Narrating Final Memories From Spousal Loss: The Role of Place and Quality of Death

Objective: Personal memories of the death of a spouse can guide bereavement adjustment. Place of death and quality of death are end-of-life factors that are likely to influence death experiences and formation of subsequent personal memories. The current study employs narrative content-analysis to examine how place and quality of death relate to affective sequences present in older adults' final memories from the death of their spouse. Method: Based on power analyses, 53 older adults were recruited and completed a Final Memory Interview. They also reported place of spouse's death (ie, in hospital, out of hospital) and quality of death across four subscales. Final memory narratives were reliably content-analyzed (interrater agreements >.70), revealing positive and negative affective sequences, including: redemption, contamination, positive stability, and negative stability. Findings: Experiencing the death of a spouse in hospital was related to narrating final memories with contamination. In terms of quality of death, reporting a less comforting social environment at time of death was related to the presence of redemption in final memories. Reporting that one's spouse received appropriate medical care related to narrating memories that showed positive stability. Conclusions: Final memories are carried with the bereaved long after their loss. Positive final memories appear to stem from witnessing a comfortable, medically appropriate death outside of a hospital setting. End-of-life 'that is' between care and aligned with patients' values for place and treatment may be critical for spouses' formation of constructive final memories and bereavement adjustment.

Grieving Parents' Meaning-Making Narration in Relation to Value Orientations: A Cross-Cultural Study

This study investigated the association between prolonged grief (PG) severity and meaning-making narration in a cross-cultural context, and specifically aimed to illustrate the role of value orientation in shaping the grieving process. 30 Chinese and 22 Swiss parents who lost their child were asked to narrate and appraise specific memories to reflect their self-evaluation of traditional and modern values. The self-reported Prolonged Grief Disorder Scale (ref ICD-11) assessed PG severity. Compared with the Swiss sample, the Chinese sample provided more elaborated memories, which was not associated with symptom severity. Both Chinese and Swiss bereaved parents with more severe PG provided more narratives of loss-related memories, particularly in response to modern values. They also provided more appraisals of negative meanings for self-defining memories, particularly in relation to their traditional values. These findings indicate that, despite cultural differences in narration tendency, PG severity in bereaved parents was associated with the maladaptive integration of autobiographical memories across different cultures, in relation to value orientations. A clinical implication is the potential value of facilitating narrations of grieving clients that center on value orientations to mitigate the hardship of the personal loss.

I occasionally wear his huge sweaters… but I often prefer not to think about it: Bereaved children talking and not talking about parental loss

The unique perspective of children communicating about the loss of a parent has rarely been studied. In this qualitative research, we interviewed 12 children aged 7-12 and asked them about their experience communicating their loss. The children's verbal and non-verbal communication was characterized by constant movements away from and closer to various aspects of their loss, illustrated by three main themes: (a) children either talking about the loss or not talking about it; (b) first talking about the loss and then stopping to talk about it; and (c) simultaneously talking and not talking about the loss. Based on Stern's interpersonal relational thinking, our findings indicate that children wish to talk about the loss but also to avoid talking about it. The possibility of choosing to talk and not to talk with themselves and close individuals about the loss allows children to think about and articulate their feelings and thoughts.

Trying to keep alive a non-traumatizing memory of the deceased: A meta-synthesis on the interpretation of loss in suicide-bereaved family members, their coping strategies and the effects on them

WHAT IS KNOWN ON THE SUBJECT?: Losing a family member due to suicide has been described as a traumatic experience, as suicide-bereaved relatives grapple to accept the particular character of death and the core elements of guilt, self-criticism and stigma it inflicts. There are long-term consequences for those who bereave due to the suicide of their beloved on, a high risk for mental and physical health problems included. Feelings of guilt and self-stigma influence help-seeking behaviour among suicide-bereaved individuals. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Coping mechanisms adopted by suicide-bereaved individuals mediate the impact of suicide on their family, and especially on the quality of relationships among them. Supporting others in need can help alleviate guilt and self-blame for the suicide while it enables the bereaved to fulfil their need to keep a non-traumatizing, or even positive bond with the deceased. WHAT THE IMPLICATIONS FOR PRACTICE ARE?: Nursing interventions to facilitate suicide-bereaved family members' participation in self-help support groups and promote their engagement in supporting others in need are important. Mental health nurses need to facilitate the replacement of dysfunctional coping strategies, such as substance use or self-blame with more adaptive ones focused on the personal needs of the bereaved, in order to help them embrace a non-traumatizing memory of the deceased while being in peace with the social environment. Screening for mental health problems and management of shame, self-stigma and guilt during the grieving period needs to be a priority in nursing interventions.

