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Kondo-Arita M, Becker CB. Changing Funerals and Their Effects on Bereavement Grief in Japan. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231158914. [PMID: 36803250 DOI: 10.1177/00302228231158914] [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: 02/23/2023]
Abstract
Bereavement is an extremely personal feeling, but Japanese society tends to disapprove of displays of negative personal emotion or weakness. For ages, mourning rituals like funerals provided an exception where social permission was given to sharing grief and seeking support. However, the form and significance of Japanese funerals have changed rapidly over the past generation, and especially since the advent of COVID-19 restrictions on assembly and travel. This paper overviews the trajectory of changes and continuities in mourning rituals in Japan, looking at their psychological and social impacts. It goes on to summarize recent Japanese research showing that appropriate funerals are not merely of psychological and social benefit, but may have an important role in reducing or supporting grief that might otherwise require medical and social work intervention.
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Affiliation(s)
- Megumi Kondo-Arita
- President's Office, Global Center of Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Carl B Becker
- Policy Science Unit, School of Medicine, Kyoto University, Kyoto, Japan
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2
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Kazan J, Lyew T, Croswell E, Buysse DJ, Gebara MA, Karp JF, Krafty RT, Rashied AA, Reynolds CF, Rollman BL, Smagula SF, Stahl ST. A digital health intervention to stabilize the 24-hour rhythm of sleep, meals, and physical activity for reducing depression among older bereaved spouses: Protocol for a randomized controlled trial. Contemp Clin Trials 2023; 124:107016. [PMID: 36414207 PMCID: PMC9839623 DOI: 10.1016/j.cct.2022.107016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite the high prevalence of depression and disruption to 24-h sleep-wake routines following the death of a spouse in late-life, no bereavement interventions have been developed to re-entrain a regular sleep-wake routine among older widow(er)s. We describe the rationale and methodology of the NIH-funded WELL Study (Widowed Elders' Lifestyle after Loss), a randomized controlled trial (RCT) comparing the efficacy of a digital health intervention (DHI) to enhanced usual care (EUC) arm for reducing depression symptoms in older spousally-bereaved adults. METHODS We will randomize approximately 200 recently bereaved (<12 months) adults aged 60+ years to one of two 12-week interventions: digital monitoring of the timing and regularity of sleep, meals, and physical activity plus weekly motivational health coaching; or enhanced usual care consisting of weekly telephone calls and similar assessment schedules. Participants will complete self-report and clinical assessments at baseline, post-intervention, and 3-, 6-, and 12-months post-intervention, and objective actigraphic assessments of their 24-h rest-activity rhythm (RAR) at baseline and 1-, 2-, and 3-months during the intervention. The primary outcome is change in depression symptoms burden (using the Hamilton Rating Scale for Depression) from pre- to post-intervention and over 12 months of follow-up. DISCUSSION WELL Study findings will inform the development of widely generalizable and scalable technology-based interventions to support bereaved spouses in community-based settings. Clinical http://Trials.gov Identifier: NCT04016896.
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Affiliation(s)
- Joseph Kazan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thandi Lyew
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emilee Croswell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marie Anne Gebara
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jordan F Karp
- Department of Psychiatry, University of Arizona, Tucson, AZ, USA
| | - Robert T Krafty
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Ammar A Rashied
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | | | - Bruce L Rollman
- Center for Behavioral Health, Media, & Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen F Smagula
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah T Stahl
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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3
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Haynes PL, Howe GW, Silva GE, Quan SF, Thomson CA, Glickenstein DA, Sherrill D, Gengler DN, Yingst A, Mayer C, Rojo-Wissar DM, Kobayashi U, Hoang M. The impact of social rhythm and sleep disruptions on waist circumference after job loss: A prospective 18-month study. Obesity (Silver Spring) 2022; 30:2023-2033. [PMID: 36062849 PMCID: PMC9509421 DOI: 10.1002/oby.23513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study prospectively examined change in waist circumference (WC) as a function of daily social rhythms and sleep in the aftermath of involuntary job loss. It was hypothesized that disrupted social rhythms and fragmented/short sleep after job loss would independently predict gains in WC over 18 months and that resiliency to WC gain would be conferred by the converse. METHODS Eligible participants (n = 191) completed six visits that included standardized measurements of WC. At the baseline visit, participants completed the social rhythm metric and daily sleep diary and wore an actigraph on their nondominant wrist each day for a period of 2 weeks. RESULTS When controlling for obesity and other covariates, WC trajectories decreased for individuals with more consistent social rhythms, more activities in their sdiocial rhythms, and higher sleep quality after job loss. WC trajectories did not change for individuals with lower scores on these indicators. CONCLUSIONS The frequency and consistency of social rhythms after job loss play a key role in WC loss. These findings support the implementation of social rhythm interventions after job loss, a potentially sensitive time for the establishment of new daily routines that have an impact on metabolic health.
