Bereavement-related depression: Did the changes induced by DSM-V make a difference? Results from a large population-based survey of French residents

Development of a novel COMPAssion focused online psyChoTherapy for bereaved informal caregivers: the COMPACT feasibility trial protocol

INTRODUCTION

An easy-to-access and effective psychotherapy for bereaved informal caregivers has not been established. People with higher self-compassion status tend to have lower bereavement related grief, psychotherapy focused on self-compassion can be promising for this population. This study aimed to examine the feasibility of online self-compassion focused psychotherapy for bereaved informal caregivers.

METHOD AND ANALYSIS

A total of 60 study participants will undergo an intervention programme comprising online sessions of 2 hours per week for five consecutive weeks and undertake postsession work. The intervention personnel will comprise psychologists who have received more than 10 hours of structured training. The primary endpoint will be assessed on the intervention completion rate, with secondary endpoints consisting of the Complicated Grief Questionnaire, Patient Health Questionnaire-9, Generalised Anxiety Disorder-7, Brief Resilience Scale and Self-Compassion Scale. Evaluations will be conducted preintervention, immediately after intervention, and 4 and 12 weeks after intervention.

ETHICS AND DISSEMINATION

This study has been reviewed and approved by the Ethics Committee of the Kyoto University Graduate School and Faculty of Medicine, Kyoto University Hospital, Japan (Approved ID: C1565). The results of this study will be disseminated through publication in a peer-reviewed journal and conference presentations.

TRIAL REGISTRATION NUMBER

UMIN000048554.

Psychological Distress in Bereaved Caregivers of Patients With Advanced Cancer

CONTEXT

Individuals caring for patients with advanced cancer (caregivers) experience psychological distress during the patient's illness course. However, data on the prevalence of bereaved caregivers' psychological distress and its relationship with the quality of patient's end of life (EOL) care are limited.

OBJECTIVES

To describe rates of depression and anxiety symptoms in bereaved caregivers of patients with advanced cancer and to understand the relationship between these outcomes and patient distress at the EOL.

METHODS

We conducted a secondary analysis of 168 caregivers enrolled in a supportive care trial for patients with incurable lung and gastrointestinal cancers and their caregivers. We used the Hospital Anxiety and Depression Scale to assess caregivers' depression and anxiety symptoms at three months after the patient's death. Caregivers also rated the patient's physical and psychological distress in the last week of life on a 10-point scale three months after the patient death. We used linear regression adjusting for caregiver age, sex, randomization, and cancer type to explore the relationship between bereaved caregivers' depression and anxiety symptoms and their ratings of physical and psychological distress in patients at the EOL.

RESULTS

Of the 168 bereaved caregivers, 30.4% (n = 51) and 43.4% (n = 73) reported clinically significant depression and anxiety symptoms, respectively. Caregiver ratings of worse physical (B = 0.32; P = 0.009) and psychological (B = 0.50; P < 0.001) distress experienced by the patient at the EOL were associated with worse depression symptoms in bereaved caregivers. Only caregiver rating of worse psychological distress experienced by the patient at the EOL (B = 0.42; P < 0.001) was associated with worse bereaved caregivers' anxiety symptoms.

CONCLUSION

Many bereaved caregivers of patients with advanced cancer experience symptoms of depression and anxiety, which are associated with their perceptions of distress in their loved ones at the EOL.

General practitioners' reported application of DSM major depressive disorder criteria after removal of the bereavement exclusion criterion

The removal of the bereavement exclusion criterion from major depressive disorder (MDD) in the 5th edition of Diagnostic and Statistical Manual of Mental Disorders generated concerns of over-diagnosing grief. Eight Australian General Practitioners (GPs) were interviewed to explore their application of MDD criteria to recently-bereaved individuals. Thematic analysis found GPs were unaware of the change and reluctant to apply MDD criteria two weeks post-bereavement. Depressive symptoms were viewed as natural grief, with diagnostic labels seen as unnecessary for patient-centered care. Our findings suggest new MDD criteria not being strictly applied by GPs, or no anticipated over-inflation of MDD diagnoses post-bereavement.

Shame, guilt, and pride after loss: Exploring the relationship between moral emotions and psychopathology in bereaved adults

BACKGROUND

Self-blame following bereavement has been implicated in the development of post-loss psychopathology. However, prior studies have not distinguished between the emotions of shame versus guilt. This study examined the cross-sectional associations among bereavement-related shame, bereavement-related guilt, and two mental disorders that commonly arise after bereavement: complicated grief and depression. In addition, exploratory analyses examined the associations between bereavement-related pride and post-loss psychopathology.

