaptation approach (31–76%) and when standard etic measures were used the disordered grief rate was 32%. Conclusion: These findings will help to guide future studies to provide accurate assessment of grief in refugee and post conflict populations and has implications for improving cultural knowledge in clinical practice.
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Affiliation(s)
- Clare Killikelly
- Division Psychopathology and Clinical Intervention, Department of Psychology, University of Zürich, Zürich, Switzerland
| | - Susanna Bauer
- Division Psychopathology and Clinical Intervention, Department of Psychology, University of Zürich, Zürich, Switzerland
| | - Andreas Maercker
- Division Psychopathology and Clinical Intervention, Department of Psychology, University of Zürich, Zürich, Switzerland
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414
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Grass L, de Figueiredo J. Advances in the Understanding of Demoralization in Oncology and Palliative Care. PSYCHO-ONCOLOGIE 2018. [DOI: 10.3166/pson-2018-0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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415
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Malgaroli M, Maccallum F, Bonanno GA. Symptoms of persistent complex bereavement disorder, depression, and PTSD in a conjugally bereaved sample: a network analysis. Psychol Med 2018; 48:2439-2448. [PMID: 30017007 DOI: 10.1017/s0033291718001769] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Complicated and persistent grief reactions afflict approximately 10% of bereaved individuals and are associated with severe disruptions of functioning. These maladaptive patterns were defined in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as persistent complex bereavement disorder (PCBD), but its criteria remain debated. The condition has been studied using network analysis, showing potential for an improved understanding of PCBD. However, previous studies were limited to self-report and primarily originated from a single archival dataset. To overcome these limitations, we collected structured clinical interview data from a community sample of newly conjugally bereaved individuals (N = 305). METHODS Gaussian graphical models (GGM) were estimated from PCBD symptoms diagnosed at 3, 14, and 25 months after the loss. A directed acyclic graph (DAG) was generated from initial PCBD symptoms, and comorbidity networks with DSM-5 symptoms of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) were analyzed 1 year post-loss. RESULTS In the GGM, symptoms from the social/identity PCBD symptoms cluster (i.e. role confusion, meaninglessness, and loneliness) tended to be central in the network at all assessments. In the DAG, yearning activated a cascade of PCBD symptoms, suggesting how symptoms lead into psychopathological configurations. In the comorbidity networks, PCBD and depressive symptoms formed separate communities, while PTSD symptoms divided in heterogeneous clusters. CONCLUSIONS The network approach offered insights regarding the core symptoms of PCBD and the role of persistent yearnings. Findings are discussed regarding both clinical and theoretical implications that will serve as a step toward a more integrated understanding of PCBD.
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416
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Prolonged grief and attachment security: A latent class analysis. Psychiatry Res 2018; 268:297-302. [PMID: 30081202 DOI: 10.1016/j.psychres.2018.07.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/05/2018] [Accepted: 07/26/2018] [Indexed: 01/05/2023]
Abstract
The death of a loved one has been associated with a wide range of mental health outcomes. Attachment theory is one of the primary paradigms for understanding bereavement outcome, yet there is comparatively little examination of the relationship between attachment style and bereavement responses. In this study we use Latent Class Analysis to identify subgroups of bereaved individuals based on patterns of prolonged grief (PG) and major depression symptom co-occurrence in 285 bereaved individuals. We then explored the relationship between these subgroups and attachment anxiety and avoidance. Three new subgroups of individuals were identified: one showing high levels of PGD and depression (PGD/depression), one showing high depression (Depression), and one showing few symptoms (Low). Attachment anxiety significantly differentiated between the three groups; the highest levels of attachment anxiety predicted membership of the PGD/depression group, the lowest levels, membership of the Low group. Attachment avoidance was predictive of greater depressive symptoms, with higher levels of attachment avoidance differentiating the two symptom groups (PGD/depression and depression) from the Low symptom group. These findings underscore the relevance of insecure attachment style to the current understanding of PGD.
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417
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Hardt M, Jobe-Shields L, Williams JL. Emotional security theory: An application to sibling bereavement. DEATH STUDIES 2018; 43:656-664. [PMID: 30207877 DOI: 10.1080/07481187.2018.1511637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 06/12/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
There is a need for guiding theory to understand the experiences and outcomes of bereaved siblings, particularly from a family systems framework. The present study investigated the relevance of emotional security theory in a sample of 72 young adults who experienced sibling bereavement. We investigated (1) whether perceptions of prolonged parental grief predicted key aspects of emotional security (disengagement, preoccupation, and security), and (2) whether emotional security mediated a relation between perceptions of prolonged parental grief and young adult emotional functioning. Results supported the potential utility of emotional security theory as a theoretical framework for understanding sibling bereavement.
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Affiliation(s)
- Madeleine Hardt
- Department of Psychology, University of Richmond , Richmond , VA , USA
- Department of Psychology, University of Missouri , Kansas City , MO , USA
| | - Lisa Jobe-Shields
- Department of Psychology, University of Richmond , Richmond , VA , USA
| | - Joah L Williams
- Department of Psychology, University of Missouri , Kansas City , MO , USA
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418
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Hoffmann R, Kaiser J, Kersting A. Psychosocial outcomes in cancer-bereaved children and adolescents: A systematic review. Psychooncology 2018; 27:2327-2338. [PMID: 30120901 DOI: 10.1002/pon.4863] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Due to the unique importance of parental and sibling relationships and concurrently existing developmental challenges, the loss of a parent or sibling due to cancer is a highly stressful event for children and adolescents. This is the first systematic review that integrates findings on psychosocial outcomes after parental or sibling cancer bereavement. METHODS A systematic search of Web of Science, PubMed, PsycINFO, and PubPsych was conducted, last in December 2017. Quantitative studies on psychosocial outcomes of children and adolescents who lost a parent or sibling due to cancer were included. RESULTS Twenty-four studies (N = 10 parental and N = 14 sibling bereavement), based on 13 projects, were included. Ten projects had cross-sectional designs. Only 2 projects used large, population-based samples and nonbereaved comparison groups. Outcomes were partially measured by single-item questions. Bereaved children and adolescents showed similar levels of depression and anxiety compared with nonbereaved or norms. Severe behavioral problems were found rarely. However, in 2 large, population-based studies, about half of the bereaved individuals reported unresolved grief. Bereaved adolescents had a higher risk for self-injury compared with the general population in one large, population-based study. Communication with health-care professionals, family, and other people; social support; distress during illness; age; gender; and time because loss were associated with psychosocial bereavement outcomes. CONCLUSIONS Results indicate a high level of adjustment in cancer-bereaved children and adolescents. A modifiable risk factor for adverse psychosocial consequences is poor communication. Prospective designs, representative samples, and validated instruments, eg, for prolonged grief, are suggested for future research.
