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Hasson-Ohayon I, Horesh D. A unique combination of horror and longing: Traumatic grief in post-October 7, 2023, Israel. J Trauma Stress 2024; 37:348-351. [PMID: 38487945 DOI: 10.1002/jts.23026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 04/04/2024]
Abstract
On October 7, 2023 (10/7), Hamas militants brutally attacked Israeli towns and villages surrounding the Gaza Strip, resulting in the killing of more than 1100 people, most of whom were civilians slaughtered in their own homes. The killings occurred under highly traumatic circumstances, including shooting, the burning of homes, hunting down people who attempted to escape, and severe sexual assault. Thus, many Israelis today experience a unique mix of both posttraumatic and severe grief reactions. Traumatic grief (TG) is often defined as a condition that results from the death of a significant other and includes symptoms similar to posttraumatic stress disorder (PTSD) that are specifically related to the deceased, such as intrusive thoughts and memories about the deceased and hypervigilance expressed by constantly looking for them or cues associated with them. However, whereas definitions, phenomenological descriptions, and clinical illustrations of PTSD are abundant and widely validated, TG has yet to receive formal diagnostic status. In this paper, we aim to reexamine TG in the context of post-10/7 Israel. We argue that TG is a critical concept for clinicians working in Israel and other conflict-exposed areas of the world today, as it accurately captures the painful mix of grief- and trauma-related symptoms. We also suggest potential explanations for the lack of acknowledgment of TG as a formal diagnosis and discuss the possible role of historical events in the formation of new, relevant psychiatric diagnoses.
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Affiliation(s)
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York, USA
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2
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Janshen A, Boelen PA, Schut HAW, Eisma MC. Do insecure attachment styles predict prolonged grief symptoms? Significant null findings. DEATH STUDIES 2024:1-9. [PMID: 38180083 DOI: 10.1080/07481187.2023.2300063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Insecure attachment is proposed to be a risk factor in the development and persistence of severe grief. Although prior research demonstrates positive cross-sectional and longitudinal correlations between attachment styles and prolonged grief symptoms, controlled longitudinal analyses yield fewer convincing results. Therefore, we sought to further clarify the concurrent and longitudinal associations between these constructs. A sample of 225 bereaved Dutch adults (87% women; Mean age: 48.86 years) participated in a three-wave longitudinal survey including measures of attachment anxiety and attachment avoidance at baseline and prolonged grief symptoms at baseline and 6- and 12-month follow-up. Attachment anxiety and attachment avoidance were significantly positively correlated with prolonged grief symptoms at all time-points. However, multiple regressions, controlling for baseline symptoms, showed that attachment anxiety, attachment avoidance, and their interaction did not predict residual change in prolonged grief symptoms. These findings cast doubt on the proposed role of insecure attachment styles in prolonged grief.
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Affiliation(s)
- Antje Janshen
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Henk A W Schut
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
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3
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Thiemann P, Street AN, Heath SE, Quince T, Kuhn I, Barclay S. Prolonged grief disorder prevalence in adults 65 years and over: a systematic review. BMJ Support Palliat Care 2023; 13:e30-e42. [PMID: 33707297 DOI: 10.1136/bmjspcare-2020-002845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/03/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Prolonged grief disorder (PGD) is a recently recognised mental health disorder with an estimated prevalence of 10% in the bereaved adult population. This review aims to appraise and summarise evidence relating to PGD in older adults (≥65 years), a growing population group, most likely to experience bereavement and often assumed to cope well. METHOD Literature from Medline, PsycINFO, CINAHL, Cochrane Library and Web of Science was searched. Epidemiological and non-epidemiological studies including data on frequency of PGD in older adults bereaved by mainly natural causes were included and a descriptive analysis undertaken. RESULTS From 2059 records, three epidemiological and six non-epidemiological studies were included. Most studies had good internal but not external validity. Conditional prevalence for PGD ranged between 3.2% and 48.8%. Heterogeneity in sample characteristics and study methodology contributed to this variability resulting in a descriptive analysis. The prevalence rate of 9.1% by Kersting et al was the best available estimate for PGD in older adults for western countries. The small number of epidemiological studies and the use of varying PGD-constructs which did not match International Classification of Diseases 11th Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria were the main limiting factors. CONCLUSION This first review on PGD prevalence in older adults suggests that, despite studies' methodological short comings, a similar proportion of older adults experience PGD as the general bereaved adult population (1:10). With older adults forming the largest subgroup among the bereaved, health and social care systems need to adapt their provision of care to address the specific needs of older adults.
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Affiliation(s)
- Pia Thiemann
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Anna Naomi Street
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sarah Eleanor Heath
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thelma Quince
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Isla Kuhn
- Medical Library, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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4
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Zachar P, First MB, Kendler KS. Prolonged Grief Disorder and the DSM: A History. J Nerv Ment Dis 2023; 211:386-392. [PMID: 37040140 DOI: 10.1097/nmd.0000000000001618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
ABSTRACT In the early 1990s, a research group that included Holly Prigerson and Charles Reynolds established that disordered grief overlaps with depression and anxiety but is not the same. They also developed a research inventory for studying disordered grief. Subsequently, Prigerson focused on measuring disordered grief using advanced psychometric techniques. Because treatment for grief-related depression reduced symptoms of depression but not grief, Katherine Shear was recruited to develop a more effective therapy. Prigerson came to conceptualize disordered grief as prolonged grief that is associated with negative outcomes. Shear came to conceptualize disordered grief as intense grief that is complicated by features that interfere with adaption to the loss. In 2013 a hybrid disorder composed of criteria from both groups was placed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) appendix. Under the leadership of the DSM Steering Committee, a summit meeting in 2019 helped break an impasse, and a revised prolonged grief disorder became an official DSM diagnosis.
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Affiliation(s)
- Peter Zachar
- Department of Psychology, Auburn University Montgomery, Montgomery, Alabama
| | - Michael B First
- Department of Psychiatry, Columbia University, New York, New York
| | - Kenneth S Kendler
- Virginia Institute for Psychiatry and Behavioral Genetics and Departments of Psychiatry and Human Genetics, Medical College of Virginia of Virginia Commonwealth University, Richmond, Virginia
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5
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Hamama-Raz Y, Shaked Y. Assumptive Worldviews and Prolonged Grief Disorder in Terror-bereaved Family Members – The Mediator’s Role of Coping Flexibility and Adjustment Disorder. JOURNAL OF LOSS & TRAUMA 2022. [DOI: 10.1080/15325024.2022.2132684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Yasmin Shaked
- School of Social Work, Ariel University, Ariel, Israel
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Schakowski A, Tönnies J, Friederich HC, Hartmann M, Haun MW. The Inventory of Complicated Grief-A Systematic Psychometric Review and Conceptual Replication Study of the Structural Validity. Assessment 2022:10731911221100980. [PMID: 35723204 DOI: 10.1177/10731911221100980] [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: 11/16/2022]
Abstract
The Inventory of Complicated Grief (ICG) is a commonly used self-report measure in psycho-oncology, best supportive care, and palliative medicine. However, existing validation studies yielded conflicting results regarding the structural validity. This study provides a psychometric review and conceptual replication of the ICG latent structure to test the hypothesis that existing studies overfit unreliable sources of variance, which overshadow the unidimensionality of the ICG. All proposed latent models identified in the psychometric review were tested in a series of confirmatory and exploratory structural equation models. Specifically, at least five to six latent intercorrelated factors were necessary to reach acceptable model fit. However, a general CG factor accounted for most variance and ICG sum scores showed predictable associations with anxiety and depressive symptoms, which suggests that the ICG is essentially unidimensional. There are indications that other measures of pathological grief show similar inconsistencies. Overall, potentially emerging subfacets of the ICG should not be interpreted as distinct "symptom clusters." If time constraints are an issue as is often the case in clinical research, complicated grief may just be measured by a reduced item set without a significant loss of information or complexity.
