Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss

Emotional vs. social loneliness and prolonged grief: a random-intercept cross-lagged panel model

Background: Bereavement following death, with loneliness as a prominent feature, can result in enduring stress and compromised health.Objective: Building on Weiss's ([1973]. Loneliness: The experience of emotional and social isolation. MIT Press) proposal of two distinct types of loneliness, this study investigated within-person associations between emotional loneliness (EL) and prolonged grief symptoms (PGS) (aim 1), as well as social loneliness (SL) and PGS (aim 2) over four years following spousal loss. Additionally, we examined the impact of gender, age, and education on the main factors.Methods: We used random-intercept cross-lagged panel modelling (RI-CLPM) to analyse self-reported data from 338 Danish spousal-bereaved adults (58% female; mean age = 72.1; range 65-81 years) on EL and SL (single-item questions) and PGS (Inventory of Complicated Grief, short version) at 6, 13, 18, and 48 months post-loss.Results: We found (1) within-person associations between EL and PGS; (2) no within-person associations between SL and PGS. In our model, PGS predicted EL over time, with no reciprocal effect. In contrast, PGS and SL were unrelated. Age did not link with EL, SL, or PGS. More years of education were associated with less EL and SL, but not with PGS. Gender influenced the association between SL and PGS.Conclusions: This study enhances our understanding of longitudinal, within-person associations between EL, SL, and PGS. Consistent with Weiss's (1973) relational theory of loneliness in widowhood, results highlight the unique role of EL. While replication is needed due to limitations like single-item measures and varying intervals, these findings emphasize EL's importance in widowhood and offer a basis for better understanding and addressing PGS. Monitoring the relationship between loneliness and grief may help healthcare providers offer timely, targeted interventions.

Prospective relations between stigma, guilt, shame, posttraumatic stress and prolonged grief symptoms among overdose and suicide loss survivors

BACKGROUND

Bereavement following suicide and fatal overdose is associated with posttraumatic stress disorder (PTSD) and prolonged grief (PG). However, information about plausible explanations for these associated symptoms is scarce. Leveraging data from two assessment points, we examine the prospective roles of stigmatization, guilt, shame, and avoidant coping on PTSD and PG symptom severity and whether these relations are similar across groups.

METHODS

We analyzed data (N = 212) from suicide- and overdose-bereaved adults who completed two waves of data collection (T1 and T2; six months apart) as part of a larger study of traumatic loss. Multigroup path analysis with serial mediation was used to estimate models of PTSD and PG symptomatology. Stigmatization (T1) and guilt (T1) were modeled as predictors, while shame (T1) and avoidant coping (T2) were modeled as mediators explaining PTSD (T2) and PG symptoms (T2).

RESULTS

Prospective relations between T1 stigma, T1 guilt, T2 PTSD and T2 PG symptoms were mediated by T1 shame and serially mediated by T2 avoidant coping. Multigroup analyses indicated similar relations across suicide and overdose-bereaved adults, but a stronger effect from T2 avoidant coping on outcomes for overdose bereaved adults.

LIMITATIONS

Online self-report and use of a convenience sample are limitations.

CONCLUSION

Our results suggest shame and avoidance may help explain elevated symptoms of PTSD and PG in the context of suicide and overdose bereavement. Accordingly, transdiagnostic interventions that concurrently target shame-related cognitions and behavioral avoidance may be promising and warrant further attention.

Help-Seeking Buffers the Impact of Grief on Quality of Life: A Study of Loss During the COVID-19 Pandemic

The COVID-19 pandemic has presented a global challenge for anticipating the support and treatment needs of bereaved individuals. However, no studies have examined how mourners have been coping with grief and which strategies may buffer negative mental health consequences. We examined the various coping strategies being used and which strategies best support quality of life. Participants completed self-report measures of demographic and loss-related characteristics, grief symptoms, quality of life (QOL), and coping strategies used. Despite help-seeking being one of the least endorsed coping strategies used, help-seeking was the only coping strategy that buffered the impact of grief on QOL for individuals with high grief severity. Results support predictions that grief may become a global mental health concern requiring increased accessibility and availability of grief therapies and professional supports for bereaved individuals during and in the aftermath of the pandemic.

Prevalence and correlates of positive and negative psychological effects of bereavement due to COVID-19: A systematic review

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic was associated with an increase in mortality rates globally. Given the high numbers of deaths and the potentially traumatic characteristics of COVID-19 deaths, it was expected that grief-related distress would be higher in COVID-19 bereaved (compared to non-COVID-19 bereaved) people. This systematic review investigates the empirical evidence regarding this claim. More specifically, this review summarizes studies up to December 2024, evaluating the prevalence and correlates of positive and negative psychological effects of COVID-19 bereavement.

METHODS

Systematic searches were conducted in PsychInfo, Web of Science, and Medline by two independent reviewers. Eligible studies included quantitative research in peer-reviewed articles reporting on positive and/or negative psychological outcomes, using validated measures, in COVID-19 bereaved adults. The primary outcome was prolonged grief symptoms (PG).

RESULTS

We identified 9918 articles, whereof 28 studies met the inclusion criteria. Rates of psychological outcomes were primarily reported in terms of (early) PG, depression, posttraumatic stress, anxiety, and pandemic grief, and varied widely between studies (e.g., PG rates ranged between 30 % and 87 %). No studies reported on positive psychological outcomes. Closer kinship to the deceased, death unexpectedness, and COVID-19 stressors were identified as correlates of increased psychopathology.

CONCLUSIONS

Due to the small number and heterogeneity of studies, knowledge about psychological effects of COVID-19 bereavement is limited. This review offers a synthesis of research evidence to inform clinicians, policy makers, public health professionals, and future research concerned with psychological effects of COVID-19 bereavement.

Growing in Suffering: The Curvilinear Relationship Between Prolonged Grief and Post-traumatic Growth of Recently Bereaved Individual During the COVID-19 Pandemic

The outbreak of the COVID-19 pandemic brought new challenges to mourning and growth of bereaved. The purpose is to explore the relationship between the prolonged grief (PG) symptoms and the post-traumatic growth (PTG) of recently bereaved people during the COVID-19 period, and the mediating role of meaning making. 305 participants were recruited to complete the Posttraumatic Growth Inventory, Inventory of Complicated Grief, and Integration of Stressful Life Experiences Scale. Hierarchical multiple regression analyses and Medcurve in SPSS were adapted to test the hypotheses. The results revealed that there was a curvilinear relationship between PG and PTG and meaning making had a completely mediating effect on this relationship. Different intervention goals - whether alleviating distress or cultivating growth - should be set up according to the level of grief for recently bereaved individuals during COVID-19. More attention should be paid to the role of meaning making in the future clinical practice.

Avoidant and Approach-Oriented Coping Strategies, Meaning Making, and Mental Health Among Adults Bereaved by Suicide and Fatal Overdose: A Prospective Path Analysis

Adults bereaved by the suicide or overdose death of someone close to them are vulnerable to adverse mental health outcomes, but little is known about how these individuals utilize avoidance- and approach-based coping strategies, how these strategies relate to outcomes, and what accounts for these associations. Informed by contemporary theories of bereavement, we utilize prospective data from suicide- and overdose-bereaved adults (N = 212) who completed two waves of online data collection approximately two years following the death (T1 and T2; six months apart) to examine the mediating role of meaning making in the relationship between coping strategies and grief-related mental health outcomes, such as prolonged grief (PG), posttraumatic stress (PTS), and depression. Path analysis with mediation was used to investigate the relations between coping strategies at T1, meaning making at T2, and mental health outcomes at T2. The results indicated direct effects of avoidant coping at T1 in predicting higher PG and PTS symptoms at T2, while approach-based coping at T1 indirectly predicted an improvement in all three T2 outcomes due to increased meaning making. These results suggest that avoidance-based strategies directly and indirectly contribute to poorer outcomes and impaired meaning making processes, while approach-based strategies lead to increased meaning making and adaptation to loss among suicide and overdose loss survivors. The clinical implications and future directions for research are discussed.

