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Abstract
This study examined the relationship between having an opportunity to say goodbye to a dying family member or friend in person or virtually, as well as attending their funeral services in person or virtually, and the bereaved individuals' psychological distress and complicated grief during the COVID-19 pandemic. Five hundred and nineteen US adults who had lost a family member or a friend between January 2020 and June 2021 completed an online survey for this study. Only a small proportion of participants were able to say goodbye to their dying family member or friend in person, and saying goodbye virtually was associated with higher levels of complicated grief and psychological distress. Those who physically attended a formal, in-person funeral or memorial service reported lower levels of psychological distress. The findings suggest a complicated process of saying goodbye in different formats during the pandemic.
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Affiliation(s)
- Cliff Yung-Chi Chen
- Educational and Community Programs, Queens College of the City University of New York, Flushing, NY, USA
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2
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You S, Kim G. Types of bereavement and depressive symptoms among older adults: Does race/ethnicity matter? Geriatr Gerontol Int 2024; 24 Suppl 1:266-272. [PMID: 38317574 DOI: 10.1111/ggi.14817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/26/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024]
Abstract
AIM To explore racial/ethnic differences in relation between types of bereavement and depressive symptoms among older adults in the USA. METHODS The sample limited to racially/ethnically diverse adults aged ≥55 (n = 879) was drawn from the third wave of the National Social Life, Health, and Aging Project (NSHAP). The NSHAP provides self-identified racial/ethnic categories (non-Hispanic Whites, Blacks, and Hispanics) of respondents who were categorized into three groups by experience of bereavement: non-loss, spousal loss, and parental loss. Using the weights, a two-way analysis of covariance with Bonferroni post-test was conducted to explore the main effect of types of loss and race/ethnicity and their interaction effects on depressive symptoms. RESULTS Spousal loss reported higher levels of depressive symptoms than non-loss or parental loss. Based on the interaction between types of loss and race/ethnicity; however, distinctive patterns were observed. Blacks and Hispanics who lose a parent reported significantly higher levels of depressive symptoms than non-Hispanic Whites did. CONCLUSIONS An increase in depressive symptoms after bereavement manifested distinctively based on racial/ethnic background and the relationship with the deceased. This implies that it is necessary to develop coping strategies concerning race/ethnicity and whom they lose. Geriatr Gerontol Int 2024; 24: 266-272.
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Affiliation(s)
- Suha You
- Department of Psychology, Chung-Ang University, Seoul, South Korea
| | - Giyeon Kim
- Department of Psychology, Chung-Ang University, Seoul, South Korea
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3
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Jann P, Neldner S, Neuner F, Mohammed R. Complicated grief and posttraumatic stress after loss and separation under terror conditions. J Trauma Stress 2024; 37:154-165. [PMID: 38009424 DOI: 10.1002/jts.22990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/22/2023] [Accepted: 10/22/2023] [Indexed: 11/28/2023]
Abstract
The lives of people in conflict areas are often characterized by the experience of traumatic events frequently accompanied by loss and separation. These can equally trigger symptoms of posttraumatic stress disorder (PTSD) and complicated grief (CG). The aim of the present study was to investigate whether affected individuals could be assigned to distinct classes at symptom-cluster levels of these two disorders. Moreover, we aimed to identify event-related and sociodemographic predictors associated with membership in these pathological classes. Participants were Iraqi internally displaced persons (IDPs; N = 199) who fled their hometowns due to the ISIS conflict and reported having lost an important person within the past 5 years. Based on the PTSD Checklist for DSM-5 (PCL-5) and Inventory of Complicated Grief (ICG), a latent class analysis (LCA) was applied to examine different classes of symptom clusters. Multinomial logistic regression was used to determine which variables predicted assignment to these symptom classes. The impact of loss and separation among IDPs in Iraq manifested in CG symptoms in more than half of the affected population and was often accompanied by PTSD. LCA identified a low-symptoms class (17.6%), CG class (33.7%), PTSD class (12.1%), and comorbid PTSD+CG class (36.7%). The sudden or violent death of a loved one was identified as a distinguishing factor for PTSD. Furthermore, separation was associated with comorbidity. Aid agencies should take these specific factors into account to improve effective and economic aid delivery to IDPs continuously affected by terror.
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Affiliation(s)
- Philipp Jann
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Sina Neldner
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Rezhna Mohammed
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
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Chami JM, Pooley JA. Widowed Young: The Role of Stressors and Protective Factors for Resilience in Coping with Spousal Loss. OMEGA-JOURNAL OF DEATH AND DYING 2023; 88:477-504. [PMID: 34541943 DOI: 10.1177/00302228211047088] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While distressing, late life spousal loss is considered a normative life event and most demonstrate resilient recovery from grief. However, for 5-7% of the population spousal loss comes early, before the age of 50, and little is known about the factors that influence adjustment in this population. We used the DPM integrative framework to examine correlates and predictors of mental wellbeing and grief intensity in an international sample of 603 young widows and widowers. Contrary to existing bereavement research, loss-orientated stressors (e.g., expectedness and cause of death) did not predict bereavement outcomes. Employment and financial wellbeing were the only statistically significant restoration-orientated stressors associated with coping, mental wellbeing and grief intensity. We found no significant associations between parental status and coping or bereavement outcomes. Loss-orientated coping, followed by inter and intrapersonal protective factors for resilience and financial wellbeing were the greatest predictors of grief intensity. Loss-orientated coping was highest in early bereavement, the greatest predictor of grief intensity and associated with being unemployed, financial insecurity and decreased protective factors for resilience. Restoration-orientated coping was highest in later bereavement, was a weak predictor of grief intensity and associated with being employed, increased financial wellbeing and protective factors for resilience. Overall, we found the young-widowed population is at heightened risk of poor adjustment. Almost two-thirds reported decreased functioning, probable depression with high rates of psychological distress. Nearly half met diagnostic criteria for prolonged grief disorder. We discuss implications for research and clinical practice.
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Affiliation(s)
- Jane Marie Chami
- Department of Psychology and Social Science, Edith Cowan University, Perth, Australia
| | - Julie Ann Pooley
- Department of Psychology and Social Science, Edith Cowan University, Perth, Australia
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Gallardo-Flores A, Morán-Carrillo JM, García-Carmona M. The Detection of Resilience in Families Grieving Over a Suicide. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231219047. [PMID: 38018537 DOI: 10.1177/00302228231219047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
The study, conducted in 2021, describes the relationship between resilience development factors and dimensions and the grief processes of persons affected by the suicide of a family member. The objective was to analyze whether the loved ones of suicide victims had developed resilient behaviors and how these were manifested during the mourning process. To achieve this, two instruments were used: the Brief Resilience Coping Scale (BRCS), and in-depth interviews, in both cases applied to a sample of 21 individuals from whom narratives of their experiences were obtained as elements for analysis. These narratives were operationalized, coded and analyzed according to the theoretical framework advanced by the authors Edith Grotberg and Cecily Knight. The behaviors detected took the form, among others, of artistic expression and/or the provisioning of support services to people affected by suicide, generally through participation in associations and self-help groups dedicated to the care and facilitation of emotional expression resulting from the traumatic event.
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Affiliation(s)
- Ana Gallardo-Flores
- Department of Social Work and Social Services, Pablo de Olavide University, Seville, Spain
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Thieleman K, Cacciatore J, Frances A. Rates of Prolonged Grief Disorder: Considering relationship to the person who died and cause of death. J Affect Disord 2023; 339:832-837. [PMID: 37474009 DOI: 10.1016/j.jad.2023.07.094] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/26/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Prolonged Grief Disorder (PGD) was recently included in DSM-5-TR. The rate of PGD is known to vary according to a number of factors and little is known about how bereaved individuals view the diagnosis. METHODS This cross-sectional study assessed PGD rates using the Prolonged Grief-13-Revised (PG-13-R) among a large sample (n = 1137) of bereaved individuals, considering the relationship to the deceased and cause of death. It also investigated bereaved individuals' attitudes toward the diagnosis. RESULTS Overall, 34.3 % of the sample met PGD criteria. Bereaved parents had the highest rate (41.6 %), followed by bereaved spouses/partners (33.7 %) and siblings (29.4 %). According to cause of death, those bereaved by substance overdose had the highest rate (59.1 %), followed by homicide/suicide (46 %) and accidental (36 %). The majority of respondents (65-95.6 %) viewed their responses, as measured by the PG-13-R items, as normal, and 98.1 % agreed that their responses in general were normal. Fewer than 12 % reported that a PGD diagnosis would be helpful to them. LIMITATIONS This study used a self-selecting, non-representative sample that was predominantly female and white. Findings may or may not apply to more diverse groups and cannot be generalized. This study also used a self-report measure rather than a clinical interview. CONCLUSIONS In line with prior research, this study found higher rates of PGD in specific subgroups, including bereaved parents, spouses, and those who lost loved ones to substance overdose, homicide/suicide, or accidents. Bereaved individuals in this sample generally did not view receiving a diagnosis of PGD as helpful.
