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Snaman JM, Chen L, Mazzola E, Helton G, Feifer D, Broden E, McCarthy S, Rosenberg AR, Baker JN, Wolfe J. Family characteristics and childcare patterns associated with early social functioning in cancer-bereaved parents. Cancer 2024; 130:2822-2833. [PMID: 38620040 DOI: 10.1002/cncr.35325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/20/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Bereaved parents experience life-long grief after the death of their child from cancer. Parents who can integrate their grief and maintain their social functioning early in bereavement, even in the setting of concurrent psychosocial distress, have improved outcomes. Identifying the factors associated with bereaved parents' early social functioning can guide future supportive interventions. METHODS The authors surveyed parents of children who died from cancer at two large centers 6-24 months after death, assessing bereavement experiences using validated and pilot tested tools. Univariable and multivariable logistical regression models were used to examine which family and child demographic, treatment, and end-of-life (EOL) factors were associated with maintained parental social functioning (T scores ≥40 on the Patient-Reported Outcomes Measurement Information System Ability to Participate in Social Roles and Activities-Short Form questionnaire). RESULTS One hundred twenty-eight parents of 88 children participated (38% household response rate); most parents identified as female (63%) and White (88%). Parents' median age was 47 years (interquartile range, 10 years); and the median time from the child's death to survey completion was 13 months (interquartile range, 10 months). In multivariate modeling, parents without household material hardship and those who felt prepared for EOL circumstances had increased odds of maintained social functioning (odds ratio, 4.7 [95% confidence interval, 1.6-13.7; p < .004] and 5.5 [95% confidence interval, 1.9-15.9; p < .002], respectively). CONCLUSIONS Parents who felt prepared for their child's EOL and those without household material hardship were more likely to have maintained social functioning in the first 2 years after their child's death. Interventions targeting EOL preparedness and alleviating household material hardship may improve bereavement outcomes.
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Affiliation(s)
- Jennifer M Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Li Chen
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Emanuele Mazzola
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Gabrielle Helton
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Doctor of Medicine Program, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Deborah Feifer
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elizabeth Broden
- School of Medicine, Yale University, New Haven, Connecticut, USA
- School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Sarah McCarthy
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
- Division of Quality of Life and Pediatric Palliative Care, Stanford School of Medicine and Stanford Medicine Children's Health, Palo Alto, California, USA
| | - Joanne Wolfe
- Massachusetts General Hospital for Children, Boston, Massachusetts, USA
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Kotwal AA, Cenzer I, Hunt LJ, Ankuda C, Torres JM, Smith AK, Aldridge M, Harrison KL. Psychosocial distress among spouses of persons with dementia before and after their partner's death. J Am Geriatr Soc 2024; 72:2336-2346. [PMID: 38822746 PMCID: PMC11323186 DOI: 10.1111/jgs.19030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/12/2024] [Accepted: 05/04/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Spouses of persons living with dementia may face heightened psychosocial distress in the years immediately before and after their partner's death. We compared the psychosocial needs of spouses of partners with dementia with spouses of partners with non-impaired cognition nearing and after the end of life, focusing on loneliness, depression, life satisfaction, and social isolation. METHODS We used nationally representative Health and Retirement Study married couples data (2006-2018), restricting to spouses 50+ years old. We included 2098 spouses with data on loneliness and depressive symptoms 2 years before and after the partner's death. We additionally examined a subset of spouses (N = 1113) with available data on life satisfaction and social isolation 2 years before their partner's death. Cognitive status of partners was classified as non-impaired cognition, cognitive impairment not dementia (cognitive impairment), and dementia. We used multivariable logistic regression to determine: 1) the change in loneliness and depression for spouses pre- and post-partner's death, and 2) life satisfaction and social isolation 2 years before the partner's death. RESULTS Spouses were on average 73 years old (SD: 10), 66% women, 7% Black, 7% Hispanic non-White, 24% married to persons with cognitive impairment, and 19% married to partners with dementia. Before their partner's death, spouses married to partners with dementia experienced more loneliness (non-impaired cognition: 8%, cognitive impairment: 16%, dementia: 21%, p-value = 0.002) and depressive symptoms (non-impaired cognition: 20%, cognitive impairment: 27%, dementia: 31%, p-value < 0.001), and after death a similar prevalence of loneliness and depression across cognitive status. Before their partner's death, spouses of partners with dementia reported less life satisfaction (non-impaired cognition: 74%, cognitive impairment: 68%; dementia: 64%, p-value = 0.02) but were not more socially isolated. CONCLUSION Results emphasize a need for clinical and policy approaches to expand support for the psychosocial needs of spouses of partners with dementia in the years before their partner's death rather than only bereavement.