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Szuhany KL, Malgaroli M, Miron CD, Simon NM. Prolonged Grief Disorder: Course, Diagnosis, Assessment, and Treatment. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:161-172. [PMID: 34690579 PMCID: PMC8475918 DOI: 10.1176/appi.focus.20200052] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Losing a loved one is one of life's greatest stressors. Although most bereaved individuals navigate through a period of intense acute grief that lessens with time, approximately 10% will develop a prolonged grief condition. This review provides an overview of the course of grief and describes risk factors for developing prolonged grief disorder. The evolution of the prolonged grief disorder diagnosis, including the latest criteria sets for ICD-11 and DSM-5, as well as common comorbid conditions and differential diagnosis are discussed. Clinically useful self-report and clinician-rated measures for assessing symptom constructs and overall prolonged grief disorder severity, evidence-based psychotherapies (such as complicated grief treatment), as well as evidence about pharmacologic approaches are presented. Finally, the authors discuss important future directions, including a potential increase in prolonged grief disorder cases due to the COVID-19 pandemic.
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Affiliation(s)
- Kristin L Szuhany
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Matteo Malgaroli
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Carly D Miron
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Naomi M Simon
- Department of Psychiatry, New York University Grossman School of Medicine, New York
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8
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Alves-Costa F, Hamilton-Giachritsis C, Halligan S. "Everything Changes": Listening to Homicidally Bereaved Individuals' Practice and Intervention Needs. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP2954-NP2974. [PMID: 29669466 DOI: 10.1177/0886260518766558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study sought to understand how individuals bereaved through homicide (murder or manslaughter) describe their postevent experiences to inform clinical needs and promote mechanisms for change. A total of 21 participants (18 females) between the ages of 29 and 66 (M age = 47.81 years, SD = 8.99) took part in this study. They were all participating in a residential program for homicidally bereaved individuals and were all residents in the United Kingdom. The sample comprised of 12 parents, five siblings, one partner, one daughter, one friend, and one grandmother of the deceased. The length of time since the bereavement varied from 12 months to 18 years (M = 2.48, SD = 1.80). Thematic analysis was used to analyze the narratives collected. Three central themes emerged, namely (a) uniqueness of the experience, (b) changed self and world, and (c) mixed experiences of support. The uniqueness of the individuals' experiences was associated with the nature of the homicide event and the consequences that are unlikely to occur in "normal" deaths (e.g., judiciary). A sense of a changed self (e.g., ongoing emotional/mental and physical responses, coping) and world (e.g., changed beliefs regarding safety and criminal activity) seemed to be contributing to different shades of (mal)adjustment. Adaptive and protective strategies were identified. The current study with a large qualitative sample generated a unique, rich description/integration about individuals' journeys following an experience of homicidal bereavement. Findings are likely to inform policy and clinical practice by considering individuals' voices.
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Cesur G, Durak-Batıgün A. A Turkish adaptation of the grief cognitions questionnaire: Factor analysis, reliability and validity. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-018-9983-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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10
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Bellet BW, LeBlanc NJ, Nizzi MC, Carter ML, van der Does FHS, Peters J, Robinaugh DJ, McNally RJ. Identity confusion in complicated grief: A closer look. JOURNAL OF ABNORMAL PSYCHOLOGY 2020; 129:397-407. [PMID: 32250140 DOI: 10.1037/abn0000520] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Complicated grief (CG) is characterized by a wide range of symptoms, including identity confusion or a sense that a part of oneself has died with the decedent. Although identity confusion is a commonly reported feature of CG, little is known about which specific aspects of self-concept are compromised. In the current study, we used qualitative coding methods to investigate which aspects of the sense of self differed between those with and without CG in a sample of 77 bereaved adults. Relative to individuals without CG, those with CG provided fewer descriptors of their self-concept overall (lower self-fluency), provided sets of descriptors that consisted of fewer categories (lower self-diversity), and had lower proportions of self-relevant preferences and activities. However, group differences were not observed for proportions of any other categories of self-concept descriptors, including references to the loss, the past, or distress-related self-statements. Directions for future research and clinical implications are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Dodd A, Guerin S, Delaney S, Dodd P. Complicated Grief: How is it Conceptualized by Professionals? JOURNAL OF LOSS & TRAUMA 2020. [DOI: 10.1080/15325024.2020.1722460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Anne Dodd
- UCD School of Psychology, University College Dublin, Dublin, Ireland
| | - Suzanne Guerin
- UCD School of Psychology, University College Dublin, Dublin, Ireland
| | | | - Philip Dodd
- St Michael’s House Intellectual Disability Service, Dublin, Ireland
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12
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Lifshitz R, Ifrah K, Markovitz N, Bluvstein I, Shmotkin D. Inventory of complicated grief: Factor structure among middle-aged and older bereaved parents. DEATH STUDIES 2020; 46:200-207. [PMID: 32065063 DOI: 10.1080/07481187.2020.1725931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study examines the psychometric properties and factorial structure of the Hebrew version of Prigerson's Inventory of Complicated Grief (ICG), on 116 middle-aged and older Israeli bereaved parents. Analysis revealed a three-factor structure: emotional distress, yearning for the dead and social-emotional detachment. A high percentage of explained variance and sound internal consistency were found for the entire scale and for all factors, as well as adequate convergent and construct validity. These findings suggest that the Hebrew version of the ICG questionnaire is reliable, valid and appropriate for evaluation of grief in later life.