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Affiliation(s)
- Kara Thieleman
- REACH Institute, Department of Psychology, Arizona State University, United States of America.
| | - Joanne Cacciatore
- School of Social Work, Arizona State University, United States of America
| | - Allen Frances
- Department of Psychiatry, Duke University, United States of America; DSM-IV Task Force, United States of America
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Thiemann P, Street AN, Heath SE, Quince T, Kuhn I, Barclay S. Prolonged grief disorder prevalence in adults 65 years and over: a systematic review. BMJ Support Palliat Care 2023; 13:e30-e42. [PMID: 33707297 DOI: 10.1136/bmjspcare-2020-002845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/03/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Prolonged grief disorder (PGD) is a recently recognised mental health disorder with an estimated prevalence of 10% in the bereaved adult population. This review aims to appraise and summarise evidence relating to PGD in older adults (≥65 years), a growing population group, most likely to experience bereavement and often assumed to cope well. METHOD Literature from Medline, PsycINFO, CINAHL, Cochrane Library and Web of Science was searched. Epidemiological and non-epidemiological studies including data on frequency of PGD in older adults bereaved by mainly natural causes were included and a descriptive analysis undertaken. RESULTS From 2059 records, three epidemiological and six non-epidemiological studies were included. Most studies had good internal but not external validity. Conditional prevalence for PGD ranged between 3.2% and 48.8%. Heterogeneity in sample characteristics and study methodology contributed to this variability resulting in a descriptive analysis. The prevalence rate of 9.1% by Kersting et al was the best available estimate for PGD in older adults for western countries. The small number of epidemiological studies and the use of varying PGD-constructs which did not match International Classification of Diseases 11th Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria were the main limiting factors. CONCLUSION This first review on PGD prevalence in older adults suggests that, despite studies' methodological short comings, a similar proportion of older adults experience PGD as the general bereaved adult population (1:10). With older adults forming the largest subgroup among the bereaved, health and social care systems need to adapt their provision of care to address the specific needs of older adults.
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Affiliation(s)
- Pia Thiemann
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Anna Naomi Street
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sarah Eleanor Heath
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thelma Quince
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Isla Kuhn
- Medical Library, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Arnout BA. The grief of loss among breast cancer patients during the COVID-19 pandemic: How can palliative care workers help? Work 2022; 74:1299-1308. [PMID: 36565093 DOI: 10.3233/wor-220400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cancer patients suffer from different losses. Studies have focused on examining grief resulting from cancer diagnosis and grief among caregivers of cancer patients and parents who lost their child to cancer. However, there are no studies on the grief resulting from losing a loved one in cancer patients. OBJECTIVE This study examined female breast cancer patients' grief and aimed to reveal how palliative care can help breast cancer who experience the grief of losing a loved one. METHODS The study applied the qualitative case study design conducted with 10 women with breast cancer; their ages ranged from 47 to 54 years. Data were collected during 18 in-depth interviews by asking semi-open-closed questions. RESULTS Thematic analysis found that losing a partner negatively affected breast cancer patients' mental health. The grief experience among breast cancer patients has many symptoms: sadness, severe anxiety, sleep disturbance, loneliness, and isolation. Results also indicated many risk factors that increase grief symptoms among breast cancer patients, such as quarantine procedures during the COVID-19 outbreak, extreme emotional attachment to a partner, guilt, self-blame, and social relations. Patients with breast cancer can face grief experienced by coping strategies such as: resorting to God, prayer, patience, and reading the Holy Qur'an. The results also emphasize the importance of integrating palliative care with treatment for breast cancer patients who experience the grief of loss. CONCLUSION The grief of loss among breast cancer patients is a complex experience. These findings have many applied aspects that benefit planning counseling and psychological programs to increase positive coping strategies for those patients with breast cancer suffering from grief of loss disorder and provide psychological services that protect them from risk factors and reduce grief symptoms which reduce the effectiveness of cancer treatments due to the symptoms of traumatic loss of a partner. These findings also emphasize the importance of palliative care for cancer patients with complex distress.
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Affiliation(s)
- Boshra A Arnout
- Department of Psychology, King Khalid University, Abha, Saudi Arabia.,Department of Psychology, Zagazig University, Zagazig, Egypt
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Cynkier P. Problemy psychiczne po śmierci osoby bliskiej jako przedmiot ekspertyzy sądowej. ARCHIVES OF FORENSIC MEDICINE AND CRIMINOLOGY 2022. [DOI: 10.4467/16891716amsik.21.007.15617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Wśród różnych form przeżywania śmierci osoby bliskiej wymienia się żałobę, jej powikłaną postać a także współwystępujące z nią zaburzenia psychiczne (najczęściej zespoły lękowe, depresja, uzależnienie od substancji psychoaktywnych, zespół stresu pourazowego). Omówiono przypadek, w którym rodzice wystąpili do sądu o odszkodowanie i zadośćuczynienie za śmierć syna, który zginął na skutek obrażeń doznanych w wypadku drogowym. U powoda po śmierci syna wystąpiła reakcja żałoby, a u powódki stan żałoby powikłanej, z którym współwystępowały objawy depresyjne. Odmienne obrazy kliniczne u każdego z powodów były uwarunkowane innymi cechami osobowości, odmiennymi modelami radzenia sobie w sytuacjach trudnych, a także schorzeniami somatycznymi. Doprowadziło to do różnych implikacji orzeczniczych u każdego z badanych. W sprawach odszkodowawczych (śmierć osób bliskich) konieczna jest diagnostyka różnicowa pomiędzy żałobą, jej powikłaną formą a zaburzeniami o charakterze reaktywnym i endogennym. Przydatna jest w tym ocena psychologiczna predyspozycji osobowościowych a także mechanizmów radzenia sobie w sytuacjach obciążających. Niekorzystanie z leczenia psychiatrycznego lub terapii psychologicznej nie może przesądzać o braku zaburzeń psychicznych. W tego rodzaju sprawach opiniowanie wymaga szczególnej ostrożności i wyważonych ocen. Należy unikać nadmiernej medykalizacji przeżyć po stracie osoby bliskiej, ale nie można też traktować stanów psychopatologicznych jedynie w kategoriach fizjologicznej reakcji na śmierć bliskiego.
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Affiliation(s)
- Przemysław Cynkier
- Faculty of Christian Philosophy, Cardinal Stefan Wyszyński University, Warsaw, Poland
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Alves-Costa F, Hamilton-Giachritsis C, Christie H, van Denderen M, Halligan S. Psychological Interventions for Individuals Bereaved by Homicide: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2021; 22:793-803. [PMID: 31640488 DOI: 10.1177/1524838019881716] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Research has demonstrated that approximately 45-50% of individuals show healthy levels of psychological and physical functioning in the first 12 months post-loss. Homicidal bereavement (loss due to murder or manslaughter) does not appear to follow this pattern. Homicide-related mental health difficulties are a serious problem worldwide, displaying high rates of lifetime incidence, high chronicity, and role impairment. Individuals are at increased risk to develop symptoms of post-traumatic stress disorder (PTSD), complicated grief (CG), and depression. Nevertheless, a systematic review specifically on the efficacy of psychological interventions following homicidal loss has not yet been conducted. The current systematic review (registered via PROSPERO) aimed to review the psychological interventions available and report their effectiveness. Of 77 records, 7 met predefined inclusion criteria. Studies presented different methodologies, tested different clinical models, and treatment conditions. Thus, a narrative systematic review was conducted. Studies included manualized interventions to deliver 1:1 and group sessions. Cognitive behavioral therapy, restorative retelling, and eye movement desensitization and reprocessing were the main models used together with psychoeducational elements about trauma and grief responses. Overall, symptoms of PTSD, CG, and depression decreased significantly postintervention. Sustained improvements were reported for PTSD and depressive symptoms at the follow-up measurements. Mixed results were found regarding how individual (age, gender) and external factors (time since loss, relationship with the deceased) impact on symptom progression. As a result of differences in methodologies, categorization of therapies, methodological differences, and small sample sizes, important questions remain unanswered. Further randomized controlled trials and expert consensus could be considered.
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Affiliation(s)
| | | | - Hope Christie
- Department of Psychology, 1555University of Bath, United Kingdom
| | | | - Sarah Halligan
- Department of Psychology, 1555University of Bath, United Kingdom
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Soydas S, Smid GE, Lenferink LIM, Djelantik AAMJ, Goodfellow B, Wilson R, Boelen PA. Psychopathology in a treatment-seeking sample of homicidally bereaved individuals: Latent class analysis. J Affect Disord 2021; 292:234-241. [PMID: 34134021 DOI: 10.1016/j.jad.2021.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Violently bereaved individuals are at increased risk of developing severe and comorbid disorders. Comorbidity may increase psychiatric symptom severity and suicide risk and decrease psychosocial functioning compared with having one disorder. We aimed to identify subgroups of individuals with similar symptom patterns, describe prevalence rates and overall levels of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) per class, and explore associations between class membership and personal and homicide related variables. METHODS We investigated the comorbidity of symptoms of PGD, PTSD, MDD, and GAD in a sample of 923 treatment-seeking homicidally bereaved individuals by deploying latent class analysis. RESULTS Three subgroups were identified: (i) a moderate distress, low depression class (12.4%), (ii) a high distress, moderate depression class (42.7%), and (iii) a high distress and high depression class (45.0%). Prevalence rates and total scores of the questionnaires followed the pattern of iii ≥ ii ≥ i (ps ≤ .001). Being female and having experienced prior life stress distinguished between all classes (ps ≤ .05). LIMITATIONS The data-driven analytic approach and reliance on self-reported routine outcome monitoring data limit the generalizability and validity of the study. Strengths include the large sample size and the inclusion of four measures in a treatment-seeking, violently bereaved sample. CONCLUSIONS Classes were most clearly distinguishable based on symptom severity, indicating high comorbidity following bereavement by homicide. This argues for an integrated treatment that targets different complaints simultaneously rather than successively.