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Affiliation(s)
- Patricia L. Haynes
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health University of Arizona, 1295 N. Martin Ave, Tucson, AZ, 85724 USA
| | - George W. Howe
- Department of Psychology, Columbian College of Arts and Sciences, George Washington University, 2125 G St NW, Washington, DC 20052 USA
| | - Graciela E. Silva
- College of Nursing, University of Arizona, 1305 N. Martin Ave, Tucson, AZ 85721 USA
| | - Stuart F. Quan
- College of Medicine, University of Arizona, Tucson, Arizona, USA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cynthia A. Thomson
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health University of Arizona, 1295 N. Martin Ave, Tucson, AZ, 85724 USA
| | - David A. Glickenstein
- Department of Mathematics, University of Arizona, 617 N. Santa Rita, Tucson, AZ 85721 USA
| | - Duane Sherrill
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, Tucson, AZ 85724 USA
| | - Devan N. Gengler
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health University of Arizona, 1295 N. Martin Ave, Tucson, AZ, 85724 USA
| | - April Yingst
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health University of Arizona, 1295 N. Martin Ave, Tucson, AZ, 85724 USA
| | - Candace Mayer
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health University of Arizona, 1295 N. Martin Ave, Tucson, AZ, 85724 USA
| | - Darlynn M. Rojo-Wissar
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health University of Arizona, 1295 N. Martin Ave, Tucson, AZ, 85724 USA
- The Miriam Hospital, Warren Alpert Medical School of Brown University, The Initiative on Stress, Trauma, and Resilience (STAR), Department of Psychiatry and Human Behavior, Center for Behavioral and Preventive Medicine, 164 Summit Ave, Providence, RI 02906 USA
| | - Ume Kobayashi
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health University of Arizona, 1295 N. Martin Ave, Tucson, AZ, 85724 USA
| | - Matthew Hoang
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health University of Arizona, 1295 N. Martin Ave, Tucson, AZ, 85724 USA
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Milić J. Aging and Neuropsychiatric Disease: A General Overview of Prevalence and Trends. Physiology (Bethesda) 2022. [DOI: 10.5772/intechopen.103102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The increasing trend of life-expectancy is becoming a significant demographic, societal and economic challenge. Currently, global number of people above sixty years of age is 900 million, while United Nations expect this number to rise to over 1.4 billion in 2030 and over 2.5 billion by 2050. Concordant to this trend, numerous physiological changes are associated with aging and brain-related ones are associated with neuropsychiatric diseases. The main goal of this chapter is to identify the most important neuropsychiatric diseases to assess in older patients to help to promote health and prevent diseases and complications associated with chronic illness, as these changes are progressive and require important psychological and setting-related social adjustments. Findings identify several health-aspects highly present in elderly: stroke, white matter lesions, dementia rise with age, changes in levels of neurotransmitters and hormones, depression as well as the bereavement following loss of the loved one, and the most common neurodegenerative disease—Alzheimer’s disease and Parkinson’s. In conclusion, studying the aging process should include all developmental, circumstantial, and individual aspects of aging. This offers opportunities to improve the health of elderly by using a wide range of skills and knowledge. Thus, further studies are necessary to elucidate what can be done do to improve the aging process and health of elderly in the future.
