Coping strategies as a causal mediator of the effect of loss-related memory characteristics and negative loss-related appraisals on symptoms of PGD, PTSD and depression

Post-migration stressors, mental health and well-being in resettled refugees from Syria: Do individuals' coping strategies matter?

BACKGROUND

The evidence is mixed as to whether individuals' coping strategies may mitigate the adverse mental health effects of post-displacement stressors in refugee populations, with some indications that the buffering effects of coping strategies are context dependent. The present study examined if problem-solving and acceptance coping strategies were effect modifiers between post-migration stressors and mental health in adult refugees from Syria resettled in Sweden.

METHODS

Study aims were investigated using cross-sectional survey data from a nationwide, randomly sampled group of adult refugees from Syria granted permanent residency in Sweden between 2011 and 2013 (Nsample = 4000, nrespondents = 1215, response rate 30.4%). Post-migration stressors examined included: financial strain, social strain, host-country competency strain and discrimination. Two mental health outcomes were used: anxiety/depression, measured with the Hopkins Symptom Checklist-25; and well-being, measured with the WHO-5 Well-being Index. Both outcomes were modelled continuously. Coping strategies were measured using the BRIEF Cope scale. Interactions between coping strategies and post-migration stressors were tested in fully adjusted linear regression models using Wald test for interaction, corrected for multiple testing using the Benjamini-Hochberg procedure.

RESULTS

Both problem-solving and acceptance coping strategies buffered the adverse association between financial strain and symptoms of anxiety/depression, and problem-solving coping strategies buffered the adverse association between host-country competency strain and anxiety/depression.

CONCLUSIONS

The study suggests that individuals' coping strategies may to some degree buffer the adverse mental health effects of financial strain and host-country competency strain experienced by refugees in the resettlement phase. Although this pattern was only found in regard to anxiety/depression and not subjective well-being, the findings show that individual-level coping skills among refugees may contribute to adaptation in the face of post-settlement adversities. Notwithstanding the importance of attending to refugees' psychosocial conditions, refugees residing in refugee camps and newly resettled refugees might benefit from interventions aiming at enhancing individual coping resources and skills. The potential effect of increased controllability and decreased conflict-proximity also warrants further exploration in future studies.

"Suddenly Feeling Dark": A Qualitative Study on the Experiences of Nurses Facing Coworker Death During the COVID-19 Pandemic

BACKGROUND

The coworkers of nurses who died because of COVID-19 infection generally experience a highly emotional grieving process. Nurses grieving the loss of a coworker during the COVID-19 pandemic experience higher psychological stress because of their high workload and the grueling shifts required to manage health emergencies during the pandemic and cope with long-standing staffing shortages. The limited number of studies discussing this issue has resulted in insufficient evidence necessary to develop effective counseling strategies and psychological support for nurses in Indonesia dealing with the massive waves of COVID-19 cases.

PURPOSE

This study was designed to elucidate the experiences of nurses across four provinces in Indonesia who had experienced the loss of a colleague during the COVID-19 pandemic.

METHODS

A qualitative research design and phenomenological approach were used in this study. Sampling was done in Jakarta, Bali, East Java, and East Nusa Tenggara using purposive sampling for the first eight participants and snowball sampling for the subsequent 34 participants. Semistructured, in-depth interviews were used to collect data from 30 participants using appropriate ethical principles. Data saturation was achieved after interviewing 23 participants, and their data were analyzed using thematic analysis.

RESULTS

Three main themes related to nurses' responses to the death of a colleague, distinguished into several stages, were identified. Stages in the first theme were as follows: (a) shocked to hear of colleague's death, (b) self-blame for failing to save a life, and (c) afraid to experience the same situation. Stages in the second theme were as follows: (a) make efforts to avoid the same thing from happening again, (b) develop strategies to avoid thoughts of loss, and (c) expect to have a psychological support system. Stages in the third theme were as follows: (a) seek new reasons, goals, directions, and meanings in life and (b) improve the physical and social health of individuals.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The range of responses from nurses to the death of a colleague during the COVID-19 pandemic identified in this study may be referenced by service providers to better provide psychological assistance and support to nursing staff. In addition, the coping strategies described by the participants provide detailed information that healthcare providers may use to deal with nurses facing death more comprehensively. This study emphasizes the importance of developing strategies to help nurses cope positively with their grief from a holistic perspective, which may be expected to impact positively the performance of nurses.

Psychometric Characteristics of the Oxford Grief Memory Characteristics Scale and Its Relationship With Symptoms of ICD-11 and DSM-5-TR Prolonged Grief Disorder

Difficulties with loss-related memories are hypothesised to be an important feature of severe and enduring grief reactions according to clinical and theoretical models. However, to date, there are no self-report instruments that capture the different aspects of memory relevant to grieving and adaptation after bereavement over time. The Oxford Grief-Memory characteristics scale (OG-M) was developed using interviews with bereaved individuals and was subject to exploratory and confirmatory factor analyses in a community sample (N = 676). Results indicated the scale was unidimensional and demonstrated excellent psychometric properties. The impact of memory characteristics on symptoms of Prolonged Grief Disorder (PGD) according to both ICD-11 and DSM-5-TR criteria were investigated using cross-lagged structural equation modelling in a three-wave longitudinal sample (N = 275) at baseline and 6 and 12 months later. Results indicated that loss-related memory characteristics predicted future symptoms of PGD after controlling for autoregressions, and concurrent associations between symptoms and memory characteristics. Cross-lagged associations between memory characteristics and symptoms were significant in the first 6 months of follow-up. After that, memory characteristics predicted future symptoms, but not the other way round. Theoretical and clinical utility of the scale and its features are discussed.