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Affiliation(s)
- Suzan Soydas
- Utrecht University, Department of Clinical Psychology, Utrecht, the Netherlands; ARQ National Psychotrauma Center, Diemen, the Netherlands.
| | - Geert E Smid
- ARQ National Psychotrauma Center, Diemen, the Netherlands; University of Humanistic Studies, Utrecht, the Netherlands
| | - Lonneke I M Lenferink
- Utrecht University, Department of Clinical Psychology, Utrecht, the Netherlands; University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands; University of Twente, Department of Psychology, Health, & Technology, Faculty of Behavioural, Management, and Social Sciences, Enschede, the Netherlands
| | - A A Manik J Djelantik
- University Medical Centre Utrecht, Department of Psychiatry, Utrecht, the Netherlands; Altrecht GGZ, Department Youth - KOOS, Utrecht, the Netherlands
| | | | - Rachel Wilson
- ASSIST Trauma Care, Rugby, the United Kingdom; NHS England, Liverpool, the United Kingdom
| | - Paul A Boelen
- Utrecht University, Department of Clinical Psychology, Utrecht, the Netherlands; ARQ National Psychotrauma Center, Diemen, the Netherlands
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12
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Caycho-Rodríguez T, Vilca LW, Vivanco-Vidal A, Saroli-Araníbar D, Carbajal-León C, Gallegos WLA, White M, Lee SA. Assessment of Dysfunctional Grief due to Death from COVID-19 in Peru: Adaptation and Validation of a Spanish Version of the Pandemic Grief Scale. TRENDS IN PSYCHOLOGY 2021. [PMCID: PMC8279032 DOI: 10.1007/s43076-021-00091-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study evaluated the psychometric properties of the Pandemic Grief Scale (PGS), using Classical Test Theory (CTT) and Item Response Theory (IRT) methods, in a sample of 458 people who have suffered the loss of a loved one due to the COVID-19 pandemic. The Pandemic Grief Scale, Patient Health Questionnaire-2 (PHQ-2), the two-item Generalized Anxiety Disorder Scale (GAD-2), and a single item on suicidal ideation were used. The unidimensional model had good fit and reliability; furthermore, convergent validity was demonstrated based on the relationships between dysfunctional grief, anxiety symptoms, depression, and suicidal ideation. Additionally, a higher presence of dysfunctional grief is required to answer using the higher response categories. The evidence of validity and reliability of the PGS in its Spanish version, using traditional and modern methods, is confirmed in Peru.
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Affiliation(s)
- Tomás Caycho-Rodríguez
- Facultad de Ciencias de La Salud, Universidad Privada del Norte, Av. Alfredo Mendiola 6062, Los Olivos, Lima, Perú
| | - Lindsey W. Vilca
- Departamento de Psicología, Universidad Peruana Unión, Lima, Perú
| | | | | | - Carlos Carbajal-León
- Facultad de Ciencias de La Salud, Universidad Privada del Norte, Av. Alfredo Mendiola 6062, Los Olivos, Lima, Perú
| | | | - Michael White
- Dirección General de Investigación, Universidad Peruana Unión, Lima, Perú
| | - Sherman A. Lee
- Department of Psychology, Christopher Newport University, Newport News, VA USA
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Kustanti CY, Chu H, Kang XL, Liu D, Pien LC, Jen HJ, Shen STH, Chen JH, Chou KR. Evaluation of the performance of instruments to diagnose grief disorders: A diagnostic meta-analysis. Int J Nurs Stud 2021; 120:103972. [PMID: 34098452 DOI: 10.1016/j.ijnurstu.2021.103972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/26/2021] [Accepted: 04/27/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Prolonged or complicated grief disorder occurs in 9.8% of bereaved adults and can progress into adverse health effects if left unresolved. Evidence on the appropriate and specific diagnostic instrument for the assessment of prolonged or complicated grief disorders is lacking. OBJECTIVE The purpose of this study was to evaluate the performance of the most widely used instruments to diagnose grief disorders, including The Inventory of Complicated Grief, The Inventory of Complicated Grief - Revised, and the Prolonged Grief Disorder-13. DESIGN Diagnostic meta-analysis. DATA SOURCES PubMed, EMBASE, CINAHL, Medline, Scopus, Web of Science, and Cochrane were searched up to July 1, 2020. METHODS We included studies evaluating the sensitivity and specificity of grief disorders diagnostic tools against the comparator tests in individuals who experienced the loss of a family member. A diagnostic meta-analysis of pooled sensitivity and specificity, likelihood ratios, and area under curve were performed with a random-effect and hierarchical model. RESULTS In the current study, 3540 participants were involved. The six studies of the Inventory of Complicated Grief had pooled sensitivity of 0.93 (95% confidence interval: 0.87 to 0.97) and specificity of 0.96 (95% confidence interval: 0.92 to 0.98). The positive likelihood ratio was 23.4 (95% confidence interval: 11.2 to 49.0) and the negative likelihood ratio was 0.07 (95% confidence interval: 0.04 to 0.14) with area under curve value at 0.96 (95% confidence interval: 0.97 to 0.99). For Prolonged Grief Disorder-13, the three included studies' pooled sensitivity was 0.51 (95% confidence interval: 0.42 to 0.60), and the pooled specificity was 0.96 (95% confidence interval: 0.93 to 0.98). The Inventory of Complicated Grief-Revised evaluation could not be performed as only two articles from the same study were identified in this meta-analysis. CONCLUSIONS The Inventory of Complicated Grief is a highly recommend instrument to differentiate the case of grief disorders. Nurses and health care professionals can use the Inventory of Complicated Grief in the diagnosis of prolonged or complicated grief disorders due to its high sensitivity and specificity values. Further evaluations are needed for the use of Prolonged Grief Disorder-13 and Inventory of Complicated Grief-Revised. REGISTRATION The study is registered with the Open Science Framework (https://osf.io/bs8n6/?view_only=109e76e59efb4d7699153f62564f57ed). Tweetable abstract: Inventory of Complicated Grief is a highly recommend instrument with high sensitivity and specificity for diagnosing grief disorders.
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Affiliation(s)
- Christina Yeni Kustanti
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Bethesda Yakkum Health Science Institute, Yogyakarta, Indonesia
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing, University of Pennsylvania, United States
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Li-Chung Pien
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Shu-Tai H Shen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jin-Hua Chen
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan; Statistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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14
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Ergün D, Şenyüz S. Prolonged grief disorder among bereaved survivors after the 2011 Van Earthquake in Turkey. DEATH STUDIES 2021; 46:1364-1371. [PMID: 33576723 DOI: 10.1080/07481187.2021.1884624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The aim of the current study was to investigate the ratio and predictors of probable Prolonged Grief Disorder (PGD) among bereaved survivors eight years after the 2011 Van earthquake. Among a sample of 495 survivors who experienced loss as a result of this earthquake, 8.9% met the criteria of probable PGD. In the binary logistic regression analysis, being woman, being aged 40 or over, personal injury, property damage, losing family members, and the psychological impact of the earthquake predicted probable PGD. The current study highlights the importance of considering PGD among bereaved survivors after earthquakes.
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Affiliation(s)
- Deniz Ergün
- Faculty of Arts and Science, Psychology Department, Near East University, Nicosia, Turkey
| | - Solmaz Şenyüz
- Faculty of Arts and Science, Psychology Department, Near East University, Nicosia, Turkey
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15
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Menichetti Delor JP, Borghi L, Cao di San Marco E, Fossati I, Vegni E. Phone follow up to families of COVID-19 patients who died at the hospital: families' grief reactions and clinical psychologists' roles. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2021; 56:498-511. [PMID: 33511652 PMCID: PMC8013378 DOI: 10.1002/ijop.12742] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/01/2021] [Indexed: 12/05/2022]
Abstract
A proportion of persons affected by coronavirus disease‐19 (COVID‐19) die and do so in extraordinary circumstances. This can make grief management extremely challenging for families. The Clinical Psychology unit of an Italian hospital offered a bereavement follow‐up call to such families. This study aimed to explore the families' experiences and needs collected during these calls, and the role that the psychologists played through the call. A total of 246 families were called over 3 months. Multiple qualitative methods included: (i) written reports of the calls with relatives of patients who died at the hospital for COVID‐19; (ii) qualitative semi‐structured interviews with psychologists involved in the calls; (iii) observation of psychologists' peer group discussions. A thematic analysis was conducted. Six themes emerged: without death rituals, solitary, unexpected, unfair, unsafe, coexisting with other stressors. Families' reactions were perceived by psychologists as close to a traumatic grief. Families' needs ranged from finding alternative rituals to giving meaning and expressing different emotions. The psychologists played both a social‐institutional and a psychological‐human role through the calls (e.g., they cured disrupted communication or validated feelings and choices). This study highlighted the potential of traumatic grief of families of COVID‐19 victims, and provided indications for supporting them within the space of a short phone call.
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Affiliation(s)
| | - Lidia Borghi
- Clinical Psychology, Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Ivan Fossati
- Unit of Clinical Psychology, Santi Paolo and Carlo Hospital of Milan, Milan, Italy
| | - Elena Vegni
- Clinical Psychology, Department of Health Sciences, University of Milan, Milan, Italy.,Unit of Clinical Psychology, Santi Paolo and Carlo Hospital of Milan, Milan, Italy
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16
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Morris SE, Souza PM, Fasciano KM. The Development of a Bereavement Support Group Curriculum for Young Adults Dealing with the Death of a Partner: A Quality Improvement Project. J Adolesc Young Adult Oncol 2020; 10:260-265. [PMID: 33164653 DOI: 10.1089/jayao.2020.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Little is known about the bereavement needs of young adults (YAs) whose partners have died from cancer. Historically, research about the impact of widowhood has focused on adults in later life. We adapted a bereavement support group curriculum used with older adults to address the unique needs of younger bereaved partners. Methods: Applying a quality improvement framework, nine bereaved YAs whose partners had recently died participated in a 6-session bereavement support group program. The participants completed an evaluation and provided feedback throughout the program. Results: The participants were six females and three males (30-43 years). The average time since the death of their partner was 7 months and four participants had dependent children. The participants evaluated the program highly, reporting they felt less isolated (4.75/5 on a 5-point Likert Scale); their concerns were similar to others (5/5); and the discussion topics were relevant to their situation (4.75/5). Additional topics for the next version of the curriculum included maintaining a relationship with in-laws, being a "solo parent," and dating. The participants also wanted the program to be extended given they had little contact with other bereaved partners. Based on this feedback, we converted the program into a drop-in group format meeting every 3 weeks, accepting new participants on a rolling basis. In parallel with the drop-in group, we plan to offer a revised 8-session bereavement support group twice a year. Conclusion: This pilot demonstrated that the bereavement support group curriculum for older bereaved adults was readily adapted for use with younger bereaved partners.