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de Feijter M, O'Connor MF, Arizmendi BJ, Ikram MA, Luik AI. The longitudinal association of actigraphy-estimated sleep with grief in middle-aged and elderly persons. J Psychiatr Res 2021; 137:66-72. [PMID: 33657460 DOI: 10.1016/j.jpsychires.2021.02.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/26/2021] [Accepted: 02/17/2021] [Indexed: 11/27/2022]
Abstract
Most people experience grief after a loss, about 10% develop complicated grief, often accompanied by sleep complaints. Yet, the role of objectively estimated poor sleep remains unclear. Therefore, we assessed the cross-sectional and longitudinal association of actigraphy-estimated sleep with grief. We included 1,776 participants (mean age: 61.8 ± 8.9 years, 55% women) of a prospective population-based cohort. Of 1,471 participants (83%) repeated measures of grief were available (median follow-up 6 years, inter quartile range 5.6-6.3). At baseline, sleep was objectively estimated using actigraphy (mean duration 6.0 ± 0.8days). At baseline and follow-up, participants were asked about significant losses and completed the Dutch Inventory of Complicated Grief (17 items, cut-off ≥22). At baseline 1,521 (86%) participants experienced no grief, 44 (2%) acute grief (<6 months, any grief score), 158 (9%) non-complicated grief (≥6 months, grief score<22), and 53 (3%) complicated grief (≥6 months, grief score≥22). In those indicating any grief (n = 255), low sleep efficiency (B = -0.16, 95%CI = -0.30;-0.02), long sleep onset latency (B = 0.07, 95%CI = 0.01; 0.14), and long wake after sleep onset (B = 0.06, 95%CI = 0.01; 0.10) were cross-sectionally associated with more grief symptoms. Over time, those with a short total sleep time (OR = 0.59, 95%CI = 0.39; 0.91), low sleep efficiency (OR = 0.95, 95%CI = 0.91; 0.99), long sleep onset latency (OR = 1.02, 95%CI = 1.00; 1.04), and long wake after sleep onset (OR = 1.02, 95%CI = 1.00; 1.03) at baseline more often experienced complicated grief than non-complicated grief at follow-up. This study suggests that objectively estimated poor sleep is associated with grief over time. Poor sleep might not only accompany grief, but also be a risk factor for developing complicated grief after a loss.
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Affiliation(s)
- Maud de Feijter
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | | | - Brian J Arizmendi
- Department of Psychology, University of Arizona, USA; Department of Psychology, Phoenix VA Health Care System, USA
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
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6
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Becker CB, Taniyama Y, Kondo-Arita M, Yamada S, Yamamoto K. How Grief, Funerals, and Poverty Affect Bereaved Health, Productivity, and Medical Dependence in Japan. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:669-689. [PMID: 32842880 PMCID: PMC9277332 DOI: 10.1177/0030222820947573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Grief has been shown to weaken bereaved persons' health, but measurements of
their lost time and medical expense remain rare. Funerals traditionally managed
and assuaged grief through ritual expression, approval, and social support.
Research suggests that satisfying funeral participation reduces grief, while
poverty exacerbates it. We hypothesized that: (1) psycho-physical symptoms of
grief, (2) abbreviation/dissatisfaction in the funeral, and (3) poverty,
correlate with decreased productivity and increased medical and social services
use. We collected data from 165 mourning families about their grief, funerals,
and subsequent medical conditions. (1) Deeper grief after bereavement in Japan
correlated with more physical problems, more down time, and more medical
dependency. (2) Low satisfaction with funerals correlated with higher hospital,
pharmacy, and counseling costs. (3) Low income families lost more time, while
declining incomes showed increased pharmaceutical costs. This suggests that
satisfying funerals and income safeguards may reduce costs of low productivity
and increased public services dependency.
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Affiliation(s)
| | - Yozo Taniyama
- Department of Religious Studies, Tohoku University, Sendai, Japan
| | - Megumi Kondo-Arita
- Nakayama International Center for Medical Cooperation, Osaka Medical College, Japan
| | - Shinya Yamada
- Department of Folklore and Folk Culture, National Museum of Japanese History, Sakura City, Japan
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Lancel M, Stroebe M, Eisma MC. Sleep disturbances in bereavement: A systematic review. Sleep Med Rev 2020; 53:101331. [PMID: 32505968 DOI: 10.1016/j.smrv.2020.101331] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022]
Abstract
Severe, persistent and disabling grief occurs among a sizable minority experiencing bereavement, with diagnostic manuals newly including complicated grief (CG) disorders. Sleep disturbances/disorders have been established as worsening affective and stress-related conditions. However, the role of sleep difficulties in bereavement and CG has not received similar scientific attention. We therefore conducted a systematic review with narrative syntheses on this topic to clarify the role of sleep in bereavement (PROSPERO: CRD42018093145). We searched PubMed, Web of Science and PsychInfo for peer-reviewed English-language articles including (at least one) bereaved sample and sleep disturbance measure. We identified 85 articles on 12.294 participants. We answered seven pre-defined research questions demonstrating: high prevalence of sleep disturbances in bereavement; positive associations of grief intensity with sleep difficulties; preliminary indications of risk factors of post-loss sleep disturbance; higher prevalence of sleep disturbances in CG, enhanced by psychiatric comorbidity (i.e., depression); and initial evidence of causal relationships between (complicated) grief and sleep. Grief therapy partly improves sleep difficulties, yet no intervention studies have specifically targeted sleep problems in bereaved persons. Causal relationships between sleep and grief require further examination in intensive longitudinal investigations, including randomized trials, thereby clarifying whether treating sleep problems enhances CG treatment effects.
