The pain of grief: Exploring the concept of psychological pain and its relation to complicated grief, depression, and risk for suicide in bereaved adults

Nurse assistants' experiences of encountering patients in grief due to the death of a loved one - a qualitative study in municipal health and social care

PURPOSE

The aim was to explore nurse assistants´ experiences of paying attention to and encountering patients receiving municipal health and social care, who are in grief due to the death of a loved one.

METHODS

A qualitative study with focus group interviews (n = 6) was conducted with nurse assistants (NAs) (n = 28) in municipal health and social care (n = 5) in southern Sweden. The data were analysed inductively using qualitative content analysis.

RESULTS

Three categories (1) Noticing changes in the patient, (2) Using different strategies to create a dialogue with the patient, (3) Experiencing challenges when encountering patients in grief, included eight sub-categories were identified. The result is captured in the theme of Having to be attentive to signs of grief after patients´ loss of loved ones, sensing the right time to approach and comfort, while having to cope with emotional challenges.

CONCLUSIONS

The NAs encountered expressions of strong emotions from patients in grief, and even expressions of a desire to end their lives. Additionally, the NAs had to deal with their own emotions that were evoked when meeting patients in grief. These challenges indicate the need for enhanced conditions in the work culture, and improved training and supervision in health and social care.

Pathways between grief, depression, hopelessness, reasons for living, and suicidal ideation in bereaved individuals

BACKGROUND

Associations between comorbid depression and grief with suicidal ideation (SI) have been inconsistent. To identify at-risk individuals, it is important to determine the role of symptom severity by examining both continuous and clinical-threshold grief and depression, in addition to other factors (i.e., hopelessness, reasons for living-RFL) associated with SI.

METHODS

Participants (n = 216) bereaved by combat, accident, or suicide completed an online survey. Associations between depression, grief, SI, RFL, and hopelessness were examined by multivariable logistic regressions and structural equation modeling (SEM).

RESULTS

Across the sample, hopelessness and RFL were associated with SI while continuous measures of grief and depression were not. In contrast, clinical-threshold grief, clinical-threshold depression, hopelessness, and RFL each were associated with SI. In addition, of the grief characteristics, yearning was the most robust correlate of SI, and Survival/Coping Beliefs (SCB) was the RFL most associated with SI. SEM indicated that direct paths between grief and SI, hopelessness and SI, and RFL and SI were significant, but not between depression and SI. Instead, depression had a strong direct effect on hopelessness, and hopelessness had a direct effect on SI.

DISCUSSION

Results are consistent with previously-identified associations between SI and clinical levels of depression and grief. More nuanced findings suggest hopelessness, yearning, and SCB as additional targets for reducing risk for SI in bereaved individuals regardless of whether they meet clinical thresholds for grief or depression.

Living with grief and thriving after loss: a qualitative study of Chinese parents whose only child has died

Introduction: Chinese bereaved parents over the age of 49 who have lost their only child are known as shidu parents. This study aimed to explore their symptoms of prolonged grief disorder (PGD) and post-traumatic growth (PTG).Methods: Shidu parents who experienced the loss of their only child at least six months prior and had no biological or adopted children at the time of the study were recruited. Eleven shidu parents participated in individual interviews conducted in Mandarin via WeChat video or voice calls. The interview guide was developed by the first researcher and refined through discussions with doctoral students and a professor specializing in bereavement. Reflexive thematic analysis was used to analyse the data from the semi-structured interviews.Results: The interviewees (3 men and 8 women) were aged between 53 and 72 years, and the time since their child's loss ranged from 2.25 to 24 years. Four themes of PGD symptoms were identified: Separation distress, Cognitive, emotional, and behavioural symptoms, Somatic responses and Changes in grief responses. Subtheme of 'feelings of inferiority or shame' and 'somatic responses' were prominent among this group, potentially representing culturally relevant grief reactions. They also experienced genuine PTG that helped them adapt to life without the child: changes in self-perception, changes in interpersonal relationships, and a changed philosophy of life. The subtheme of 'living for self' emerged as a potentially unique PTG among shidu parents.Conclusion: Shidu parents share some important similarities with bereaved individuals across cultures, but also exhibit some unique characteristics. Considering their persistent intense grief, regular screening for grief severity, physical issues, and suicidal ideation is essential. Culturally sensitive interventions that acknowledge and validate their sense of inferiority or shame may be beneficial. Additionally, fostering PTG may support shidu parents in coping with their loss and adapting to life.