Resting-state functional connectivity of the rostral and dorsal anterior cingulate cortex in older bereaved adults

BACKGROUND

Older adults are at higher risk of losing a loved one, with approximately 10 % developing prolonged grief disorder (PGD) after loss. PGD is characterized by distressing and impairing symptoms, reduced life quality, and increased suicide risk. While attentional processes may contribute to PGD pathophysiology, the rostral (rACC) and dorsal anterior cingulate cortex (dACC) appear to play different yet complementary roles in attention in the bereavement context. However, the respective contributions of the connectivity of these two regions in PGD symptom severity have never been evaluated. This study investigated the associations between PGD symptom severity and resting-state functional connectivity (rsFC) of the rACC and dACC.

METHODS

Resting-state fMRI scans were collected from N = 81 older adults who experienced loss >1 year prior, along with the inventory of complicated grief (ICG). Seed-based voxel-wise rsFC analysis was performed to investigate associations between ICG total scores and rsFC for the rACC and dACC.

RESULTS

Higher ICG scores were associated with increased rsFC between the rACC and left frontal areas and right rACC, and between the dACC and clusters in the posterior cingulate and parietal cortex. Individuals with probable PGD (ICG ≥ 30) exhibited greater increases in dACC-parietal cortex rsFC than those without (ICG < 30).

CONCLUSIONS

PGD symptom severity in bereaved older adults was associated with disruptions in rsFC patterns within and between brain regions related to impaired emotion regulation, memory processing, and attentional biases in grief, with stronger changes in individuals with probable PGD. These brain regions might serve as targets for future treatment development efforts.

Prolonged grief disorder

Prolonged grief disorder is a mental health disorder recently included in diagnostic manuals worldwide. This Review presents published research evidence in strong support for the current conceptualisation of prolonged grief disorder: a diagnosable mental health condition with core symptoms of yearning, preoccupation, or both, which is associated with symptoms of emotional pain, identity disturbances, loss of meaning and purpose, and functional impairment. The public and academic discourse surrounding prolonged grief disorder has catalysed researchers to produce methodologically rigorous research evidence in support of this much-needed diagnosis. A coherent syndrome of prolonged grief disorder has a typical onset of 6 to 12 months after the death of a close person. Prolonged grief disorder is associated with various poor outcomes, including negative health outcomes (eg, high blood pressure), increased rates of suicidality, low life satisfaction, and increased service use. Psychotherapy is the main treatment for prolonged grief disorder. Theoretical models of the cause and maintenance of prolonged grief disorder are presently being refined through the rapidly increasing empirical literature. Awareness of prolonged grief disorder by general health practitioners, as well as mental health specialists, is key to appropriate early intervention.

Feasibility, Acceptability, and Effectiveness of Adding an Evidence-Based Parent/Caregiver Program for Bereaved Families to Usual Community-Based Services

This paper briefly describes the development of the Resilient Parenting for Bereaved Families program (RPBF) and presents an evaluation of adding the RPBF to usual care (UC) provided by community agencies supporting families of bereaved children. The RPBF was adapted from the caregiver component of a family program that demonstrated significant benefits for parentally children and their parents in a randomized controlled trial. The current study found that the implementation of the RPBF program was feasible for implementation by community providers and was highly acceptable to caregivers. Subgroups of caregivers (n = 44) who received the RPBF in addition to UC (i.e., child groups and caregiver support groups) reported greater improvement in quality of parenting and complicated grief and reductions in children's behavior problems as compared with caregivers (n = 30) who received UC only. Improvement in parenting mediated the RPBF program's effect to reduce children's behavior problems.

Adaptive Grief in Bereaved Dementia Caregivers: An Evolutionary Concept Analysis

Bereaved dementia caregivers face unique challenges in navigating grief, yet research on dementia-specific adaptive grieving remains limited. Expanding on a prior scoping review, this concept analysis clarifies the theoretical construct of adaptive grief among bereaved dementia caregivers using Rodgers' evolutionary approach, which views concepts as dynamic and evolving. A review of 11 data sources (2013-2024) across nursing, sociology, medicine, and psychology identified three key attributes of dementia-specific adaptive grief: (1) rebuilding purpose: reconnecting with interests and community on one's own terms, (2) integrating change: blending past, present, and future experiences to regain direction, and (3) growing toward potential: pursuing self-defined goals and personal development. By defining dementia-specific adaptive grief, this concept analysis provides healthcare professionals with a clearer framework to recognize its evolving nature and distinguish it from maladaptive grief. It also emphasizes the need for longitudinal and culturally diverse research to inform tailored interventions that better support bereaved dementia caregivers.

Psilocybin-Assisted suppoRtive psychoTherapy IN the treatment of prolonged Grief (PARTING) trial: protocol for an open-label pilot trial for cancer-related bereavement

INTRODUCTION

Prolonged grief disorder (PGD) represents a substantial public health issue, especially in oncology settings where it affects up to 30% of bereaved carers. Current best-practice treatments are lengthy, and up to 50% of participants have persistent PGD. Building on encouraging recent research with psychedelic-assisted therapies, the Psilocybin-Assisted suppoRtive psychoTherapy IN the treatment of prolonged Grief (PARTING) trial is the first study to consider psilocybin-assisted psychotherapy as a potential treatment for prolonged grief.

METHODS AND ANALYSIS

PARTING is an open-label pilot trial of psilocybin-assisted psychotherapy for approximately 15 people with cancer-related PGD. It aims to investigate feasibility, safety, acceptability, participant experience and participant-reported therapeutic effects. Over a 5-week intervention period, participants will undergo three preparation sessions before receiving a psychoactive (25 mg) dose of psilocybin alongside non-directive supportive guidance, followed by four integration sessions. All sessions will be delivered by a psychologist and either a nurse or Indigenous Therapist. An artificial intelligence-assisted tool will be used to create an artwork of participants' psychedelic experience.Outcomes will be investigated over a 12-month follow-up period. Feasibility will be assessed through recruitment/retention rates and completion of follow-up assessments. Safety will be evaluated via adverse events over 12 months and the comparison of physiological measures (vital signs, biochemistry, haematology, ECG) recorded during screening and 1 day after the psilocybin dose. Qualitative thematic analysis of semistructured interviews with participants and trial therapists will assess acceptability and the therapeutic potential of the treatment. Diagnostic clinical interviews for PGD and quantitative participant-reported measures of therapeutic effects are also being collected. Participant-reported measures include grief severity, depression, anxiety, grief avoidance, psychological flexibility, connectedness, and quality of life.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from QIMR Berghofer Medical Research Institute Human Research Ethics Committee (P3801). Dissemination of results will occur via conference presentations, peer-reviewed publications and media.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN12623000827639).