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Affiliation(s)
- Sue E Morris
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Phoebe M Souza
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Karen M Fasciano
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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17
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Gonschor J, Eisma MC, Barke A, Doering BK. Public stigma towards prolonged grief disorder: Does diagnostic labeling matter? PLoS One 2020; 15:e0237021. [PMID: 32915800 PMCID: PMC7485774 DOI: 10.1371/journal.pone.0237021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/18/2020] [Indexed: 12/02/2022] Open
Abstract
The recent introduction of prolonged grief disorder (PGD) as a diagnostic category may cause negative social reactions (i.e. public stigma). Vignette experiments demonstrate that persons with both PGD symptoms and a PGD diagnosis elicit more public stigma than persons who experience integrated grief. However, the strength of the influence of the diagnosis itself remains unclear: We aimed to clarify if the diagnostic label PGD produces additional public stigma beyond PGD symptoms. We further compared whether public stigma varies between the label PGD and the label major depressive episode (MDE) (when PGD symptoms are present) and if gender of the bereaved person influences public stigma or moderates the aforementioned effects. Eight-hundred fifty-two participants (77% female; Mage = 32.6 years, SD = 13.3) were randomly assigned to read online one of eight vignettes describing either a bereaved male or female, with PGD symptoms and PGD diagnosis; PGD symptoms and MDE diagnosis; PGD symptoms and no diagnosis, or no PGD symptoms and no diagnosis (i.e., integrated grief). Following the vignettes, participants indicated which negative characteristics they ascribed to the person, their emotional reactions, and preferred social distance from the person. People with PGD symptoms and PGD (or MDE) diagnosis were attributed more negative characteristics, and elicited more negative emotions and a stronger desire for social distance than people with integrated grief. However, public stigma did not differ for people with both PGD symptoms and diagnosis compared to people only experiencing PGD symptoms. Gender of the bereaved only had an influence on desired social distance, which was larger towards men. Helping severely distressed bereaved people (regardless of diagnostic status) cope with negative social reactions may help them adapt to bereavement. Results demonstrate that the experience of severe grief reactions, yet not a diagnostic label per se, causes public stigma.
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Affiliation(s)
- Judith Gonschor
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
- * E-mail:
| | - Maarten C. Eisma
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Antonia Barke
- Clinical and Biological Psychology, Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Bettina K. Doering
- Clinical and Biological Psychology, Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
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18
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Morris S, Fletcher K, Goldstein R. The Grief of Parents After the Death of a Young Child. J Clin Psychol Med Settings 2020; 26:321-338. [PMID: 30488260 DOI: 10.1007/s10880-018-9590-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research demonstrates that severe forms of grief and grief-related pathology exist in the general population. Less attention, however, has been paid to the grief of parents following the death of a young, dependent child. In this review, we summarize a search of Pubmed, PsycINFO and Web of Science from 1995 to 2017, using the terms 'parental complicated grief', 'parental traumatic grief', and 'parent Prolonged Grief Disorder', specifically addressing parental grief and identified risk factors for complicated or prolonged grief. Forty-two studies met criteria and indicate a significant burden of complicated or prolonged grief in parents of children dying from virtually any cause. It appears that the empiric literature is undermined by great variability, including the composition of samples, the causes of death studied, the psychometric measures used, and post-loss intervals. We conclude that the uniform severity of grief experiences following the death of a young child is potentially a distinct subtype of grief, deserving of attention in its own right in future research and diagnostic formulations.
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Affiliation(s)
- Sue Morris
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.
| | - Kalen Fletcher
- Department of Social Work, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Richard Goldstein
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
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19
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Ting A, Lucette A, Carver CS, Cannady RS, Kim Y. Preloss Spirituality Predicts Postloss Distress of Bereaved Cancer Caregivers. Ann Behav Med 2020; 53:150-157. [PMID: 30052710 DOI: 10.1093/abm/kay024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Although spirituality has been identified as a psychological resource relevant to coping with caregiving stress, little is known about the differential roles of spirituality's facets in bereaved caregivers' adjustment. Purpose This study examined this question with regard to bereavement-specific and general distress in cancer caregivers. Methods Cancer caregivers provided data at 2 years after their relative's diagnosis when all the patients were alive (Time 1, preloss) and 3 years later, after the patient had died (Time 2, postloss: N = 128). Demographics and three facets of spirituality (meaning, peace, and faith) were measured at Time 1. Psychological distress and time since the death were measured at Time 2. Results Younger age, less education, and being a spousal caregiver of the patient related to greater bereavement-specific and general distress (ts ≥ 2.02, ps < .05, partial η2 ≥ .15). Above and beyond these demographic factors, two preloss spirituality facets related to postloss distress. Specifically, a greater sense of inner peace at preloss was prospectively associated with less bereavement-specific distress (both intrusive thoughts and hyperarousal, ts ≥ 2.24, ps < .05, partial η2 ≥ .41). Greater reliance on faith at preloss was also prospectively associated with lower intrusive thoughts (t = 2.24, p < .05, partial η2 = .34). Conclusion Findings highlight the importance of preloss sense of peace as a predictor of psychological distress during bereavement. Programs and interventions might be designed to help caregivers find inner peace while caregiving, in an effort to augment their resiliency against psychological distress when facing the loss of the patient.
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Affiliation(s)
- Amanda Ting
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Aurelie Lucette
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Charles S Carver
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Youngmee Kim
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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20
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Simon NM, Shear K, Reynolds CF, Cozza SJ, Mauro C, Zisook S, Skritskaya N, Robinaugh DJ, Malgaroli M, Spandorfer J, Lebowitz B. Commentary on evidence in support of a grief-related condition as a DSM diagnosis. Depress Anxiety 2020; 37:9-16. [PMID: 31916663 PMCID: PMC7430251 DOI: 10.1002/da.22985] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/03/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022] Open
Abstract
The death of a loved one is one of life's greatest stressors. Most bereaved individuals experience a period of acute grief that diminishes in intensity as they adapt to the changes brought about by their loss. Over the past four decades, a growing body of research has focused on a form of prolonged grief that is painful and impairing. There is a substantial and growing evidence base that supports the validity and significance of a grief-related disorder, including the clinical value of being able to diagnose it and provide effective targeted treatment. ICD-11 will include a new diagnosis of prolonged grief disorder (PGD). DSM-5 called this condition persistent complex bereavement disorder (PCBD) and included it in Section III, signaling agreement that a diagnosis is warranted while further research is needed to determine the optimal criteria. Given the remaining uncertainties, reading this literature can be confusing. There is inconsistency in naming the condition (including complicated grief as well as PGD and PCBD) and lack of uniformity in identifying it, with respect to the optimal threshold and timeframe for distinguishing it from normal grief. As an introductory commentary for this Depression and Anxiety special edition on this form of grief, the authors discuss the history, commonalities, and key areas of variability in identifying this condition. We review the state of diagnostic criteria for DSM-5 and the current ICD-11 diagnostic guideline, highlighting the clinical relevance of making this diagnosis.
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Affiliation(s)
- Naomi M. Simon
- Department of Psychiatry, NYU Langone Health/NYU School of Medicine, New York, NY
| | | | | | - Stephen J. Cozza
- Center for the Study of Traumatic Stress, Uniformed Services University for the Health Sciences
| | - Christine Mauro
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Sidney Zisook
- University of California San Diego and San Diego Healthcare System, San Diego, CA
| | | | - Donald J. Robinaugh
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Matteo Malgaroli
- Department of Psychiatry, NYU Langone Health/NYU School of Medicine, New York, NY
| | - Julia Spandorfer
- Department of Psychiatry, NYU Langone Health/NYU School of Medicine, New York, NY
| | - Barry Lebowitz
- University of California San Diego and San Diego Healthcare System, San Diego, CA
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21
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Cozza SJ, Hefner KR, Fisher JE, Zhou J, Fullerton CS, Ursano RJ, Shear MK. Mental health conditions in bereaved military service widows: A prospective, case-controlled, and longitudinal study. Depress Anxiety 2020; 37:45-53. [PMID: 31765052 DOI: 10.1002/da.22971] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 10/09/2019] [Accepted: 10/30/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND/OBJECTIVES Bereavement is associated with increases in prevalence of mental health conditions and in healthcare utilization. Due to younger age and bereavement by sudden and violent deaths, military widows may be vulnerable to poor outcomes. No systematic research has examined these effects. METHOD Using outpatient medical records from wives of active-duty military service members (SMs), we compared the prevalence of mental health conditions and mental healthcare visits among case widows (n = 1,375) to matched (on age, baseline healthcare utilization, SM deployment, and rank) nonbereaved control military wives (n = 1,375), from 1 year prior (Yr-1) to 2 years following (Yr+1 and Yr+2) SM death. Prevalence risk ratios and confidence intervals were compared to determine prevalence rates of mental health conditions and outpatient mental healthcare visits over time. RESULTS The prevalence of any mental health condition, as well as a distinct loss- and stress-related mental health conditions, significantly increased from Yr-1 to Yr+1 and Yr+2 for cases as did mental healthcare utilization. Widows with persistent disorders (from Yr+1 to Yr+2) exhibited more mental conditions and mental healthcare utilization than widows whose conditions remitted. CONCLUSION Bereavement among military widows was associated with a two- to fivefold increase in the prevalence of depression, posttraumatic stress disorder, and adjustment disorder postdeath, as well as an increase in mental healthcare utilization. An increase in the prevalence of loss- and stress-related conditions beyond 1 year after death indicates persistent loss-related morbidity. Findings indicate the need for access to healthcare services that can properly identify and treat these loss-related conditions.