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Affiliation(s)
- Rahel Hoffmann
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Julia Kaiser
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
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419
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Nakajima S. Complicated grief: recent developments in diagnostic criteria and treatment. Philos Trans R Soc Lond B Biol Sci 2018; 373:20170273. [PMID: 30012739 PMCID: PMC6053994 DOI: 10.1098/rstb.2017.0273] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/12/2022] Open
Abstract
Although grief is a natural response to loss among human beings, some people have a severe and prolonged course of grief. In the 1990s, unusual grief persisting with a high level of acute symptoms became known as 'complicated grief (CG)'. Many studies have shown that people who suffer from CG are at risk of long-term mental and physical health impairments and suicidal behaviours; it is considered a pathological state, which requires clinical intervention and treatment. DSM-5 (2013 Diagnostic and statistical manual of mental disorders, 5th edn) proposed 'persistent complex bereavement disorder' as a psychiatric disorder; it is similar to CG in that it is a trauma- and stress-related disorder. In recent years, there has been considerable research on the treatment of CG. Randomized controlled trials have suggested the efficacy of cognitive behavioural therapy including an exposure component that is targeted for CG. However, experts disagree about the terminology and diagnostic criteria for CG. The ICD-11 (International classification of diseases, 11th revision) beta draft proposed prolonged grief disorder as a condition that differs from persistent complex bereavement disorder with respect to terminology and the duration of symptoms. This divergence has arisen from insufficient evidence for a set of core symptoms and the biological basis of CG. Future studies including biological studies are needed to reach consensus about the diagnostic criteria for CG.This article is part of the theme issue 'Evolutionary thanatology: impacts of the dead on the living in humans and other animals'.
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Affiliation(s)
- Satomi Nakajima
- Department of Human Sciences, Musashino University, 3-3-3 Ariake, Koto-ku, Tokyo 135-8181, Japan
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420
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Narrative Identity and Grief Reactions: A Prospective Study of Bereaved Partners. JOURNAL OF APPLIED RESEARCH IN MEMORY AND COGNITION 2018. [DOI: 10.1016/j.jarmac.2018.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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421
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Welch RJ, Rao R, Gordon PS, Say EAT, Shields CL. Optical Coherence Tomography of Small Retinoblastoma. Asia Pac J Ophthalmol (Phila) 2018; 7:301-306. [PMID: 29984562 DOI: 10.22608/apo.2018189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To investigate hand-held optical coherence tomography (HH-OCT) characteristics of small (<1 mm thickness) retinoblastoma. DESIGN Retrospective observational case series. METHODS Patient and tumor data were extracted from the medical record and analyzed along with HH-OCT scans. Determination of tumor layer of origin was performed using a layer-by-layer analysis of HH-OCT data and specific HH-OCT-related features were described. RESULTS There were 20 sub-millimeter retinoblastomas from 16 eyes of 15 patients. Mean largest tumor basal diameter by HH-OCT was 2.2 mm (median, 1.9; range, 0.7-4.1 mm), and mean tumor thickness was 468 μm (median, 441; range, 151-998 μm). In all cases, the retinoblastoma caused discontinuity or disruption of the inner nuclear (INL), outer plexiform (OPL), outer nuclear (ONL), and external limiting membrane (ELM) layers (20/20, 100%). Tumor origin was in the INL in 19/20 (95%) and equivocal (INL vs ONL) in 1/20 (5%). Intratumoral microcalcification was present in 14/20 tumors (70%). There were 2 characteristic findings (signs) on HH-OCT including the INL "fish tail" sign with splaying of the INL at the tumor margin (19/20, 95%) and the ONL "shark fin" sign with folding of the ONL and OPL, conforming to the lateral tumor margins (15/20, 75%). Both signs were concurrently present in 15 tumors (15/20, 75%). CONCLUSIONS HH-OCT demonstrated that sub-millimeter retinoblastoma seems to originate from the INL, with tumor base and thickness growth progressing in a linear relationship. Characteristic HH-OCT findings included intratumoral microcalcification, INL "fish tail" sign, and ONL "shark fin" sign.
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Affiliation(s)
- R Joel Welch
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Raksha Rao
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Phillip S Gordon
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Emil Anthony T Say
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
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422
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Pohlkamp L, Kreicbergs U, Prigerson HG, Sveen J. Psychometric properties of the Prolonged Grief Disorder-13 (PG-13) in bereaved Swedish parents. Psychiatry Res 2018; 267:560-565. [PMID: 29982112 DOI: 10.1016/j.psychres.2018.06.004] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 11/18/2022]
Abstract
This study aimed to validate the Swedish version of the Prolonged Grief Disorder-13 tool (PG-13) by examining its psychometric properties, including factor structure, discriminant and concurrent validity. The PG-13 was assessed in a sample of Swedish parents who had lost a child to cancer 1-5 years previously. The sample included 225 parents (133 mothers and 92 fathers) with a mean age of 46.02 years (SD = 8.15) and 16.0% met the criteria for Prolonged Grief Disorder (PGD). A principal component analysis was performed, and the results supported a one-factor structure of the PG-13. The PG-13 was shown to have high internal consistency and intelligible associations with concurrent psychological symptoms and grief rumination as well as with known risk factors for PGD. These results indicate satisfactory psychometric properties of the instrument, thus supporting the use of the PG-13 as a valid measure of PGD.
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Affiliation(s)
- Lilian Pohlkamp
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Holly G Prigerson
- Center for Research on End of Life Care, Weill Cornell Medicine, New York, NY, United States
| | - Josefin Sveen
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden; Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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423
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Treml J, Kersting A. [Prolonged grief disorder]. DER NERVENARZT 2018; 89:1069-1078. [PMID: 30116835 DOI: 10.1007/s00115-018-0577-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Grief is a natural response to the loss of a loved one and its intensity usually lessens over time. Approximately 10% of bereaved persons, however, experience persistent symptoms resulting in the development of a prolonged grief disorder (PGD). A PGD shows a distinct symptom cluster and is considered for inclusion as a diagnosis in the upcoming revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11). It is distinct from other mental disorders but symptoms overlap, especially with major depression and posttraumatic stress disorder. In addition to diagnostic criteria and differential diagnosis, the following article also describes prevalence rates, comorbidities, risk factors as well as treatment options for PGD.