Symptoms of prolonged grief in chronic pain patients: Results of a cross-sectional study

Chronic pain and prolonged grief disorder (PGD) share emotional, cognitive, and motivational components related to significant loss. This cross-sectional study examines whether individuals with chronic pain present symptoms of PGD and whether time since diagnosis plays a role in psychological deterioration. Thirty patients with chronic primary low back pain (CPLBP) and thirty healthy controls were recruited. The Inventory of Complicated Grief-Revised, the Numeric Pain Rating Scale, the Beck Depression Inventory-II, the Beck Anxiety Inventory, and the 5-level EQ-5D version were used. The results indicate clinically significant psychological distress and reduced quality of life in CPLBP patients. Furthermore, their psychological profile showed similarities with symptoms of prolonged grief. While time since diagnosis appeared to be linked to greater psychological distress, its effect diminished when considering pain intensity. These findings suggest that grief-related responses may contribute to chronic pain and highlight the need for interventions that address both emotional and physical impact.

Caregiving burden, receipt of palliative care, and the use of bereavement support: secondary analysis of population-based data

BACKGROUND

The levels of support needs among people bereaved due to cancer are high; however, bereavement support services are underutilised. Reasons are unknown. We aimed to examine the relationship of caregiving burden and involvement of palliative care with the utilisation of formal bereavement support by family carers of people who died of cancer.

METHODS

Secondary analysis of population-based mortality follow-back study (QUALYCARE) with bereaved relatives of adults who registered the death of an adult due to cancer and involved in caregiving. We ran a multivariate logistic regression to determine whether caregiving burden and palliative care involvement explain the utilisation of bereavement support.

RESULTS

Out of 523 family members involved in caregiving (66% women, Mage=59 (SD = 14), 43% spouses/partners, 41% adult children), 149 (28.8%) utilised formal bereavement support (73.8% women, Mage=60 (SD = 14), 55% spouse/partner, 36% adult children). We found higher grief intensity (measured by the Texas Revised Inventory of Grief) than the reported population norms. Bivariate analysis confirmed the hypothesised associations. However, these were not retained in the multivariate model. Utilisation of bereavement support was associated with presence at the moment of death (OR 1.769, 95%CI = 1.044-2.994) and grief intensity (1.036, 95%CI = 1.015-1.058).

CONCLUSIONS

Subjective experiences such as grief intensity and being present at the moment of death are associated with the need for formal bereavement support, raising the issue of continuity of care for family carers into bereavement. Further research is warranted to better understand the complex relationships between caregiving, bereavement, and the role of palliative care in facilitating access to bereavement support.

Conducting Grief Support Groups in Prison: A Pragmatic Feasibility and Impact Study

Unaddressed grief and trauma may precipitate and maintain problematic substance use, criminal behavior, and resultant incarceration. We detail the implementation and evaluation of an evidence-based grief support group model conducted in seven groups in the two substance-use disorder treatment programs within a state correctional facility. The three aims of this project were to (1) train Department of Corrections mental health clinicians in the grief support group model, (2) conduct seven grief support groups facilitated by trained clinical social workers in two substance-use disorder treatment programs within the prison, and (3) evaluate impact of the grief support group model on participant grief. This is a pragmatic intervention feasibility evaluation of 69 incarcerated people in seven grief support groups facilitated by prison mental health clinicians trained in the grief support group model. The investigation resulted in high satisfaction and self-efficacy among clinician trainees, research feasibility being established, the intervention being found acceptable and practical, and client participants reporting clinically significant reductions in grief severity and grief improvement. The grief support group model holds promise as a complementary modality within a well-designed therapeutic program at the proper time for clients with severe grief.

Improving Outcomes for ICU Family Members: The Role of Spiritual Care

Having a family member hospitalized in the intensive care unit (ICU) can be a stressful experience for family members, encompassing both psychological and spiritual distress. With over 5 million ICU admissions annually in the United States, it is imperative to enhance the experiences and coping mechanisms of ICU family members. In particularly challenging situations, some family members even face psychological effects known as post-intensive care syndrome-family, which includes anxiety, depression, and posttraumatic stress. The distress may be worsened when patients and families experience poor communication or medical care, which has been shown to be more common among minoritized populations including Black and Hispanic patients and families. Family members' emotional and spiritual distress also has an effect on the medical decisions they make for the patient. While research has delved into the impact of spiritual care for ICU family members, further investigation is still needed to determine the most effective approaches for delivering such care. This narrative review will describe a conceptual model aimed at guiding future research in this endeavor. The model proposes that chaplains provide emotional, spiritual, and information support to ICU family members. This affects both their ICU experience, decision making, and outcomes for the patient and family. This process is also affected by characteristics of the family such as race, ethnicity, and economic status. This model helps identify gaps in research, including the need for randomized trials of spiritual care that identify mechanisms underlying outcomes and demonstrate impact of spiritual care, and consider race, ethnicity, and other characteristics.

Psychopathological Symptoms of Individuals Recently Bereaved During COVID-19 Pandemic: Symptom Profiles, Predictive Factors and Correlations With Insomnia

AIMS

This study aimed to identify subgroups of individuals bereaved within the past 1 year during the COVID-19 pandemic based on symptoms of prolonged grief disorder (PGD), depression and post-traumatic stress (PTSD). Additionally, we examined class differences in socio-demographic and loss-related variables and explored the associations between class membership and insomnia.

METHODS

A total of 324 individuals (72.2% female) who experienced bereavement within 12 months (M = 4.01 months, SD = 2.45) completed Inventory of Complicated Grief (ICG), Patient Health Questionnaire (PHQ-9), PTSD Checklist for DSM-5 (PCL-5) and Insomnia Severity Index (ISI). Latent class analysis (LCA) with three-step and BCH procedure was employed.

RESULTS

Three distinct subgroups were identified: a high symptoms class (33.4%), a high PGD, moderate depression and PTSD class (35.2%) and a moderate PGD, low depression and PTSD class (31.4%), especially yearning, preoccupation, emotional pain and loneliness, were predominant. Class membership was influenced by relationship to the deceased and expectancy of death but not by time since loss. Death due to COVID-19 did not significantly differentiate class membership compared to other causes. Additionally, significant differences in insomnia severity were observed across classes (p < 0.001).

CONCLUSION

Distinct psychopathological patterns emerged among recently bereaved individuals during the pandemic, with PGD symptoms being particularly prominent. Tailored strategies may help address distinct symptom profiles and co-morbid symptoms within bereavement care.

Factors associated with grief in family carers of people with dementia in Japan: a systematic review

BACKGROUND

The purpose of this study was to systematically review the existing literature on grief in family carers of people with dementia in Japan and to synthesise the evidence on the prevalence and associated factors of pre- and post-death grief of the carers.

METHODS

CiNii Research, J-STAGE, and ICHUSHI were searched for studies published in Japanese and MEDLINE, PsycINFO, and CINAHL for studies written in English up to 30 November, 2023.

RESULTS

Of the 315 references identified, eight studies that met the eligibility criteria were included: six studies investigated pre-death grief, and two studies investigated post-death grief. One low-quality study reported the prevalence of pre-death grief (28.6%), and no studies reported the prevalence of complicated grief as post-death grief. Less social support and greater levels of depressive symptoms and caregiving burden were associated with greater levels of pre-death grief, while no studies reported significant factors associated with complicated grief. Most of the studies had small sample sizes and poor study quality.

CONCLUSIONS

Limited evidence makes it difficult to draw conclusions about the prevalence of pre-/post-death grief and associated factors among family carers of people with dementia in Japan. Future studies focusing on grief using validated measures are needed.