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Affiliation(s)
- Marike Lancel
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands; Psychiatric Sleep Center Assen, Mental Health Services Drenthe, the Netherlands.
| | - Margaret Stroebe
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Maarten C Eisma
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
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8
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Milic J, Saavedra Perez H, Zuurbier LA, Boelen PA, Rietjens JA, Hofman A, Tiemeier H. The Longitudinal and Cross-Sectional Associations of Grief and Complicated Grief With Sleep Quality in Older Adults. Behav Sleep Med 2019; 17:31-40. [PMID: 28107032 DOI: 10.1080/15402002.2016.1276016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE/BACKGROUND About 15% of grievers experience complicated grief. We determined cross-sectional and longitudinal relations of grief and complicated grief with sleep duration and quality in the general population of elderly adults. PARTICIPANTS We included 5,421 men and women from the prospective population-based Rotterdam Study. METHODS The Inventory of Complicated Grief was used to define grief and complicated grief. We assessed sleep with the Pittsburgh Sleep Quality Index. RESULTS After 6 years, 3,511 (80% of survivors) underwent the follow-up interview. Complicated grief was cross-sectionally associated with shorter sleep duration and lower sleep quality. These associations were explained by the presence of depressive symptoms. The prospective analyses showed that sleep duration and sleep quality did not decline further during follow-up of persons who experienced grief or complicated grief. CONCLUSION In community-dwelling, middle-aged and older adults, persons with normal and complicated grief had both a shorter sleep duration and a lower sleep quality, mainly explained by depressive symptoms. However, prospective analyses showed that sleep quality and sleep duration do not decline further in persons with normal grief and complicated grief.
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Affiliation(s)
- Jelena Milic
- a Department of Epidemiology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Heidi Saavedra Perez
- a Department of Epidemiology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Lisette A Zuurbier
- a Department of Epidemiology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Paul A Boelen
- b Department of Clinical and Health Psychology , Utrecht University , Utrecht , The Netherlands
| | - Judith A Rietjens
- c Department of Public Health , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Albert Hofman
- a Department of Epidemiology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Henning Tiemeier
- a Department of Epidemiology , Erasmus Medical Center , Rotterdam , The Netherlands.,d Department of Psychiatry , Erasmus Medical Center , Rotterdam , The Netherlands.,e Department of Child and Adolescent Psychiatry , Erasmus Medical Center , Rotterdam , The Netherlands
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9
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Stahl ST, Emanuel J, Albert SM, Dew MA, Schulz R, Robbins-Welty G, Reynolds CF. Design and Rationale for a Technology-based Healthy Lifestyle Intervention in Older Adults Grieving the Loss of a Spouse. Contemp Clin Trials Commun 2017; 8:99-105. [PMID: 29170758 PMCID: PMC5695565 DOI: 10.1016/j.conctc.2017.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Experiencing the death of a spouse during late life is associated with an increased risk of developing debilitating mental health problems. Healthy lifestyle practices, such as regular exercise, healthy eating, and good sleep hygiene are promising strategies to influence the mental health and associated physical symptoms of late-life spousal bereavement. Objective This paper describes the design and rationale of an intervention development study addressing selective and indicated prevention of depression, anxiety, and/or complicated grief disorder(s) among adults 60 years and older who are grieving the recent loss (within 8 months) of a spouse or partner. Methods In Phase I, now complete, we developed and standardized behavioral self-monitoring of daily lifestyle choices via an electronic diary (BSM) and the combined BSM + motivational interviewing-based lifestyle coaching (BSM+MI) to be administered to participants grieving the loss of loved one. In Phase II, we have been implementing the interventions in a randomized controlled trial and addressing challenges related to recruitment. Randomization is to one of three cells: BSM, BSM+MI, or an enhanced usual care condition. Discussion Several challenges in implementing our lifestyle interventions to older widow(er)s who are at risk for common mental disorders have been identified. Direct outreach to hospice organizations is an effective way to identify older adults in the early months following spousal death. Results from study may advance the field of grief support and promote a healthy adaptation to widowhood.