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Affiliation(s)
- Rinat Lifshitz
- The Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel
| | - Kfir Ifrah
- School of Psychological Sciences and the Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel
- Faculty of Social and Community Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | - Noam Markovitz
- The Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel
- Psychology Department, Lowenstein Rehabilitation Hospital, Raanana, Israel
| | - Irit Bluvstein
- The Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel
| | - Dov Shmotkin
- School of Psychological Sciences and the Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel
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Simon NM, Shear K, Reynolds CF, Cozza SJ, Mauro C, Zisook S, Skritskaya N, Robinaugh DJ, Malgaroli M, Spandorfer J, Lebowitz B. Commentary on evidence in support of a grief-related condition as a DSM diagnosis. Depress Anxiety 2020; 37:9-16. [PMID: 31916663 PMCID: PMC7430251 DOI: 10.1002/da.22985] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/03/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022] Open
Abstract
The death of a loved one is one of life's greatest stressors. Most bereaved individuals experience a period of acute grief that diminishes in intensity as they adapt to the changes brought about by their loss. Over the past four decades, a growing body of research has focused on a form of prolonged grief that is painful and impairing. There is a substantial and growing evidence base that supports the validity and significance of a grief-related disorder, including the clinical value of being able to diagnose it and provide effective targeted treatment. ICD-11 will include a new diagnosis of prolonged grief disorder (PGD). DSM-5 called this condition persistent complex bereavement disorder (PCBD) and included it in Section III, signaling agreement that a diagnosis is warranted while further research is needed to determine the optimal criteria. Given the remaining uncertainties, reading this literature can be confusing. There is inconsistency in naming the condition (including complicated grief as well as PGD and PCBD) and lack of uniformity in identifying it, with respect to the optimal threshold and timeframe for distinguishing it from normal grief. As an introductory commentary for this Depression and Anxiety special edition on this form of grief, the authors discuss the history, commonalities, and key areas of variability in identifying this condition. We review the state of diagnostic criteria for DSM-5 and the current ICD-11 diagnostic guideline, highlighting the clinical relevance of making this diagnosis.
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Affiliation(s)
- Naomi M. Simon
- Department of Psychiatry, NYU Langone Health/NYU School of Medicine, New York, NY
| | | | | | - Stephen J. Cozza
- Center for the Study of Traumatic Stress, Uniformed Services University for the Health Sciences
| | - Christine Mauro
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Sidney Zisook
- University of California San Diego and San Diego Healthcare System, San Diego, CA
| | | | - Donald J. Robinaugh
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Matteo Malgaroli
- Department of Psychiatry, NYU Langone Health/NYU School of Medicine, New York, NY
| | - Julia Spandorfer
- Department of Psychiatry, NYU Langone Health/NYU School of Medicine, New York, NY
| | - Barry Lebowitz
- University of California San Diego and San Diego Healthcare System, San Diego, CA
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Andrus M. Exhibition and Film About Miscarriage, Infertility, and Stillbirth: Art Therapy Implications. ART THERAPY 2019. [DOI: 10.1080/07421656.2019.1697577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tay AK, Mohsin M, Rees S, Tam N, Kareth M, Silove D. The structure and psychosocial correlates of complicated bereavement amongst refugees from West Papua. Soc Psychiatry Psychiatr Epidemiol 2019; 54:771-780. [PMID: 30778622 DOI: 10.1007/s00127-019-01666-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Refugees may be at risk of experiencing a complicated form of bereavement. As yet, however, the nosological status of this putative category across cultures remains in question. We apply qualitative and quantitative methods to investigate the manifestations, prevalence, factorial structure and psychosocial correlates of complicated bereavement amongst refugees from West Papua, a population with no past exposure to western concepts of grief or to formal mental health services. METHODS Qualitative methods (focus groups and informant interviews) were used to identify cultural expressions of complicated bereavement derived from international classification systems, that is, DSM 5 persistent complex bereavement disorder (PCBD) and ICD-11 prolonged grief disorder (PGD) in developing a structured interview applied by trained field workers. Participants were adult West Papuan refugees and their offspring recruited from households (n = 486, response 85.8%) across nine villages in a remote town in Papua New Guinea. RESULTS The qualitative data obtained from focus groups (n = 20) and informant interviews (n = 4) with local psychiatrists supported the cultural validity of complicated bereavement. 16% (n = 78) of the sample met criteria for PCBD based on DSM-5 criteria and 103 (21%) met criteria for PGD based on ICD-11 criteria. Confirmatory factor analysis yielded a six-factor model of complicated bereavement with a moderately good fit to the data. The model included dimensions of anger/negative appraisal (AN), avoidance/giving up, estrangement from others, and confusion and diminished identity. In contrast, the DSM-5 three-factor model and the ICD-11 two-factor model each yielded a poor fit. Cumulative traumatic losses (β = 0.16, P = 0.03), duration since displacement [(β = 0.10, P = 0.02)] and postmigration living difficulties (β = 0.20, P = 0.01) were associated with an aggregated index of complicated bereavement, supporting the concurrent validity of the structure identified. CONCLUSIONS Culture and exposure to persecution and displacement may contribute to the content and configuration of the complicated bereavement reaction, an issue that requires recognition in international classification systems and clinical practice.
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Affiliation(s)
- Alvin Kuowei Tay
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia.
| | - Mohammed Mohsin
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
| | - Susan Rees
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
| | - Natalino Tam
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
| | - Moses Kareth
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
| | - Derrick Silove
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
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O'Connor M, Lasgaard M, Larsen L, Johannsen M, Lundorff M, Farver-Vestergaard I, Boelen PA. Comparison of proposed diagnostic criteria for pathological grief using a sample of elderly bereaved spouses in Denmark: Perspectives on future bereavement research. J Affect Disord 2019; 251:52-59. [PMID: 30903989 DOI: 10.1016/j.jad.2019.01.056] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/12/2019] [Accepted: 01/22/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND A distinct grief-specific disorder is included in the ICD-11. Lack of clarity remains regarding whether different proposed diagnostic criteria capture similar or different diagnostic entities. Our aim was to examine the specificity of four proposed diagnostic criteria-sets for pathological grief in a population-based sample. METHODS Participants were 206 conjugally bereaved elderly Danes (59% female; mean age = 72.5 years, SD = 4.2; range 65-81) who completed self-report questionnaires six months post-loss. The main measure was the Danish version of Inventory of Complicated Grief-Revised. RESULTS Results indicate substantial agreement between Prolonged Grief Disorder (PGD), Persistent Complex Bereavement Disorder (PCBD) and ICD-11-PGD (kappa's = 0.69-0.84), which found 6-9% of cases tested positive for pathological grief. Complicated Grief (CG) was partly in agreement with the three other symptom-diagnostic tests (kappa's = 0.13-0.20), and the prevalence-rate of pathological grief was 48%. LIMITATIONS The low response-rate of 39%. The selective inclusion of data ≥6 months post-loss prevents a comparison of acute and prolonged grief reactions. Using self-reported data, not diagnostic interviews, challenges the validity of our findings. Using a sample of elderly people may limit the generalizability of our results to other age groups. CONCLUSION We suggest that PGD, PCBD and ICD-11-PGD may be more discriminative in identifying a specific grief-related psychopathology, while CG may identify a broader set of grief reactions.