The pain and relief of grief: Mental pain and mental pain acceptance associations with post-loss pathologies and growth among young widows and widowers

Mental pain is a core symptom of bereavement, yet its study with grief pathologies is still scarce. Mental pain acceptance may also affect the associations between mental pain, grief pathologies, and post-loss growth (PLG). The current study aims to investigate the associations between mental pain, mental pain acceptance, and post-loss outcomes in a sample of young widow(er)s. 257 young Israeli widow(er)s completed questionnaires assessing mental pain, mental pain acceptance, depression, complicated grief (CG), suicidal risk and PLG. Paths analyses revealed that depression mediated the positive associations between mental pain and suicidal risk and CG, and mental pain acceptance moderated the positive association between mental pain and depression. Mental pain acceptance also moderated the negative association between mental pain and PLG. The study's findings highlight the crucial role of mental pain and mental pain acceptance in the associations between adverse and favorable post-loss outcomes among bereaved individuals.

The resilience mediation effect on the relationship of suicide risk and psychological pain in nursing students: Structural equation modelling

WHAT IS KNOWN ON THE SUBJECT?: Suicide is an important health problem that has been common all over the world in recent years. Nursing students are a high-risk group for suicide. Factors affecting suicide risk should be investigated and included in psychiatric nursing interventions. Psychological pain is a predisposing condition for suicide risk. Studies focus on the relationship between suicide risk and psychological pain. Studies examining the moderator factors affecting this relationship are limited. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: By means of the structural equation model, the effect of resilience mediation on the relationship of suicide risk and psychological pain has been shown. In the process of going from psychological pain to suicide, resilience takes on a buffer function with its mediating effect, and this process can be prevented by the development of resilience. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Resilience can be added as a protective factor for suicide to the practices of psychiatric nursing. Initiatives to strengthen resilience can be added to psychiatric nursing practices. In this way, psychological pain and the risk of suicide can be reduced by strengthening resilience. Psychological pain can be added as a risk factor for suicide to the practices of psychiatric nursing. Within the scope of psychiatric nursing practices, nursing interventions can be structured to assess and reduce psychological pain. Interventions on strategies to manage and cope with psychological pain and initiatives to strengthen resilience can be added to suicide prevention programs created for nursing students.

ABSTRACT

INTRODUCTION: Nursing students are a high-risk group for suicide. Psychiatric nurses should investigate risk factors for suicide.

AIM

The aim of this study was to examine the resilience mediation effect in the relationship of suicide risk and psychological pain in nursing students.

MATERIALS AND METHODS

This cross-sectional study was conducted between March and May 2021 with 619 students in the Akdeniz University Faculty of Nursing. A Descriptive Information Form, the Suicide Probability Scale, the Psychache Scale and the Brief Resilience Scale were used to collect data. The structural equation model approach was used to examine the resilience mediating effect on the relation between suicide risk and psychological pain, and Path Analysis was performed. The reporting of the study was conducted according to STROBE.

RESULTS

A semi-mediatory effect of resilience was found between psychological pain and the risk of suicide, and the effect size was determined to be broad (0.57).

DISCUSSION

Resilience can be considered as a protective factor for suicide prevention in psychiatric nursing practices.

CONCLUSION

Resilience has an effect on the relationship between psychological pain and suicide risk.

IMPLICATIONS FOR PRACTICES

The results of this study may guide psychiatric nursing practices in reducing and preventing suicide risk.

The relationship between chronotype and food addiction: Serial mediation of social jetlag and psychological pain

This study evaluates how food addiction is related to chronotype, social jetlag, and psychological pain. Of the participants (n = 1,035 university students), 16.6% had a morning chronotype, 25.1% had an evening chronotype, and 25.1% were clinically addicted to eating. The mean sleep durations for participants were 7.41 ± 2.18 h and 8.95 ± 3.0 h on weekdays and weekends, respectively. The mean misalignment time for social jetlag was 1.45 ± 1.5 h. Food addiction, psychological pain, and social jetlag levels were high among participants with the evening chronotype. The risk factors for food addiction included being female, having an evening chronotype, and having high body mass index levels and psychological pain. The total indirect effect of psychological pain and social jetlag on the relationship between chronotype and food addiction was 20.6%. However, the social jetlag effect is relatively minor compared to psychological pain. The significant conclusions of this study are as follows. Clinical food addiction is prevalent among students, and a strong direct correlation between chronotype and food addiction was observed. The study emphasizes the importance of being aware of chronotype and mental status in establishing a healthy diet and lifestyle.