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Affiliation(s)
- J Treml
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland.
| | - A Kersting
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland
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424
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Milman E, Neimeyer RA, Fitzpatrick M, MacKinnon CJ, Muis KR, Cohen SR. Prolonged grief symptomatology following violent loss: the mediating role of meaning. Eur J Psychotraumatol 2018; 8:1503522. [PMID: 30128081 PMCID: PMC6095024 DOI: 10.1080/20008198.2018.1503522] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 06/02/2018] [Accepted: 07/01/2018] [Indexed: 01/19/2023] Open
Abstract
Background: Prolonged Grief Disorder (PGD) is over-represented among those who have lost loved ones to violent causes. To tailor PGD interventions for this vulnerable population it is critical to examine the aetiology of PGD specifically in the context of violent death bereavement. Previous studies have suggested that violent loss increases symptoms of PGD by hindering the mourner's ability to make meaning of the death or its aftermath. However, these studies have relied on cross sectional data that preclude genuine prediction and have not differentiated among specific themes of meaning. Objective: This study aimed to identify specific themes of meaning that mediate the detrimental impact of violent loss on subsequent emergence of PGD symptomatology among the violently bereft. Method: A longitudinal, prospective design (N = 171) was used to assess violent loss and themes of meaning an average of six months post-loss allowing for prediction of PGD symptoms an average of eight months later. Results: Violent loss had a significant indirect effect on PGD symptomatology when meaning themes focusing on sense of peace and continuing bonds served as mediators. Conclusions: This study demonstrates the mediating role that specific meaning themes play in the development of PGD symptomatology following violent loss. These findings highlight the potential benefits of applying a meaning-based intervention approach with the violently bereft.
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Affiliation(s)
- Evgenia Milman
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | | | - Marilyn Fitzpatrick
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | | | - Krista R. Muis
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - S. Robin Cohen
- Departments of Oncology and Medicine, McGill University, Palliative Care Research, Jewish General Hospital, Montreal, QC, Canada
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425
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Boelen PA, Djelantik AAAMJ, de Keijser J, Lenferink LIM, Smid GE. Further validation of the Traumatic Grief Inventory-Self Report (TGI-SR): A measure of persistent complex bereavement disorder and prolonged grief disorder. DEATH STUDIES 2018; 43:351-364. [PMID: 30015568 DOI: 10.1080/07481187.2018.1480546] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/15/2018] [Accepted: 04/13/2018] [Indexed: 06/08/2023]
Abstract
The Traumatic Grief Inventory Self-Report version (TGI-SR) is an 18-item self-report measure. It was designed to assess symptoms of Persistent Complex Bereavement Disorder (PCBD) included in Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 and Prolonged Grief Disorder (PGD) proposed by an international group of experts in grief. The research in this article used data from a bereaved patient sample and people who lost loved ones in the Ukrainian airplane crash in July 2014. Findings indicated that the TGI-SR is a reliable and valid tool to assess disturbed grief in research and to identify people needing a more comprehensive assessment of their grief in clinical settings.
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Affiliation(s)
- Paul A Boelen
- a Department of Clinical Psychology, Faculty of Social Sciences , Utrecht University , Utrecht , The Netherlands
- b Arq Psychotrauma Expert Group , Diemen , The Netherlands
| | - A A A Manik J Djelantik
- a Department of Clinical Psychology, Faculty of Social Sciences , Utrecht University , Utrecht , The Netherlands
- b Arq Psychotrauma Expert Group , Diemen , The Netherlands
| | - Jos de Keijser
- c Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences , University of Groningen , Groningen , The Netherlands
| | - Lonneke I M Lenferink
- a Department of Clinical Psychology, Faculty of Social Sciences , Utrecht University , Utrecht , The Netherlands
- c Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences , University of Groningen , Groningen , The Netherlands
| | - Geert E Smid
- b Arq Psychotrauma Expert Group , Diemen , The Netherlands
- d Foundation Centrum 45 Diemen , The Netherlands
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426
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Gamino LA, Sewell KW, Prosser-Dodds L, Hogan NS. Intuitive and Instrumental Grief: A Study of the Reliability and Validity of the Grief Pattern Inventory. OMEGA-JOURNAL OF DEATH AND DYING 2018; 81:532-550. [PMID: 29983097 DOI: 10.1177/0030222818786403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A convenience sample of 209 participants completed the Grief Pattern Inventory (GPI) together with the Hogan Grief Reaction Checklist (HGRC), the Integration of Stressful Life Events Scale (ISLES), and the Myers-Briggs Type Indicator (MBTI). Alpha coefficients of the GPI's intuitive and instrumental subscales were improved by eliminating low-performing items and empirically reassigning items from the GPI dissonant subscale. The two modified scales showed a near zero intercorrelation indicating they were independent constructs in this sample, a conclusion further verified by factor analysis. Both styles correlated with distress measures from the HGRC and correlated negatively with adaptation indicators from the ISLES, though the findings were stronger for intuitive grievers. MBTI findings revealed that intuitive grievers endorsed significantly more "feeling" in how processing occurs while grievers who preferred sensing/thinking functions more often identified with the instrumental grief pattern. Implications of these findings for scholars and clinicians are discussed.
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Affiliation(s)
- Louis A Gamino
- Baylor Scott & White Health, Temple, TX, USA.,Texas A&M University College of Medicine, Temple, TX, USA
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427
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Killikelly C, Maercker A. Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability. Eur J Psychotraumatol 2018; 8:1476441. [PMID: 29887976 PMCID: PMC5990943 DOI: 10.1080/20008198.2018.1476441] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 05/02/2018] [Indexed: 12/19/2022] Open
Abstract
A new mental health disorder, prolonged grief disorder (PGD), will be included in the 11th edition of the International Classification of Diseases (ICD-11). We provide a brief overview of the historical conceptualizations of disordered grief and the previous research efforts to assess and define this condition. We describe the new ICD-11 PGD symptom criteria and how they are conceptualized in terms of the World Health Organization's call for improved clinical utility. Finally, we review the research evidence for the clinical utility of the new ICD-11 PGD symptom structure and usability in the international arena.
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Affiliation(s)
- Clare Killikelly
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zürich, Zürich, Switzerland
| | - Andreas Maercker
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zürich, Zürich, Switzerland
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428
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Goldstein RD, Lederman RI, Lichtenthal WG, Morris SE, Human M, Elliott AJ, Tobacco D, Angal J, Odendaal H, Kinney HC, Prigerson HG. The Grief of Mothers After the Sudden Unexpected Death of Their Infants. Pediatrics 2018; 141:peds.2017-3651. [PMID: 29712764 PMCID: PMC6173829 DOI: 10.1542/peds.2017-3651] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 02/04/2023] Open
Abstract
UNLABELLED : media-1vid110.1542/5741323271001PEDS-VA_2017-3651Video Abstract BACKGROUND: The loss of a child is associated with elevated grief severity, and sudden infant death syndrome (SIDS) is the leading cause of postneonatal mortality in the United States. The diagnosis of prolonged grief disorder (PGD) has gained broader acceptance and use. Little is known about PGD in mothers after SIDS. METHODS Between May 2013 and July 2016, we assessed 49 SIDS-bereaved mothers living in informal settlements near Cape Town, South Africa, and on the Pine Ridge Indian Reservation and 359 SIDS-bereaved mothers affiliated with SIDS parent-support organizations in the United States, United Kingdom, Australia, New Zealand, and the Netherlands. We examined PGD symptom severity and diagnostic prevalence rates between the samples and other significant grief indicators during the period 2 to 48 months after the deaths of their infants. RESULTS Extremely high, persistent, and similar rates of PGD were found in both samples at every time interval. The prevalence of PGD was 50.0% in either sample (mean months from loss: 20.5 vs 24.9). Daily, intrusive emotional pain or yearning was found in 68.1% of subjects; yearning was significantly associated with emotional pain (P < .0001). Role confusion and anger were the most prevalent symptoms, reported by the majority at every time interval. Rates of role confusion, anger, and diminished trust in others remained constant. Acceptance was less prevalent than other grief indicators at every interval. CONCLUSIONS Severe symptoms and heightened risk for PGD was seen in mothers after their infants died of SIDS, with discernible symptom profiles. Given their involvement with families after SIDS, pediatricians may have a unique role in identifying this problem and helping address its consequences.