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Affiliation(s)
- Maja O'Connor
- Unit for Bereavement Research, Department of Psychology, Aarhus University, Aarhus, Denmark; The Danish National Center for Grief, Copenhagen, Denmark.
| | | | - Lene Larsen
- The Danish National Center for Grief, Copenhagen, Denmark
| | - Maja Johannsen
- Unit for Bereavement Research, Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Marie Lundorff
- Unit for Bereavement Research, Department of Psychology, Aarhus University, Aarhus, Denmark
| | | | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands; Arq Psychotrauma Expert Group, Diemen, the Netherlands
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Killikelly C, Lorenz L, Bauer S, Mahat-Shamir M, Ben-Ezra M, Maercker A. Prolonged grief disorder: Its co-occurrence with adjustment disorder and post-traumatic stress disorder in a bereaved Israeli general-population sample. J Affect Disord 2019; 249:307-314. [PMID: 30797123 DOI: 10.1016/j.jad.2019.02.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/18/2019] [Accepted: 02/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Prolonged grief disorder (PGD) is a new disorder included in the WHO International Classification of Diseases 11th version (ICD-11). This study is the first to use these new ICD-11 PGD guidelines to examine prevalence rates, predictors of PGD and disorder co-occurrence with other stress-related disorders in a survey of 544 bereaved Israelis. METHODS Descriptive statistics, correlation, linear regression and mediation analysis examined the validity of the ICD-11 diagnostic algorithm. RESULTS Prevalence of PGD in the Israeli population sample is low (2%). The prevalence rate of post-traumatic stress disorder (PTSD) was 7.2% and for adjustment disorder (AjD) was 17.8%. A significant positive correlation found between scores on these measures indicates concurrent validity. Mediation analysis found that symptoms of PGD were predicted by serious life events, and significantly mediated by symptoms of PTSD and AjD. A regression analysis found significant predictors of PGD symptom severity, including socio-demographic and person-specific predictors. LIMITATIONS This study did not assess the index-death of the grief questionnaire. No conclusions could be made regarding the relationship between the type of loss and grief severity. Furthermore, the time since loss (time criterion) was not assessed. CONCLUSIONS This study is the first to examine prevalence rates of ICD-11 PGD in a population-based survey. The mediation relationship between serious life events, AjD, PTSD and PGD supports a vulnerability model of stress related disorders whereby the number of stressful life events may predict symptoms of stress related disorders.
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Affiliation(s)
- Clare Killikelly
- University of Zürich, Department of Psychology, Division Psychopathology and Clinical Intervention, CH-8050 Zürich, Switzerland.
| | - Louisa Lorenz
- University of Zürich, Department of Psychology, Division Psychopathology and Clinical Intervention, CH-8050 Zürich, Switzerland; Klinik im Hasel, Stationäre Therapie, Gontenschwil, Switzerland
| | - Susanna Bauer
- University of Zürich, Department of Psychology, Division Psychopathology and Clinical Intervention, CH-8050 Zürich, Switzerland
| | | | | | - Andreas Maercker
- University of Zürich, Department of Psychology, Division Psychopathology and Clinical Intervention, CH-8050 Zürich, Switzerland
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Cantwell-Bartl AM, Tibballs J. Place, Age, and Mode of Death of Infants and Children with Hypoplastic Left Heart Syndrome: Implications for Medical Counselling, Psychological Counselling, and Palliative Care. J Palliat Care 2019. [DOI: 10.1177/082585970802400203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A review of outcomes of hypoplastic left heart syndrome at a pediatric hospital 1983–2004 identified 154 deaths among 206 children (75%). Of 134 surgically treated, 82 (62%) died: 68 (83%) in intensive care, six (7%) in the operating theatre, three (4%) during transport from home, two (2%) on the cardiac ward, one (1 %) at home, one (1 %) in the emergency department, and one (1 %) elsewhere. Seventy died after stage one Norwood surgery (median age: 13 days), three died after second stage surgery (ages: 3, 4, and 20 months), two died after third stage surgery (ages: 1.2 and 3.5 years), two died after heart transplantation (ages: 4.6 and 15 years), and five died after non-Norwood surgery. All 72 infants treated without surgery died: 68 died at a median age 3 days; 57 (79%) in intensive care, three (4%) on the ward, and 12 (17%) elsewhere. Discussion involves strategies to support parents and staff at diagnosis, and before and after a child's death.
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Affiliation(s)
- Annie M. Cantwell-Bartl
- Pediatric Intensive Care Unit, The Royal Children's Hospital and Department of Social Work, The University of Melbourne
| | - James Tibballs
- Intensive Care Unit and Department of Pediatrics, Royal Children's Hospital, Melbourne, The University of Melbourne, Parkville, Victoria, Australia
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19
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Lee MS, Hwang JW, Bhang SY. A Qualitative Study on the Process of the Mental Health Assessment and Intervention after the Sewol Ferry Disaster: Focusing on Survivors among Danwon High School Students. Soa Chongsonyon Chongsin Uihak 2018; 29:161-171. [PMID: 32595310 PMCID: PMC7289463 DOI: 10.5765/jkacap.180013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/27/2018] [Accepted: 08/13/2018] [Indexed: 11/05/2022] Open
Abstract
Objectives This study aimed to identify the process of psychosocial assessment, the experience of intervention, and the improvement after the disaster that Danwon high school students survived from the sinking of the Motor Vessel (MV) Sewol in South Korea on April 16, 2014. Methods We conducted in-depth qualitative research using individual interviews from January to February 2017. Twenty-one of 75 Danwon high school students survived by the MV Sewol disaster were studied. Two interviewers participated in the in-depth interview. Interviews were transcribed verbatim, coded, and analyzed through content analysis based on psychosocial assessment and intervention after the disaster. Results Twenty-one participants were 20 years old, where 10 were male (47.62%), and 11 were female (52.38%). More than 75% of the interviewed students felt that mental health services were needed, and more than 85% required mental health assessments. Regarding psychiatric symptoms, the students reported that they suffered depression and insomnia (19.05%), anxiety (14.29%), nightmares and phobias (9.52%), and difficulties regarding concentration, aggression, and game addiction (4.76%). Conclusion Despite survivors experiencing the same disaster, there were differences in their responses to mental health assessments and interventions experienced during the three years, and conflicting opinions were reported. In planning future evaluations and interventions, it is necessary for strategies to cope with flexibly to consider the characteristics and symptoms of the survivors while maintaining principles.