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Affiliation(s)
- Ashwin A Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Irena Cenzer
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Lauren J Hunt
- Department of Physiological Nursing, University of California San Francisco, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Claire Ankuda
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Jacqueline M Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Melissa Aldridge
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Krista L Harrison
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
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Szanto K, Prigerson HG, Stahl ST. Is Social Connection the Solution for Reducing Widower Suicide in Late Life? Am J Geriatr Psychiatry 2024; 32:832-834. [PMID: 38448306 DOI: 10.1016/j.jagp.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Katalin Szanto
- Department of Psychiatry (KS, STS), University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Life Care, Department of Radiology, Department of Medicine (HGP), Weill Cornell Medicine, NYC, NY
| | - Sarah T Stahl
- Department of Psychiatry (KS, STS), University of Pittsburgh School of Medicine, Pittsburgh, PA
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4
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Xu X, Skritskaya NA, Zhou N, Wen J, Shi G, Shear MK. A case report to understand the use of an evidence-based approach of prolonged grief therapy in Chinese culture. DEATH STUDIES 2024:1-10. [PMID: 38758643 DOI: 10.1080/07481187.2024.2355228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Prolonged grief disorder (PGD) is a new diagnosis that may cause significant functional impairment. Prolonged grief therapy (PGT) is a manualized 16-session intervention, whose efficacy has been demonstrated in studies primarily from Western cultures. The current report aimed to present a case to illustrate the use of PGT in Chinese culture. The client was a bereaved adult suffering from PGD after the death of her mother ten years ago. Additionally, she lost her father three months ago. Questionnaires were completed before and after treatment. In-depth interview was conducted at a 3-month follow-up. The client's scores for grief, functional impairment, grief-related beliefs and avoidance, depression and insomnia all decreased substantially after treatment. The follow-up feedbacks indicated that the beneficial effects of PGT persisted in the client's life. This case report provides preliminary evidence that bereaved people in China could benefit greatly from PGT, with minimal cultural adaptation.
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Affiliation(s)
- Xin Xu
- Department of Psychology, School of Education, Soochow University, Suzhou, China
| | - Natalia A Skritskaya
- Center for Prolonged Grief, Columbia School of Social Work, New York, New York, USA
| | - Ningning Zhou
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Jun Wen
- Division of Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Guangyuan Shi
- Center for psychological development, Tsinghua University, Beijing, China
| | - M Katherine Shear
- Center for Prolonged Grief, Columbia School of Social Work, New York, New York, USA
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5
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Prigerson HG, Singer J, Killikelly C. Prolonged Grief Disorder: Addressing Misconceptions With Evidence. Am J Geriatr Psychiatry 2024; 32:527-534. [PMID: 38001019 DOI: 10.1016/j.jagp.2023.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023]
Abstract
There are many misconceptions about Prolonged Grief Disorder (PGD). We show with data that PGD is a diagnosis that applies to a rare few of mourners who are at risk of significant distress and dysfunction. Those mourners who meet criteria for PGD have been shown to benefit from specialized, targeted treatment for it. The case against PGD is empirically unsubstantiated, and the need for scientific examination of effective treatments is warranted.