METHODS

Participants included 92 bereaved adults who experienced the death of a family member at least one year prior to the study. Participants completed self-report measures of complicated grief symptoms, depression symptoms, shame, guilt, and pride.

RESULTS

Shame and guilt were positively correlated with complicated grief and depression symptoms. When controlling for their shared variance, only shame remained a significant predictor of post-loss psychopathology. Follow-up analyses indicated that the effect of guilt on psychopathology depended on the level of shame, and vice versa. At low shame, guilt predicted psychopathology; however guilt did not predict psychopathology at moderate to high shame. At low to moderate guilt, shame predicted psychopathology; however shame did not predict psychopathology at high guilt. Pride negatively predicted depression symptoms, but not complicated grief symptoms, when we controlled for shame and guilt.

LIMITATIONS

Limitations include the cross-sectional design and modest sample size.

CONCLUSIONS

Our analyses identify shame as the more pathogenic moral emotion for bereaved adults. However, whereas guilt in the absence of shame is often considered adaptive, we found that guilt predicted greater psychological distress at low levels of shame in this sample.

The critical reception of the DSM-5: Towards a typology of audiences

Since its initial publication, the Diagnostic and Statistical Manual of Mental Disorders has been the object of criticism which has led to regular revisions by the American Psychiatric Association. This article analyses the debates that surrounded the publication of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Building on the concepts of public arenas and reception theory, it explores the meaning encoded in the manual by audiences. Our results, which draw from a thematic analysis of traditional and digital media sources, identify eight audiences that react to the American Psychiatric Association's narrative of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.): conformist, reformist, humanist, culturalist, naturalist, conflictual, constructivist and utilitarian. While some of their claims present argumentative polarities, others overlap, thus challenging the idea, often presented in academic publications, of a fixed debate. In order to further discuss on the Diagnostic and Statistical Manual of Mental Disorders, we draw attention to claims that 'travel' across different communities of audiences.

Grief, depressive symptoms, and inflammation in the spousally bereaved

Grief is conceptualized by strong negative emotions, which include longing, sadness, and preoccupations with thoughts, recollections, and images of the spouse. In the initial months after the loss of a spouse, those who are widowed are at risk for cardiovascular problems and premature mortality. In the general population, depression is characterized by chronic low-grade inflammation, a key predictor of cardiovascular problems, morbidity, and mortality. Although depression and grief share similarities, they are distinct constructs. We aimed to identify if grief was related to inflammation among those who had a spouse recently die. We also sought to determine if those who are widowed and already experience elevated levels of depressive symptoms compared with the general population had higher levels of inflammation compared with those who are widowed who report fewer depressive symptoms. Ninety-nine recently bereaved individuals (M = 84.74 days since passing, SD = 18.17) completed a blood draw and psychological assessments. Proinflammatory T cell-derived cytokines were assessed, which included interferon gamma (IFN-γ), interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), IL17-A, and IL-2. Bereaved individuals with a higher grief severity (using an established cut-score) had higher levels of the proinflammatory cytokines IFN-γ, IL-6, and TNF-α than those with less grief severity. Those who experienced higher levels of depression exhibited elevated levels of proinflammatory cytokines compared with those who had lower levels of depression (using a continuous measure of depressive symptoms, as well as an established cut score). This is the first study to demonstrate that inflammatory markers can distinguish those who are widowed based on grief severity such that those who are higher on grief severity have higher levels of inflammation compared with those who are lower on grief severity. These findings also add to the broader literature on depression and inflammation by showing that even in a population with high levels of depressive symptoms, there is a positive relationship between depression and inflammation.

Normal Complications and Abnormal Assumptions After Perinatal Death

There are several ways, clinically, to approach grief after perinatal death, including from a humanistic or a medicalized perspective. The death of a baby is complicated. The loss is an embodied one that incites deep psychological wounds and can be isolating for many parents. Parents process their grief experiences within a sometimes oppressive social context that either sees their expressions of loss as a normal response to an abnormal tragedy or as pathology. Several diagnostic categories have been proposed relative to the traumatic grief experiences of grieving parents that potentially affect them. We explore this nomenclature and, through the lens of a Social-Cognitive Processing Model, examine social support, attitudes, context, and oppressive interpersonal and social structures that affect parents. Clinical implications are discussed.

