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Blood C, Cacciatore J. "It Started After Trauma": The Effects of Traumatic Grief on Sleep Paralysis. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:1451-1472. [PMID: 35546322 DOI: 10.1177/00302228221093895] [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] [Indexed: 11/15/2022]
Abstract
Adverse life events are associated with the often-terrifying REM sleep parasomnia of sleep paralysis (SP), but the impact of bereavement on SP has not been specifically examined. This exploratory, mixed-methods study (N = 168) includes qualitative data from 55 participants who described factors they believed led to their SP. Of these, almost half with a traumatic loss listed death-related precipitants. In unadjusted (bivariate) negative binomial regression models, traumatic death, time since death, religiosity, and age estimated increased SP frequency in the prior month, prior year, or both. In multivariable models, traumatic death, time since death, and age estimated increased frequency in the prior month, prior year, or both. Unexpectedly, in all models, as compared to death ≥9 years earlier, prior month SP was greater with death 1-6 years earlier, but not <1 year earlier. Discussion includes the possible role of social constraints in traumatic grief trajectories and care provider recommendations.
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Affiliation(s)
- Cybele Blood
- Field Instructor, School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Joanne Cacciatore
- Professor, School of Social Work, Arizona State University, Phoenix, AZ, USA
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2
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Riguzzi M, Thaqi Q, Peng-Keller S, Lorch A, Blum D, Naef R. Adoption of evidence-based end-of-life and bereavement support to families in cancer care: A contextual analysis study with health professionals. J Clin Nurs 2024; 33:3599-3614. [PMID: 38291546 DOI: 10.1111/jocn.17033] [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: 05/24/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Abstract
AIMS To investigate the level of adoption of evidence-based family engagement and support during end-of-life cancer care and subsequent bereavement and its contextual facilitators and barriers from health professionals' perspectives, and to explore differences between professional groups. DESIGN Contextual analysis using an online cross-sectional survey. METHODS This study was conducted in four Swiss hospitals and three home care oncology and palliative care services. Non-parametric testing was used to investigate the level of adoption and differences between nurses, physicians, occupational- and physiotherapists and psychosocial professionals (chaplains, onco-psychologists and social workers). The STROBE checklist for cross-sectional studies was followed. RESULTS The majority of the 111 participating health professionals were nurses. Adoption was statistically significantly higher during end-of-life care than bereavement, with nurses and physicians reporting higher levels than the other professional groups. Guidance on end-of-life family care was available in about half of the cases, in contrast to a quarter for bereavement care. Self-perceived knowledge, skills and attitudes were moderate to high, with nurses and physicians reporting higher levels than others, except for general skills in working with families. Organisational structures were experienced as rather supportive, with the psychosocial group appraising the organisational context as significantly less conducive to fully implementing end-of-life and bereavement care than others, particularly during the end-of-life phase. CONCLUSION Evidence-based family engagement and support were better adopted during end-of-life care than bereavement. Overall, nurses and physicians felt better enabled to care for families compared to other professional groups. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. PROTOCOL REGISTRATION https://osf.io/j4kfh. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Implementation and quality improvement efforts should focus particularly on the bereavement phase and be tailored to professional groups. IMPACT The findings show that evidence-based family engagement and support practices during end-of-life were rather well adopted in contrast to subsequent bereavement care, with nurses and physicians better enabled than other professionals to provide care. A better understanding of health professionals' contributions and roles in family care is important to build interprofessional capacity for evidence-based end-of-life and bereavement support. REPORTING METHOD The STROBE checklist for reports of cross-sectional studies was followed (von Elm et al., 2007).
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Affiliation(s)
- Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Qëndresa Thaqi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Simon Peng-Keller
- Spiritual Care, Faculty of Theology, University of Zurich, Zurich, Switzerland
| | - Anja Lorch
- Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - David Blum
- Competence Centre for Palliative Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Centre for Palliative Care, City Hospital Zurich, Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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3
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Totland TH, Titlestad KB, Lindeman SK. What do Professional Helpers Describe as Important Competence when Supporting Persons Bereaved by a Drug-Related Death. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241265150. [PMID: 39037426 DOI: 10.1177/00302228241265150] [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: 07/23/2024]
Abstract
Bereaved persons following a drug-related death (DRD) experience significant stress, an increased risk of health-related problems, complicated grief reactions and a risk of higher mortality. Despite the support received from professional helpers being important, research has yet to examine their perspectives to understand and meet the bereaved's needs and increase the helpers' competence. Hence, this qualitative study explored professional helpers' perspectives on essential skills and competencies when supporting bereaved following DRD. We conducted focus group interviews with 29 professional helpers from diverse health and welfare services across six Norwegian municipalities. Reflexive thematic analysis generated three main themes: Diversity of competence, Basic human competence and Balancing act between different considerations. It is crucial that municipal services explicitly define the needs of bereaved persons following a DRD and determine the necessary professional competencies and appropriate intervention levels required.