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Affiliation(s)
| | - Jonathan Singer
- Department of Psychological Science (JS), Texas Tech University, Lubbock, TX; Fred Hutchinson Cancer Center (JS), Seattle, WA
| | - Clare Killikelly
- Department of Psychology, Psychopathology and Clinical Intervention (CK), University of Zurich, Zurich, Switzerland
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6
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Hansen KL, Guldin MB, Fosgerau CF. Grief participation rights and the social support hierarchy: Exploring the communicative role of the bereaved in a social support interaction. DEATH STUDIES 2024; 48:465-477. [PMID: 37471460 DOI: 10.1080/07481187.2023.2235582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
This article explores how bereaved individuals co-construct social support and social norms in the social interaction of 14 bereavement group meetings in Denmark. To study this, we used a discourse analytical approach focusing on how the participants position their social supporters. The results show that the participants designate, uphold, and presuppose two hierarchical positions to bereaved and non-bereaved supporters with different abilities to understand them. Based on this finding, the concepts of "grief participation rights" and "social support hierarchy" are proposed to supplement existing notions of "rights to grieve" and "grief hierarchy." These concepts suggest that non-bereaved supporters are not accorded the same participatory rights in social support conversations as bereaved individuals who have suffered a similar loss as the speaker. The concepts are discussed in relation to effective social support and in the context of research on social disconnection in grief.
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Affiliation(s)
- Kathrine Lund Hansen
- Department of Nordic Studies and Linguistics, Copenhagen University, Copenhagen, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
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7
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Driggers A, Kennedy RE, Williams BR, Brown CJ, Buys DR. Changes in Life-Space Mobility With Loss of Relatives and Friends Among Older Adults: Results From the UAB Study of Aging. THE GERONTOLOGIST 2024; 64:gnad116. [PMID: 37638853 PMCID: PMC10943496 DOI: 10.1093/geront/gnad116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Increasing age brings a greater risk of death of friends and family (hereafter referred to as loss) potentially impacting individuals' life-space mobility (LSM) trajectory. RESEARCH DESIGN AND METHODS Using the UAB study of aging, we examined differences in LSM trajectories of 1,000 community-dwelling older Alabamians (65 + years) with and without loss over 8.5 years. We measured LSM using UAB's Life-Space Assessment (LSA), a validated instrument assessing movement through zones ranging from their bedroom to out of town. We assessed loss every 6 months using a standard bereavement questionnaire capturing spousal, other relative, or friend loss. We used piecewise linear mixed-effects models to compare LSA trajectories. RESULTS At baseline, those who later experienced loss, compared with those who did not were younger, more likely to be female, and overall in better health. Those without loss had a baseline mean LSA score of 49.5 and a decline of 0.08 points per year (p < .001). Those with loss had a baseline LSA score of 60 and declined by 1.0 point per year before loss (p < .001), accelerating to 1.8 points per year after loss (p < .001). DISCUSSION AND IMPLICATIONS Those with loss do not experience acute decline postloss but do have an acceleration of the preexisting decline. Although additional research may explain the impact of loss on LSM; this finding suggests that more interventions such as social, mental, or health care services, may be needed for those who experience loss. Specifically, bereaved individuals may benefit from it.