Parents' mental health after termination of pregnancy for foetal anomaly - a systematic review

AIMS/BACKGROUND

Terminating a desired pregnancy due to foetal anomalies has been linked to significant distress. It is however less clear what long-term psychological implications the parents face in the aftermath. This systematic review aimed to explore the mental health outcomes of parents after the termination of pregnancy due to foetal anomaly (TOPFA) after gestational week 12 + 0.

DESIGN/METHODS

Following the PRISMA guidelines and using the PEO (Problem, Exposure, Outcome) framework, we conducted a comprehensive search across six electronic databases. The search was restricted to English studies published since 2000. Eligible studies provided quantitative assessments of mental health outcomes post-TOPFA. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Given the heterogeneity in outcome measures, the findings were synthesised narratively.

RESULTS

Of the 2261 papers identified, 11 studies (four cross-sectional and seven cohort studies) were included. Results demonstrated variations in symptoms of trauma-related stress, depressive symptoms, and grief reactions across the different studies post-TOPFA. Variations were found to be related to time since TOPFA and the difference in assessment tools used. Factors investigated as predictors of mental health outcomes, including gestational age, educational level, and religion, showed inconsistent findings, though partner support consistently correlated with lower levels of grief. Male partners, included in two studies, generally reported fewer symptoms of psychological distress.

CONCLUSION

This review explores a range of mental health outcomes and highlights the need for better quality studies that consider the psychological impact of TOPFA on partners. Further, this systematic review stresses the need of standardisation in measurement tools for assessing mental health symptoms.

Pathways from spousal bereavement to cognitive functioning in Pakistani older adults: Mediational role of social rhythms and moderating role of social support

OBJECTIVE

This study investigated the association between spousal bereavement and cognitive functioning among Pakistani community dwelling older adults.

METHODS

This cross-sectional study was completed in Pakistan in 2022-2023. A total sample of 135 bereaved older adults (Mage = 67.7, SD = 7.37) was obtained from the twin cities of Rawalpindi and Islamabad, Pakistan, via purposive sampling. Data were collected through the Montreal Cognitive Assessment Scale (MoCA), the Core Bereavement Item (CBI), the Inventory of Complicated Grief (ICG), the Multidimensional Scale of Perceived Social Support(MSPSS) and the Brief Social Rhythm Scale (BSRS). All scales were administered in Urdu language.

RESULTS

Correlation analysis revealed a significant negative relationship between normative grief, complicated grief and cognitive functioning. Results generated, using PROCESS Macro Model 4 after controlling for age and duration of bereavement, revealed that normative grief and cognitive functioning were partially mediated by social rhythms. No mediation was formed after controlling for education. Complicated grief and cognitive functioning were not mediated by social rhythms. Perceived social support did not moderate the relationship between normative grief and complicated grief. However, only the perceived support from family moderated the relationship between complicated grief and cognitive functioning.

CONCLUSIONS

Social rhythm regularity did not mediate cognitive decline among grieving older adults. However, results highlight the importance of support from family in preventing cognitive decline. Findings suggested that understanding the underlying pathways associated with cognitive decline among older adults are vital for the development of specific intervention and prevention strategies.

Exploring Differences in Presentation and Treatment Outcomes Between Black and White American Adults With Prolonged Grief Disorder

Prolonged grief disorder (PGD) is a condition of persistent, intense grief and PGD-targeted psychotherapy (PGDT) is an efficacious treatment. This study aimed to compare participants with PGD who self-identified as Black versus White, with respect to baseline features and response to PGDT. We performed a secondary data analysis of 55 Black and 455 White adults from two randomized clinical trials. Racial differences in baseline features were examined using Chi-squared and T-tests. We compared assessment completion and treatment response rates (PGDT vs. no PGDT) by race and evaluated posttreatment self-reported measures using linear models. There were racial differences in the cause of death, relation to the deceased, and taking comfort in religion. Black participants had similar ratings to their counterparts on impairment and grief severity at baseline. However, they had higher scores on a baseline measure of typical grief-related beliefs. Both racial groups had significantly greater response rates to PGDT than the comparison treatment. Similarly, PGDT resulted in lower posttreatment impairment than the comparison treatment for both racial groups. However, only the White participants had a difference in posttreatment grief severity between the treatment groups. This study supports the idea that PGD characteristics are similar in Black and White treatment seeking individuals, and that Black and White participants display improvement in response to PGDT.

Strategies for Coping With Complicated Grief in Relatives of Patients Who Are Critically Ill: An Observational Single-Center Cohort Study

BACKGROUND

Relatives of patients who are critically ill who die are at high risk for symptoms of complicated grief (CG) with potential individual and social burdens. The prevalence and predictors of CG, and in particular the involvement of individual facets of relatives' coping strategies, are not well understood.

RESEARCH QUESTION

How high is the prevalence and what are the predictors of CG, and how are coping strategies associated with CG symptoms?

STUDY DESIGN AND METHODS

In this observational single-center cohort study, relatives of patients who are critically ill who died while in the ICU were surveyed 6 months later, using the Inventory of Complicated Grief (ICG) and the Brief Coping Orientation to Problems Experienced questionnaire, to assess CG symptoms and coping strategies, respectively. Patients' and relatives' characteristics were obtained. The primary outcome was the ICG sum score.

RESULTS

Relatives of 89 of the 298 patients who died in the ICU during the study period were included. The mean ± SD ICG sum score was 41.6 ± 10.9. Eighty-four relatives (94.4%) had an ICG score ≥ 25. Multivariable analysis revealed that being a partner significantly affected the ICG sum score (coefficient, 4.9; 95% CI, 1.8 to 8.0; P = .003), as did the coping strategies of self-distraction (coefficient, 4.4; 95% CI, 2.5 to 6.3; P < .001), acceptance (coefficient, -4.4; 95% CI, -6.3 to -2.5; P < .001), and self-blame (coefficient, 3.8; 95% CI, 1.4 to 6.3; P = .002).

INTERPRETATION

Almost all relatives of deceased patients who are critically ill exhibit symptoms of CG. Relatives' functional and dysfunctional coping strategies may be associated with their CG symptoms. Knowledge of individual relatives' coping strategies may be helpful in supporting them. Adequate supportive interventions should be developed.

ICD-11 Prolonged Grief Disorder, Physical Health, and Somatic Problems: A Systematic Review

Background

Since Prolonged Grief Disorder's (PGD) inclusion as a mental health disorder in the ICD-11 in 2018, much of the peer-reviewed research has focused on its prevalence, assessment, and co-occurrence with other mental health disorders. There is also emerging research literature on the association between PGD and physical and somatic health outcomes. In light of this, the objective of this review was to identify and summarise the extant research on the association between PGD, and outcomes related to physical health and somatic complaints among bereaved individuals.

Method

A systematic review utilized electronic databases (Web of Science, MEDLINE, Cochrane Library, PsycINFO) up to October 10, 2023. Included were cohort and cross-sectional studies since 2018 exploring links between ICD-11 PGD and physical/somatic health outcomes. Two researchers independently identified eligible studies meeting inclusion/exclusion criteria, employing quality assessment instruments to evaluate methodological rigor.

Results

From the 418 articles that were initially screened, 18 met the inclusion criteria. The studies reported significant associations between PGD and physical health, somatic symptom distress, insomnia severity, blood pressure, bodily distress syndrome, chronic physical diseases, and poor- caregiver health profiles.

Conclusion

Out of the 18 studies eligible for analysis, 13 (72%) established a significantly strong or moderate association between PGD and physical or somatic illness, highlighting the intricate nature of this connection. Further research is required to assess the breadth of physical and somatic health problems associated with PGD and to understand the psychological and biological mechanisms that underpin these observed relationships.