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Affiliation(s)
- Torill Hauge Totland
- Haugesund Municipality, Haugesund, Norway
- Western Norway University of Applied Sciences, Bergen, Norway
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4
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Ivynian SE, Maccallum F, Chang S, Breen LJ, Phillips JL, Agar M, Hosie A, Tieman J, DiGiacomo M, Luckett T, Philip J, Dadich A, Grossman C, Gilmore I, Harlum J, Kinchin I, Glasgow N, Lobb EA. Support needs of Australians bereaved during the COVID-19 pandemic: A cross-sectional survey study. PLoS One 2024; 19:e0304025. [PMID: 38843213 PMCID: PMC11156310 DOI: 10.1371/journal.pone.0304025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 05/05/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND COVID-19 disrupted access to bereavement support. The objective of this study was to identify the bereavement supports used by Australians during the COVID-19 pandemic, perceived helpfulness of supports used, prevalence and areas of unmet support need, and characteristics of those with unmet support needs. METHODS A convenience sample of bereaved adults completed an online questionnaire (April 2021-April 2022) about their bereavement experiences including support use and perceived helpfulness, unmet support needs and mental health. Multiple logistic regression was conducted to determine sociodemographic correlates of unmet needs. Open-ended responses were examined using content analysis to determine key themes. RESULTS 1,878 bereaved Australians completed the questionnaire. Participants were mostly women (94.9%) living in major cities (68%) and reported the death of a parent (45%), with an average age of 55.1 years (SD = 12.2). The five most used supports were family and friends, self-help resources, general practitioners, psychologists, and internet/online community groups. Notably, each was nominated as most helpful and most unhelpful by participants. Two-thirds (66%) reported specific unmet support needs. Those with unmet needs scored lower on mental health measures. Correlates of unmet needs included being of younger age, being a spouse or parent to the deceased; reporting more impacts from public health measures, and not reporting family and friends as supports. The most frequent unmet need was for social support after the death and during lockdown. CONCLUSIONS This study demonstrates the complexity of bereavement support needs during a pandemic. Specialised grief therapy needs to be more readily available to the minority of grievers who would benefit from it. A clear recommendation for a bereavement support action plan is to bolster the ability of social networks to provide support in times of loss. The fostering of social support in the wake of bereavement is a major gap that needs to be addressed in practice, policy, and research.
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Affiliation(s)
- Serra E. Ivynian
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Fiona Maccallum
- Faculty of Health and Behavioural Sciences, School of Psychology, University of Queensland, St Lucia, QLD, Australia
| | - Sungwon Chang
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Lauren J. Breen
- Curtin School of Population Health and Curtin enAble Institute, Curtin University, Perth, Western Australia
| | - Jane L. Phillips
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Meera Agar
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Annmarie Hosie
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
- School of Nursing & Midwifery, University of Notre Dame Australia, Darlinghurst, NSW, Australia
- St Vincent’s Health Network Sydney, Darlinghurst, NSW, Australia
| | - Jennifer Tieman
- Faculty of Health Sciences, RePaDD, Flinders University, Adelaide, SA, Australia
| | - Michelle DiGiacomo
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Tim Luckett
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jennifer Philip
- Department of Medicine, St Vincent’s Hospital, University of Melbourne, Fitzroy, VIC, Australia
| | - Ann Dadich
- School of Business, Western Sydney University, Parramatta, NSW, Australia
| | | | - Imelda Gilmore
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Janeane Harlum
- District Palliative Care Service, Liverpool Hospital, Liverpool, NSW, Australia
| | - Irina Kinchin
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland
| | - Nicholas Glasgow
- Medical School, Australian National University, Canberra, ACT, Australia
| | - Elizabeth A. Lobb
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
- Department of Palliative Care, Calvary Health Care Kogarah, Kogarah, NSW, Australia
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5
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Xiao C, Zhu B, Wei J. Letter to the editor: In-depth understanding of prolonged grief disorder: Analysis based on a development atlas. J Psychiatr Res 2024; 173:163-165. [PMID: 38537482 DOI: 10.1016/j.jpsychires.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/17/2024]
Affiliation(s)
- Chunfeng Xiao
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, PR China.
| | - Boheng Zhu
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, PR China
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, PR China.