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Affiliation(s)
- Amelia Driggers
- Department of Agricultural and Biological Engineering, Mississippi State University, Starkville, Mississippi, USA
| | - Richard E Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Beverly Rosa Williams
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cynthia J Brown
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - David R Buys
- Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Starkville, Mississippi, USA
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8
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Ng YH, Jiao K, Suen MHP, Wang J, Chow AYM. The role of the social environment on dementia caregivers' pre-death grief: A mixed- methods systematic review. DEATH STUDIES 2024:1-20. [PMID: 38497324 DOI: 10.1080/07481187.2024.2329755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This systematic review examined the role of social environment in pre-death grief experiences of dementia caregivers. Ninety-three Chinese and English articles were included from a comprehensive search of empirical studies using nine databases. Six social environment domains were generated: the person with dementia, dyadic relationship, family members and the wider community, health and social care services, place of care, and social-cultural contexts. A complex interplay between caregivers and their social environments that aggravate and attenuate pre-death grief experiences is evident. Research has focused mainly on the effects of people with dementia and dyadic relationships and has paid modest attention to the effects of family, relatives, and health and social care services. Caregivers' experiences with their friends, fellow caregivers, the wider community, and social-cultural norms are influential but understudied. Future research could adopt a systems thinking approach with sociological perspectives to generate a comprehensive and nuanced understanding of pre-death grief experiences.
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Affiliation(s)
- Yong Hao Ng
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Keyuan Jiao
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Margaret H P Suen
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Juan Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Amy Y M Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Wanza C, Rief W, Doering BK. The Inventory of Social Expectations in Bereavement: Development and psychometric validation of a new instrument. DEATH STUDIES 2024:1-11. [PMID: 38424671 DOI: 10.1080/07481187.2024.2318592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Negative expectations concerning social interactions contribute to feelings of loneliness. Since loneliness is one of the most pronounced challenges for bereaved individuals, we investigated grief-specific social expectations and its association with loneliness and grief severity. Initially, we developed an Inventory of Social Expectations in Bereavement (ISEB). Its factorial and psychometric validity was then tested in a bereaved sample (N = 344; 28.3 ± 11.1 years; 74.4% female). A two-factor solution for the scale fit the data best (factor 1: "relationship to others," factor 2: "relationship to the deceased") and demonstrated good psychometric validity. Higher ISEB-levels were associated with higher levels in grief severity and loneliness. The results suggest that individual social expectations affect the experience of loneliness after the loss of a significant other. The ISEB assesses these expectations time-efficiently and provides a basis for therapeutic interventions. Expressing expectations as probabilistic beliefs about the future renders them amenable for corrective experiences in clinical practice.
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Affiliation(s)
- Caroline Wanza
- Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Winfried Rief
- Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
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10
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Snaman JM, Mazzola E, Helton G, Feifer D, Morris SE, Clark L, Baker JN, Wolfe J. Early Bereavement Psychosocial Outcomes in Parents of Children Who Died of Cancer With a Focus on Social Functioning. JCO Oncol Pract 2023; 19:e527-e541. [PMID: 36724414 DOI: 10.1200/op.22.00538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The early grief experience of parents of children who died of cancer remains understudied. Understanding psychosocial symptomology and functioning of parents early in their bereavement is essential to developing supportive interventions aimed at offsetting poor mental and physical outcomes. METHODS Parents of children from two centers who died of cancer 6 to 24 months before were mailed a survey that included validated tools and additional Likert scale-based questions. We used correlation and univariate and multiple regression analyses to assess the associations between psychosocial and grief outcomes and parental social functioning. RESULTS One hundred twenty-five parents representing 88 children completed the survey. Most respondents identified as female (63%), White (84%), and non-Hispanic (91%). The mean time since child's death was 14.7 (range, 8-26) months. Bereaved parents' mean score for social functioning was only slightly below normative values, and most parents indicated post-traumatic growth and adaptive coping. Parents had high symptom levels for depression, anxiety, post-traumatic stress, and prolonged grief, with those identifying as female having significantly higher symptom scores. Using multivariate analysis, parental scores for resilience and continuing bonds were associated with higher social functioning scores and parental scores for depressive symptoms and prolonged grief were associated with lower social functioning scores. CONCLUSION Although bereaved parents exhibit resilience and positive coping, they also show high levels of psychosocial distress in the first 2 years after their child's death, which may reflect the typical parental bereavement experience. Screening for low parental social functioning may identify parents who would benefit from additional support early in bereavement.