A Systematic Review of MRI Studies and the "Emotional paiN and social Disconnect (END)" Brain Model of Suicidal Behavior in Youth

Introduction

Risk of suicidal ideation and suicidal behaviors greatly increases during adolescence, and rates have risen dramatically over the past two decades. However, few risk factors or biomarkers predictive of suicidal ideation or attempted suicide have been identified in adolescents. Neuroimaging correlates hold potential for early identification of adolescents at increased risk of suicidality and risk stratification for those at high risk of suicide attempt.

Methods

In this systematic review, we evaluated neural regions and networks associated with suicidal ideation and suicide attempt in adolescents derived from magnetic resonance imaging (MRI) studies. A total of 28 articles were included in this review.

Results

After descriptively synthesizing the literature, we propose the Emotional paiN and social Disconnect (END) model of adolescent suicidality and present two key neural circuits: (1) the emotional/mental pain circuit and (2) the social disconnect/distortion circuit. In the END model, the emotional pain circuit-consisting of the cerebellum, amygdala, and hippocampus-shows similar aberrations in adolescents with suicidal ideation as in those with a history of a suicide attempt (but to a smaller degree). The social disconnect circuit is unique to adolescent suicide attempters and includes the lateral orbitofrontal cortex (OFC), the temporal gyri, and the connections between them.

Conclusion

Our proposed END brain model of suicidal behavior in youth, if confirmed by future prospective studies, can have implications for clinical goals of early detection, risk stratification, and intervention development. Treatments that target emotional pain and social disconnect may be ideal interventions for reducing suicidality in adolescents.

Best Practice in Telephone Bereavement Support: A Thematic Analysis of Bereavement Support Providers' Perspectives

Telephone bereavement support is recommended in bereavement care policy and practice; however, little is known about what constitutes best practice. To explore how best practice in telephone bereavement support is conceptualized by those who provide the service, 26 healthcare professionals working in Australian hospitals, hospices, and other palliative care settings were interviewed. Thematic analysis was used to construct seven themes: A Valuable Service with Limited Resources, The First Call, The Dance of Rapport, A Space to Share, Identifying and Responding to Risk, Maintaining Contact, and Training and Development Needs. Participants viewed telephone bereavement support as an effective and accessible tool in supporting individuals' processing of and adaptation to loss; however, concerns remain regarding the quality and consistency of care provided. Greater resourcing of bereavement care is required, and telephone bereavement care providers' perspectives offer a foundation to ensure the service is evidence-based, pragmatic, and supported by quality training.

Transcending the self to transcend suffering

Suffering is inevitable in human life. Our perspective paper theorizes on precise mechanisms for how self-transcendence-the state in which an individual looks beyond the self and adopts a larger perspective including concern for others and the world-may help people endure the experience of suffering. From an examination of empirical literature ranging from social psychology to clinical research, we propose that self-transcendence may aid the endurance of suffering along three psychological levels: (1) On the level of affect, the unique profundity and positivity of self-transcendent experiences (e.g., awe, flow, compassion) may supersede and reduce the salience of negative affect arising from suffering (e.g., fear, despair, depressive mood). (2) On the level of cognition, the larger frame of reference provided by self-transcendent thinking may contextualize one's suffering as something comprehendible, thereby helping to resolve the challenges of making meaning from suffering (e.g., that one's existing meaning systems are unable to explain the suffering event). (3) On the level of motivation, the drive to fulfill one's need for self-transcendence may counterbalance the more hedonically-oriented motivations that can promote negative coping strategies in response to suffering (e.g., avoidance, substance abuse). All three mechanisms may also provoke downstream prosocial behaviors that help embed the individual into networks of social support. Altogether, by synthesizing specific mechanisms from affective, cognitive, and motivational self-transcendent processes, our paper establishes a theoretical framework for how self-transcendence may help people endure and transcend suffering, thereby elevating the conditions and experiences of our existence.