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6
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Lichtenthal WG, Roberts KE, Donovan LA, Breen LJ, Aoun SM, Connor SR, Rosa WE. Investing in bereavement care as a public health priority. Lancet Public Health 2024; 9:e270-e274. [PMID: 38492580 PMCID: PMC11110717 DOI: 10.1016/s2468-2667(24)00030-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 03/18/2024]
Abstract
Morbidity and mortality associated with bereavement is an important public health issue, yet economic and resource investments to effectively implement and sustain integrated bereavement services are sorely lacking at national and global levels. Although bereavement support is a component of palliative care provision, continuity of care for bereaved individuals is often not standard practice in palliative and end-of-life contexts. In addition to potentially provoking feelings of abandonment, failure to extend family-centred care after a patient's death can leave bereaved families without access to crucial psychosocial support and at risk for illnesses that exacerbate the already substantial public health toll of interpersonal loss. The effect of inadequate bereavement care disproportionately disadvantages vulnerable groups, including those living in resource-constrained settings. We build on available evidence and previous recommendations to propose a model for transitional care, firmly establishing bereavement care services within health-care institutions, while respecting their finite resources and the need to ultimately transition grieving families to supports within their communities. Key to the transitional bereavement care model is the bolstering of community-based supports through development of compassionate communities and upskilling of professional services for those with more substantial bereavement support needs. To achieve this goal, interprofessional health workers, institutions, and systems must shift bereavement care from an afterthought to a public health priority.
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Affiliation(s)
- Wendy G Lichtenthal
- Center for the Advancement of Bereavement Care, Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Kailey E Roberts
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Leigh A Donovan
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Lauren J Breen
- Curtin School of Population Health and Curtin enAble Institute, Curtin University, Perth, WA, Australia
| | - Samar M Aoun
- Medical School, University of Western Australia, Perth, WA, Australia; Perron Institute for Neurological and Translational Science, Perth, WA, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | | | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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7
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Riguzzi M, Thaqi Q, Lorch A, Blum D, Peng-Keller S, Naef R. Contextual determinants of guideline-based family support during end-of-life cancer care and subsequent bereavement care: A cross-sectional survey of registered nurses. Eur J Oncol Nurs 2024; 70:102555. [PMID: 38626610 DOI: 10.1016/j.ejon.2024.102555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/09/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE In end-of-life cancer care, 10-20% of bereaved family members experience adverse mental health effects, including prolonged grief disorder. Despite great efforts, evidence-based recommendations to support their grieving process and well-being are often not successfully adopted into routine clinical care. This study identified facilitators and barriers using implementation science methodology. METHODS 81 registered nurses working in cancer care from four hospitals and three home care services in Switzerland assessed their current family support practices in end-of-life care and bereavement care. They then assessed organisational attributes of their institution and their own individual characteristics and skills regarding literature-based factors of potential relevance. Facilitators and barriers to guideline-based family support were determined using fractional logistic regression. RESULTS Service specialisation in palliative care, a culture that supports change, the availability of family support guidelines, billing/reimbursement of bereavement support services, and individual knowledge of family support and skill were systematically associated with higher adoption of guideline-based family support practices. Lack of privacy with families and insufficient training acted as significant barriers. CONCLUSIONS While several potentially relevant factors have emerged in the literature, certain organisational and individual determinants actually empirically predict guideline-based family support according to nurses in end-of-life cancer care, with some determinants having much stronger implications than others. This provides crucial guidance for focussing quality improvement and implementation efforts through tailored strategies, especially with scarce resources. Furthermore, adoption is lower in bereavement care than in end-of-life care, suggesting a particular need for supportive organisational cultures including specific training and billing/reimbursement options.