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Affiliation(s)
- Sarah T. Stahl
- Department of Psychiatry, University of Pittsburgh, USA
- Corresponding author. Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| | - James Emanuel
- Department of Psychiatry, University of Pittsburgh, USA
| | - Steven M. Albert
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, USA
| | | | - Richard Schulz
- Department of Psychiatry, University of Pittsburgh, USA
- University Center for Social and Urban Research, University of Pittsburgh, USA
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10
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A pilot study of virtual support for grief: Feasibility, acceptability, and preliminary outcomes. COMPUTERS IN HUMAN BEHAVIOR 2017. [DOI: 10.1016/j.chb.2017.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cognitive Behavioral Social Rhythm Group Therapy for Veterans with posttraumatic stress disorder, depression, and sleep disturbance: Results from an open trial. J Affect Disord 2016; 192:234-43. [PMID: 26748739 DOI: 10.1016/j.jad.2015.12.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/09/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Cognitive Behavioral Social Rhythm Therapy (CBSRT) is a group psychotherapy tailored for Veterans with Posttraumatic Stress Disorder (PTSD), Major Depressive Disorder (MDD), and sleep disturbances. The aims of this study were to introduce and present initial outcomes of Cognitive Behavioral Social Rhythm Therapy (CBSRT), a 12-week skills group therapy designed to improve sleep and mood by reducing chaotic or isolated lifestyles in Veterans with PTSD. METHODS Twenty-four male Veterans with at least moderate PTSD and MDD participated in this open trial. Main outcomes were the daily sleep diary for sleep disturbances, the Clinician-Administered PTSD Scale (CAPS) for PTSD, and the Hamilton Depression Rating scale for MDD. RESULTS Veterans improved on all measures (a) with large within subject effects on PTSD symptoms, MDD symptoms, and sleep quality, and (b) with 46-58% of the sample receiving clinically significant benefits on MDD and PTSD symptoms respectively. The consistency of social rhythms was associated with the average reduction in global CAPS scores over time. Only 13% of participants dropped-out of the group therapy prematurely suggesting that this new group therapy is relatively well-tolerated by Veterans. LIMITATIONS Future research that employs a control condition is necessary to establish efficacy of CBSRT. CONCLUSIONS Data from this initial pilot study demonstrate that CBSRT may be an effective group treatment option for Veterans presenting with all three symptom complaints. These data also suggest that daily routine may be an important mechanism to consider in the treatment of PTSD symptoms comorbid with depression.
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12
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Pfoff MK, Zarotney JR, Monk TH. Can a function-based therapy for spousally bereaved seniors accrue benefits in both functional and emotional domains? DEATH STUDIES 2014; 38:381-386. [PMID: 24666144 PMCID: PMC3970179 DOI: 10.1080/07481187.2013.766658] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Late-life spousal bereavement has detrimental effects in daily functioning and emotional distress. This study tested the hypothesis that a therapy based exclusively upon functioning issues (sleep and daily lifestyle regularity) would accrue benefits in both functional and emotional domains. A comparison was made with a control therapy that concentrated on emotional issues, and specifically avoided discussing sleep or lifestyle regularity. Thirty-eight spousally bereaved seniors were randomly assigned to either functional or control therapy. Assessments were made before, during, and after a 6-month, 10-session individual therapy. The functional therapy assisted in both functional and emotional domains and the hypothesis was confirmed.
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Affiliation(s)
| | - Joette R. Zarotney
- Sleep and Chronobiology Center, University of Pittsburgh Department of Psychiatry
| | - Timothy H. Monk
- Sleep and Chronobiology Center, University of Pittsburgh Department of Psychiatry
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13
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Characteristics of the bereavement experience of older persons after spousal loss: An integrative review. Int J Nurs Stud 2013; 50:1108-21. [DOI: 10.1016/j.ijnurstu.2012.11.026] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 11/23/2012] [Accepted: 11/29/2012] [Indexed: 11/16/2022]
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14
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Nseir S, Larkey LK. Interventions for spousal bereavement in the older adult: an evidence review. DEATH STUDIES 2013; 37:495-512. [PMID: 24520924 DOI: 10.1080/07481187.2011.649941] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The loss of a spouse is a significant psychological and physical health issue for older adults, the fastest growing age group in the United States. A search was performed to review publications over the last 20 years examining the effect of interventions on grieving processes for older bereaved spouses. Nine publications met inclusion criteria and were critically reviewed. Study designs, populations, and outcomes measured varied widely. All intervention types showed improvements in grief-related outcomes, but statistical significance of major measures between interventions and controls was absent in all but one study using a mind-body intervention. Recommendations for future studies include testing of secondary and tertiary bereavement types and categorizing grief patterns in study populations.