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Affiliation(s)
- Jennifer M Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.,Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Emanuele Mazzola
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - Gabrielle Helton
- Doctor of Medicine Program, University of Colorado School of Medicine, Aurora, CO
| | - Deborah Feifer
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Sue E Morris
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.,Department of Psychiatry, Boston Children's Hospital and Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Lisa Clark
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.,Department of Pediatrics, Boston Children's Hospital, Boston, MA
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11
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Zou X, Xu X, Tang R, Jiao K, Qian W, Shen X, Wang J. Potential risk factors for acute grief during the COVID-19 pandemic: The mediating role of avoidance processes. Clin Psychol Psychother 2022; 30:202-212. [PMID: 36303248 PMCID: PMC9874740 DOI: 10.1002/cpp.2794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 02/03/2023]
Abstract
Bereavement during the COVID-19 pandemic may have some unique characteristics that become potential risk factors (e.g., absence of grief rituals, no opportunity to say goodbye to the deceased and loneliness caused by social distancing) for acute grief. Avoidance processes could be significant mediators in the context of the pandemic. The current study aimed to investigate whether and how these COVID-19-related risk factors were related to acute grief severity. Bereaved adults (n = 319) who lost significant others during the COVID-19 pandemic completed a self-report questionnaire package measuring COVID-19-related factors, grief severity and depressive and anxious avoidance. Regression analyses suggested that among the three potential risk factors (loneliness, grief rituals and opportunity to say goodbye), loneliness was significantly associated with acute grief after controlling for basic demographic and loss-related information. Structural equation models suggested that depressive avoidance and anxious avoidance partially mediated the associations of loneliness with acute grief severity. The findings indicate that dealing with loss during the COVID-19 pandemic warrants further exploration concerning how potential environmental risk factors may impede adaptation to loss. Depressive and anxious avoidance processes may play important roles in grief interventions for isolated and lonely bereaved people.
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Affiliation(s)
- Xinyan Zou
- Faculty of PsychologyBeijing Normal UniversityBeijingChina,Mental Health Education and Counselling CenterUniversity of Science and Technology of ChinaHefeiChina
| | - Xin Xu
- Faculty of PsychologyBeijing Normal UniversityBeijingChina
| | - Renzhihui Tang
- Faculty of PsychologyBeijing Normal UniversityBeijingChina
| | - Keyuan Jiao
- Department of Social Work and Social AdministrationUniversity of Hong KongHong Kong
| | - Wenli Qian
- Faculty of PsychologyBeijing Normal UniversityBeijingChina
| | - Xinlan Shen
- Faculty of PsychologyBeijing Normal UniversityBeijingChina
| | - Jianping Wang
- Faculty of PsychologyBeijing Normal UniversityBeijingChina
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12
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Falzarano F, Winoker H, Burke RV, Mendoza JA, Munoz F, Tergas A, Maciejewski PK, Prigerson HG. Grief and Bereavement in the Latino/a Community: A Literature Synthesis and Directions for Future Research. Health Equity 2022; 6:696-707. [PMID: 36225662 PMCID: PMC9536343 DOI: 10.1089/heq.2022.0031] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Bereavement and grief are social phenomena influenced by a multitude of cultural factors. Prior studies of bereavement adjustment have primarily focused on bereaved survivors who identify racially as white; knowledge of the experience of grief and bereavement among racial/ethnic and other minority groups, particularly among Latino/a groups, in the United States is limited. Objective The purpose of this review is to synthesize the literature documenting the bereavement experiences of the Latino/a community, evaluate the strength of the current evidence, and provide recommendations to guide future research. Method A narrative review of research on grief and bereavement in the Latino/a community published between 1990 and 2021. Two authors used a thematic, deductive approach to categorize emergent prevalent themes from the literature and used The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and The Oxford Center for Evidence-Based Medicine-Evidence Quality Rating Scale (OCEBM) approaches to evaluate the strength of the qualitative and quantitative reports reviewed. Results Searches revealed 26 reports that were categorized into six themes: cultural values, mourning rituals, immigration, spirituality, disparities related to the COVID-19 pandemic, and the effects of COVID-19 on Latino/a communities. Our evaluation concludes that the evidence in this area is weak, with limited methodologically rigorous research examining the influence of culture on bereavement among Latino/a groups. Conclusion Research is needed to identify Latino/a groups' mental health, cultural, social, and family needs and how fulfillment of mourning rituals and other cultural factors may promote or impede bereavement adjustment. Investigation into factors that may protect bereaved survivors against adverse mental health outcomes is also needed. A better understanding of Latino/a grief and bereavement is a step toward the development of culturally competent interventions designed to promote the mental health and psychosocial adjustment of Latino/a mourners.