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Affiliation(s)
- Mi-Sun Lee
- Department of Meditation Psychology, Nungin University, Hwaseong, Korea
| | - Jun-Won Hwang
- Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Soo-Young Bhang
- Department of Psychiatry, Eulji University School of Medicine, Eulji University Hospital, Seoul, Korea
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20
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Kamp KS, O'Connor M, Spindler H, Moskowitz A. Bereavement hallucinations after the loss of a spouse: Associations with psychopathological measures, personality and coping style. DEATH STUDIES 2018; 43:260-269. [PMID: 29757086 DOI: 10.1080/07481187.2018.1458759] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 12/14/2017] [Accepted: 02/08/2018] [Indexed: 06/08/2023]
Abstract
Bereavement hallucinations (BHs) were assessed in 175 conjugally bereaved participants 4 years post loss, to explore whether BHs were: (a) associated with psychological distress and (b) predicted by sociodemographic variables, personality and/or coping style. Participants with BHs scored significantly higher than those without BHs on prolonged grief, post-traumatic stress, depression symptoms, and emotional loneliness. Hierarchical logistic regression analysis showed avoidant coping, openness to experience, and length of marriage to significantly predict BHs, while detached coping was negatively associated with BHs. This study suggests that BHs may be an indicator of psychological distress in bereavement.
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Affiliation(s)
- Karina Stengaard Kamp
- a Department of Psychology and Behavioral Sciences , Aarhus University , Bartholins Allé 11 , Aarhus C , DK , 8000 , Denmark
| | - Maja O'Connor
- a Department of Psychology and Behavioral Sciences , Aarhus University , Bartholins Allé 11 , Aarhus C , DK , 8000 , Denmark
| | - Helle Spindler
- a Department of Psychology and Behavioral Sciences , Aarhus University , Bartholins Allé 11 , Aarhus C , DK , 8000 , Denmark
| | - Andrew Moskowitz
- b Touro College Berlin, Campus Am Rupenhorn , Am Rupenhorn 5 , Berlin , 14055 , Germany
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21
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Nakajima S. Complicated grief: recent developments in diagnostic criteria and treatment. Philos Trans R Soc Lond B Biol Sci 2018; 373:20170273. [PMID: 30012739 PMCID: PMC6053994 DOI: 10.1098/rstb.2017.0273] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/12/2022] Open
Abstract
Although grief is a natural response to loss among human beings, some people have a severe and prolonged course of grief. In the 1990s, unusual grief persisting with a high level of acute symptoms became known as 'complicated grief (CG)'. Many studies have shown that people who suffer from CG are at risk of long-term mental and physical health impairments and suicidal behaviours; it is considered a pathological state, which requires clinical intervention and treatment. DSM-5 (2013 Diagnostic and statistical manual of mental disorders, 5th edn) proposed 'persistent complex bereavement disorder' as a psychiatric disorder; it is similar to CG in that it is a trauma- and stress-related disorder. In recent years, there has been considerable research on the treatment of CG. Randomized controlled trials have suggested the efficacy of cognitive behavioural therapy including an exposure component that is targeted for CG. However, experts disagree about the terminology and diagnostic criteria for CG. The ICD-11 (International classification of diseases, 11th revision) beta draft proposed prolonged grief disorder as a condition that differs from persistent complex bereavement disorder with respect to terminology and the duration of symptoms. This divergence has arisen from insufficient evidence for a set of core symptoms and the biological basis of CG. Future studies including biological studies are needed to reach consensus about the diagnostic criteria for CG.This article is part of the theme issue 'Evolutionary thanatology: impacts of the dead on the living in humans and other animals'.
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Affiliation(s)
- Satomi Nakajima
- Department of Human Sciences, Musashino University, 3-3-3 Ariake, Koto-ku, Tokyo 135-8181, Japan
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22
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Thompson MR, Whiteman AD, Loucks KD, Daudt HML. Complicated Grief in Canada: Exploring the Client and Professional Landscape. JOURNAL OF LOSS & TRAUMA 2017. [DOI: 10.1080/15325024.2017.1358574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | - Karen D. Loucks
- Bereavement Services, Victoria Hospice, British Columbia, Canada
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Aldridge MD, Bradley EH. Epidemiology And Patterns Of Care At The End Of Life: Rising Complexity, Shifts In Care Patterns And Sites Of Death. Health Aff (Millwood) 2017; 36:1175-1183. [DOI: 10.1377/hlthaff.2017.0182] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Melissa D. Aldridge
- Melissa D. Aldridge ( ) is an associate professor in the Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, in New York City
| | - Elizabeth H. Bradley
- Elizabeth H. Bradley is president of and a professor of political science and science, technology, and society at Vassar College, in Poughkeepsie, New York
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Reisbig AMJ, Hafen M, Siqueira Drake AA, Girard D, Breunig ZB. Companion Animal Death. OMEGA-JOURNAL OF DEATH AND DYING 2017; 75:124-150. [DOI: 10.1177/0030222815612607] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Human–animal relationships are increasingly incorporated into families as a normal part of family life. Despite this, relationships with animals are often viewed as inferior to human relationships. This becomes problematic during times of loss and grief when members of a grieving companion animal owner's support system do not understand the salience of the relationship with the animal. Veterinary and other helping professionals need basic information about the experience of companion animal loss in order to help support and normalize the experiences of grieving companion animal owners. The present study qualitatively describes human–animal relationships and the subsequent loss and coping experienced by owners of beloved companion animals. Comparison with human and other types of loss and factors unique to companion animal loss are discussed, and practical applications for veterinary and other helping professionals are provided.
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Affiliation(s)
- Allison M. J. Reisbig
- Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, NE, USA
| | - McArthur Hafen
- College of Veterinary Medicine, Kansas State University, KS, USA
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25
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Cardoso D, Ferreira L, Rocha J, Leite M, Almeida V. Long-term effects of the Entre-os-Rios tragedy on grief and traumatic stress symptoms. DEATH STUDIES 2017; 41:256-260. [PMID: 27983463 DOI: 10.1080/07481187.2016.1271836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In 2001, in Entre-os-Rios, Portugal, a bridge fell on Douro River; all 59 passengers from 1 bus and 3 cars died and 36 bodies have never been recovered. The objective is to reveal the cumulative risk from multiple losses and unrecovered bodies, 10 years after, compared with grievers from road accidents. There are 2 groups of relatives of victims: from this tragedy (n = 20), with at least 1 unrecovered body; and from road traffic accidents (n = 20), with the same time after loss. The prevalence of prolonged grief was 95% and for traumatic stress was 70%. The associated factors of multiple losses and unrecovered bodies increase the long-term risk (relative risk = 1.6 to 2.8; R2 = .20 to .28) for prolonged and traumatic grief, providing evidence that the absence of body is an important long-term factor.