Adaptation of the Spanish Grief and Meaning Reconstruction Inventory: An Initial Validation and Network Analysis

The current study was conducted to adapt the Grief and Meaning Reconstruction Inventory (GMRI) into Spanish and to establish its psychometric properties in a group of 202 mourners seeking treatment in Spain. A confirmatory factor analysis established that the Spanish GMRI yielded eight factors, displaying strong reliability and convergent validity, through the scale's inverse correlation with the Inventory of Complicated Grief and various measures of psychological distress, explaining a 48% of the variance of the former measure. A network analysis suggested that sense-making could play a central role in meaning-making during bereavement.

Risk and correlates of prolonged grief disorder in bereaved Chinese university students

Bereavement can present significant challenges for university students, yet the proportion at risk of prolonged grief disorder (PGD) remains unclear. This study examined the proportion at risk of PGD and associated factors among Chinese university students. Using an online survey administered to bereaved university students in mainland China (N = 948), 424 students (Mage=21.60, 56.1% female) reported a significant loss for more than 12 months. Chi-squared and t-tests were used to examine associations between PGD risk and related factors. Results showed 14.2% of the sample were at high risk of PGD. The most frequently reported symptoms were a marked sense of disbelief, intense emotional pain, and yearning for the deceased. PGD risk was associated with physical health, age and relationship to the deceased, expectedness and cause of death, resilience, and stress since the loss. Identifying these correlates can inform future prevention or intervention strategies for bereaved university students.

The Psychosocial and Contextual Predictors of Revenge Desire and Attitudes in Crime Victims: A Scoping Review

Criminal victimization is associated with an increased risk of violent offending, which can be motivated by revenge. Experiencing revenge desire could also be harmful for crime victims' mental health. To limit revenge's harmful effects, researchers have examined the predictors of revenge desire and attitudes. However, little is known about the predictors of revenge desire and attitudes in crime victims specifically. This scoping review aims to identify the contextual and psychosocial predictors of revenge desire and attitudes from the existing literature. Databases (PsycInfo, PsycArticles, SCOPUS, Web of Science and MEDLINE) were searched in February 2024. Papers published in English, with data pertaining to the psychosocial and contextual predictors of revenge desire and attitudes in crime victims, were included. Quantitative studies and meta-analyses were included. Qualitative studies and reviews were excluded. Risk of bias was assessed using JBI's critical appraisal tools. 3689 records were screened. 10 reports, covering 14 studies, were included. A narrative review was conducted. Four categories of predictors were identified, namely 1) offence-related predictors, 2) mental health predictors, 3) criminal justice system predictors, and 4) demographic predictors. Significant predictors included PTSD symptoms, which were correlated with higher revenge desire, and participation in restorative justice, which was found to lower crime victims' desire for violent revenge in a series of randomized controlled trials. However, this review highlights the need for further research in this area. Many predictors were merely examined in a single study, so require replication. In addition, studies were largely cross-sectional, limiting conclusions about causation.

The Meaning in Loss protocol: A clinical trial of online grief therapy

For a minority of the bereaved, the loss of a significant other can trigger an overwhelming emotional reaction and impaired functioning across life domains, known as prolonged grief disorder (PGD). Hence, ongoing efforts have been made to refine existing treatments to increase their efficacy and to accommodate the idiosyncrasies of grief reactions. This study presents the results of an open clinical trial of the feasibility and effectiveness of the Meaning in Loss (MIL) protocol in an online format. The brief intervention of 12 to 16 sessions combines constructivist and narrative strategies to explore and work through impediments to meaning reconstruction in loss. The sample included 25 participants diagnosed with PGD who were treated by six therapists. Baseline and post-therapy comparisons showed a significant improvement in all clinical measures (grief symptomatology, depression and general distress) and an increase of meaning making regarding the loss. Meaning making was found to be a prospective mediator of symptomatic improvement in grief across the course of therapy. These findings suggest the effectiveness of the MIL protocol in decreasing grief specific and associated symptomatology and argue for the relevance of further controlled evaluations of its efficacy. Moreover, results confirm previous findings that meaning making is a relevant factor in the evolution of grief reactions, including in the context of psychotherapy.

Effectiveness and Acceptability of Interventions Offered for Those Bereaved by Parental Loss to Suicide in Childhood: A Mixed Methods Systematic Review

OBJECTIVES

Identify interventions offered for children bereaved by parental suicide, investigate reported effectiveness and explore the acceptability of identified interventions.

METHOD

Six electronic databases were systematically searched for primary studies investigating intervention effectiveness and acceptability, (August 2011 to June 2023). Eligibility required inclusion of participants bereaved by parental suicide during childhood among sample populations. Methodological quality was evaluated applying JBI critical appraisal tools. Narrative synthesis was conducted using parallel-results convergent design.

RESULTS

Of the 22 eligible reports, 19 articles reported on 12 manual-based supports provided during childhood; three papers described users' experiences of various specified intervention types offered following childhood loss. Twenty-one studies reported on interventions offered for heterogeneous participant groups that included children bereaved by parental suicide. Time from loss to intervention generally included both recent (1 < 30mths) and more distant loss, with just one intervention described as solely for recently bereaved children. Eight interventions (n = 12 studies) demonstrated significant positive effects (p < 0.05), for maladaptive grief, mental health, quality of life. Only one study investigated suicide-related outcomes. Qualitative findings (n = 8 studies) facilitated development of four acceptability themes: Perceived utility, Relationships, Components and Delivery.

CONCLUSIONS

Heterogeneity in causes of loss/trauma and relationships with the deceased limit specific conclusions regarding effectiveness/acceptability of reviewed interventions for children bereaved by parental suicide. Few sub-group analyses of effects were reported, and qualitative evidence specifically from children bereaved by parental suicide was limited. Further research is recommended regarding mixed-user interventions, specifically for children bereaved by parental suicide.

Amygdala-Centered Emotional Processing in Prolonged Grief Disorder: Relationship With Clinical Symptomatology

BACKGROUND

Prolonged grief disorder (PGD) is a multidimensional condition with adverse health consequences. We hypothesized that enhanced negative emotional bias characterizes this disorder and underlies its key clinical symptoms.

METHODS

In a cross-sectional design, chronically grieving older adults (age 61.5 ± 8.9 years) experiencing probable PGD (n = 33) were compared with demographic- and time since loss-equated integrated (adaptive) grief participants (n = 38). To probe generalized negative affective reactivity, participants performed an emotional face-matching task during functional magnetic resonance imaging scanning and completed demographic and clinical assessments. Contrast maps (fearful + angry faces [-] shapes) were generated to determine group differences in brain activity within hypothesized affective and regulatory processing regions (amygdala, anterior insula, dorsal anterior cingulate, dorsolateral prefrontal cortex) and in exploratory whole-brain regression analyses.

RESULTS

The PGD group showed higher right amygdala activation to negative emotional stimuli than the integrated grief group (pcorrected < .05), which positively correlated with intrusive thoughts. Generalized psychophysiological interaction analysis revealed lower task-dependent functional connectivity (FC) between the right amygdala and posterior cingulate cortex/precuneus in PGD (pcorrected < .05), which negatively correlated with avoidance of loss reminders. Resting-state FC between the identified right amygdala and thalamus was higher in PGD (pcorrected < .05), which negatively correlated with loneliness.