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Affiliation(s)
- Stacey Nseir
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona 85004, USA.
| | - Linda K Larkey
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona 85004, USA
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15
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Germain A, Shear KM, Walsh C, Buysse DJ, Monk TH, Reynolds CF, Frank E, Silowash R. Dream content in complicated grief: a window into loss-related cognitive schemas. DEATH STUDIES 2013; 37:269-284. [PMID: 24524436 PMCID: PMC3929213 DOI: 10.1080/07481187.2011.641138] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Bereavement and its accompanying psychological response (grief) constitute potent experiences that necessitate the reorganization of cognitive-affective representations of lost significant attachment figures during both wakefulness and dreaming. The goals of this preliminary study were to explore whether the dream content of 77 adults with complicated grief (CG) differed from that of a normative sample and whether CG patients who dream of the deceased differ from CG patients who do not dream of the deceased on measures of daytime emotional distress. CG dreams were characterized by more family and familiar characters including the deceased (in women), and fewer social interactions and emotions compared to norms. Increased representations of familiar characters in CG dreams may reflect attempts to reorganize relational cognitive schemas to compensate for the loss.
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Affiliation(s)
- Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15210, USA.
| | | | - Colleen Walsh
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15210, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15210, USA
| | - Timothy H Monk
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15210, USA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15210, USA
| | - Ellen Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15210, USA
| | - Russell Silowash
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15210, USA
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Depression in the spousally bereaved elderly: correlations with subjective sleep measures. DEPRESSION RESEARCH AND TREATMENT 2013; 2013:409538. [PMID: 23634298 PMCID: PMC3619539 DOI: 10.1155/2013/409538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 02/21/2013] [Indexed: 11/30/2022]
Abstract
Complaints of poor sleep and symptoms of depression are likely to coexist in the spousally bereaved elderly. This study was concerned with the correlation between depressive symptoms and various measures of subjectively reported sleep using questionnaire and diary instruments in 38 bereaved seniors (60y+). Correlations between the sleep measures and days since loss and grief intensity were also calculated. All sleep disruption measures correlated significantly with depression score, but only sleep duration correlated with grief intensity, and no sleep measure correlated with days since loss. Therapies which address both sleep and depression are likely to be of benefit to bereaved seniors.
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Conlon A, Aldredge P. Married to a memory: undetected grief in an assisted living environment. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2013; 9:249-255. [PMID: 24295095 DOI: 10.1080/15524256.2013.846892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Annemarie Conlon
- a School of Social Work , Virginia Commonwealth University , Richmond , Virginia , USA
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18
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Doheny EP, Greene BR, Foran T, Cunningham C, Fan CW, Kenny RA. Diurnal variations in the outcomes of instrumented gait and quiet standing balance assessments and their association with falls history. Physiol Meas 2012; 33:361-73. [PMID: 22369925 DOI: 10.1088/0967-3334/33/3/361] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
One in three adults aged over 65 falls every year, resulting in enormous costs to society. Incidents of falling vary with time of day, peaking in the early morning. The aim of this study was to determine if the ability of instrumented gait and balance assessments to discriminate between participants based on their falls history varies diurnally. Body-worn sensors were used during a 3 m gait assessment and a series of quiet standing balance tests. Each assessment was performed four times during a single day under supervised conditions in the participant's homes. 40 adults aged over 60 years (19 fallers) participated in this study. A range of parameters were derived for each assessment, and the ability of each parameter to discriminate between fallers and non-fallers at each recording time was examined. The effect of falls history on single support time varied significantly with recording time, with a significantly reduced single support time observed at the first and last recording session of the day. Differences were observed between fallers and non-fallers for a range of other gait parameters; however, these effects did not vary with assessment time. The quiet standing assessments examined in this study revealed significant variations with falls history; however, the sensitivity of the examined quiet standing assessments to falls risk does not appear to be time dependent. These results indicate that, with the exception of single support time, the association of gait and quiet standing balance parameters with falls risk does not vary diurnally.
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Affiliation(s)
- Emer P Doheny
- Technology Research for Independent Living Centre, St. James's Hospital, Dublin, Ireland.