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Affiliation(s)
- Stephen J Cozza
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kathryn R Hefner
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Joscelyn E Fisher
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jing Zhou
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Carol S Fullerton
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Robert J Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - M Katherine Shear
- Center for Complicated Grief, Columbia School of Social Work, Columbia University, New York, New York.,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
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22
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Geronazzo-Alman L, Fan B, Duarte CS, Layne CM, Wicks J, Guffanti G, Musa GJ, Hoven CW. The Distinctiveness of Grief, Depression, and Posttraumatic Stress: Lessons From Children After 9/11. J Am Acad Child Adolesc Psychiatry 2019; 58:971-982. [PMID: 30877043 DOI: 10.1016/j.jaac.2018.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 10/30/2018] [Accepted: 11/13/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The clinical and nosological significance of grief reactions in youth exposed to a shared trauma (9/11, the September 11, 2001 terrorist attacks on the United States) was tested by examining whether the predictors (ie, non-loss-related trauma versus traumatic bereavement), clinical correlates, factorial structure, and phenomenology of grief reactions are distinct from those of major depressive disorder (MDD) and 9/11-related posttraumatic stress disorder (PTSD). METHOD In a representative sample of New York City schoolchildren (N = 8,236; grades 4-12; n = 1,696 bereaved), assessed 6 months post-9/11, multivariate regressions examined predictors of grief, PTSD, and MDD, as well as the incremental validity of grief in predicting health problems and functional impairment. Factor analysis and latent class analysis determined, respectively, the factorial and the syndromic distinctiveness of grief, PTSD, and MDD. RESULTS Four types of evidence supporting the distinctiveness of grief emerged. (1) Bereavement was associated with grief independently of PTSD and MDD, but not with PTSD and MDD after adjusting for grief; conversely, non-loss related trauma was associated primarily with PTSD. (2) Grief contributed uniquely to functional impairment. (3) Grief reactions loaded on a separate factor. (4) Youth with elevated grief reactions fell into two classes characterized by only moderate and negligible probability of co-occurring PTSD and MDD symptoms, respectively. CONCLUSION A multifaceted approach provided convergent evidence that grief reactions are independent of other common types of postdisaster child and adolescent psychopathology, and capture a unique aspect of bereavement-related distress. These findings suggest that grief reactions in traumatically bereaved youth merit separate clinical attention, informing tailored interventions.
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Affiliation(s)
- Lupo Geronazzo-Alman
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY.
| | - Bin Fan
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
| | - Cristiane S Duarte
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
| | - Christopher M Layne
- UCLA-Duke University National Center for Child Traumatic Stress, Los Angeles, CA
| | - Judith Wicks
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
| | | | - George J Musa
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
| | - Christina W Hoven
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
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23
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Dodd A, Guerin S, Delaney S, Dodd P. Psychiatrists', psychologists' and counselors' attitudes regarding complicated grief. J Affect Disord 2019; 256:358-363. [PMID: 31207559 DOI: 10.1016/j.jad.2019.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/18/2019] [Accepted: 06/02/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Complicated grief encompasses various presentations where aspects of grief do not become integrated into the bereaved person's life. Professionals' attitudes to complicated grief may impact how they engage with bereaved patients/clients. The aim of this study was to empirically examine the attitudes of mental health professionals, specifically psychologists, psychiatrists and counselor/psychotherapists, regarding complicated grief and to investigate any between profession-differences. METHOD Psychiatrists, counselor/psychotherapists and psychologists were recruited using publicly available databases managed by professional bodies. A total of 185 professionals (71.8% female), returned a questionnaire containing usable data (23.8% response rate). RESULTS Over two-thirds of the professionals (68.5%) supported the inclusion of complicated grief in diagnostic manuals while only a quarter (25.1%) thought that recognition of complicated grief might lead to the pathologization of 'normal' grief. The majority of respondents (83.0%) thought that diagnosing complicated grief would increase the likelihood of clients accessing support and there was no significant difference between the groups. LIMITATIONS Although the response rate compares favorably with other studies it is nonetheless somewhat lower than optimum, and it is possible that those who responded were more interested in bereavement and consequently, that the attitudes held by participants are different from those who did not participate. CONCLUSION The attitude to a diagnosis of complicated grief was more positive than the specialist literature suggests, with the benefits of having a diagnosis of complicated grief outweighing the risks of pathologization.
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Affiliation(s)
- Anne Dodd
- UCD School of Psychology, Newman Building, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Suzanne Guerin
- UCD School of Psychology, Newman Building, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Susan Delaney
- Irish Hospice Foundation, Morrison Chambers, Nassau St, Dublin 2, Ireland.
| | - Philip Dodd
- St Michael's House Intellectual Disability Service, Ballymun Rd, Dublin 9, Ireland.
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24
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The relationship between substance misuse and complicated grief: A systematic review. J Subst Abuse Treat 2019; 103:43-57. [PMID: 31229191 DOI: 10.1016/j.jsat.2019.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/07/2019] [Accepted: 05/20/2019] [Indexed: 01/06/2023]
Abstract
Complicated grief is a prolonged, bereavement-specific disorder with significant psychological and physical consequences. Although complicated grief represents a risk to individuals with substance misuse, this relationship is poorly understood. Consequently, this systematic literature review examined empirical findings regarding the relationship between substance misuse and complicated grief. We searched 11 databases to identify pertinent quantitative studies published in English. Our search yielded 12 peer-reviewed journal articles (N = 1749) published between 1997 and 2017. Included studies evaluated the prevalence, assessment, etiology, correlates, risk factors, and treatment of complicated grief and substance misuse among individuals with one or both conditions. Our review found evidence of a positive relationship between complicated grief and substance misuse. Individuals with substance misuse were at increased risk for subsequent development of complicated grief, particularly when increases in substance consumption preceded bereavement. Conversely, complicated grief predicted increases in smoking and alcohol dependence. Multiple risk factors for individuals with complicated grief and substance misuse were identified and discussed. An existing complicated grief assessment performed well among individuals with substance misuse, and grief interventions were effective in reducing symptoms of complicated grief and substance misuse simultaneously. Given the severity of consequences associated with both conditions, more research is needed to understand this relationship, identify effective assessment tools, and evaluate intervention strategies to improve outcomes.
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25
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Tay AK, Mohsin M, Rees S, Tam N, Kareth M, Silove D. The structure and psychosocial correlates of complicated bereavement amongst refugees from West Papua. Soc Psychiatry Psychiatr Epidemiol 2019; 54:771-780. [PMID: 30778622 DOI: 10.1007/s00127-019-01666-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Refugees may be at risk of experiencing a complicated form of bereavement. As yet, however, the nosological status of this putative category across cultures remains in question. We apply qualitative and quantitative methods to investigate the manifestations, prevalence, factorial structure and psychosocial correlates of complicated bereavement amongst refugees from West Papua, a population with no past exposure to western concepts of grief or to formal mental health services. METHODS Qualitative methods (focus groups and informant interviews) were used to identify cultural expressions of complicated bereavement derived from international classification systems, that is, DSM 5 persistent complex bereavement disorder (PCBD) and ICD-11 prolonged grief disorder (PGD) in developing a structured interview applied by trained field workers. Participants were adult West Papuan refugees and their offspring recruited from households (n = 486, response 85.8%) across nine villages in a remote town in Papua New Guinea. RESULTS The qualitative data obtained from focus groups (n = 20) and informant interviews (n = 4) with local psychiatrists supported the cultural validity of complicated bereavement. 16% (n = 78) of the sample met criteria for PCBD based on DSM-5 criteria and 103 (21%) met criteria for PGD based on ICD-11 criteria. Confirmatory factor analysis yielded a six-factor model of complicated bereavement with a moderately good fit to the data. The model included dimensions of anger/negative appraisal (AN), avoidance/giving up, estrangement from others, and confusion and diminished identity. In contrast, the DSM-5 three-factor model and the ICD-11 two-factor model each yielded a poor fit. Cumulative traumatic losses (β = 0.16, P = 0.03), duration since displacement [(β = 0.10, P = 0.02)] and postmigration living difficulties (β = 0.20, P = 0.01) were associated with an aggregated index of complicated bereavement, supporting the concurrent validity of the structure identified. CONCLUSIONS Culture and exposure to persecution and displacement may contribute to the content and configuration of the complicated bereavement reaction, an issue that requires recognition in international classification systems and clinical practice.
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Affiliation(s)
- Alvin Kuowei Tay
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia.
| | - Mohammed Mohsin
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
| | - Susan Rees
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
| | - Natalino Tam
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
| | - Moses Kareth
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
| | - Derrick Silove
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
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O'Connor M, Lasgaard M, Larsen L, Johannsen M, Lundorff M, Farver-Vestergaard I, Boelen PA. Comparison of proposed diagnostic criteria for pathological grief using a sample of elderly bereaved spouses in Denmark: Perspectives on future bereavement research. J Affect Disord 2019; 251:52-59. [PMID: 30903989 DOI: 10.1016/j.jad.2019.01.056] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/12/2019] [Accepted: 01/22/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND A distinct grief-specific disorder is included in the ICD-11. Lack of clarity remains regarding whether different proposed diagnostic criteria capture similar or different diagnostic entities. Our aim was to examine the specificity of four proposed diagnostic criteria-sets for pathological grief in a population-based sample. METHODS Participants were 206 conjugally bereaved elderly Danes (59% female; mean age = 72.5 years, SD = 4.2; range 65-81) who completed self-report questionnaires six months post-loss. The main measure was the Danish version of Inventory of Complicated Grief-Revised. RESULTS Results indicate substantial agreement between Prolonged Grief Disorder (PGD), Persistent Complex Bereavement Disorder (PCBD) and ICD-11-PGD (kappa's = 0.69-0.84), which found 6-9% of cases tested positive for pathological grief. Complicated Grief (CG) was partly in agreement with the three other symptom-diagnostic tests (kappa's = 0.13-0.20), and the prevalence-rate of pathological grief was 48%. LIMITATIONS The low response-rate of 39%. The selective inclusion of data ≥6 months post-loss prevents a comparison of acute and prolonged grief reactions. Using self-reported data, not diagnostic interviews, challenges the validity of our findings. Using a sample of elderly people may limit the generalizability of our results to other age groups. CONCLUSION We suggest that PGD, PCBD and ICD-11-PGD may be more discriminative in identifying a specific grief-related psychopathology, while CG may identify a broader set of grief reactions.