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Affiliation(s)
- Daniela Cardoso
- a CESPU Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde , Gandra , Portugal
| | - Lúcia Ferreira
- a CESPU Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde , Gandra , Portugal
| | - José Rocha
- a CESPU Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde , Gandra , Portugal
| | - Manuela Leite
- a CESPU Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde , Gandra , Portugal
| | - Vera Almeida
- a CESPU Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde , Gandra , Portugal
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26
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Shimizu K, Kikuchi S, Kobayashi T, Kato S. Persistent complex bereavement disorder: clinical utility and classification of the category proposed for Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Psychogeriatrics 2017; 17:17-24. [PMID: 26781759 DOI: 10.1111/psyg.12183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 10/19/2015] [Accepted: 11/19/2015] [Indexed: 11/29/2022]
Abstract
AIM Persistent complex bereavement disorder (PCBD) was proposed as a bereavement-related clinical category in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, which included the disorder among conditions for further study. This is an independent clinical category in which intense yearning for the deceased continues for at least 12 months. However, the diagnostic features are still inconclusive. We suggest a variation of PCBD for making category from our clinical experiences. METHOD We presented two representative case studies in which grief caused by bereavement was observed as the root of the pathological condition. We examined the disorder's pathological conditions, diagnoses, and appropriate treatments based on the cases we experienced. RESULTS Both cases involved elderly women who lost their spouse through illness and experienced prolonged grief for an extended period, resulting in hospital admission. Based on the two cases, we believe that PCBD can also include a psychotic type with hallucinations as a major symptom. While studying PCBD, we took into account specific cultural characteristics of Japanese people and their present day social environment. CONCLUSIONS Such cases would be suggestive when determining the PCBD clinical category in the future. PCBD is considered to be clinically very useful, especially in an extremely aged society as seen in developed countries, including Japan.
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Affiliation(s)
- Kanako Shimizu
- Department of Psychiatry, Jichi Medical University, Tochigi, Japan
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27
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Huh HJ, Kim KH, Lee HK, Chae JH. Attachment styles, grief responses, and the moderating role of coping strategies in parents bereaved by the Sewol ferry accident. Eur J Psychotraumatol 2017; 8:1424446. [PMID: 29372009 PMCID: PMC5774413 DOI: 10.1080/20008198.2018.1424446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 12/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background: Previous studies on the influence of different types of attachment on grief responses have yielded contradictory outcomes. Little research has been conducted to identify the psychological processes that moderate the relationship between attachment representations and patterns of grief in disaster-related grief. Objective: The present study examines the effects of different attachment types on the grief responses of parents bereaved by loss of a child in a ferry accident, along with the moderating role of coping strategies. Methods: Bereaved parents (n = 81) completed self-report questionnaires evaluating attachment, coping strategies, complicated grief, and shame/guilt. We performed correlational analyses to examine the associations among variables. We also conducted hierarchical regression analyses and simple slope analyses to examine the moderation effects of coping strategies. Results: Anxious attachment was associated with severe shame/guilt, and avoidant attachment correlated with complicated grief. Anxious attachment was positively associated with all types of coping strategies, and avoidant attachment was negatively related to problem- and emotion-focused coping. The use of problem-focused coping strategies was a significant moderator of the relationship between the avoidant attachment dimension and shame/guilt. Avoidant attachment had a significant effect on shame/guilt in groups with a high level of problem-focused coping. In contrast, none of the coping strategies significantly moderated the relationship between anxious attachment and grief response. Conclusions: The results suggest that people with highly avoidant attachment might be overwhelmed by shame and guilt when they try to use problem-focused coping strategies. This finding suggests that grief interventions should be organized with consideration of individual differences in attachment representations.
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Affiliation(s)
- Hyu Jung Huh
- Department of Psychiatry, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - Kyung Hee Kim
- Department of Psychology, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Hee-Kyung Lee
- Department of Psychology, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
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28
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Tolstikova K, Fleming S, Chartier B. Grief, Complicated Grief, and Trauma: The Role of the Search for Meaning, Impaired Self-Reference, and Death Anxiety. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/105413730501300402] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The present study explored the nature of grief and trauma following the loss of a loved one. The concept of complicated grief (CG) was investigated, and the overlapping symptoms of trauma, CG, and grief were explored. Comparisons were made between those who reported CG and/or trauma and those who did not report CG or trauma in relation to search for meaning, death anxiety, and self-regulation. The failure to find meaning in the death of a loved one, impaired self-reference, and death anxiety were found to play a significant role in both trauma and CG.
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29
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Richardson SJ, Lund DA, Caserta MS, Dudley WN, Obray SJ. Sleep Patterns in Older Bereaved Spouses. OMEGA-JOURNAL OF DEATH AND DYING 2016. [DOI: 10.2190/0d4f-epmw-3yul-c1jk] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The study examined the prevalence and pattern of reports of sleep disturbance over two years in a group of 296 adults aged 50 years and over, and assessed the relationship between patterns of sleep disturbance and bereavement adjustment over time. A sample of 192 widows and widowers were compared to a matched sample of 104 non-bereaved persons. About half of the bereaved respondents experienced sleep disruption in the first month following their loss. Regardless of bereavement status, one-third of the sample experienced ongoing sleep disruption, and 10% consulted a physician for difficulty sleeping. Persons with a pattern of consistent sleep disturbance showed statistically significant differences in grief outcomes that persisted over time and tended to be female, older, with poor health, and taking more medications.
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30
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Hogan NS, Worden JW, Schmidt LA. An Empirical Study of the Proposed Complicated Grief Disorder Criteria. OMEGA-JOURNAL OF DEATH AND DYING 2016. [DOI: 10.2190/gx7h-h05n-a4dn-rlu9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Diagnostic criteria for complicated grief have been proposed as a pathological disorder for inclusion into the next edition of the DSM. However, to date, little empirical testing of the criteria to support or refute the diagnostic claims has been completed. Since the original criteria were developed based on work with widows and widowers, further testing with other bereft groups is needed before advancing complicated grief to a diagnosis worthy of inclusion in diagnostic systems. The present study was undertaken to empirically test the complicated grief disorder criteria. The basic criteria of the complicated grief disorder, formerly called traumatic grief, separation distress, and traumatic distress, were not isolated as distinct constructs in confirmatory factor analyses, and conceptualization as a unitary construct did not provide an adequate fit of the model to the data. Further analyses did not support the distinctness between complicated grief and depression, or complicated grief and normal grief. Based on these findings, both further investigation into the validity of complicated grief disorder as a diagnosis and verification of the validity of the diagnostic criteria is warranted before declaring this phenomenon appropriate for inclusion in diagnostic systems.