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Affiliation(s)
| | | | - Wendy G. Lichtenthal
- Department of Psychiatry and Behavioral Sciences,
Memorial Sloan Kettering Cancer Center,,Department of Psychiatry, and
| | - Sue E. Morris
- Department of Psychosocial Oncology and Palliative
Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Melanie Human
- Department of Obstetrics and Gynaecology, Faculty of
Medicine and Health Science, Stellenbosch University, Cape Town, South Africa;
and
| | - Amy J. Elliott
- Department of Pediatrics, Sanford School of Medicine,
University of South Dakota, Sioux Falls, South Dakota
| | - Deb Tobacco
- Department of Pediatrics, Sanford School of Medicine,
University of South Dakota, Sioux Falls, South Dakota
| | - Jyoti Angal
- Department of Pediatrics, Sanford School of Medicine,
University of South Dakota, Sioux Falls, South Dakota
| | - Hein Odendaal
- Department of Obstetrics and Gynaecology, Faculty of
Medicine and Health Science, Stellenbosch University, Cape Town, South Africa;
and
| | - Hannah C. Kinney
- Pathology, Boston Children’s Hospital and
Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Holly G. Prigerson
- Center for Research on End-of-Life Care, Weill
Cornell Medicine, Cornell University, New York, New York
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429
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Rosner R, Rimane E, Vogel A, Rau J, Hagl M. Treating prolonged grief disorder with prolonged grief-specific cognitive behavioral therapy: study protocol for a randomized controlled trial. Trials 2018; 19:241. [PMID: 29678193 PMCID: PMC5910599 DOI: 10.1186/s13063-018-2618-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/28/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Prolonged grief disorder (PGD) has emerged as a well-defined and relatively common mental disorder that will be included in the upcoming revision of the International Classification of Diseases. Recent trials with grief-specific, mostly cognitive behavioral interventions for patients with a clinically relevant diagnosis of PGD showed large effect sizes. However, a small trial suggested that non-specific behavioral activation might suffice to improve PGD. So, more evidence for the relative efficacy of grief-specific treatments is needed, as is more research on the predictors of treatment success. The purpose of the proposed trial is to evaluate a newly developed and successfully pilot-tested, prolonged grief-specific, integrative cognitive behavioral therapy (PG-CBT) compared to an active yet unspecific treatment, present-centered therapy (PCT). METHODS In a multicenter, randomized controlled trial with 204 adults with a primary diagnosis of PGD, PG-CBT is compared to PCT, assuming the superiority of PG-CBT. Both treatments consist of 20 to 24 individual sessions, with an overall treatment length of about 6 months. The primary outcome, grief symptom severity, is assessed by blinded interviewers 12 months after randomization. Secondary outcomes are grief symptom severity at post treatment, in addition to self-reported overall mental health symptoms, depressive and somatoform symptoms at post treatment and 12 months post randomization. Possible moderators and mediators of treatment success are also explored. DISCUSSION The trial is designed to avoid bias as much as possible (stratified randomization performed independently, blinded outcome assessment, intention-to-treat-analysis, balanced treatment dose, continuous supervision, control for allegiance effects) thereby enhancing internal validity. At the same time, some aspects of the trial will ensure clinical relevance (recruiting at outpatient clinics that are part of routine health care and keeping exclusion criteria to a minimum). Since the trial is powered adequately for the primary outcome, all secondary analyses including moderator analyses are exploratory by nature. The results will extend the knowledge on efficacious treatment of PGD and its predictors. TRIAL REGISTRATION German Clinical Trials Register, ID: DRKS00012317 . Registered on 6 September 2017.
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Affiliation(s)
- Rita Rosner
- 0000 0001 1245 5350grid.440923.8Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 26, 85071 Eichstätt, Germany
| | - Eline Rimane
- 0000 0001 1245 5350grid.440923.8Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 26, 85071 Eichstätt, Germany
| | - Anna Vogel
- 0000 0001 1245 5350grid.440923.8Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 26, 85071 Eichstätt, Germany
| | - Jörn Rau
- 0000 0004 1936 9756grid.10253.35Coordinating Center for Clinical Trials of the Philipps University of Marburg, Karl-von-Frisch-Straße 4, D-35043 Marburg, Germany
| | - Maria Hagl
- 0000 0001 1245 5350grid.440923.8Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 26, 85071 Eichstätt, Germany
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430
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Yi X, Gao J, Wu C, Bai D, Li Y, Tang N, Liu X. Prevalence and risk factors of prolonged grief disorder among bereaved survivors seven years after the Wenchuan earthquake in China: A cross-sectional study. Int J Nurs Sci 2018; 5:157-161. [PMID: 31406818 PMCID: PMC6626251 DOI: 10.1016/j.ijnss.2018.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 03/12/2018] [Accepted: 04/02/2018] [Indexed: 11/25/2022] Open
Abstract
Background This study aimed to determine the prevalence and predictive factors of prolonged grief disorder (PGD) among those bereaved by the Wenchuan earthquake in Southwestern China seven years after the event. Methods A cross-sectional survey based on census tracts was conducted on the bereaved earthquake survivors. Responses to the questionnaire regarding PGD and its potential associated factors were obtained either through face-to-face or telephone interview. PGD was screened by a validated Chinese version of the PGD questionnaire-13 (PG-13). Bivariate and multivariate regression analyses were used to determine the prevalence and associated risk factors of PGD. Results A total of 1464 bereaved earthquake survivors, with a response rate of 97.6%, were included in the study. Of the 1464 respondents studied, 124 (8.47%) were diagnosed with PGD. Multivariate regression analysis demonstrated that PGD in the bereaved earthquake individuals was significantly associated with several factors, including age, economic burden, close kinship with the deceased, and living with the deceased before the loss. Wenchuan earthquake bereaved aged 41–60 years were more likely to develop PGD compared to those aged younger than 40 or older than 60 (OR = 2.075, 95%CI = 1.297–3.319). Those who had a close kinship with the deceased had a higher tendency to develop PGD (OR = 5.144, 95%CI = 2.716–9.740). The odds of PGD among the earthquake bereaved with economic burdens were higher relative to those who did not experience an economic burden (OR = 8.123, 95%CI = 2.657–24.831). Those who living with the deceased before loss also had a higher tendency to develop PGD (OR = 0.179, 95%CI = 0.053–0.602). Conclusions This study revealed that a significantly high proportion (8.47%) of the Wenchuan earthquake-bereaved remain grieving seven years after the event. Those diagnosed with PGD should receive appropriate interventions from clinical psychologists. The risk factors identified in this study are crucial for the early screening and prevention of PGD in future nursing and psycho-clinical practices.