Why Does Grief Hurt?

Abstract. Grief is a major physical and psychological health concern for adults, as well as a key risk factor for depression. The direct and indirect costs of depression in adults place heavy burdens on societal resources. Indeed, bereavement is a stressful and profound life experience, with the grieving process combining reactions to a loss that may originate in complications for bereaved individuals. The goal of this systematic review is to synthesize the findings regarding depression and grief. Studies related to the topic were obtained from multiple databases through rigorous exclusion and inclusion criteria. Only empirical studies with quantitative methodologies were included. Objectives, sample (type of sample, % male, and age), instruments, and main conclusions were extracted from each study. Overall, there are personality and contextual factors that, in addition to affecting depressive reactions following a loss, may also interface with one’s ability to grieve. Furthermore, after the patient’s death, there was a decrease in depressive symptoms over time, indicating that these symptoms are dynamic. Individuals who experience prolonged grief exhibit depressive symptoms, and those who suffer a loss may have depressive symptoms, but in a natural and non-pathological way, that is, sadness and not depression. Depression tends to decrease over time, with the existence of more children and a focus on occupation.

Entangled: A mixed method analysis of nurses with mental health problems who die by suicide

Nurses die by suicide at a higher rate than the general population. Previous studies have observed mental health problems, including substance use, as a prominent antecedent before death. The purpose of this study was to explore the characteristics of nurses who died by suicide documented in the death investigation narratives from the National Violent Death Reporting System from 2003 to 2017 using thematic analysis and natural language processing. One thousand three hundred and fifty-eight subjects met these inclusion criteria. Narratives from 601 subjects were thematically analyzed and 2544 individual narratives were analyzed using natural language processing. The analyses revealed five themes: "mental health treatment," "poor general health and chronic pain," "substance use," "worsening mental health after bereavement," and "repeating a family member's suicide." Mental health/substance use, chronic illness, and chronic pain were seen to coexist in a complex, interdependent manner that appeared to be entangled in the nurses' narratives before death. These findings echo the need for reducing the stigmatization of mental health problems in nursing and removing barriers to help-seeking behaviors as early preventative interventions. Future research is needed to determine if a comprehensive healthcare integration approach to address these entangled problems would reduce suicide vulnerability in nurses and improve their quality of life.

Grieving as a form of learning: Insights from neuroscience applied to grief and loss

Recent grief research suggests that the influential cognitive stress theory should be updated with evidence from cognitive neuroscience. Combining human and animal neuroscience with attachment theory, we propose that semantic knowledge of the everlasting nature of the attachment figure and episodic, autobiographical memories of the death are in conflict, perhaps explaining the duration of grieving and generating predictions about complications in prolonged grief disorder (PGD). Our gone-but-also-everlasting model emphasizes that grieving may be a form of learning, requiring time and experiential feedback. Difficulties before loss, such as spousal dependency or pre-existing hippocampal volume, can prolong learning and predict PGD. Complications such as avoidance, rumination, and stress-induced hippocampal atrophy may also develop after loss and create functional or structural mechanisms predicting PGD.

A Narrative Review of Suicide: Aiming at a More Encompassing Understanding

The suicide experience combines despair with the perception of suicide as the last option to alter its suffering effectively and actively. Shneidman’s phenomenology understands the suicidal mind in terms of psychological pain, as opposed to focusing on the individual context. This article aims to meet and review information from articles and books published in the area of the Phenomenology of Suicide, mostly between 2017 and 2021. By integrating and relating the different philosophical perspectives of the patient, his or her family, and the mental health worker, it is intended to identify emotions that are common to different groups affected by suicide, regardless of the context, experiences, and means used to commit suicide. The phenomenological description of self-determination experienced in suicide helps to improve the understanding of the suicidal mind, which can be useful in understanding questions that relate to issues such as assisted suicide and suicide prevention. The management of post-suicide consequences, especially the stigma, a cross-cutting challenge for all these groups, benefits from the specialized support of health professionals, either through psychotherapy and pharmacotherapy or support groups.