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Affiliation(s)
- Maja O'Connor
- Unit for Bereavement Research, Department of Psychology, Aarhus University, Aarhus, Denmark; The Danish National Center for Grief, Copenhagen, Denmark.
| | | | - Lene Larsen
- The Danish National Center for Grief, Copenhagen, Denmark
| | - Maja Johannsen
- Unit for Bereavement Research, Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Marie Lundorff
- Unit for Bereavement Research, Department of Psychology, Aarhus University, Aarhus, Denmark
| | | | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands; Arq Psychotrauma Expert Group, Diemen, the Netherlands
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Steil R, Gutermann J, Harrison O, Starck A, Schwartzkopff L, Schouler-Ocak M, Stangier U. Prevalence of prolonged grief disorder in a sample of female refugees. BMC Psychiatry 2019; 19:148. [PMID: 31088419 PMCID: PMC6518607 DOI: 10.1186/s12888-019-2136-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/30/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Prolonged Grief Disorder (PGD) is a distinct syndrome that follows bereavement. It is different from other mental disorders and is characterized by symptoms such as yearning for the bereaved, or intense emotional pain or distress. Violent loss is one major risk factor for the development of PGD. OBJECTIVES PGD has been studied in different populations, mostly in small samples, with only a few of them being representative. Although research highlighted that traumatic experiences paired with challenges related to migration make refugees particularly vulnerable to PGD, PGD has only rarely been studied in refugees. Thus, this article a) examines the prevalence of PGD in female refugees in Germany according to the criteria proposed by Prigerson and colleagues in 2009, and b) associates PGD with other common psychopathology (e.g. anxiety, depression, somatization and trauma). METHOD A total of 106 female refugees were assessed for bereavement and PGD. Of these 106 individuals, 85 were interviewed using the Prolonged Grief Disorder Scale (PG-13). Symptoms of anxiety and depression were assessed by the Hopkins Symptom Checklist-25 (HSCL-25), somatization was assessed by the Somatization Subscale of the Symptom-Checklist-90 (SCL-90), and the number of witnessed and experienced trauma was assessed by the Posttraumatic Diagnostic Scale (PDS/HTQ). RESULTS Ninety of the 106 participants had experienced bereavement, and among those, 9.41% met criteria for PGD. The most frequent PGD symptoms were bitterness, longing or yearning for the bereaved, and lack of acceptance of the loss. Furthermore, grief symptoms were significantly associated with symptoms of depression, anxiety, somatization, and the number of experienced traumatic events. CONCLUSION The PGD prevalence rate found corresponds with previous studies, demonstrating that prevalence rates for PGD are especially high in refugees. High prevalence rates of bereavement as well as PGD highlight the need for assessment and specifically tailored treatment of PGD in refugees. PGD goes along with significant psychopathology, which further emphasizes the need for treatment.
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Affiliation(s)
- Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany.
| | - Jana Gutermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany
| | - Octavia Harrison
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany
| | - Annabelle Starck
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany
| | - Laura Schwartzkopff
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany
| | - Meryam Schouler-Ocak
- Department of Psychiatry, Institute of Medicine, University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany
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Szabó Á, Kok AAL, Beekman ATF, Huisman M. Longitudinal Examination of Emotional Functioning in Older Adults After Spousal Bereavement. J Gerontol B Psychol Sci Soc Sci 2019; 75:1668-1678. [DOI: 10.1093/geronb/gbz039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
This study examined trajectories of emotional functioning in three domains (depressive symptoms, emotional, and social loneliness) for individuals who experienced spousal bereavement and investigated cross-domain adaptation. We hypothesized that emotional difficulties after bereavement would be more detectable in emotional loneliness than depressive symptoms or social loneliness.
Methods
Using latent class growth analysis, we modeled changes in depressive symptoms, emotional loneliness, and social loneliness from 12 years pre- to 12 years post-bereavement on data from 686 older adults to identify trajectories indicating adaptive and maladaptive functioning in each domain.
Results
Most participants reported depressive symptoms below the clinically relevant threshold by showing a resilient (15.5%) or a slightly elevated (53.5%) trajectory post-bereavement. One third (31%) reported clinically relevant depressive symptoms. More than half of the sample reported emotional loneliness post-bereavement, varying form prolonged (17%), increasing and prolonged (28.3%), and chronically high (8.9%) levels. Remaining participants displayed resilience (13.5%) or recovery (32.3%). Social loneliness showed four trajectories: very low and resilient (43.3%), low and resilient (27.5%), increasing (20.2%), and chronically high (9%) levels. One third of participants maintained adaptive, whereas 12% displayed maladaptive, functioning across all domains post-bereavement.
Discussion
An increase in emotional loneliness was the most commonly observed change after spousal bereavement. This highlights the central role of emotional loneliness in depression after bereavement.
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Affiliation(s)
- Ágnes Szabó
- School of Health Sciences, Massey University, Wellington, New Zealand
| | - Almar A L Kok
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam, The Netherlands
- Vrije Universiteit, Amsterdam, Department of Sociology, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Martijn Huisman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam, The Netherlands
- Vrije Universiteit, Amsterdam, Department of Sociology, Amsterdam, The Netherlands
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Milman E, Neimeyer RA, Fitzpatrick M, MacKinnon CJ, Muis KR, Cohen SR. Rumination moderates the role of meaning in the development of prolonged grief symptomatology. J Clin Psychol 2019; 75:1047-1065. [DOI: 10.1002/jclp.22751] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/19/2018] [Accepted: 12/27/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Evgenia Milman
- Department of Educational and Counselling PsychologyMcGill UniversityMontreal Quebec
| | | | - Marilyn Fitzpatrick
- Department of Educational and Counselling PsychologyMcGill UniversityMontreal Quebec
| | | | - Krista R. Muis
- Department of Educational and Counselling PsychologyMcGill UniversityMontreal Quebec
| | - S. Robin Cohen
- Departments of Oncology and MedicineMcGill UniversityMontreal Quebec
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30
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Trajectories of prolonged grief one to six years after a natural disaster. PLoS One 2018; 13:e0209757. [PMID: 30576369 PMCID: PMC6303052 DOI: 10.1371/journal.pone.0209757] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 12/12/2018] [Indexed: 11/29/2022] Open
Abstract
Background The long-term trajectories of prolonged grief are poorly understood. The aims were to examine the course of grief among bereaved disaster survivors up to six years post loss and factors predicting worse bereavement outcome. A third aim was to explore differences in grief indicators between trajectories. Methods Bereaved Swedish tourists who survived the 2004 Indian Ocean tsunamis responded to surveys including the Inventory of Complicated Grief 1 to 6 years after the disaster. Latent growth mixture modeling was used to identify longitudinal trajectories of grief. Multinomial logistic regression analysis was used to examine predictors of class membership. Results Three trajectories were identified: resilient (41% of the sample), recovering (48%), and chronic (11%). The strongest predictor of chronic grief was the loss of one’s child. When examining grief indicators, the chronic trajectory was characterized by not accepting the loss, while yearning was common in all trajectories. Conclusions This study highlights the importance of considering how traumatically bereaved individuals can be affected by loss for several years after a disaster, especially after losing one’s child. An inability to accept the loss, more so than yearning, appears to characterize bereaved survivors at risk of a chronic trajectory of grief.
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31
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Williams JL, Eddinger JR, Rynearson EK, Rheingold AA. Prevalence and Correlates of Suicidal Ideation in a Treatment-Seeking Sample of Violent Loss Survivors. CRISIS 2018; 39:377-385. [DOI: 10.1027/0227-5910/a000520] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abstract. Background: Family members grieving the traumatic death of a loved one, as in cases of homicide, suicide, and fatal accidents, are at risk for a number of trauma and bereavement-related mental health problems, including posttraumatic stress disorder (PTSD), depression, prolonged grief disorder, and suicidal ideation (SI). Aims: The purpose of this study was to examine the prevalence and correlates of SI among a sample of 130 treatment-seeking traumatically bereaved family members. Method: Adults seeking treatment at two clinics on the US West Coast were assessed for SI, clinical outcomes, and death-related characteristics. Results: Overall, 42% of traumatically bereaved family members endorsed some form of active or passive SI on the Beck Depression Inventory suicide item. The type of loss experienced (i.e., homicide, suicide, fatal accident) was not associated with SI. Although individuals with SI reported more severe symptoms across all clinical outcomes, avoidance (OR = 2.22) and depression (OR = 1.16) were uniquely associated with SI even after adjusting for PTSD-related intrusions and hyperarousal. Limitations: Results should be interpreted in light of limitations associated with cross-sectional data and a single-item outcome of SI. Conclusion: Routine screening for SI should be standard practice for providers working with traumatically bereaved families.