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Affiliation(s)
- Xin Yi
- Academy of Nursing, Chengdu University of Traditional Chinese Medicine, Sichuan, China.,Academy of Medicine and Nursing, Chengdu University, Sichuan, China
| | - Jing Gao
- Academy of Nursing, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Chenxi Wu
- Academy of Nursing, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Dingxi Bai
- Academy of Nursing, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Yingchun Li
- Academy of Nursing, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Ni Tang
- Academy of Nursing, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Xiaoyun Liu
- Academy of Nursing, Chengdu University of Traditional Chinese Medicine, Sichuan, China
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431
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432
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Eisma MC. Public stigma of prolonged grief disorder: An experimental study. Psychiatry Res 2018; 261:173-177. [PMID: 29309956 DOI: 10.1016/j.psychres.2017.12.064] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/27/2017] [Accepted: 12/30/2017] [Indexed: 12/25/2022]
Abstract
Prolonged grief disorder (PGD), characterized by severe, persistent and disabling grief, is being considered for inclusion in the International Classification of Diseases' 11 (ICD-11) and a related disorder, Persistent Complex Bereavement Disorder (PCBD), is included for further investigation in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). Establishing diagnoses for pathological grief may lead to stigmatization. Additionally, it has been argued that people experiencing severe grief responses after loss of non-family members (i.e., disenfranchised grief) may experience more stigmatizing reactions. Yet, no research to date has investigated this. To fill this gap in knowledge, 379 adults from the general population were randomly allocated to read one of 4 different vignettes of a person with and without a grief disorder diagnosis who had lost a friend or a spouse. After reading the vignettes, we assessed: 1) characteristics ascribed to the person, 2) emotional reactions to the person, and 3) desire for social distance. Notably, people with a diagnosis were attributed relatively more negative characteristics, and elicited more anger, anxiety and pro-social emotions and a stronger desire for social distance. Stigmatization and its negative consequences appear a valid concern to the establishment of pathological grief disorders in diagnostic manuals.
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Affiliation(s)
- Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.
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433
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Hoffmann R, Große J, Nagl M, Niederwieser D, Mehnert A, Kersting A. Internet-based grief therapy for bereaved individuals after loss due to Haematological cancer: study protocol of a randomized controlled trial. BMC Psychiatry 2018; 18:52. [PMID: 29482525 PMCID: PMC5827988 DOI: 10.1186/s12888-018-1633-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/12/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Approximately 10% of the individuals experiencing the death of a loved one develop prolonged grief disorder (PGD) after bereavement. Family members of haematological cancer patients might be particularly burdened since their loss experience is preceded by a very strenuous time of disease and aggressive treatment. However, support needs of relatives of cancer patients often remain unmet, also after the death of the patient. Therapeutic possibilities are enhanced by providing easily available and accessible Internet-based therapies. This study will adapt and evaluate an Internet-based grief therapy for bereaved individuals after the loss of a significant other due to haematological cancer. METHODS The efficacy of the Internet-based grief therapy is evaluated in a randomized controlled trial with a wait-list control group. Inclusion criteria are bereavement due to hematological cancer and meeting the diagnostic criteria for PGD. Exclusion criteria are severe depression, suicidality, dissociative tendency, psychosis, posttraumatic stress disorder, substance use disorder, and current psychotherapeutic or psychopharmacological treatment. The main outcome is PGD severity. Secondary outcomes are depression, anxiety, somatization, posttraumatic stress, quality of life, sleep quality, and posttraumatic growth. Data is collected pre- and posttreatment. Follow-up assessments will be conducted 3, 6, and 12 months after completion of the intervention. The Internet-based grief therapy is assumed to have at least moderate effects regarding PGD and other bereavement-related mental health outcomes. Predictors and moderators of the treatment outcome and PGD will be determined. DISCUSSION Individuals bereaved due to haematological cancer are at high risk for psychological distress. Tailored treatment for this particularly burdened target group is missing. Our study results will contribute to a closing of this healthcare gap. TRIAL REGISTRATION German Clinical Trial Register UTN: U1111-1186-6255 . Registered 1 December 2016.
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Affiliation(s)
- Rahel Hoffmann
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Julia Große
- 0000 0001 2230 9752grid.9647.cDepartment of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Michaela Nagl
- 0000 0001 2230 9752grid.9647.cDepartment of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Dietger Niederwieser
- 0000 0001 2230 9752grid.9647.cDivision of Haematology and Medical Oncology, University of Leipzig, Johannisallee 32A, 04103 Leipzig, Germany
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, University Medical Centre Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| | - Anette Kersting
- 0000 0001 2230 9752grid.9647.cDepartment of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
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434
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Doering BK, Barke A, Friehs T, Eisma MC. Assessment of grief-related rumination: validation of the German version of the Utrecht Grief Rumination Scale (UGRS). BMC Psychiatry 2018; 18:43. [PMID: 29426323 PMCID: PMC5807860 DOI: 10.1186/s12888-018-1630-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 02/01/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Bereavement can result in severe mental health problems, including persistent, severe and disabling grief symptoms, termed complicated grief. Grief rumination (i.e., repetitive thought about the causes and consequences of the loss) is a malleable cognitive risk-factor in adjustment to bereavement. The Utrecht Grief Rumination Scale (UGRS) was recently developed to assess grief rumination. The present study aimed to develop and validate a German version of the UGRS. METHODS An online survey including measures of demographic and loss-related variables, grief rumination (UGRS), depressive rumination (brooding and reflection), and symptoms of depression, anxiety, and complicated grief, was administered online among 159 persons (87% women) who had lost a first-degree relative in the past three years. UGRS item analyses, a confirmatory factor analysis and associations of grief rumination with brooding, reflection and symptom levels were performed. RESULTS The internal consistency of the UGRS was good. The confirmatory factor analysis obtained a good fit for a model with five correlated grief rumination subscales. The UGRS contributed uniquely to the prediction of complicated grief symptoms even when controlling for symptoms of anxiety and depression, brooding, reflection, and demographic and loss-related variables. Discriminant validity of the UGRS was demonstrated by the fact that higher UGRS scores were found in participants with a higher likelihood of receiving a diagnosis of complicated grief (d > 1.60). CONCLUSION The translated UGRS showed very good psychometric properties and the correlations with maladaptive ruminative styles and complicated grief symptoms demonstrated the clinical relevance of grief rumination. Limitations concerning generalisability of the results are discussed.