Gender differences in psychiatric and medical comorbidity with post-traumatic stress disorder

BACKGROUND

Post-traumatic stress disorder (PTSD) is associated with significant personal and societal burden. The present study examines the gender-specific differences in this burden in terms of the co-occurrence of psychiatric disorders and medical conditions with PTSD in the general population of France.

METHODS

The study is based on a cross-sectional general population survey of 21,879 adults. Trained interviewers used a computer-assisted telephone interviewing system to administer the Composite International Diagnostic Interview-Short Form to screen for psychiatric disorders and medical conditions in the previous 12 months.

RESULTS

One third of those with moderately severe PTSD (35.3%) and half of those with severe PTSD (54.2%) suffered from comorbid depression. The prevalence of anxiety disorders and substance use disorders was also greater among severe cases of PTSD. Chronic back or neck problems, frequent or severe headaches, arthritis or rheumatism and hypertension were highly prevalent among adults with PTSD. Adjusting for gender, age, education, employment and marital status, moderately severe and severe PTSD diagnoses were associated with significantly greater odds of comorbid psychiatric disorders and medical conditions. With few exceptions, the pattern of gender differences in psychiatric and medical morbidity among those with moderate or severe PTSD were similar to differences observed among those without PTSD.

CONCLUSIONS

The findings highlight the burden of co-occurring psychiatric and medical conditions among PTSD sufferers in France and suggest the need for careful consideration of comorbidity in the assessment and service planning for PTSD.

Bereavement Challenges and Their Relationship to Physical and Psychological Adjustment to Loss

OBJECTIVE

The psychosocial challenges confronted by bereaved survivors may contribute to poor bereavement adjustment. Measures of the challenges of bereavement are limited. This study is a preliminary examination of the factor structure of a new measure of bereavement challenges and their relationships to quality of life and mental illness in bereaved cancer caregivers. This measure was designed to identify intervention targets to reduce the likelihood of prolonged grief.

METHODS

Caregivers of advanced cancer patients were administered measures of bereavement challenges (Bereavement Challenges Scale, BCS), quality of life (Medical Outcomes Study Short Form-36), prolonged grief (PG-13), and mental disorders (Structured Clinical Interview for the DSM-IV). Principal component factor analyses identified the underlying factor structure of the BCS. We examined associations between the factors and caregiver quality of life, prolonged grief, and rates of mental disorders.

RESULTS

A factor analysis identified five factors: "Challenges with Connecting with Others," "Challenges with Change," "Challenges Imagining a Hopeful Future," "Challenges with Accepting the Loss," and "Challenges with Guilt." Greater endorsement of bereavement challenges was associated with worse quality of life, more severe symptoms of prolonged grief, and greater likelihood of meeting criteria for a mental disorder.

CONCLUSIONS

Assessing the challenges associated with bereavement is important to understanding barriers to bereaved individuals' adjustment. The five factors of the BCS point to potential targets for clinical intervention. Additional research on the BCS is needed, including validation in larger more diverse samples, and confirmation that reduction of these challenges is associated with less psychiatric morbidity and, specifically, symptoms of prolonged grief.

Factors associated with suicidal ideation disclosure: Results from a large population-based study

BACKGROUND

It is crucial for clinicians and researchers to understand the factors associated with the disclosure of suicidal ideation. Describing the characteristics of those who do not disclose their suicidal ideation or who disclose their ideation only to close others, to health professionals or to both may help researchers and clinicians in their preventive efforts to treat persons at risk for suicidal behavior.

METHODS

The sample was drawn from a large cross-sectional survey (n=22,138) on mental health in France. The analyses were based on the 4,156 persons (17.1%) who endorsed lifetime suicidal ideation with or without a history of suicide attempt and who indicated whether and to whom they disclosed their ideation. Socio-demographics, current mental disorders, and social connectedness were assessed.

RESULTS

Half of those with suicidal ideation had not shared their ideation with anyone, 6.3% did so with health professionals only, 20% with friends or family only, and 20% with both healthcare professionals and close others. Male gender, older age, lower education level and poor social connectedness were associated with greater odds of non-disclosure. Adjusting for socio-demographics and social connectedness, suicidal behavior and mental disorders were overall associated an increased likelihood of sharing suicidal ideation with health professionals.

LIMITATIONS

Cross-sectional survey assessing lifetime suicidal ideation and disclosure.

CONCLUSIONS

The findings provide important insight into the individual and social factors to take into account in suicidal ideation disclosure.