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Randler C, Bausback V. Morningness-eveningness in women around the transition through menopause and its relationship with climacteric complaints. BIOL RHYTHM RES 2010. [DOI: 10.1080/09291010903407631] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Sleep and emotions: a focus on insomnia. Sleep Med Rev 2010; 14:227-38. [PMID: 20137989 DOI: 10.1016/j.smrv.2009.10.007] [Citation(s) in RCA: 524] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 10/16/2009] [Accepted: 10/17/2009] [Indexed: 11/21/2022]
Abstract
Insomnia disorder is defined as difficulties in initiating/maintaining sleep and/or non-restorative sleep accompanied by decreased daytime functioning, persisting for at least four weeks. For many patients suffering from depression and anxiety, insomnia is a pervasive problem. Many of the aetiological theories of insomnia postulate that heightened emotional reactivity contributes to the maintenance of symptoms. This review focuses on the role of emotional reactivity in insomnia, and how the relationship between insomnia and depression and anxiety may be mediated by emotional reactivity. Furthermore, studies investigating the valence of emotions in insomnia are reviewed. Overall, there is empirical evidence that dysfunctional emotional reactivity might mediate the interaction between cognitive and autonomic hyperarousal, thus contributing to the maintenance of insomnia. Moreover, dysfunctions in sleep-wake regulating neural circuitries seem to be able to reinforce emotional disturbances. It seems plausible that dysfunctional emotional reactivity modulates the relationship between insomnia and depression and anxiety. Considering the interaction between sleep and emotional valence, poor sleep quality seems to correlate with high negative and low positive emotions, both in clinical and subclinical samples. Good sleep seems to be associated with high positive emotions, but not necessarily with low negative emotions. This review underlines the need for future research on emotions in insomnia.
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A feasibility study of a two-session home-based cognitive behavioral therapy-insomnia intervention for bereaved family caregivers. Palliat Support Care 2009; 7:197-206. [PMID: 19538802 DOI: 10.1017/s147895150900025x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In 2008 over two million family caregivers will become bereaved. The vast majority of these caregivers have provided 'round-the-clock care for a period ranging from months to years. Bereaved family caregivers report insomnia symptoms that persist beyond 1 year, longer than what is seen in bereaved noncaregivers, placing them at increased risk of depression and complicated grief. Despite some rewarding elements, caregiving is a stressful and exhausting role that often requires the caregiver to restructure his or her life around the needs of the patient. Once the patient dies, the structure is lost. Cognitive behavioral therapy interventions are effective in providing structure. This pilot study explored the feasibility of a two-session home-based cognitive behavioral therapy-insomnia (CBT-I) intervention for bereaved family caregivers. METHOD A 5-week longitudinal descriptive study design was used with 11 adult primary family caregivers of patients who died from cancer. A master's prepared nurse delivered two CBT-I intervention sessions in participant homes. Data collection sessions occurred at baseline, 3, and 5 weeks. A debriefing session was held at Week 6. RESULTS Participant evaluations of the intervention indicated that it was feasible and acceptable (e.g., 100% would recommend it to others); objective data further supported its feasibility (e.g., 100% completed the trial). In addition, when comparing baseline with Weeks 3 and 5, participants demonstrated improvement in insomnia and depressive symptoms. SIGNIFICANCE OF RESULTS The results of this pilot study suggest that the intervention is feasible and acceptable and produces promising effects on insomnia and depressive symptoms in bereaved family caregivers.
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Monk TH, Buysse DJ, Begley AE, Billy BD, Fletcher ME. Effects of a two-hour change in bedtime on the sleep of healthy seniors. Chronobiol Int 2009; 26:526-43. [PMID: 19360494 DOI: 10.1080/07420520902821119] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Some of the sleep disruption seen in seniors (>65 yrs) may be due to alteration of the circadian pacemaker phase and/or its phase angle with bedtime. The purpose of this study was to determine the effects of 2 h changes in the timing of bedtime (both earlier and later) on the sleep of seniors. Ten healthy seniors (9 F, 1 M, age 70-82 yrs) were each studied individually during three 120 h sessions (each separated by >2 weeks) in a time-isolation laboratory. On nights 1 and 2, bedtime and rise-time occurred at the subjects' habitual times; on nights 3-5, bedtime was specified by the experiment, but rise-time was at the subjects' discretion (without knowledge of clock time). Under the control condition, subjects went to bed at their habitual bedtime (HBT), under the earlier bedtime condition at (HBT-2 h), and under the later bedtime condition at (HBT+2 h). Sleep was polysomnnographically recorded and rectal temperature continuously monitored. Although total sleep time increased in the earlier compared to the later condition (p<0.01), sleep efficiency decreased and wake after sleep onset increased (p<0.01). Subjective ratings of sleep were also worse under the earlier (HBT-2 h) than under later (HBT+ 2 h) condition (p<0.05). Performance did not differ between the earlier and later conditions. The larger the phase angle between actual bedtime and circadian temperature minimum (Tmin), the longer the time spent in bed and total sleep time, and the worse the sleep efficiency and subjective sleep ratings. There were no effects related to the phase angle between Tmin and rise-time. The relative benefits of longer vs. more efficient sleep in the elderly require further investigation.