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Affiliation(s)
- Bettina K. Doering
- Clinical Psychology & Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Antonia Barke
- Clinical Psychology & Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Thilo Friehs
- Clinical Psychology & Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Maarten C. Eisma
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
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435
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Exploration of the Associations Between Responses to Affective States and Psychopathology in Two Samples of People Confronted With the Loss of a Loved One. J Nerv Ment Dis 2018; 206:108-115. [PMID: 29293167 DOI: 10.1097/nmd.0000000000000781] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Adaptive regulation of positive and negative affect after the loss of a loved one may foster recovery. In two studies, using similar methods but different samples, we explored the association between positive (i.e., dampening and enhancing) and negative (i.e., rumination) affect regulation strategies and symptoms levels of postloss psychopathology. Study 1 used data from 187 people confronted with the death of a loved one. In study 2, the sample consisted of 134 relatives of long-term missing persons. Participants completed self-reports tapping prolonged grief, depression, posttraumatic stress symptoms, and affect regulation strategies. Hierarchical regression analyses showed that both negative and positive affect regulation strategies explained significant amounts of variance symptom levels in both samples. In line with previous work, our results suggest that negative and positive affect regulation strategies relate to postloss psychopathology. Future research should explore how both affect regulation strategies may adequately be addressed in treatment.
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436
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Eckholdt L, Watson L, O'Connor M. Prolonged grief reactions after old age spousal loss and centrality of the loss in post loss identity. J Affect Disord 2018; 227:338-344. [PMID: 29136603 DOI: 10.1016/j.jad.2017.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/20/2017] [Accepted: 11/04/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND The loss of a spouse is a major life event. Previous research found that centrality of the loss to one's identity using Centrality of Event Scale (CES) is related to complicated bereavement reactions, such as depression, posttraumatic stress symptoms (PTS), and prolonged grief symptoms (PGS). This study aims to examine loss-centrality in elderly bereaved people up to 4 years post loss, to determine the relation of loss-centrality to complicated bereavement reactions, such as PGS, depression, and PTS, and to identify early predictors of loss-centrality. METHOD Self-reported data were collected from 208 elderly bereaved people (mean age 72 years, 63.9% women), who completed measures of psychological distress (PTS, depression, PGS) as well as intra- and interpersonal factors (coping-style, crisis support, satisfaction with life, and NEO-PI-R) at 2, 6, and 48 months post spousal loss. CES was measured 48 months post spousal loss. RESULTS In line with previous findings (Boelen, 2012a), loss-centrality 4 years following the loss was significantly related to depression, PTS, and PGS. Additionally, early PGS and gender predicted later loss-centrality. LIMITATIONS Self-repport data was used rather than clinical interviews. CES was only measured 48 months post loss. PGS was first measured 6 months post. CONCLUSIONS The results support the link between loss-centrality and post loss psychopathology in a population particularly vulnerable to complicated bereavement reactions. The close link between prolonged grief and CES may be relevant in developing treatments for PGS, especially considering the potential relationship between high CES, high PGS, and possibly lack of acceptance of the loss.
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Affiliation(s)
- Lena Eckholdt
- Department of Psychology, Aarhus University, Denmark
| | - Lynn Watson
- Department of Psychology, Aarhus University, Denmark
| | - Maja O'Connor
- Department of Psychology, Aarhus University, Denmark.
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437
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Tsai WI, Kuo SC, Wen FH, Prigerson HG, Tang ST. Prolonged grief disorder and depression are distinct for caregivers across their first bereavement year. Psychooncology 2018; 27:1027-1034. [DOI: 10.1002/pon.4629] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Wei-I Tsai
- Graduate Institute of Clinical Medical Sciences; Chang Gung University; Tao-Yuan Taiwan
| | - Su-Ching Kuo
- Graduate Institute of Clinical Medical Sciences; Chang Gung University; Tao-Yuan Taiwan
- Department of Nursing; Yuanpei University of Medical Technology; Hsinchu Taiwan
| | - Fur-Hsing Wen
- Department of International Business; Soochow University; Taipei Taiwan
| | | | - Siew Tzuh Tang
- School of Nursing; Chang Gung University; Tao-Yuan Taiwan
- Department of Nursing; Chang Gung Memorial Hospital at Kaohsiung; Kaohsiung Taiwan
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
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438
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Djelantik AAAMJ, Smid GE, Kleber RJ, Boelen PA. Early indicators of problematic grief trajectories following bereavement. Eur J Psychotraumatol 2018; 8:1423825. [PMID: 29372008 PMCID: PMC5774421 DOI: 10.1080/20008198.2018.1423825] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/17/2017] [Indexed: 01/02/2023] Open
Abstract
Background: Little is known about the development of Prolonged Grief Disorder (PGD) symptoms over time in adults. For clinical purposes, it would be useful to have knowledge about early indicators of a problematic grief trajectory. Objective: This study aimed to identify classes of bereaved individuals with similar trajectories of PGD symptoms and to design a provisional screening tool including symptoms predicting membership of classes with problematic grief trajectories. Method: In a Dutch sample of 166 bereaved individuals, we conducted a latent class analysis to identify classes of bereaved individuals with similar trajectories of PGD symptoms between two time points (mean of 6 and 18 months post-loss, respectively). Next, we used Receiver Operating Characteristic (ROC) analyses to examine which symptoms at baseline best predicted membership of classes with problematic grief trajectories. Results: We found four different classes: a class including individuals with persistent high PGD symptoms (class 1, 6%), a class of individuals with persistent moderate PGD symptoms (class 2, 35%), a class of individuals with slightly decreasing moderate PGD symptoms (class 3, 33%) and a class of individuals with persistent low PGD symptoms (class 4, 26%). The endorsement of symptoms 'yearning', 'stunned', 'life is empty' and 'bitterness' as present 'often' during the preceding month at baseline best-predicted membership of class 1 or 2. Conclusions: Two classes of individuals with problematic grief trajectories were identified. Four symptoms were found which could act as early indicators of these two classes in a provisional screening tool.