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Affiliation(s)
- Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland.
| | - Qëndresa Thaqi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland
| | - Anja Lorch
- Department of Medical Oncology and Haematology Clinic, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - David Blum
- Competence Centre for Palliative Care, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Centre for Palliative Care, City Hospital Zurich, Tièchestrasse 99, 8037 Zurich, Switzerland
| | - Simon Peng-Keller
- Spiritual Care, Faculty of Theology, University of Zurich, Kirchgasse 9, 8001 Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland
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8
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Goveas JS. Underscoring the Significance of Memorial Attendance in Reducing Future Psychological Distress in Bereaved Older Women. Am J Geriatr Psychiatry 2023; 31:1058-1061. [PMID: 37543462 DOI: 10.1016/j.jagp.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Joseph S Goveas
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI.
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9
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Telaar B, Hanauer C, Rosner R, Doering BK. Predictors of Client Satisfaction With Bereavement Counselling: The Role of Negative Effects. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231193806. [PMID: 37534590 DOI: 10.1177/00302228231193806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Bereaved persons seeking help in bereavement counselling report generally high client satisfaction. However, qualitative research suggests that some clients also indicate dissatisfying experiences and negative effects. The aim of this study was to investigate the contribution of content-, counsellor- and client-related characteristics and negative effects to client satisfaction. Bereaved participants (n = 53) who had completed bereavement counselling were recruited either online or via counselling organizations. In an online survey, they provided information about client-, loss- and counselling-related variables, present grief severity, negative effects of counselling and client satisfaction. In a hierarchical linear regression analysis controlling for recruitment strategy, online-recruited participants were less satisfied. In a second step additionally considering number of sessions, grief severity and negative effects, experiencing more negative effects predicted lower client satisfaction. The results indicate that negative effects could play an important role for client satisfaction. More research is needed to investigate this phenomenon.
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Affiliation(s)
- Berit Telaar
- Clinical Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Christina Hanauer
- Clinical Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Rita Rosner
- Clinical Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Bettina K Doering
- Clinical Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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10
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Hanauer C, Telaar B, Al-Dawaf N, Rosner R, Doering BK. 'Feeling disconnected' - risk factors for PGD and themes in grief counselling during the COVID-19 pandemic. A mixed-method study. Eur J Psychotraumatol 2023; 14:2183006. [PMID: 36912798 PMCID: PMC10013402 DOI: 10.1080/20008066.2023.2183006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Background: Due to its high death toll and measures to curb the pandemic, COVID-19 has affected grieving experiences and may contribute to risk factors for Prolonged Grief Disorder (PGD). Persons at risk for PGD often seek support from grief counselling.Objective: To explore whether pandemic-associated risk factors have become more important topics in counselling in a mixed-method design.Method: German grief counsellors (n = 93) rated whether pre-defined risk factors had become more important in grief counselling and indicated additional important themes in an open format.Results: The counsellors indicated that all pre-defined risk factors had become more important, though differing significantly in their frequency. Most frequently endorsed risk factors were lack of social support, limited possibilities to accompany a dying loved one and absence of traditional grief rituals. Qualitative analysis identified three additional themes: the societal impact of the pandemic, its impact on bereavement support and health care, and a chance for personal growth.Conclusions: The pandemic has affected bereavement experiences and grief counselling. Counsellors should monitor grief processes and specific risk factors to provide the best possible care for bereaved people when needed.
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Affiliation(s)
- Christina Hanauer
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Berit Telaar
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Nadja Al-Dawaf
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Bettina K Doering
- Clinical Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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11
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Bates U, Brennan J, Keegan O. Implementation and evaluation of a National Bereavement Support line in response to the COVID-19 pandemic in Ireland. J Public Health (Oxf) 2022:6780263. [PMID: 36310507 PMCID: PMC9620359 DOI: 10.1093/pubmed/fdac119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/05/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Background This study describes the design, implementation and evaluation of a national bereavement helpline developed as proactive tiered response to immediate be reavement care during the COVID pandemic, operated in partnership between a national charity and the National Health Service. The service was based on Psychological First Aid principles adapted to integrate bereavement education. Its aim was to provide asupportive compassionate listening service, education advice resources and sign posting to community services. Methods Two independent psychologist were commissioned to undertake a retrospective service evaluation of six months of the operation of the line, using a volunteer survey, interviews and line usage data. Results and Conclusions Results show that the line is meeting a need, PFA + Bereavement is providing a useful framework for service delivery, and there is good adherence to the model. Volunteers are experiencing working on the line as challenging but rewarding. Supervision and debriefing are essential for volunteer well being and confidence. Approximately 10% of callers were referred onto other services. Management report that they good oversight of governance issues and are planning for the future development, and funding of the line for the next two years.