CONCLUSIONS

Dysregulated amygdala-centric neural activity and FC during processing of negative affective stimuli and at rest appear to differentiate prolonged from integrated grief in older adults. Future investigations that use interventions to target amygdala-centric neural circuit abnormalities may provide new insights into the role of enhanced negative bias and related mechanisms that underlie PGD and support treatment efficacy.

Depression is Associated with Treatment Response Trajectories in Adults with Prolonged Grief Disorder: A Machine Learning Analysis

Although evidence-based treatments for Prolonged Grief Disorder (PGD) exist, pretreatment characteristics associated with differential improvement trajectories have not been identified. To identify clinical factors relevant to optimizing PGD treatment outcomes, we used unsupervised and supervised machine learning to study treatment effects from a double-blinded, placebo-controlled, randomized clinical trial. Participants were randomized into four treatment groups for 20 weeks: citalopram with grief-informed clinical management, citalopram with prolonged grief disorder therapy (PGDT), pill placebo with PGDT, or pill placebo with clinical management. The trial included 333 PGD patients aged 18-95 years (M age = 53.9; SD ± 14.4), predominantly female (77.4%) and white (84.4%). Symptom trajectories were assessed using latent growth mixture modeling based on Inventory for Complicated Grief scores collected at six time points every 4 weeks. The relationship between patient-level characteristics and assigned trajectories was examined using logistic regression with elastic net regularization based on the administration of citalopram, PGDT, and risk factors for developing PGD. Three distinct response trajectories were identified: lesser severity responders (60%, n = 200), greater severity responders (18.02%, n = 60), and non-responders (21.92%, n = 73). Differences between greater severity responders and non-responders emerged as statistically significant by Week 8. The elastic net model demonstrated acceptable discrimination between responders and non-responders (AUC = .702; accuracy = .684). Higher baseline depression severity, grief-related functional impairment, and absence of PGDT were associated with reduced treatment response likelihood. These findings underscore the importance of early identification of clinical factors to optimize individualized PGD treatment strategies.

Trial Registration

clinicaltrials.gov Identifier: NCT01179568.

Ecological momentary assessment in prolonged grief research: Feasibility, acceptability, and measurement reactivity

Ecological momentary assessment (EMA) is a method of data collection that entails prompting individuals to report their experiences (e.g., thoughts, feelings, and behaviors) in real time over the course of their day-to-day lives. By providing rich information about how these experiences unfold over time within an individual, EMA has the potential to substantially advance our understanding of grief. However, there is uncertainty about how bereaved adults will respond to EMA, especially among those with high prolonged grief symptom severity. Accordingly, we evaluated the feasibility and acceptability of an EMA protocol in bereaved adults with low and high prolonged grief severity. Participants completed six 12-item EMA surveys per day on their smartphones for 17 days. Adherence was high (mean survey completion = 90%, median = 96%), and only 6% of participants withdrew. Adherence remained high in those with high prolonged grief symptom severity (mean = 86%; median = 96%). On average, participants reported agreement that survey frequency and length were acceptable. There was no evidence for systematic worsening of symptoms during EMA data collection. Together, these findings suggest that EMA is feasible, acceptable, and safe for bereaved adults, including those with high prolonged grief symptom severity.

Narrative review of the potential for psychedelics to treat Prolonged Grief Disorder

Prolonged Grief Disorder (PGD) is distinct from yet related to non-pathologic grief, depression, addiction, and Post-Traumatic Stress Disorder (PTSD) with a prevalence of up to 10% in bereaved populations. Hallmarks of PGD include functional impairment a year or more post-bereavement and intense yearning for the deceased. Current treatments for PGD are typically psychological rather than psychopharmacological, and more treatment options are needed. Psychedelics such as psilocybin and MDMA may be a promising treatment avenue for PGD. Randomized clinical trials demonstrated the efficacy of psilocybin in reducing symptom severity in depression and MDMA in reducing PTSD symptomatology. Furthermore, psychedelics often produce subjective effects (such as transcendence, mystical experiences, and a sense of oneness) that may be uniquely relevant to the existential distress experienced in PGD. No randomized clinical trials have thus far been conducted on the safety and efficacy of psychedelics for PGD. Initial research, including survey-based studies and an open-label trial, has begun to shed light on the possible benefits of psychedelics in the alleviation of grief. While the evidence from these studies is preliminary, it suggests a consistent trend towards the effectiveness of psychedelics in grief reduction. Conducting a randomized clinical trial would be an appropriate next step to explore the potential efficacy of using psychedelics to treat PGD.

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.

Complicated Grief in a Spanish Sample of Victims of Terrorism: Evidence of Validity of the Inventory of Complicated Grief

The Inventory of Complicated Grief (ICG) is the most widely used instrument to measure complicated grief (CG), but its psychometric properties have hardly been examined in relatives of those who died by violent means. The objective of this study was to obtain evidence of validity of the ICG in a relatives of those who died due to terrorist attacks in Spain. The factorial structure, internal consistency, and relationship with depression, anxiety, and post-traumatic stress were analyzed in a Spanish sample of 211 relatives of people who died in terrorist attacks. The ICG presented a one-factor structure that supports the validity of its total score. This score showed excellent internal consistency indices (alpha = .927; omega = .932) and adequate correlation indices with depression, anxiety, and post-traumatic stress (r = .71, .63 and .76, respectively). The ICG provides reliable and valid measures of CG in adults who have lost a family member due to violent death.

Psychometric Properties of the Persian Version of the Inventory of Complicated Grief

The aim of this study was to investigate the psychometric properties of the Persian version of the Inventory Complicated Grief (ICG) including reliability, validity and factorial structure. In this cross-sectional study, 332 women and men bereaved at least 6 months from the adult population of Iran. The results showed Cronbach's alpha was found to be 0.94 for the scales overall score. Inventory Complicated Grief found a positive and significant correlation between the beck depression inventory (BDI) (r = .62, p < .001) and grief experience questionnaire (r = .74, p < .001). Still, he also found that there was a negative correlation between adult hope scale (r = -.44, p < .001). Furthermore, the results of the EFA result showed four factors on this scale. Overall, ICG showed good reliability and validity in Iranian population and it could be applied for assessing their Complicated Grief.

The effectiveness of acceptance and commitment therapy in reducing the symptoms of complicated grief, corona disease anxiety, and improving the quality of life in the survivors of the deceased due to COVID-19

BACKGROUND

COVID-19 is an infectious disease that has threatened the physical and mental health of people and in many cases leads to death. The present study investigated the effectiveness of acceptance and commitment therapy (ACT) in reducing the symptoms of complicated grief, and corona disease anxiety, and improving the quality of life in the survivors of the deceased due to COVID-19.

MATERIALS AND METHODS

The research method was an experimental design with pre-test, post-test, and follow-up with a control group and random assignment to the intervention and the control groups. Thirty-eight people who met the study criteria were selected as a sample and assigned to the two intervention and control groups using a simple randomization method (19 people in each group). Measures included the complex grief scale, the coronavirus anxiety scale, and the short form of the World Health Organization quality of life scale. Then, mixed analysis of variance was used to compare the average variables between the two groups. Also, the independent t-test was used to compare the mean quantitative outcomes between the two groups.

RESULTS

The results showed that there were significant changes over time between the experimental and control groups (with a small effect coefficient) in complicated grief symptoms (P < 0.05), corona disease anxiety (P = 0.001), and quality of life (P = 0.001). Also, the results of all three variables showed that there were significant differences between pre-test and post-test (P < 0.05) and between pre-test and follow-up (P value < 0.05), but the difference between post-test and follow-up was insignificant.