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Affiliation(s)
- Joah L. Williams
- Department of Psychology, University of Missouri – Kansas City, MO, USA
| | | | - Edward K. Rynearson
- Separation and Loss Services, Virginia Mason Medical Center, Seattle, WA, USA
| | - Alyssa A. Rheingold
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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32
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Treml J, Kersting A. [Prolonged grief disorder]. DER NERVENARZT 2018; 89:1069-1078. [PMID: 30116835 DOI: 10.1007/s00115-018-0577-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Grief is a natural response to the loss of a loved one and its intensity usually lessens over time. Approximately 10% of bereaved persons, however, experience persistent symptoms resulting in the development of a prolonged grief disorder (PGD). A PGD shows a distinct symptom cluster and is considered for inclusion as a diagnosis in the upcoming revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11). It is distinct from other mental disorders but symptoms overlap, especially with major depression and posttraumatic stress disorder. In addition to diagnostic criteria and differential diagnosis, the following article also describes prevalence rates, comorbidities, risk factors as well as treatment options for PGD.
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Affiliation(s)
- J Treml
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland.
| | - A Kersting
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland
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Milman E, Neimeyer RA, Fitzpatrick M, MacKinnon CJ, Muis KR, Cohen SR. Prolonged grief symptomatology following violent loss: the mediating role of meaning. Eur J Psychotraumatol 2018; 8:1503522. [PMID: 30128081 PMCID: PMC6095024 DOI: 10.1080/20008198.2018.1503522] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 06/02/2018] [Accepted: 07/01/2018] [Indexed: 01/19/2023] Open
Abstract
Background: Prolonged Grief Disorder (PGD) is over-represented among those who have lost loved ones to violent causes. To tailor PGD interventions for this vulnerable population it is critical to examine the aetiology of PGD specifically in the context of violent death bereavement. Previous studies have suggested that violent loss increases symptoms of PGD by hindering the mourner's ability to make meaning of the death or its aftermath. However, these studies have relied on cross sectional data that preclude genuine prediction and have not differentiated among specific themes of meaning. Objective: This study aimed to identify specific themes of meaning that mediate the detrimental impact of violent loss on subsequent emergence of PGD symptomatology among the violently bereft. Method: A longitudinal, prospective design (N = 171) was used to assess violent loss and themes of meaning an average of six months post-loss allowing for prediction of PGD symptoms an average of eight months later. Results: Violent loss had a significant indirect effect on PGD symptomatology when meaning themes focusing on sense of peace and continuing bonds served as mediators. Conclusions: This study demonstrates the mediating role that specific meaning themes play in the development of PGD symptomatology following violent loss. These findings highlight the potential benefits of applying a meaning-based intervention approach with the violently bereft.
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Affiliation(s)
- Evgenia Milman
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | | | - Marilyn Fitzpatrick
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | | | - Krista R. Muis
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - S. Robin Cohen
- Departments of Oncology and Medicine, McGill University, Palliative Care Research, Jewish General Hospital, Montreal, QC, Canada
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34
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Boddez Y. The presence of your absence: A conditioning theory of grief. Behav Res Ther 2018; 106:18-27. [DOI: 10.1016/j.brat.2018.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 03/30/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
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Wenn J, O'Connor M, Breen LJ, Rees CS. Exploratory study of metacognitive beliefs about coping processes in prolonged grief symptomatology. DEATH STUDIES 2018; 43:143-153. [PMID: 29474138 DOI: 10.1080/07481187.2018.1440032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite research examining the role of metacognitive beliefs about coping processes in maintaining psychological disorders, to date, no studies have explored their role in the maintenance of prolonged grief. Twelve semistructured interviews were conducted with bereavement specialists and bereaved people with elevated grief to identify metacognitive beliefs about coping processes relevant to prolonged grief. Analysis revealed several metacognitive beliefs potentially driving maladaptive coping processes used by people with prolonged grief symptomatology. Findings may underpin the development of interventions that aim to modify unhelpful metacognitive beliefs that perpetuate maladaptive coping processes.
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Affiliation(s)
- Jenine Wenn
- a School of Psychology, Faculty of Health Sciences , Curtin University , Perth , Western Australia , Australia
| | - Moira O'Connor
- a School of Psychology, Faculty of Health Sciences , Curtin University , Perth , Western Australia , Australia
| | - Lauren J Breen
- a School of Psychology, Faculty of Health Sciences , Curtin University , Perth , Western Australia , Australia
| | - Clare S Rees
- a School of Psychology, Faculty of Health Sciences , Curtin University , Perth , Western Australia , Australia
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36
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Aoyama M, Sakaguchi Y, Morita T, Ogawa A, Fujisawa D, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Factors associated with possible complicated grief and major depressive disorders. Psychooncology 2018; 27:915-921. [DOI: 10.1002/pon.4610] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Maho Aoyama
- Tohoku University Graduate School of Medicine; Sendai Miyagi Japan
| | | | - Tatsuya Morita
- Seirei Mikatahara General Hospital; Hamamatsu Shizuoka Japan
| | - Asao Ogawa
- National Cancer Center Hospital East; Kashiwa Chiba Japan
| | | | | | - Satoru Tsuneto
- Graduate School of Medicine Kyoto University; Kyoto Japan
| | - Yasuo Shima
- Tsukuba Medical Center Hospital; Tsukuba Ibaraki Japan
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Do prolonged grief disorder symptoms predict post-traumatic stress disorder symptoms following bereavement? A cross-lagged analysis. Compr Psychiatry 2018; 80:65-71. [PMID: 29055233 DOI: 10.1016/j.comppsych.2017.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/21/2017] [Accepted: 09/05/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bereavement can precipitate different forms of psychopathology, including prolonged grief disorder (PGD) and posttraumatic stress disorder (PTSD) symptoms. How these symptoms influence each other is unclear. The aim of this study was to examine the temporal relationship of symptoms of PGD and PTSD following bereavement. METHODS We included 204 individuals, confronted with the loss of a loved one within the past year, who completed self-report measures of PGD and PTSD and again completed these measures one year later. We conducted a cross-lagged analysis to explore cross-lagged and autoregressive relationships. RESULTS A significant cross-lagged relationship was found between PGD symptoms at time point 1 (T1) and PTSD symptoms at time point 2 (T2) (β=0.270, p<0.001). Furthermore, PGD symptoms at T1 predicted PGD symptoms at T2 and PTSD symptoms at predicted PTSD symptoms at T2 (β=0.617 and β=0.458, ps<0.001, respectively). In addition, PGD and PTSD symptoms were significantly correlated on both time points. CONCLUSIONS We found that PGD symptoms predict PTSD symptoms after a loss. Potentially, this could help to design new strategies and interventions for bereaved individuals. Additionally, PGD symptom levels predicted PGD symptom levels one year later, independently of the PTSD levels. This finding adds to the accumulating evidence that PGD is a distinct disorder.
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Currier JM, Farnsworth JK, Drescher KD, McDermott RC, Sims BM, Albright DL. Development and evaluation of the Expressions of Moral Injury Scale-Military Version. Clin Psychol Psychother 2017; 25:474-488. [DOI: 10.1002/cpp.2170] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 10/19/2017] [Accepted: 11/27/2017] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Kent D. Drescher
- National Center for PTSD; VA Palo Alto Health Care System; Menlo Park CA USA
| | - Ryon C. McDermott
- Department of Professional Studies; University of South Alabama; Mobile AL USA
| | - Brook M. Sims
- Psychology Department; University of South Alabama; Mobile AL USA
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Banyasz A, Weiskittle R, Lorenz A, Goodman L, Wells-Di Gregorio S. Bereavement Service Preferences of Surviving Family Members: Variation among Next of Kin with Depression and Complicated Grief. J Palliat Med 2017; 20:1091-1097. [DOI: 10.1089/jpm.2016.0235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alissa Banyasz
- Department of Psychiatry, Psychosocial Oncology, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | | | - Amanda Lorenz
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Lauren Goodman
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sharla Wells-Di Gregorio
- Department of Psychiatry, Psychosocial Oncology, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
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40
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Große J, Treml J, Kersting A. Impact of caregiver burden on mental health in bereaved caregivers of cancer patients: A systematic review. Psychooncology 2017; 27:757-767. [DOI: 10.1002/pon.4529] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Julia Große
- Department für Psychische Gesundheit; Universität Leipzig Medizinische Fakultät; Leipzig Germany
| | - Julia Treml
- Department für Psychische Gesundheit; Universität Leipzig Medizinische Fakultät; Leipzig Germany
| | - Anette Kersting
- Department für Psychische Gesundheit; Universität Leipzig Medizinische Fakultät; Leipzig Germany
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41
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Thompson MR, Whiteman AD, Loucks KD, Daudt HML. Complicated Grief in Canada: Exploring the Client and Professional Landscape. JOURNAL OF LOSS & TRAUMA 2017. [DOI: 10.1080/15325024.2017.1358574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | - Karen D. Loucks
- Bereavement Services, Victoria Hospice, British Columbia, Canada
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Burke LA, Neimeyer RA, Bottomley JS, Smigelsky MA. Prospective Risk Factors for Intense Grief in Family Members of Veterans Who Died of Terminal Illness. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1054137317699580] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Laurie A. Burke
- The University of Memphis, TN, USA
- Memphis Veterans Affairs Medical Center, TN, USA
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43
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Crunk AE, Burke LA, Robinson EHM. Complicated Grief: An Evolving Theoretical Landscape. JOURNAL OF COUNSELING AND DEVELOPMENT 2017. [DOI: 10.1002/jcad.12134] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- A. Elizabeth Crunk
- Department of Child, Family, and Community Sciences; University of Central Florida
| | | | - E. H. Mike Robinson
- Department of Child, Family, and Community Sciences; University of Central Florida
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44
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Djelantik AAAMJ, Smid GE, Kleber RJ, Boelen PA. Symptoms of prolonged grief, post-traumatic stress, and depression after loss in a Dutch community sample: A latent class analysis. Psychiatry Res 2017; 247:276-281. [PMID: 27936439 DOI: 10.1016/j.psychres.2016.11.023] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 11/16/2016] [Accepted: 11/16/2016] [Indexed: 11/27/2022]
Abstract
Mental health problems following loss can manifest as heterogeneous symptomatology that may include symptoms of Prolonged Grief Disorder (PGD), Post-Traumatic Stress Disorder (PTSD), and Major Depressive Disorder (MDD). However, the co-occurrence of symptoms of these three disorders is still only partially explored. The aims of this study were to identify subgroups (i.e., classes) in a Dutch sample of bereaved individuals, based on severity and/or co-occurrence of symptoms and to identify predictors for these subgroups, taking into account all three disorders. Using data from 496 participants who filled in questionnaires assessing PGD, PTSD and MDD, we conducted latent class analyses to identify different symptom classes. Predictors of these classes were identified using one-way ANOVA, Chi Square tests and multinomial regression analysis. We found three different classes: a resilient class, a PGD class and a combined PGD/PTSD class. Violent cause of death, loss of a child, and loss of a partner were associated with membership of the combined PGD/PTSD class. This study increases our understanding of the predictability of symptomology outcome following bereavement. This is a first step towards designing assessment and intervention methods, specifically directed towards subgroups of individuals sharing characteristic symptomatology.