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Affiliation(s)
| | - Joanne Brennan
- Doctoral Programme, Trinity College Dublin, Dublin 2, Ireland
| | - Orla Keegan
- Address correspondence to Orla Keegan, E-mail:
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12
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Moya-Salazar J, Zuñiga N, Cañari B, Jaime-Quispe A, Chicoma-Flores K, Contreras-Pulache H. The End of Life Accompanied by COVID-19: A Qualitative Study on Grief During the First OutBreak In Peru (Part I). OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221134424. [PMID: 36226870 PMCID: PMC9561526 DOI: 10.1177/00302228221134424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Due to the massive deaths and high level of contagion brought about by COVID-19, burial practices and the way we bury our dead are being affected by SARS-CoV-2 confinement and control measures. Here, we aimed to examine the changing of death, dying, and mourning during the first wave and quarantine applied in Peru with the arrival of COVID-19 in 2020. Using a qualitative approach, 15 participants who lost a family member because of COVID-19 were interviewed by telephone and video call. Our results revealed that death in isolation, the loss of rituals, and the farewell to relatives have dramatically affected family members. Peruvian funeral practices were altered by health provisions, making it a challenge to accompany relatives at the end of life. This way of coping with death can affect family wellbeing, for which no interventions have yet been proposed to improve the quality of life during bereavement.
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Affiliation(s)
- Jeel Moya-Salazar
- School of Medicine, Faculties of
Health Science, Universidad Norbert
Wiener, Lima, Peru
- Hospital Nacional Docente Madre Niño
San Bartolomé, Lima, Peru
- Qualitative Unit, Nesh Hubbs, Lima, Peru
| | - Nahomi Zuñiga
- School of Medicine, Faculties of
Health Science, Universidad Norbert
Wiener, Lima, Peru
- Qualitative Unit, Nesh Hubbs, Lima, Peru
| | - Betsy Cañari
- School of Medicine, Faculties of
Health Science, Universidad Norbert
Wiener, Lima, Peru
- Qualitative Unit, Nesh Hubbs, Lima, Peru
| | - Alexis Jaime-Quispe
- School of Medicine, Faculties of
Health Science, Universidad Norbert
Wiener, Lima, Peru
- Qualitative Unit, Nesh Hubbs, Lima, Peru
| | | | - Hans Contreras-Pulache
- School of Medicine, Faculties of
Health Science, Universidad Norbert
Wiener, Lima, Peru
- South America Center for Education
and Research in Public Health, Universidad Norbert
Wiener, Lima, Peru
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13
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Doering BK, Barke A, Vogel A, Comtesse H, Rosner R. Predictors of Prolonged Grief Disorder in a German Representative Population Sample: Unexpectedness of Bereavement Contributes to Grief Severity and Prolonged Grief Disorder. Front Psychiatry 2022; 13:853698. [PMID: 35558417 PMCID: PMC9090313 DOI: 10.3389/fpsyt.2022.853698] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/01/2022] [Indexed: 12/13/2022] Open
Abstract
Most people adapt to bereavement over time. For a minority, the grief persists and may lead to a prolonged grief disorder (PGD). Identifying grievers at risk of PGD may enable specific prevention measures. The present study examined the extent to which the subjective unexpectedness of the death predicted grief outcomes above and beyond known sociodemographic and objective loss-related variables in a sample drawn from a population-representative investigation. In our sample (n = 2,531), 811 participants (M age 55.1 ± 17.8 years, 59.2% women) had experienced the loss of a significant person six or more months ago. Participants provided demographic and loss-related information, perceptions of the unexpectedness of the death and completed the Prolonged Grief Disorder-13 + 9 (PG-13 + 9). The PG-13 + 9 was used to determine PGD caseness. A binary logistic regression investigated predictors of PGD caseness, and a linear regression predictors of grief severity. ANCOVAs compared PGD symptoms between the groups who had experienced an "expected" vs. "unexpected" loss, while controlling for the relationship to the deceased and time since loss. The loss of a child (OR = 23.66; 95%CI, 6.03-68.28), or a partner (OR = 5.32; 95%CI, 1.79-15.83), the time since loss (OR = 0.99; 95%CI, 0.99-1.00) and the unexpectedness of the death (OR = 3.58; 95%CI, 1.70-7.69) were significant predictors of PGD caseness (Nagelkerke's R2 = 0.25) and grief severity. Participants who had experienced the loss as unexpected (vs. expected) reported higher scores on all PGD symptoms. Unexpectedness of the death emerged as significant risk factor for PGD, even after controlling for demographic and other loss-related variables. While our findings replicate previous research on the importance of the relationship to the deceased as a risk factor for PGD, they also highlight the importance of assessing the subjective unexpectedness of a death and may help to identify risk groups who can profit from preventive interventions.