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Affiliation(s)
- A. A. A. Manik J. Djelantik
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
- Foundation Centrum ’45, Diemen, The Netherlands
| | - Geert E. Smid
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
- Foundation Centrum ’45, Diemen, The Netherlands
| | - Rolf J. Kleber
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Paul A. Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
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439
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Do prolonged grief disorder symptoms predict post-traumatic stress disorder symptoms following bereavement? A cross-lagged analysis. Compr Psychiatry 2018; 80:65-71. [PMID: 29055233 DOI: 10.1016/j.comppsych.2017.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/21/2017] [Accepted: 09/05/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bereavement can precipitate different forms of psychopathology, including prolonged grief disorder (PGD) and posttraumatic stress disorder (PTSD) symptoms. How these symptoms influence each other is unclear. The aim of this study was to examine the temporal relationship of symptoms of PGD and PTSD following bereavement. METHODS We included 204 individuals, confronted with the loss of a loved one within the past year, who completed self-report measures of PGD and PTSD and again completed these measures one year later. We conducted a cross-lagged analysis to explore cross-lagged and autoregressive relationships. RESULTS A significant cross-lagged relationship was found between PGD symptoms at time point 1 (T1) and PTSD symptoms at time point 2 (T2) (β=0.270, p<0.001). Furthermore, PGD symptoms at T1 predicted PGD symptoms at T2 and PTSD symptoms at predicted PTSD symptoms at T2 (β=0.617 and β=0.458, ps<0.001, respectively). In addition, PGD and PTSD symptoms were significantly correlated on both time points. CONCLUSIONS We found that PGD symptoms predict PTSD symptoms after a loss. Potentially, this could help to design new strategies and interventions for bereaved individuals. Additionally, PGD symptom levels predicted PGD symptom levels one year later, independently of the PTSD levels. This finding adds to the accumulating evidence that PGD is a distinct disorder.
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440
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Eisma MC, Lenferink LIM. Response to: Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability. Eur J Psychotraumatol 2018; 9:1512249. [PMID: 30220983 PMCID: PMC6136388 DOI: 10.1080/20008198.2018.1512249] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/20/2018] [Accepted: 08/08/2018] [Indexed: 12/05/2022] Open
Affiliation(s)
- Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Lonneke I M Lenferink
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.,Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
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441
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Zhou N, Yu W, Huang H, Shi G, Luo H, Song C, Xing Y, Wang J, Killikelly C. Latent profiles of physical and psychological outcomes of bereaved parents in China who lost their only child. Eur J Psychotraumatol 2018; 9:1544026. [PMID: 30479701 PMCID: PMC6249556 DOI: 10.1080/20008198.2018.1544026] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 10/22/2018] [Accepted: 10/26/2018] [Indexed: 11/25/2022] Open
Abstract
Background: Along with the implementation of the one-child policy in China, a special group of bereaved parents called 'shiduer' (), meaning parents bereaved by the loss of their only child, emerged. Although previous research has examined the physical and psychological health of this population, individual differences in physical and psychological outcomes are still not well understood. Objective: This study aimed to identify heterogenous subgroups of Chinese bereaved parents who lost their only child based on the physical and psychological health of this population as well as the predictive factors of each subgroup. Method: Latent profile analysis was used to explore underlying patterns of physical and psychological indicators including subjective physical health, negative psychological outcomes (i.e. depression, post-traumatic stress disorder and prolonged grief disorder) and positive psychological outcomes (i.e. post-traumatic growth) among a sample of Chinese bereaved parents who lost their only child (N = 536). A three-step approach was used to examine the effects of covariates including quality of spousal relationship and recruitment channels on psychological and physical outcomes. Results: A three-profile model identified severity-based groupings of a 'resilient' subgroup (n = 153), a 'coping' subgroup (n = 338) and a 'dysfunctional' subgroup (n = 45). Less satisfaction with spousal relationship and recruitment from institutions in the community and online self-help groups (vs. offline support groups) are associated with the membership of the 'coping' or 'dysfunctional' subgroup compared to the 'resilient' subgroup. Conclusions: There is heterogeneity regarding the physical and psychological health of Chinese parents after losing their only child. The predictive effects of the quality of spousal relationship and the recruitment channels could provide directions for professional intervention.
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Affiliation(s)
- Ningning Zhou
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
| | - Wei Yu
- School of Children's Development & Education, China Women's University, Beijing, P. R. China
| | - Hui Huang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
| | - Guangyuan Shi
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
| | - Haoxian Luo
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
| | - Chao Song
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
| | - Yilun Xing
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
| | - Jianping Wang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China.,Department of Clinical Psychology, Capital Medical University, Beijing, P. R. China
| | - Clare Killikelly
- Division of Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland
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442
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Lenferink LIM, Piersma E, de Keijser J, Smid GE, Boelen PA. Cognitive therapy and eye movement desensitization and reprocessing for reducing psychopathology among disaster-bereaved individuals: study protocol for a randomized controlled trial. Eur J Psychotraumatol 2017; 8:1388710. [PMID: 29163863 PMCID: PMC5687800 DOI: 10.1080/20008198.2017.1388710] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/21/2017] [Indexed: 01/05/2023] Open
Abstract
Background: Confrontation with a traumatic (e.g. disaster-related) loss is a risk factor for the development of psychopathology, including symptoms of prolonged grief (PG), posttraumatic stress (PTS), and depression. Although interventions have been developed for reducing post-loss psychopathology, more research into the effectiveness of treatment is needed to improve care for bereaved persons. Cognitive therapy (CT) and eye movement desensitization and reprocessing (EMDR) have been shown to be effective in trauma-exposed populations. We hypothesize that CT and EMDR are also effective in reducing symptoms among people exposed to traumatic loss. Objective: In this article we describe the rationale of a randomized controlled trial (RCT) to examine (1) treatment effects of CT and EMDR for reducing PG, PTS, and depression among traumatically bereaved people, and (2) the associations between improvements in PG, PTS, and depression symptoms on the one hand and tentative mechanisms of change, including a sense of unrealness, negative cognitions, avoidance behaviour, and intrusive memories, on the other hand. Method: A two-armed (intervention versus waiting list controls) RCT will be conducted. Participants will be asked to fill in questionnaires prior to treatment, during treatment, and one, 12, and 24 weeks post-treatment. Potential participants are people who have lost one or multiple significant other(s) in the Ukrainian plane disaster in 2014 with clinically significant levels of self-rated PG, PTS, and/or depression. Multiple regression, including analysis of covariance, and multilevel regression analyses will be used. Discussion: There is a need for treatment for psychopathology following traumatic loss. Strengths of this study are the development of a treatment that targets grief and trauma-related complaints and the examination of potential mechanisms of change in CT and EMDR. Bereaved people, clinicians, and researchers could benefit from the results of this study.