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Affiliation(s)
- Francesca Falzarano
- Center for Research on End-of-Life Care, Division of Geriatrics & Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Hillary Winoker
- Center for Research on End-of-Life Care, Division of Geriatrics & Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | | | | | | | - Paul K. Maciejewski
- Center for Research on End-of-Life Care, Division of Geriatrics & Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Holly G. Prigerson
- Center for Research on End-of-Life Care, Division of Geriatrics & Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
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13
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Harrison O, Windmann S, Rosner R, Steil R. Interpersonal problems and cooperative behavior in patients suffering from prolonged grief disorder as compared to bereaved healthy controls. J Clin Psychol 2022; 78:1912-1924. [PMID: 35247273 DOI: 10.1002/jclp.23340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/07/2021] [Accepted: 02/12/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Interpersonal factors, such as impairments in social interaction or lack of social support, have an important share when it comes to the development, maintenance, and progression of various mental disorders. METHODS Individuals suffering from prolonged grief disorder (PGD) and matched bereaved healthy controls (n = 54) underwent a thorough diagnostic procedure, further completed the Inventory of Interpersonal Problems (IIP-D-32), and participated in a finitely iterated prisoner's dilemma (FIPD). RESULTS Individuals suffering from PGD reported significantly more interpersonal problems. Both groups behaved differently in the FIPD with healthy controls being more carefully, adapting their behavior more flexible, whereas PGD patients displayed a lower responsiveness, which may indicate an inability to adapt to changes in relationships. CONCLUSION We conclude that interpersonal problems appear to be a relevant feature of PGD. Future studies need to clarify the causal relation behind this link, and should also include measures of attachment, social support, and disconnectedness.
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Affiliation(s)
- Octavia Harrison
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Sabine Windmann
- Department of Cognitive Psychology II, Goethe University Frankfurt, Frankfurt, Germany
| | - Rita Rosner
- Department of Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Bavaria, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany.,Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Gießen, Germany
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14
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Attachment and grief in young adults after the loss of a close friend: a qualitative study. BMC Psychol 2022; 10:10. [PMID: 35033193 PMCID: PMC8760658 DOI: 10.1186/s40359-022-00717-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background Although many lose a close friend each year, they are seldom the focus of grief research. However, these losses often cause severe and long-lasting reactions. Deaths among adolescents and young adults are also often caused by traumatic events, e.g. from accidents, suicides, and homicides, placing them at significant risk for complicated grief reactions. The focus of this paper is bereaved friends after the shootings at Utøya, Norway in 2011, which is among a few studies that focus on bereaved friends, exploring how attachment affects the grief process after the loss of a close friend. Methods This paper explores qualitative data from in-depth interviews with thirteen bereaved friends, conducted about 28 months after the loss. The interview sample consisted of eight females and five males, aged 18–31 years. The interviews were semi-structured, with a theme guide of 14 questions, and the method used for analyses was systematic text condensation. Results Two main themes were identified from the analyses of the interviews: Friendship and Grief, with the subordinate themes: The importance of the friendship, Longing and remembrance, How the loss has affected other relationships, How the loss has affected the friend’s daily lives, Processing of the grief and Not being family. For most of the bereaved friends the loss and the grief had a profound effect on them and their overall lives, from daily functioning in school or at work, to changes in attitudes, and the way they were met as bereaved. Conclusions The support, intimacy, and feelings of togetherness we share with our friends are of great importance and value for all people, but maybe especially for young people. When adolescents and young adults experience losses, their reactions are often intense and long-lasting, and especially complicated grief reactions can affect school performance and concentration, health, result in emotional problems; and disrupt development (e.g. identity formation and social skills). We don’t know much about the grief of bereaved friends and how their reactions can be explained. Thus, we hope that these findings could shed light on their grief reactions, and provide new knowledge on the short- and long-term psychological impact of losses of friends.