ABSTRACT

INTRODUCTION: Losing a family member to suicide is a traumatic experience which includes guilt and self-stigma. Yet, there is lack of data synthesis on the survivors' experience.

AIM

A meta-synthesis of qualitative data on the interpretation of loss in suicide-bereaved family members, their coping strategies and the effects on family.

METHOD

A meta-ethnographic synthesis following a systematic literature search and evaluation of the methodological quality of the selected studies was applied.

RESULTS

The narratives of 326 individuals (parents/siblings/children/spouses) reported in sixteen studies were analysed. Trying to achieve a balance between keeping alive a non-traumatizing memory of the deceased, destigmatizing and liberating themselves from self-blame, self-criticism and guilt while being able to transform this experience into support towards others in need, was identified as the essence of the experience of the bereaved.

DISCUSSION

Although suicide within a family is a traumatic experience, spiritual and existential implications among the bereaved have been reported; their coping mechanisms mediate the impact of suicide on family sustainability.

IMPLICATIONS FOR PRACTICE

Nursing interventions to facilitate adoption of coping strategies centred on keeping a non-traumatizing memory of the deceased among the bereaved and promote their participation in self-help groups and activities to support others in need are important.

Longitudinal Changes in Suicide Bereavement Experiences: A Qualitative Study of Family Members over 18 Months after Loss

Family members bereaved by their loved ones' suicidal death normally undergo a complicated and lengthy bereavement process. In this qualitative case study, we explored longitudinal changes in the suicide bereavement process by applying assimilation analysis, based on the Assimilation Model (AM) and the Assimilation of Problematic Experiences Scale (APES), to longitudinal interview data collected from two Chinese suicide-bereaved individuals within the first 18 months after their loss. The results showed that over time the participants both progressed in adapting to their traumatic losses. Assimilation analysis both effectively elaborated the difference in the inner world of the bereaved and clearly demonstrated development in their adaptation to the loss. This study contributes new knowledge on the longitudinal changes in suicide bereavement experiences and demonstrates the applicability of assimilation analysis to suicide bereavement research. Professional help and resources need to be tailored and adapted to meet the changing needs of suicide-bereaved family members.

Adaptive and harmful autobiographical remembering after the loss of a loved one

Objectives: Remembering one's personal past serves psychosocial functions. Adaptive use of autobiographical memory is related to well-being but little research has focused on grief. We address this in two studies theoretically grounded in the model of reminiscence and health.Method: Participants were adults who were actively grieving, and in both studies, completed the Reminiscence Functions Scale and grief-related measures (i.e. feelings of grief, positive changes in life perspective). Study 1 focused on uses for generally recalling one's past and Study 2 on uses of memories of the deceased.Results: Across studies, self-negative ways of remembering were associated with stronger feelings of grief and also mediated relations between social ways of remembering and grief. Self-positive ways of remembering the deceased (Study 2) were associated with having experienced positive changes in life perspective since the loss.Conclusion: The discussion focuses on how memories of one's personal past are linked to the experience of loss, even years into bereavement.

Perceived Determinants of Disclosing Suicide Loss

Background: People who lost a loved one to suicide (i.e., suicide loss survivors, SLS) often struggle to talk about their experiences. However, previous studies suggest beneficial effects of disclosure among this group. Aims: This study aimed to identify determinants of disclosing suicide loss. Method: We conducted qualitative interviews with 22 female SLS focusing on determinants of disclosing suicide loss. Interviews were transcribed and analyzed using qualitative content analysis. Results: We identified contextual factors, perceived risks, and perceived benefits as determinants of disclosing suicide loss. Contextual factors included social settings and characteristics of conversation partners. Perceived risks included emotional distress among oneself and others as well as stigma-related risks of disclosing. Perceived benefits included participants' desire for authenticity and social support, as well as positive effects for grieving and fighting suicide stigma. Limitations: Findings are limited to the current female sample. Conclusion: SLS need support in identifying safe places for disclosure and in developing coping strategies to deal with suicide stigma and emotional distress experienced by themselves and others. Future research should investigate the general public's ability and attitudes to provide support after suicide loss and investigate disclosure decisions among male SLS.