CONCLUSIONS

ACT has significant effects on reducing the symptoms of complicated grief and corona disease anxiety as well as on improving the quality of life in the survivors of the deceased due to COVID-19.

Longitudinal Study of Bereavement Outcomes Among Palliative Caregivers Mourners: Psychological Profiles in Prolonged Grief and Psychopathology

Prolonged grief (PG) is a mental health condition characterized by severe distress following a loss. This study examines the roles of attachment styles, social support, stressful life events (SLEs), and pre-existing psychopathology in predicting PG and post-bereavement psychopathology among 74 caregivers of palliative patients. Using validated assessment tools, the study employed hierarchical regression and fuzzy-set qualitative comparative analysis (fsQCA) to identify predictors of prolonged grief and psychological outcomes over six months. Results showed that pre-existing psychopathology and PG risk predicted post-bereavement psychopathology, though not PG itself. Low social support and high SLEs were linked to worse outcomes, while strong social support and low stress predicted positive outcomes. These findings highlight the importance of multiple interacting factors in understanding grief and emphasize the need for interventions that enhance social support, manage stress, and address mental health conditions to reduce psychological distress in bereaved caregivers.

Adaptation and Validation of the Pet Bereavement Questionnaire (PBQ) for Chinese Population

Despite the increasing prevalence of pet ownership in Chinese societies, standardized tools to assess grief from pet loss remain lacking. Research predominantly focuses on Western populations, creating a gap in understanding pet bereavement in Chinese cultural settings. This study aimed to adapt and validate the Pet Bereavement Questionnaire (PBQ-C) for a Chinese context to create a culturally appropriate assessment tool. A total of 246 participants with companion animal loss experiences were recruited through the university of the research team. They were invited to complete an online survey including the PBQ-C, the Depression subscale of the Depression Anxiety Stress Scales (DASS-21), and the Inventory of Complicated Grief (ICG). Both Exploratory Factor Analysis and Confirmatory Factor Analysis were conducted to examine the psychometric properties of the PBQ-C and the findings supported a three-factor structure-grief, anger, and guilt-aligned with the original PBQ, with three items reassigned to different factors. Despite these adjustments, the PBQ-C demonstrated strong internal consistency, reflecting the reliability of the questionnaire in measuring the same construct across its items; split-half reliability, indicating its ability to produce consistent results when divided into two parts; and concurrent validity, showing that the PBQ-C correlates well with other established measures of grief. The validated PBQ-C provides a culturally sensitive tool for assessing pet bereavement in Chinese society that can promote research and counselling support for this under-researched and under-recognized type of loss of human-animal relationships.

Family members' long-term grief management: A prospective study of factors during ongoing palliative care and bereavement

OBJECTIVES

Up to 10% of bereaved individuals can develop prolonged grief disorder. Several risk factors for prolonged grief symptom severity in family members have been identified, but there is a lack of knowledge regarding the multivariable effects between family members coping with loss and patient-related factors for prolonged grief symptom severity during bereavement. The aim was to identify risk factors for prolonged grief symptom severity in family members 1 year after patient death in relation to (1) the family member and the patient during ongoing palliative care and (2) the family member during bereavement.

METHODS

The participants consisted of family members (n = 99) of patients admitted to palliative home care in Sweden. The participants completed a survey during ongoing palliative care and at a follow-up 1 year after the patient's death.

RESULTS

The model selection chose 4 demographic and 4 preloss variables: family member's nervousness and stress, the patient's sense of security during palliative care, family members' sense of security during palliative care, and a family member attachment security anxiety dimension. Two postloss variables were positively associated with prolonged grief symptom severity: family members' continuing bond - internalized and continuing bond - externalized.

SIGNIFICANCE OF RESULTS

How family members coped depended on (i) variables linked to the family members themselves, (ii) the relationship to the patient, and (iii) some patient-specific variables. There was also a link between preloss variables and postloss prolonged grief symptom severity. Hence, it should be possible to identify family members with a heightened risk for longer-term prolonged grief symptoms.

Advance care planning in patients with respiratory failure

Advance care planning (ACP) is a complex and iterative communication process between patients, surrogates and clinicians that defines goals of care that may include, but is not limited to, documentation of advance directives. The aim of ACP is to promote patient-centred care tailored to the patient's clinical situation through informed preparation for the future and improved communication between patient, clinicians and surrogates, if the latter need to make decisions on patient's behalf.The aim of this article is to review research related to ACP in acute and chronic respiratory failure, regarding the process, communication, shared decision-making, implementation and outcomes.Research has produced controversial results on ACP interventions due to the heterogeneity of measures and outcomes, but positive outcomes have been described regarding the quality of patient-physician communication, preference for comfort care, decisional conflict and patient-caregiver congruence of preferences and improved documentation of ACP or advance directives.The main barriers to ACP in chronic respiratory failure are the uncertainty of prognosis (particularly in the organ failure trajectory), the choice of the best timing for initiation and the lack of training of healthcare workers. In acute respiratory failure, the ACP process can be very short, should include the patient whenever possible, and is based on a discussion of treatments appropriate to the patient's functional status prior to the event (e.g. assessment of frailty) and clear communication of the likely consequences of possible options.All healthcare worker dealing with patients with serious illnesses should have training in communication skills to promote engagement in ACP discussions.

Effectiveness of a cognitive-behavioral group therapy for complicated grief in relatives of patients with cancer: A randomized clinical trial

INTRODUCTION

Complicated grief can affect a large number of individuals who have lost a relative due to cancer.

OBJECTIVES

To assess the efficacy of a cognitive-behavioral grief therapy (CBGT) group for complicated grief (CG) in those who have lost a relative due to cancer in comparison with a psychoeducational and emotional expression intervention group (PSDEEI).

METHODS

A randomized clinical trial was used, in which 249 relatives of deceased cancer patients with CG were randomly assigned to CBGT or PSDEEI. Complicated grief (Inventory of Complicated Grief [ICG]), depression (Beck Depression Inventory [BDI-II]), hopelessness (Beck Hopelessness Scale [BHS]), anxiety (Beck Anxiety Inventory [BAI]) symptoms, and general health (Goldberg's General Health Questionnaire [GHQ28]) were assessed at pretreatment, posttreatment, and follow-up at 6 and 12 months.

RESULTS

The CBGT group improved significantly (p < 0.001), with the scores in ICG, BDI-II, BAI, BHS, and GHQ28 (p < 0.001) being higher than those for the PSDEEI group in each of the assessed moments, with high effect sizes: ICG (η2 = 0.16), BDI (η2 = 0.10), BAI (η2 = 0.06), BHS (η2 = 0.21), and GHQ28 (η2 = 0.21). At the 12-month follow-up, the number of cases of CG decreased by 81.1% for the CBGT group vs. 31.7% in the PSDEEI group.

SIGNIFICANCE OF RESULTS

The CBGT treatment was effective for CG, depression, anxiety, and hopelessness symptoms and for mental health and was superior to the PSDEEI treatment.

Grief on pain and quality of life in combat veterans with PTSD

Background: Persistent Complex Bereavement Disorder (PCBD) comprises a set of grief symptoms that are often linked to other psychological conditions such as PTSD and depression, may be prevalent in Veterans with combat experience, and may also impact general health.Objective: This study investigated the association between grief and sleep, pain, PTSD, and depression, among Veterans participating in a clinical trial for PCBD treatment.Method: Data from 155 Veterans receiving treatments for PCBD were analysed to explore the association between PCBD and symptoms of sleep pain, PTSD, and depression. Veterans experiencing grief reported symptoms related to physical health, emotional problems, energy, and fatigue, emotional well-being, social functioning, presence of pain, and general health. PCBD appeared to have a specific association with pain and physical functioning, independent of other variables.Conclusions: This study examined the potential independent association of PCBD on physical and mental health in Veterans with PTSD. PCBD appeared to have a very specific and significant association with pain and physical functioning. In other words, the pain of grief was related to ratings of physical pain. Future research on PCBD should address the potentially bidirectional association with bodily pain, particularly chronic pain, in relation to loss, with specific attention to potential mechanisms underlying this relationship.