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Zhou N, Sun Y, She Z, Xu X, Peng Y, Liu X, Xi J. Grief and growth among Chinese parents who lost their only child: the role of positive and negative experiences of social support from different sources. Eur J Psychotraumatol 2022; 13:2079874. [PMID: 35695884 PMCID: PMC9176330 DOI: 10.1080/20008198.2022.2079874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In China, bereaved parents who have lost their only child are known as Shidu parents, and they tend to present high levels of prolonged grief reactions. To date, a widespread focus has been placed on positive social support, while potential negative experiences have been relatively neglected. Additionally, the role of social support from different sources (i.e. close family members [partner, siblings, grandchildren], peers, and others [relatives, friends, colleagues]) has not been examined thoroughly. OBJECTIVE The present study investigated whether social support from different sources has a differential impact on postloss adaptation (i.e. prolonged grief and growth). The loss-orientated and restoration-orientated coping strategies of the dual process model were also tested for their mediating roles. METHODS A total of 277 Chinese Shidu parents were recruited to complete a series of questionnaires including social support from different sources, prolonged grief symptoms, posttraumatic growth, and dual process coping strategies. Correlation analyses, paired sample t tests and structural equation modelling were conducted. RESULTS More positive support were related to less prolonged grief symptoms and more posttraumatic growth, while more negative support was only related to more prolonged grief. Positive support from close family members and others was significantly related to prolonged grief/growth, and negative support from these sources was significantly positively associated with prolonged grief. Positive or negative support from people who shared a similar experience was unrelated to prolonged grief/growth. Positive and negative support were related to prolonged grief and growth through loss-oriented coping strategies. CONCLUSION Overall, the present study indicated that positive and negative support experiences from different sources functioned differently in the recovery of Chinese Shidu parents and that loss-oriented coping played a mediating role. These findings highlight the importance of differentiating social support by traits in coping with grief and the crucial mediating role of loss-oriented coping. HIGHLIGHTS More positive support correlated with less prolonged grief and more growth, while more negative support correlated with more prolonged grief.Support from family members and friends was more potent than that from peers.Social Support correlated with prolonged grief/growth through loss-oriented coping.
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Affiliation(s)
- Ningning Zhou
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, People's Republic of China.,Shanghai Changning Mental Health Center, Shanghai, People's Republic of China
| | - Yue Sun
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, People's Republic of China.,Shanghai Changning Mental Health Center, Shanghai, People's Republic of China
| | - Zhuang She
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, People's Republic of China.,Shanghai Changning Mental Health Center, Shanghai, People's Republic of China
| | - Xin Xu
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, People's Republic of China
| | - Yanan Peng
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, People's Republic of China.,Shanghai Changning Mental Health Center, Shanghai, People's Republic of China
| | - Xinyang Liu
- Shanghai Key Laboratory of Brain Functional Genomics (Ministry of Education), School of Psychology and Cognitive Science, East China Normal University, Shanghai, People's Republic of China
| | - Juzhe Xi
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, People's Republic of China.,Shanghai Changning Mental Health Center, Shanghai, People's Republic of China
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