The social health domain of people bereaved by a drug-related death and associations with professional help: A cross-sectional study

People bereaved by traumatic deaths are vulnerable to long-lasting impairments in social health, including the quality of social relationships and the capacity to manage their social lives. In this Norwegian study involving 255 participants bereaved by a drug-related death, we aimed to investigate their social health and associations with professional help. The results of a cross-sectional survey showed that participants on average rated their social health as poor, though with large variations within the group. Participants who reported high satisfaction with professional help reported significantly higher scores on most social health-related variables. More research is needed on professional help focusing on the social health of traumatically bereaved people.

The relational landscape of bereavement after anticipated death: An interpretive model

To complement existing literature and better capture the diversity of factors influencing grief, a more interpersonal understanding is required. Thus, we used the relational landscape's concept and empirical investigation to clarify the roles of individuals surrounding the bereaved. Sixteen interviews with bereaved individuals by euthanasia or natural death were analyzed using Interpretive Description. We present a model describing five types of actors in the environment of the bereaved and their ways of "being with" or giving space. We also include four lived landscapes in our model, with the purpose of describing how bereavement can be experienced within the social environment.

Disclosure of Grief Questionnaire (DGQ): Entwicklung und Validierung eines Fragebogens zur Erfassung von Kommunikationsmustern nach Trauerfällen

Zusammenfassung. Für die Verarbeitung belastender Ereignisse ist das Offenlegen der persönlichen Erfahrungen gegenüber dem sozialen Umfeld von zentraler Bedeutung. Allerdings gibt es bislang keine geeigneten Instrumente zur Erfassung der Kommunikationsmuster nach Trauerfällen. Ziel der aktuellen Studie war daher, den Fragebogen zum Offenlegen von traumatischen Erfahrungen (FOT; Müller, Beauducel, Raschka & Maercker, 2000 ) für Trauerprozesse zu adaptieren und seine psychometrische Qualität über eine Online-Befragung von 302 Personen, die mindestens einen Trauerfall erlebt hatten, zu überprüfen. In einer Hauptkomponentenanalyse ergab sich eine 2-Faktoren-Lösung mit den beiden Faktoren „Verschwiegenheit“ und „Mitteilungsbedürfnis“. Die psychometrischen Kennwerte der Skalen sind mit Cronbachs α-Werten zwischen .82 – .88 als zufriedenstellend bis gut einzuordnen. Ebenso kann die Konstruktvalidität vor dem Hintergrund signifikanter Korrelationen mit verwandten Maßen als gegeben angesehen werden. Der „Disclosure of Grief Questionnaire“ (DGQ) ist somit ein reliables und valides Instrument zur Erfassung der individuellen Kommunikationsmuster nach einem Trauerfall.

Loss in the Life Story: Remembering Death and Illness Across Adulthood

The experience of loss has not often been studied in the life story literature. Life disruption when loss of a loved one occurs may make loss events distinct, even from other challenges, when recalled. Optimally, individuals incorporate such events into their life story in a way that allows them to reflect positively on their life overall. We suggest that telling narratives that represent loss as leading to personal growth or as highlighting one’s connectedness to others may allow a positive view of life overall. In contrast, ruminating may signal a lack of meaningful integration of the event. The current study investigates personal growth from, communion in, and rumination about memories of past loss events. It also determines how these factors relate to positive reflection on one’s life overall. Age was explored as a moderator of these relations. Participants (29 younger adults, 40 older adults) narrated an autobiographical loss event and, for comparison, a non-loss challenging life event and a neutral event. Narratives were self-rated for rumination and extent of resultant personal growth, and reliably content-coded for themes of communion. Participants also completed a measure of positive reflection on their life. Loss narratives resulted in more personal growth and contained more communion themes than other challenging or neutral events. Greater loss-related personal growth predicted more positive life reflection for younger adults. How individuals recall and incorporate loss into their life story may relate differentially to psychosocial outcomes in different life phases.

Case report on the multiple pathways to posttraumatic stress disorder following suicide

Trauma pathology is not only a sum of risk factors, but emerges as a result of complex causal interaction. The case presented here illustrates the pathway from suicide exposure to the development of fully-fledged treatment-resistant posttraumatic stress disorder (PTSD), demonstrating how recognized risk factors can act in tandem to generate a difficult to treat syndrome. From a clinical perspective, bottom-up approaches that take into account real coping experiences of people bereaved by suicide are more effective to facilitate recovery and prevent adverse outcomes. Finally, even though treatment is often implemented, the diagnosis can be missed further complicating coping and treatment.