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Affiliation(s)
- A A A Manik J Djelantik
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands.
| | - Geert E Smid
- Arq Psychotrauma Expert Group, Diemen, The Netherlands; Foundation Centrum '45, Diemen, The Netherlands
| | - Rolf J Kleber
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands
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Kokou-Kpolou K, Mbassa Menick D, Moukouta CS, Baugnet L. Implications du corps et du lien social dans les thérapies traditionnelles du deuil pathologique au Togo. ACTA ACUST UNITED AC 2017. [DOI: 10.3917/lautr.052.0047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Bellet BW, Neimeyer RA, Berman JS. Event Centrality and Bereavement Symptomatology: The Moderating Role of Meaning Made. OMEGA-JOURNAL OF DEATH AND DYING 2016; 78:3-23. [DOI: 10.1177/0030222816679659] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The centrality of a loss to a bereaved individual’s identity is associated with greater symptomatology, whereas meaning made of a loss is associated with positive outcomes. This article examines meaning made as a moderator of the relationship between event centrality and symptomatology. Our sample consisted of 204 bereaved undergraduate university students. Centrality was assessed using the Centrality of Events Scale, meaning made was assessed using the Integration of Stressful Life Experiences Scale, and symptomatology was assessed using the posttraumatic stress disorder Checklist-Civilian and Inventory of Complicated Grief-Revised. Meaning made had a significant moderating effect on the relationship between centrality and both measures of symptomatology. At lower levels of meaning made, centrality had a strong and positive association with symptomatology; at higher levels of meaning made, this association became weaker. These results suggest that meaning made is the key to understanding how centrality affects bereavement outcomes.
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Nickrand HL, Brock CM. Culinary Grief Therapy: Cooking for One Series. J Palliat Med 2016; 20:181-183. [PMID: 27602803 DOI: 10.1089/jpm.2016.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although loss of loved ones is a universal experience, individuals who experience this loss grieve in different ways. Complicated grief involves the development of trauma symptoms, such as flashbacks, anxiety, and fear associated with daily activities after a death that disrupts the healthy grieving process. Daily activities such as eating, meal planning, grocery shopping, managing finances, and household maintenance can become painful and isolating for those experiencing complicated grief. Cognitive behavioral therapy is used to address irrational beliefs, feelings of depression or anger, and avoidance or numbing behaviors with a goal of leading the individual to adapting to a life, which no longer includes the lost loved one. OBJECTIVE As part of the bereavement counseling program in a hospice, a need was identified in individuals who had lost loved ones and were having difficulty with adjusting to meal planning, grocery shopping, and cooking for one. To address this need for grief counseling centered on meal planning, grocery shopping, meal preparations, and eating meals alone, "Culinary Grief Therapy: Cooking for One Series" was developed with a local Culinary Arts Program. DESIGN Partnering with a local community college culinary arts program, the Cooking for One Series provides an interactive venue for cognitive behavioral therapy centered on meal planning and meal times. Along with demonstrations and hands-on experiences, participants are engaged in bereavement counseling with hospice staff. RESULTS Initial reactions to Culinary Grief Therapy have been positive. Many attendees have participated in multiple workshops, and the number of participants grows for each offering. CONCLUSIONS Culinary Grief Therapy is a novel approach to the needs of those experiencing the loss of a loved one and may reduce or prevent complicated grief associated with meal planning, grocery shopping, and cooking for one.
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Affiliation(s)
- Heather L Nickrand
- 1 AMITA Health Alexian Brothers Medical Center , AMITA Health Alexian Brothers Hospice, Elk Grove Village, Illinois
| | - Cara M Brock
- 2 College of Pharmacy, Roosevelt University , Schaumburg, Illinois
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Abstract
A great deal of research, notably by Prigerson and colleagues (e.g., Prigerson & Jacobs, 2001; see Prigerson & Maciejewski, this issue) and Horowitz and colleagues (e.g., Horowitz, this issue; Horowitz, Bonanno, & Holen, 1993), has recently been conducted with the purpose of establishing criteria for the designation of Complicated Grief (CG) as a mental disorder for inclusion in DSM-V. Some dissenting voices have been heard from teams of researchers adopting different approaches and/or using different criteria and diagnostic categorizations. We argue the need for a conceptual framework as a starting point for understanding the different positions on this CG—DSM controversy. This analysis is used as a tool to evaluate the questions posed by the Editor of this Special Issue, Colin Murray Parkes: (1) Should Complicated Grief be regarded as a psychiatric disorder? (2) Does the syndrome described by Prigerson and colleagues meet the required scientific criteria? Discrepancies emerge between scholars in the ways that they have conceptualized and assessed complicated grief and associated disorders: Examination of the positions of researchers within the framework reveals five systematically different approaches. We argue that potential criteria and diagnostic categorization systems emerging from the different perspectives need to be considered. General implications of DSM-V (non)inclusion are summarized.
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Tsai WI, Prigerson HG, Li CY, Chou WC, Kuo SC, Tang ST. Longitudinal changes and predictors of prolonged grief for bereaved family caregivers over the first 2 years after the terminally ill cancer patient's death. Palliat Med 2016; 30:495-503. [PMID: 26311571 DOI: 10.1177/0269216315603261] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A significant minority of bereaved caregivers experience prolonged grief. However, few longitudinal studies have examined prolonged grief, especially in an Asian context. AIM We explored longitudinal changes and factors predicting prolonged grief in bereaved caregivers of terminally ill Taiwanese cancer patients. DESIGN Observational, prospective, and longitudinal. Prolonged grief symptoms were measured with the PG-13 at 6, 13, 18, and 24 months postloss. SETTING/PARTICIPANTS A convenience sample of 493 caregivers (83.3% participation rate) of terminally ill cancer patients was recruited from a medical center in Taiwan. RESULTS The prevalence of prolonged grief decreased significantly over time from the patient's death (7.73%, 1.80%, 2.49%, and 1.85% at 6, 13, 18, and 24 months postloss, respectively, p < 0.05 at all times in reference to 6 months postloss). Caregivers' likelihood of prolonged grief was significantly higher if they had severe preloss depressive symptoms, negatively perceived their relative's dying situation, and were poorly prepared for the patient's death. However, the likelihood of prolonged grief decreased significantly with greater perceived concurrent social support and subjective caregiving burden right before the patient's death. CONCLUSION Prolonged grief in bereavement diminished over time and was predicted by modifiable factors before, during, and after bereavement. To facilitate bereavement adjustment and avoid prolonged grief, healthcare professionals should develop and provide at-risk caregivers with effective interventions starting when patients are still alive to improve their dying experience, to facilitate preparedness for the patient's forthcoming death, to alleviate caregivers' preloss depressive symptoms, and to enhance their perceived postloss social support.
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Affiliation(s)
- Wei-I Tsai
- School of Nursing, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Holly G Prigerson
- Sociology in Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Chung-Yi Li
- Department of Public Health, National Cheng Kung University, Tainan, Taiwan, R.O.C
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, R.O.C
| | - Su-Ching Kuo
- School of Nursing, Chang Gung University, Taoyuan, Taiwan, R.O.C. Department of Nursing, Yuanpei University, Hsinchu, Taiwan, R.O.C
| | - Siew Tzuh Tang
- School of Nursing, Chang Gung University, Taoyuan, Taiwan, R.O.C.
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Spuij M, Prinzie P, Boelen PA. Psychometric Properties of the Grief Cognitions Questionnaire for Children (GCQ-C). JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2016; 35:60-77. [PMID: 28286374 PMCID: PMC5323485 DOI: 10.1007/s10942-016-0236-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Negative thinking is seen as an important mediating factor in the development of prolonged grief disorder (PGD), a syndrome encompassing debilitating symptoms of grief. No measure of specific grief related cognitions is available yet. Based on an adult measure of negative thinking in adults we developed a questionnaire for children, the Grief Cognitions Questionnaire for Children (GCQ-C). This study investigated several psychometric properties of the GCQ-C. Both reliability and validity were investigated in this study, in which hundred fifty-one children and adolescents (aged 8-18 years) participated. Findings showed that items of the GCQ-C represented one underlying dimension. Furthermore, the internal consistency and temporal stability were found to be adequate. Third, the findings supported the concurrent validity (e.g., significant positive correlations with self-report indices of PGD, depression and posttraumatic stress disorder), convergent and divergent validity of the GCQ-C. This study provides further evidence for the importance of negative thinking in PGD in children and adolescents.
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Affiliation(s)
- Mariken Spuij
- Department of Child and Adolescent Studies, Utrecht University, PO Box 80140, 3508 TC Utrecht, The Netherlands
| | - Peter Prinzie
- Department of Pedagogical Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Paul A. Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
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