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Affiliation(s)
- Bettina K Doering
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.,Clinical Psychology and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Antonia Barke
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Anna Vogel
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Hannah Comtesse
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Rita Rosner
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
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14
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Keegan O, Murphy I, Benkel I, Limonero JT, Relf M, Guldin MB. Using the Delphi technique to achieve consensus on bereavement care in palliative care in Europe: An EAPC White Paper. Palliat Med 2021; 35:1908-1922. [PMID: 34488504 DOI: 10.1177/02692163211043000] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The WHO definition of palliative care includes bereavement support as integral to palliative care, yet a previous survey of bereavement support in palliative care in Europe has shown a range of service responses to loss. A rigorous approach to agreeing and implementing a palliative care bereavement framework was required. AIM The aim of this study was to develop consensus on best-practice recommendations for bereavement care principles, structures, processes and delivery based on current practice and evidence. DESIGN In accordance with Guidance on Conducting and Reporting Delphi Studies, a consensus-building five-round Delphi technique was performed. A scoping review of research literature informed drafting of 54 statements by the EAPC Bereavement Task Force. Evaluation of the statements was performed by an expert panel using a 5-point Likert scale. ⩾80% agreement were defined as essential items and 75%-79% agreement were defined as desirable items. Items with a consensus rating <75% were revised during the process. SETTING/PARTICIPANTS The Delphi study was carried out by an expert panel among membership organisations of the European Association for Palliative Care. RESULTS In total, 376 email requests to complete Delphi questionnaire were distributed with a response rate of 23% (n = 87) and a follow-up response-rate of 79% (n = 69). Of the initial 54 statements in six dimensions, 52 statements were endorsed with 26 essential statements and 26 desirable statements. CONCLUSIONS The six dimensions and 52 statements agreed through this Delphi study clarify a coherent direction for development of bereavement services in palliative care in Europe.
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Affiliation(s)
- Orla Keegan
- Head of Education & Bereavement, Irish Hospice Foundation, Dublin, Ireland
| | - Irene Murphy
- Maymount University Hospital and Hospice, Cork, Ireland
| | | | - Joaquim T Limonero
- Facultat de Psicologia, Universitat Autonoma de Barcelona, Barcelona, Spain
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15
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Abstract
Purpose of Review The objective of this review is to provide background on common theories of grief, describe the impact of grief on older adults and to introduce various modalities that are currently used and/or being researched for treatment. The objective is also to condense information and identify what has been found beneficial versus what has been found lacking. A brief examination of overlap of other disorders is done. It also will suggest what further research is necessary on this subject, and highlight what research is being done during the COVID-19 Pandemic. Findings The latest research of grief primarily involves refining the definitions of grief. More concrete definitions of grief will help for better screening tools, and thus target interventions more appropriately. There is considerable need for applying it to the unique and real-world COVID-19 pandemic. Summary Grief disorders are relatively common and the symptoms overlap other disorders. Since the treatments differ, identifying grief disorders is important, especially in the elderly who are more susceptible to grief disorders. Therapy improves grief better than medications, but medications will help with any co-occurring disorders. No clear superior therapy has been identified but research continues. The pandemic has highlighted the need to refine the definitions of grief disorders and to treat them effectively.
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16
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Affiliation(s)
- Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
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17
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Eisma MC, Boelen PA. Commentary on: A Call to Action: Facing the Shadow Pandemic of Complicated Forms of Grief. OMEGA-JOURNAL OF DEATH AND DYING 2021; 87:334-340. [PMID: 34018437 PMCID: PMC10064452 DOI: 10.1177/00302228211016227] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this contribution, we respond to a letter in Omega: Journal of Death and Dying by Doka. Signatories of this letter to the President of the United States convey concerns that deaths during the COVID-19 pandemic will lead to a higher prevalence of severe and persistent grief, i.e., prolonged grief disorder. We support their call to action to direct government funding to helping those who develop this condition during the COVID-19 pandemic. However, we think that concerns about prolonged grief disorder during the pandemic can be more convincingly conveyed by firmly embedding such concerns within scientific literature. Therefore, we highlight prior scientifically informed opinion pieces from various international researchers who voiced similar concerns in the early months of the pandemic. Additionally, we provide an overview of pioneering empirical research elucidating whether prolonged grief disorder and related mental health problems will become more prevalent during the pandemic.