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Affiliation(s)
- Timothy H Monk
- Neuroscience Clinical and Translational Research Center, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Monk TH, Germain A, Buysse DJ. The Sleep of the Bereaved. SLEEP AND HYPNOSIS : AN INTERNATIONAL JOURNAL OF SLEEP, DREAM, AND HYPNOSIS 2009; 11:219. [PMID: 20802799 PMCID: PMC2929135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE: Sleep disruption is common in widow(er)s. The objective of this study was to characterize the sleep of Spousally Bereaved (SB) seniors (60y+) studied within 4-19 months of being widowed. METHOD: Subjective (PSQI, 2-weeks diary) and objective (2-weeks actigraphy) baseline sleep measures were obtained in 47 (38f, 9m) Spousally Bereaved (SB) seniors, 33 (25f, 8m) Good Sleeper Controls (GSC), and 47 (38f, 9m) Older Adults with Insomnia (OAI); each group with the same mean age (72y). OAI subjects passed formal diagnostic criteria for primary or co-morbid insomnia. GSC subjects had no diagnosis of insomnia. At baseline (pre-treatment), all subjects completed 2 weeks of detailed sleep diary and wrist actigraphy, and completed the Pittsburgh Sleep Quality Index (PSQI) among other measures. RESULTS: Significant group effects appeared in PSQI (GSC: 2.4, SB: 6.7, OAI: 10.5; Effect Sizes [ES]>1) and diary measures. In diary measures, for Total Sleep Time, Sleep Efficiency and Wake After Sleep Onset, SB were better than OAI and worse than GSC (0.47<ES<1.19). For Sleep Latency, SB were worse than GSC (ES=0.57), but similar to OAI. However, actigraphy results indicated no significant SB vs. GSC, or SB vs. OAI, differences in any of the sleep measures considered. CONCLUSION: The sleep disruption of bereaved seniors appears to be intermediate between GSC and OAI, as reported either retrospectively using the PSQI, or prospectively using a sleep diary. Only in diary sleep latency, were SB and OAI values similar. This pattern was not, however, observed when parallel objective actigraphic measures were considered.
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Affiliation(s)
- Timothy H Monk
- Neuroscience Clinical and Translational Research Center Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center
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Abstract
<p>Bereavement is a ubiquitous part of the human condition. Almost no person makes it through his or her life without having to cope with the loss of a loved one several different times. The loss of a parent, child, or grandparent can be very distressing. For many, the most devastating loss is that of their spouse or partner, which usually occurs during later life. More than 800,000 older Americans are widowed every year. Apart from the severe emotional strain of the loss of a loved one, there are profound changes in lifestyle and status, often accompanied by reductions in financial security, perceived personal safety, and freedom of action. Thus, late-life spousal bereavement (LLSB) comprises one of the major impacts of bereavement on society.
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<h4>ABOUT THE AUTHORS</h4>
<p>Timothy H. Monk, PhD, DSc, is Professor of Psychiatry, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Anne Germain, PhD, is Assistant Professor of Psychiatry, University of Pittsburgh School of Medicine. Charles F. Reynolds III, MD, is the Professor of Geriatric Psychiatry and Professor of Neurology and Neuroscience, University of Pittsburgh Medical Center.</p>
<p>Address correspondence to Timothy H. Monk, DSc, Western Psychiatric Institute and Clinic, Room E1123, 3811 O’Hara Street, Pittsburgh PA 15213; fax 412-246-5300; or e-mail <a href="mailto:monkth@upmc.edu">monkth@upmc.edu</a>.</p>
<p>Dr. Monk, Dr. Germain, and Dr. Reynolds have disclosed no relevant financial relationships.</p>
<h4>EDUCATIONAL OBJECTIVES</h4>
<ol><li>Recognize the importance of sleep disruption in bereavement.
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<li>Explain the possible role of insomnia treatment for bereaved individuals.
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<li>Discuss the etiology of sleep disorders in bereavement.
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</ol>
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Affiliation(s)
- Timothy H Monk
- Professor of Psychiatry, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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