Bereaved parents' and siblings' healthcare needs, healthcare utilization, and satisfaction with healthcare services eight years after the 2011 Utøya terror attack

Understanding the healthcare needs of bereaved individuals following terrorism is crucial for organizing healthcare services. This cross-sectional study examined the terror-related healthcare needs, healthcare utilization, and satisfaction with professional healthcare among 122 traumatically bereaved parents and siblings eight years after the 2011 Utøya terrorist attack in Norway. Results showed that over 50% of the participants currently needed help coping with their grief or with mental and somatic symptoms, and only 34% were actively utilizing healthcare related to the terror attack. Furthermore, 68% reported not getting sufficient help, suggesting a treatment gap. One-third rated the professional help and treatment as unsatisfactory, with 28% reporting that they had not received competent help. More somatic and posttraumatic stress symptoms were associated with higher healthcare needs, whilst higher levels of insomnia symptoms were associated with lower healthcare satisfaction. This emphasizes the need to recognize, professionally intervene, and provide competent support for traumatically bereaved individuals.

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.

Self-compassion-based online group psychotherapy for bereavement-related grief: The COMPACT feasibility trial

OBJECTIVE

This study aimed to examine the feasibility and effectiveness of online group psychotherapy focused on self-compassion for individuals experiencing bereavement-related grief.

METHOD

This single-arm feasibility trial involved participants aged 18 years or older who had experienced bereavement at least 6 months prior the five-week intervention. Outcomes were measured at baseline, immediately post-intervention, and 4 and 12 weeks later. The primary endpoint was the percentage of participants who completed four out of five sessions; the pre-defined feasibility criterion was 70%. Secondary endpoints included measures of grief, depression, anxiety, self-compassion, and resilience.

RESULTS

The program was conducted in three courses with 18, 26, and 16 participants, respectively. The primary endpoint was met for 83.1% of participants (54/65). Cohen's d effect sizes ([95% CI] 12 weeks vs. baseline) for grief, depression, anxiety, self-compassion, and resilience were - 0.25 [-0.52, 0.03], -0.64 [-0.94, -0.34], -0.48 [-0.77, -0.19], 0.50 [0.21, 0.79], and - 0.07 [-0.34, 0.21], respectively.

CONCLUSIONS

Online group psychotherapy focused on self-compassion for individuals with bereavement-related grief is feasible and effective for addressing grief and psychological distress. Randomized controlled trials are warranted to confirm the intervention's efficacy.

TRIAL REGISTRATION NUMBER

UMIN000048554, registered 2 August 2022.

Psychological sequelae following second-trimester termination of pregnancy: A longitudinal study

INTRODUCTION

The decision to terminate a pregnancy due to fetal anomalies can have a significant emotional impact, especially in second-trimester terminations. Previous studies on the psychological consequences of pregnancy termination have had limitations, and little is known about the outcomes for partners and the impact of fetal donation. Therefore, we aimed to investigate the psychological effects of second-trimester pregnancy termination and identify factors associated with outcomes in both women and men, including donation of fetal remains to science.

MATERIAL AND METHODS

A longitudinal cohort study was conducted at the Amsterdam UMC in the Netherlands, involving women and partners who underwent termination at or before 23 weeks and 6 days of gestation. Questionnaires were administered at termination, 6 weeks, and 4 months after. We utilized validated questionnaires to assess psychological morbidity (grief, post-traumatic stress and postnatal depression and quality of life [QoL]), and factors that could potentially influence outcomes.

RESULTS

Of 241 participants, women displayed more pronounced psychological distress than men, though both groups improved over time. Four months after termination, 27.4% of women and 9.1% of men showed signs of pathological grief. Scores indicative for postnatal depression occurred in 19.8% women and 4.1% of men. A prior psychiatric history was a consistent predictor of poorer outcomes. Fetal donation to the Dutch Fetal Biobank was associated with reduced likelihood of symptoms of complicated grief four months after termination.

CONCLUSIONS

Second-trimester termination of pregnancy for fetal anomalies can lead to psychological morbidity, particularly in women. However, there is a notable improvement over time for both groups. Individuals with prior psychiatric history appear more vulnerable post-termination. Also, fetal donation to science did not have a negative impact on psychological well-being.

Psychometric Evaluation of the Traumatic Grief Inventory-Self Report Plus (TGI-SR+) in Chinese Bereaved People

OBJECTIVE

The Traumatic Grief Inventory-Self Report Plus (TGI-SR+) measures the most recent prolonged grief disorder (PGD) symptom sets defined in the 11th edition of the International Statistical of Diseases and Related Health Problems (ICD-11) and the text revision of the fifth edition of the Diagnostical and Statistical Manual of Mental Disorders (DSM-5-TR). However, the TGI-SR+ has not yet been translated and validated in Chinese. This study aims to evaluate the psychometric properties of the Chinese translation of the TGI-SR+.

METHODS

We examined the Chinese TGI-SR+'s factor structure, internal consistency, convergent validity, discriminant validity, known-groups validity, and optimal clinical cut-off scores in 443 Chinese bereaved adults.

RESULTS

Confirmatory factor analyses showed that the two-factor models showed the best fit for the Chinese TGI-SR+ items assessing ICD-11 and DSM-5-TR prolonged grief symptoms. Items assessing ICD-11 and DSM-5-TR prolonged grief symptoms demonstrated good internal consistency. Associations of TGI-SR+ scores with symptom levels of prolonged grief (assessed by the International Prolonged Grief Disorder Scale), posttraumatic stress, anxiety, and depression supported convergent and discriminant validity. Associations with background/loss-related variables provided evidence for known-groups validity. Cut-off points for probable ICD-11 PGD (liberal scoring rule), probable ICD-11 PGD (conservative scoring rule), and probable DSM-5-TR PGD were ≥67, ≥75, and ≥68, respectively.

DISCUSSION

The Chinese TGI-SR+ appears to be a reliable and valid measure to assess prolonged grief symptoms per ICD-11 and DSM-5-TR among Chinese bereaved adults.

Maladaptive Personality Characteristics, Coping and Situational Factors Predict Symptoms of Complicated Grief and Health Difficulties

Grief responses range from minimal changes in functioning to debilitating, prolonged, complicated grief. The objective of the current study was to clarify the relationship between maladaptive personality characteristics, coping and situational factors associated with symptoms of complicated grief and health difficulties among bereaved individuals who had lost a loved one within the past six months to two years (N = 304; 59% male; M age = 33.49, SD = 9.98, range 20-81). Situational risk factors, coping (self-distancing, denial, substance use, positive reframing, acceptance, religion, self-blame, behavioral disengagement, venting and humor) and maladaptive personality traits significantly predicted either symptoms of complicated grief or health difficulties. Coping strategies partially mediated the relationship between maladaptive personality traits and symptoms of complicated grief and health difficulties. Overall, these findings highlight the importance of maladaptive personality traits and coping strategies in the conceptualization of complicated grief and should be a greater focus of clinical intervention.