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31
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Hogan NS, Worden JW, Schmidt LA. Considerations in Conceptualizing Complicated Grief. OMEGA-JOURNAL OF DEATH AND DYING 2016. [DOI: 10.2190/8565-3t0t-6jud-4xkh] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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32
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Geiger PJ, Boggero IA, Brake CA, Caldera CA, Combs HL, Peters JR, Baer RA. Mindfulness-Based Interventions for Older Adults: A Review of the Effects on Physical and Emotional Well-being. Mindfulness (N Y) 2016; 7:296-307. [PMID: 27200109 PMCID: PMC4868399 DOI: 10.1007/s12671-015-0444-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This comprehensive review examined the effects of mindfulness-based interventions on the physical and emotional wellbeing of older adults, a rapidly growing segment of the general population. Search procedures yielded 15 treatment outcome studies meeting inclusion criteria. Support was found for the feasibility and acceptability of mindfulness-based interventions with older adults. Physical and emotional wellbeing outcome variables offered mixed support for the use of mindfulness-based interventions with older adults. Potential explanations of mixed findings may include methodological flaws, study limitations, and inconsistent modifications of protocols. These are discussed in detail and future avenues of research are discussed, emphasizing the need to incorporate geriatric populations into future mindfulness-based empirical research.
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Tay AK, Rees S, Chen J, Kareth M, Silove D. Factorial structure of complicated grief: associations with loss-related traumatic events and psychosocial impacts of mass conflict amongst West Papuan refugees. Soc Psychiatry Psychiatr Epidemiol 2016; 51:395-406. [PMID: 26228854 DOI: 10.1007/s00127-015-1099-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/11/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Definitions of complicated grief vary across diagnostic systems, being represented as persistent complex bereavement (PCB) in DSM-5 and prolonged grief disorder (PGD) in the proposed revision of the ICD system. A past study in a high-income country has identified a six-factor structure for complicated grief, but there are no data testing this or any other model across cultures. The present study reports findings from a survey amongst West Papuan refugees (n = 230, response rate = 92 %) residing in Port Moresby, Papua New Guinea. MATERIALS AND METHODS We applied culturally adapted measures of conflict-related traumatic event (TEs) (drawing specifically on domains of conflict and loss), symptoms of complicated grief adapted and modified to the culture, and a multidimensional psychosocial index of the broader effects of conflict and displacement. RESULTS Confirmatory factor analysis yielded a single higher order construct of complicated grief comprising six factors of yearning/preoccupation; shock/disbelief; anger/negative appraisal; behavioural change; estrangement from others/impairment; and a novel dimension of confusion/diminished identity. In contrast, our analysis failed to support DSM or ICD models of PCB or PGD. A Multiple Indicators Multiple Causes (MIMIC) model revealed that traumatic loss and the sense of injustice each were associated with the unitary construct of complicated grief and its subdomains of yearning/preoccupation; shock/disbelief; anger/negative appraisal (exclusive to injustice); and estrangement from others/social impairment (exclusive to TE domain of conflict and loss). CONCLUSIONS Conflict and loss associated with feelings of injustice may be especially pathogenic in generating the anger/negative appraisal component of complicated grief amongst refugees.
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Affiliation(s)
- Alvin Kuowei Tay
- Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia. .,Centre for Population Mental Health Research, Liverpool Hospital, Cnr Forbes and Campbell Streets, Liverpool, NSW, 2170, Australia.
| | - Susan Rees
- Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia.,Centre for Population Mental Health Research, Liverpool Hospital, Cnr Forbes and Campbell Streets, Liverpool, NSW, 2170, Australia.,The Ingham Institute, Applied Medical Research Centre, Liverpool, NSW, Australia
| | - Jack Chen
- Simpson Centre for Health Services Research, University of New South Wales, Sydney, Australia.,The Ingham Institute, Applied Medical Research Centre, Liverpool, NSW, Australia
| | - Moses Kareth
- Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia.,Centre for Population Mental Health Research, Liverpool Hospital, Cnr Forbes and Campbell Streets, Liverpool, NSW, 2170, Australia
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia.,Centre for Population Mental Health Research, Liverpool Hospital, Cnr Forbes and Campbell Streets, Liverpool, NSW, 2170, Australia.,The Ingham Institute, Applied Medical Research Centre, Liverpool, NSW, Australia
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Allahdadian M, Irajpour A, Kazemi A, Kheirabadi G. Strategy for Mental Health Improvement of Iranian Stillborn Mothers From Their Perspective: A Qualitative Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e21081. [PMID: 26889389 PMCID: PMC4752696 DOI: 10.5812/ircmj.21081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 09/08/2014] [Accepted: 09/29/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mothers got stressed when they are informed about the occurrence of stillbirth. Many researchers believe that the failure to provide the required care by health teams during this hard time is the main determinant of maternal mental health in the future. In other words, psychosocial support by medical care providers can significantly improve mental outcomes of mother after stillbirth. OBJECTIVES This study aimed to explore stillborn mothers' suggested strategies to provide maternal mental health in the experience of stillbirth. PATIENTS AND METHODS Twenty women who had experienced stillbirths participated in this qualitative content analysis study. They were selected through purposeful sampling method. Data were gathered by individual interviews recorded on audiotapes, transcripted and then analyzed. Then, transcriptions were coded and classified. Finally, 3 main categories and 9 subcategories were emerged. RESULTS Analysis of participants' viewpoints and their opinions about strategies to provide maternal mental health in the experience of stillbirth lead to development of 3 main categories: "before delivery strategies" with 3 subcategories, "during labor strategies" with 3 subcategories, and "postpartum strategies" with 3 subcategories. Analyses of findings showed that, health care providers can mitigate some of the long-term negative mental outcomes of stillborn mothers by spending extra time with grieving mothers, facilitating bonding, and validating their emotional expressions. CONCLUSIONS According to the results, revision and modification of the care plan in the experience of stillbirth seems necessary to improve mental health in these mothers. According to suggested strategies, midwives and health care providers are health professionals who can effectively and properly care for stillborn mothers.
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Affiliation(s)
- Maryam Allahdadian
- Student Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Alireza Irajpour
- Department of Critical Care Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Ashraf Kazemi
- Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Gholamreza Kheirabadi
- Department of Psychiatry, Behavioral Sciences Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IR Iran
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Klyce DW, Bombardier CH, Davis TJ, Hartoonian N, Hoffman JM, Fann JR, Kalpakjian CZ. Distinguishing Grief From Depression During Acute Recovery From Spinal Cord Injury. Arch Phys Med Rehabil 2015; 96:1419-25. [DOI: 10.1016/j.apmr.2015.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/29/2015] [Accepted: 02/18/2015] [Indexed: 11/29/2022]
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O'Connor M, Nickerson A, Aderka IM, Bryant RA. The temporal relationship between change in symptoms of prolonged grief and posttraumatic stress following old age spousal bereavement. Depress Anxiety 2015; 32:335-40. [PMID: 25693504 DOI: 10.1002/da.22349] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 12/09/2014] [Accepted: 12/13/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND High levels of prolonged grief symptoms (PGS) and posttraumatic stress symptoms (PTS) are relatively common following bereavement. The two types of bereavement complications share some but not all of the same features. Little research has studied which of the two precedes the other following the death of a loved one. The purpose of this study was to examine the temporal relationship between change in PGS and PTS during the first 4 years following old age spousal loss. METHODS Participants were 237 Danes (40% male; mean age = 73 years, SD = 4.4; range 65-81) who during the year of 2006 lost their spouse. Participants completed self-report questionnaires at 6 months (n = 237), 13 months (n = 198), 18 months (n = 192), and 48 months (n = 213) post loss. Main outcome measures were Inventory of Complicated Grief-Revised and the Harvard Trauma Questionnaire. RESULTS Lower level mediation analyses were performed. Results indicated that PGS mediated 83% of the relationship between time and PTS, whereas PTS only mediated 17% of the relationship between time and PGS. These results suggest that changes in PGS mediated changes in PTS following spousal bereavement to a greater extent than vice versa. CONCLUSIONS The findings in the present study indicate that changes in PGS may precede and potentially directly impact changes in PTS following bereavement. This tentative conclusion points to the potential value of targeting PGS in psychological interventions at an early point in the long-term perspective following old age spousal bereavement.