The causal systems approach to prolonged grief: Recent developments and future directions

The network theory of prolonged grief posits that causal interactions among symptoms of prolonged grief play a significant role in their coherence and persistence as a syndrome. Drawing on recent developments in the broader network approach to psychopathology, we argue that advancing our understanding of the causal system that gives rise to prolonged grief will require that we (a) strengthen our assessment of each component of the grief syndrome, (b) investigate intra-individual relationships among grief components as they evolve over time within individuals, (c) incorporate biological and social components into network studies of grief, and (d) generate formal theories that posit precisely how these biological, psychological, and social components interact with one another to give rise to prolonged grief disorder.

Prolonged Grief Disorder: Course, Diagnosis, Assessment, and Treatment

Losing a loved one is one of life's greatest stressors. Although most bereaved individuals navigate through a period of intense acute grief that lessens with time, approximately 10% will develop a prolonged grief condition. This review provides an overview of the course of grief and describes risk factors for developing prolonged grief disorder. The evolution of the prolonged grief disorder diagnosis, including the latest criteria sets for ICD-11 and DSM-5, as well as common comorbid conditions and differential diagnosis are discussed. Clinically useful self-report and clinician-rated measures for assessing symptom constructs and overall prolonged grief disorder severity, evidence-based psychotherapies (such as complicated grief treatment), as well as evidence about pharmacologic approaches are presented. Finally, the authors discuss important future directions, including a potential increase in prolonged grief disorder cases due to the COVID-19 pandemic.

Different semantic and affective meaning of the words associated to physical and social pain in cancer patients on early palliative/supportive care and in healthy, pain-free individuals

Early palliative/supportive care (ePSC) is a medical intervention focused on patient's needs, that integrates standard oncological treatment, shortly after a diagnosis of advanced/metastatic cancer. ePSC improves the appropriate management of cancer pain. Understanding the semantic and emotional impact of the words used by patients to describe their pain may further improve its assessment in the ePSC setting. Psycholinguistics assumes that the semantic and affective properties of words affect the ease by which they are processed and comprehended. Therefore, in this cross-sectional survey study we collected normative data about the semantic and affective properties of words associated to physical and social pain, in order to investigate how patients with cancer pain on ePSC process them compared to healthy, pain-free individuals. One hundred ninety patients and 124 matched controls rated the Familiarity, Valence, Arousal, Pain-relatedness, Intensity, and Unpleasantness of 94 words expressing physical and social pain. Descriptive and inferential statistics were performed on ratings in order to unveil patients' semantic and affective representation of pain and compare it with those from controls. Possible effects of variables associated to the illness experience were also tested. Both groups perceived the words conveying social pain as more negative and pain-related than those expressing physical pain, confirming previous evidence of social pain described as worse than physical pain. Patients rated pain words as less negative, less pain-related, and conveying a lower intense and unpleasant pain than controls, suggesting either an adaptation to the pain experience or the role played by ePSC in improving patients' ability to cope with it. This exploratory study suggests that a chronic pain experience as the one experienced by cancer patients on ePSC affects the semantic and affective representation of pain words.

Traumatic grief research and care in the aftermath of the COVID-19 pandemic

BACKGROUND

A significant increase in the number of individuals suffering from prolonged grief disorder is expected in the aftermath of the COVID-19 pandemic for two main reasons. First, the number of excess deaths has contributed to an immense number of bereaved individuals. Second, recent literature has shown that circumstances associated with COVID-19 deaths may be contributing to increased risk for the development of prolonged grief disorder.

OBJECTIVE

To best support those affected by loss during the COVID-19 pandemic, it is important to inform clinicians and researchers about the development, the nature and the treatment of prolonged grief disorder and employ sound research.

METHOD

In this editorial, we discuss important themes regarding prolonged grief disorder in the aftermath of the COVID-19 pandemic, to gather and present useful information for clinicians and researchers.

RESULTS

The following themes were addressed: 1. Harmonization in the diagnosis of prolonged grief disorder. 2. Screening tools and interventions. 3. Pharmacotherapy. 4. Special attention for the elderly. 5. Special attention for children and adolescents. 6. A causal system perspective for understanding grief and prolonged grief disorder.

CONCLUSIONS

If those involved in bereavement research and care manage to collaborate, the tragic consequences of COVID-19 might catalyse improvement of care for those most impaired following the loss of a loved one.