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Affiliation(s)
- Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
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18
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Rosner R, Comtesse H, Vogel A, Doering BK. Prevalence of prolonged grief disorder. J Affect Disord 2021; 287:301-307. [PMID: 33812243 DOI: 10.1016/j.jad.2021.03.058] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/27/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prolonged grief is a disorder (PGD) characterized by severe and disabling grief reactions for an extended period of time after the loss of a significant person. ICD-11 and DSM-5-TR differ substantially in individual criteria. OBJECTIVE Estimation of the respective prevalence of PGDICD-11 and PGDDSM-5-TR and the frequency with which single symptoms of prolonged grief occur in the general population. METHODS Out of a representative sample of the German general population (N=2498), n = 914 reported a significant loss and prolonged grief symptoms based on the extended version of the self-reported Prolonged Grief Disorder-13+9 (PG13+9). Sociodemographic and loss-related characteristics were collected. RESULTS The probable prevalence of PGDICD-11 was 1.5% and that of PGDDSM-5-TR was 1.2% in the general sample. Among bereaved persons (n=914), the prevalence of developing PGDICD-11 was 4.2% and that of PGDDSM-5-TR was 3.3%. Diagnostic agreement between the two criteria-sets was very high and did not increase after heightening the accessory symptom threshold for PGDICD-11. Difficulties accepting the loss was the most frequent single symptom (14-25%) and grief-related impairment was common (10-16%). Over 60% of participants with a probable PGD diagnosis utilized health care services. LIMITATIONS Results are based on self-reported data. The PG13+9 was not designed to assess grief symptoms according to ICD-11 and DSM-5-TR diagnostic criteria. CONCLUSIONS Prolonged grief according to ICD-11 and DSM-5-TR is a notable disorder in the general population. Among bereaved persons, single symptoms of prolonged grief are relatively frequent and cause substantial degrees of impairment.
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Affiliation(s)
- Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.
| | - Hannah Comtesse
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.
| | - Anna Vogel
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Bettina K Doering
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
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19
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Djelantik AAAMJ, Bui E, O'Connor M, Rosner R, Robinaugh DJ, Simon NM, Boelen PA. Traumatic grief research and care in the aftermath of the COVID-19 pandemic. Eur J Psychotraumatol 2021; 12:1957272. [PMID: 34567440 PMCID: PMC8462871 DOI: 10.1080/20008198.2021.1957272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A significant increase in the number of individuals suffering from prolonged grief disorder is expected in the aftermath of the COVID-19 pandemic for two main reasons. First, the number of excess deaths has contributed to an immense number of bereaved individuals. Second, recent literature has shown that circumstances associated with COVID-19 deaths may be contributing to increased risk for the development of prolonged grief disorder. OBJECTIVE To best support those affected by loss during the COVID-19 pandemic, it is important to inform clinicians and researchers about the development, the nature and the treatment of prolonged grief disorder and employ sound research. METHOD In this editorial, we discuss important themes regarding prolonged grief disorder in the aftermath of the COVID-19 pandemic, to gather and present useful information for clinicians and researchers. RESULTS The following themes were addressed: 1. Harmonization in the diagnosis of prolonged grief disorder. 2. Screening tools and interventions. 3. Pharmacotherapy. 4. Special attention for the elderly. 5. Special attention for children and adolescents. 6. A causal system perspective for understanding grief and prolonged grief disorder. CONCLUSIONS If those involved in bereavement research and care manage to collaborate, the tragic consequences of COVID-19 might catalyse improvement of care for those most impaired following the loss of a loved one.
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Affiliation(s)
- A A A Manik J Djelantik
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department Youth - KOOS, Altrecht GGZ, Utrecht, The Netherlands
| | - Eric Bui
- Department Psychiatry, University of Caen Normandy, Caen, France
| | - Maja O'Connor
- Department of Psychology, Unit for Bereavement Research, Aarhus University/The Danish National Center for Grief, Aarhus, Denmark
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Donald J Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Naomi M Simon
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Paul A Boelen
- ARQ National Psychotrauma Centre, Diemen, The Netherlands.,ARQ Centrum'45, Diemen, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherland
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