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Affiliation(s)
- Lonneke I. M. Lenferink
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Eline Piersma
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Jos de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | | | - Paul A. Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
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443
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Yu M, Tang S, Wang C, Xiang Z, Yu W, Xu W, Wang J, Prigerson HG. Avoidance of Bereavement-Related Stimuli in Chinese Individuals Experiencing Prolonged Grief: Evidence from a Dot-Probe Task. Front Psychol 2017; 8:1201. [PMID: 28769844 PMCID: PMC5511967 DOI: 10.3389/fpsyg.2017.01201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/30/2017] [Indexed: 12/30/2022] Open
Abstract
Background: Attentional bias refers to a preference for (e.g., vigilance) or a shifting away (e.g., avoidance) of one’s focus with respect to specific stimuli. Accumulating evidence suggests that an attentional bias toward death/threat-related stimuli exists in bereaved individuals experiencing prolonged grief (PG). Measuring for different processing may reflect different cognitive characteristics. Therefore, this study sought to compare information-processing biases in Chinese individuals with high versus low levels of PG symptomatology at supraliminal and subliminal levels, respectively. Method: A 2 (grief level) × 2 (consciousness level) × 2 (word type) three-factor mixed design with supraliminal and subliminal tasks was utilized in the current study. Based on their Prolonged Grief Questionnaire-13 (PG-13) scores, 38 participants were included in the low-PG group, and 34 individuals were included in the high-PG group. All the participants completed a dot-probe task in which they were primed with death-related and life-related words paired with neutral stimuli. Results: High-PG individuals were slower in reacting to the death-related information in both supraliminal and subliminal tasks. After controlling for other symptoms in the backward deletion regression, PG-13 scores significantly predicted the avoidance tendency to death-related words in the supraliminal task, while anxiety was the best predictor of turning one’s vision away from death-related stimuli in the subliminal trials. Conclusion: The results suggested that high PG is associated with a tendency to avoid death-related words. Future research is needed to explore interventions that address the avoidance of death-related stimuli among individuals with elevated, or diagnosable, levels of PG.
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Affiliation(s)
- Meng Yu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal UniversityBeijing, China
| | - Suqin Tang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal UniversityBeijing, China.,Department of Social Work and Social Administration, The University of Hong KongHong Kong, China
| | - Chenyi Wang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal UniversityBeijing, China
| | - Zhendong Xiang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal UniversityBeijing, China
| | - Wei Yu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal UniversityBeijing, China
| | - Wei Xu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal UniversityBeijing, China
| | - Jianping Wang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal UniversityBeijing, China.,Department of Clinical Psychology, Capital Medical UniversityBeijing, China
| | - Holly G Prigerson
- Center for Research on End-of-Life Care, Weill Cornell Medicine College, New YorkNY, United States
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444
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González D, Carvalho M, Cantillo J, Aixalá M, Farré M. Potential Use of Ayahuasca in Grief Therapy. OMEGA-JOURNAL OF DEATH AND DYING 2017; 79:260-285. [DOI: 10.1177/0030222817710879] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The death of a loved one is ultimately a universal experience. However, conventional interventions employed for people suffering with uncomplicated grief have gathered little empirical support. The present study aimed to explore the potential effects of ayahuasca on grief. We compared 30 people who had taken ayahuasca with 30 people who had attended peer-support groups, measuring level of grief and experiential avoidance. We also examined themes in participant responses to an open-ended question regarding their experiences with ayahuasca. The ayahuasca group presented a lower level of grief in the Present Feelings Scale of Texas Revised Inventory of Grief, showing benefits in some psychological and interpersonal dimensions. Qualitative responses described experiences of emotional release, biographical memories, and experiences of contact with the deceased. Additionally, some benefits were identified regarding the ayahuasca experiences. These results provide preliminary data about the potential of ayahuasca as a therapeutic tool in treatments for grief.
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Affiliation(s)
- Débora González
- ICEERS—International Center for Ethnobotanical Education Research & Service, Roosendaal, The Netherlands
| | - María Carvalho
- ICEERS—International Center for Ethnobotanical Education Research & Service, Roosendaal, The Netherlands
- Centro de Estudos em Desenvolvimento Humano (CEDH), Faculdade de Educação e Psicologia, Universidade Católica Portuguesa, Rua Diogo Botelho, Portugal
| | - Jordi Cantillo
- ICEERS—International Center for Ethnobotanical Education Research & Service, Roosendaal, The Netherlands
| | - Marc Aixalá
- ICEERS—International Center for Ethnobotanical Education Research & Service, Roosendaal, The Netherlands
| | - Magí Farré
- Autonomous University of Barcelona, Barcelona, Spain
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol (IGTP), Badalona, Spain
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445
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Lenferink LIM, Eisma MC, de Keijser J, Boelen PA. Grief rumination mediates the association between self-compassion and psychopathology in relatives of missing persons. Eur J Psychotraumatol 2017; 8:1378052. [PMID: 29163871 PMCID: PMC5687807 DOI: 10.1080/20008198.2017.1378052] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/22/2017] [Indexed: 12/15/2022] Open
Abstract
Background: The disappearance of a loved one is a unique type of loss, also termed 'ambiguous loss', which may heighten the risk for developing prolonged grief (PG), depression, and posttraumatic stress (PTS) symptoms. Little is known about protective and risk factors for psychopathology among relatives of missing persons. A potential protective factor is self-compassion, referring to openness toward and acceptance of one's own pain, failures, and inadequacies. One could reason that self-compassion is associated with lower levels of emotional distress following ambiguous loss, because it might serve as a buffer for getting entangled in ruminative thinking about the causes and consequences of the disappearance ('grief rumination'). Objective: In a sample of relatives of missing persons we aimed to examine (1) the prediction that greater self-compassion is related to lower symptom-levels of PG, depression, and PTS and (2) to what extent these associations are mediated by grief rumination. Method: Dutch and Belgian relatives of long-term missing persons (N = 137) completed self-report measures tapping self-compassion, grief rumination, PG, depression, and PTS. Mediation analyses were conducted. Results: Self-compassion was significantly, negatively, and moderately associated with PG, depression, and PTS levels. Grief rumination significantly mediated the associations of higher levels of self-compassion with lower levels of PG (a*b = -0.11), depression (a*b = -0.07), and PTS (a*b = -0.11). Specifically, 50%, 32%, and 32% of the effect of self-compassion on PG, depression, and PTS levels, respectively, was accounted for by grief rumination. Conclusions: Findings suggest that people with more self-compassion experience less severe psychopathology, in part because these people are less strongly inclined to engage in ruminative thinking related to the disappearance. Strengthening a self-compassionate attitude using, for instance, mindfulness-based interventions may therefore be a useful intervention to reduce emotional distress associated with the disappearance of a loved one.
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Affiliation(s)
- Lonneke I M Lenferink
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.,Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Jos de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
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