Angels of Courage: The Experiences of Mothers Who Have Been Bereaved by Suicide

Despite the increasing number of people being bereaved by suicide, little is understood concerning the experiences of those bereaved by suicide as they struggle to make sense of a loved one's death. The current study explored the experiences of four mothers who had been bereaved by suicide and the role of support groups in the meaning-making process following bereavement by suicide. Participants were interviewed and transcribed interviews were then analysed from an interpretative phenomenological perspective. Four main themes were identified: Continuing role of the mother; A never-ending quest; Finding sanctuary; and Rising up from the ashes. These themes relate to a range of emotions following bereavement by suicide, the meaning-making process, the social context and the role of the support group. Clinical implications are discussed in relation to these findings.

A Qualitative Systematic Review of the Bereavement Process Following Suicide

Despite the fact that a large number of people are bereaved by suicide each year, the experiences of those bereaved by suicide are poorly understood. It has been suggested that a contributing factor in relation to this lack of understanding has been the use of quantitative methods, which may not be sensitive to the bereavement process and its thematic content. Therefore, the current article outlines a systematic review of 11 qualitative studies that address issues related to the bereavement process following suicide. The results indicate that those bereaved by suicide encounter a range of difficult feelings following suicide including blame, guilt, and emptiness and that these feelings are affected by participants’ ability to make meaning of the event. The meaning-making process is a complex one that occurs within a difficult social context in which both those bereaved by suicide and members of the wider community struggle to interact with each other in a beneficial way. Clinical implications of these findings are discussed.

Adult Disclosure of Child Sexual Abuse: A Literature Review

Victims of childhood sexual abuse carry the experience of abuse into adulthood. One of the dilemmas victims face during adulthood is the decision to disclose or conceal the abuse. Although adult disclosure may be affected by former disclosure during childhood, adult survivors face new challenges and dilemmas, such as to whom, when, and how to tell. The purpose of this article is to review the domains found in the literature on survivors' experiences regarding disclosure of child sexual abuse during adulthood, all of which were published between 1980 and 2013. Domains include decisions to disclose during adulthood, barriers and facilitators to disclosure and potential recipients of the disclosure, as well as the process of telling and its impact on survivors' well-being. The authors present implications for policy, practice, and research.

Death thoughts and images in treatment-seekers after violent loss

Violent loss survivors often describe experiencing recurrent imagery about their loved one's death. The Death Imagery Scale assesses 5 kinds of imagery: reenactment, rescue, revenge, reunion, and remorse. We explored the frequency of these forms of imagery and their associations with PTSD, depression, and/or complicated grief (CG) among 130 treatment-seeking survivors who were, on average, 3.5 years postloss. Reenactment, rescue, and remorse imagery were most frequently endorsed, and all forms of imagery were associated with PTSD, depression, and CG. Bereaved parents reported more remorse and reunion imagery than others. Homicide survivors reported more revenge imagery than suicide and accident survivors.

Learning through loss: implementing lossography narratives in death education

Students may have a greater willingness to discuss issues of death and loss through written assignments; however, there is little guidance for instructors regarding how to manage these sensitive assignments, nor how students benefit from them. The authors implemented and evaluated a "lossography" assignment in an undergraduate thanatology course in which students wrote about their losses and anonymously shared these narratives with their classmates. Although many themes of loss emerged, the most frequently reported significant loss was death of a grandparent. Additionally, most significant losses occurred in childhood/adolescence. Prominent themes related to student learning included gaining self-awareness, knowledge about grief responses, and compassion for others. Students (N = 64) also completed a survey reflecting on their course learning. Of all aspects of course delivery, 44% identified the lossography as the most beneficial, whereas 97% recommended this assignment for future students. The implications of the assignment for death education are also discussed.

Selective disclosure in a first conversation about a family death in James Agee's novel A Death in the Family

The first conversation of a family about a family death is a neglected but potentially important topic. In a first conversation in James Agee's (1957/ 2006) novel A Death in the Family, the member who knows the most about the accidental death of another member discloses information selectively. The first conversation in Agee's novel suggests that communication and caring in the first family conversation about a death is attuned to family member emotions, particularly those of the family member considered most vulnerable, and that the aim is not a shared narrative that is true, but one that people can live with.