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Affiliation(s)
- Maja O'Connor
- Unit for Psychooncology and Health Psychology, Department of Psychology, Aarhus University, Aarhus C, Denmark
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Bruinsma SM, Tiemeier HW, Verkroost-van Heemst J, van der Heide A, Rietjens JAC. Risk factors for complicated grief in older adults. J Palliat Med 2015; 18:438-46. [PMID: 25671395 DOI: 10.1089/jpm.2014.0366] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Older adults grieving the death of a spouse have been found to have a higher risk of complicated grief compared with younger adults. OBJECTIVE The study objective was to find out whether personal characteristics of the patient and the bereaved partner, or characteristics of the patient's illness, end-of-life care, and the nature of death are risk factors for complicated grief in older adults. METHODS We performed a nested case-control study within the Rotterdam Study. We selected 100 couples of which one person had deceased and the other person experienced "complicated grief," and 100 control couples of which one person had deceased and the other person experienced "normal grief." Complicated grief was assessed with a 17-item Inventory of Complicated Grief (ICG). Determinants were assessed using several sources of information that were available for all participants of the Rotterdam Study. Additionally, medical files of the deceased were manually screened. Logistic regression analysis was performed. RESULTS Only depression at baseline was significantly associated with complicated grief. Bereaved partners with depression at baseline had a higher risk of complicated grief compared to bereaved partners without depression (OR=3.48; 95% CI=1.40-8.68). CONCLUSIONS Our results suggest that complicated grief in older adults is not clearly related to the circumstances of dying of the deceased partner. Preexisting conditions such as depression seem to be more important in explaining the occurrence of complicated grief.
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Affiliation(s)
- Sophie M Bruinsma
- 1 Department of Public Health, Erasmus University Medical Centre , Rotterdam, the Netherlands
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Barbosa V, Sá M, Carlos Rocha J. Randomised controlled trial of a cognitive narrative intervention for complicated grief in widowhood. Aging Ment Health 2014; 18:354-62. [PMID: 24073815 DOI: 10.1080/13607863.2013.833164] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The implementation of bereavement interventions is frequently requested, and its effectiveness has been controversial. The aim of this study is to evaluate the effectiveness of a cognitive narrative intervention for complicated grief (CG) for controlling post-traumatic and depressive issues. METHOD The study is a randomised controlled trial and uses the Socio Demographic Questionnaire (SDQ), the Inventory of Complicated Grief (ICG), the Beck Depression Inventory (BDI) and the Impact of Events Scale-Revised (IES-R). There were three phases in the study: (1) The SDQ and CG evaluations were applied to bereaved elders (n = 82). The bereaved elders with the 40 highest ICG values (≥25) were randomly allocated into two groups: the intervention group (n = 20) and control group (n = 20); (2) participants were evaluated using the BDI and IES-R and the IG gave informed consent to participate in an intervention with four weekly 60-min sessions addressing recall, emotional and cognitive subjectivation, metaphorisation and projecting. (3) Two months later, the ICG, BDI and IES-R assessments were repeated. RESULTS Outcome measures showed a statistically significant reduction of CG, depressive and traumatic symptoms compared to the controls. Very high effect sizes for the ICG, BDI and IES-R reflect the effectiveness of the intervention along the longitudinal profile. CONCLUSIONS These results reinforce the importance of brief interventions that combine a reduced number of sessions with lower costs, which is reflected in an increased adherence to the programme along with high effectiveness.
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Nanni MG, Biancosino B, Grassi L. Pre-loss symptoms related to risk of complicated grief in caregivers of terminally ill cancer patients. J Affect Disord 2014; 160:87-91. [PMID: 24445130 DOI: 10.1016/j.jad.2013.12.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 12/12/2013] [Accepted: 12/13/2013] [Indexed: 12/16/2022]
Abstract
PURPOSE A number of studies have underlined a 10-20% prevalence of complicated grief (CG) among caregivers of cancer patients. The study aimed at examining the relationship between pre-loss criteria for CG and post-loss diagnosis of CG and at evaluating the validity and factor structure of a predictive tool, the Inventory of Complicated Grief (ICG), in order to identify the risk of developing CG in a sample of Italian caregivers. METHODS Sixty family members of terminally ill patients admitted to hospice and receiving a Palliative Prognostic Score (PaP) predictive 30 day survival time <30% completed the Pre-Death ICG (ICG-PL) (T0). Family members were met again 6 months after the death of their loved one (T1) and submitted to the interview for Complicated Grief (Post-loss interview-PLI). RESULTS Caseness for CG was shown in 18.3% of caregivers at T1. ICG-PL score (T0) were higher among those who developed CG at T1 than non-cases. A cut off score ≥49 on the ICG-PL (AUC=0.98) maximized sensitivity (92%) and specificity (98%) on caseness at T1. Pre-loss criteria related to traumatic distress, separation distress and emotional symptoms in general were significantly related to a post-loss diagnosis of CG, while no effect was shown on duration of pre-loss distress. CONCLUSIONS The use of short screening tools, like the ICG-PL, may help health care professionals to identify subjects at risk for CG.
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Affiliation(s)
- Maria Giulia Nanni
- Section of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Corso Giovecca 203, 44121 Ferrara, Italy.
| | - Bruno Biancosino
- Section of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Corso Giovecca 203, 44121 Ferrara, Italy; Integrated Department of Mental Health and Drug Abuse, NHS Local Health Agency, Ferrara, Italy
| | - Luigi Grassi
- Section of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Corso Giovecca 203, 44121 Ferrara, Italy
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Ogden SP, Simmonds JG. Psychologists' and counsellors' perspectives on prolonged grief disorder and its inclusion in diagnostic manuals. COUNSELLING & PSYCHOTHERAPY RESEARCH 2013. [DOI: 10.1080/14733145.2013.790456] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
OBJECTIVES The construct of complicated grief (CG) has garnered increased empirical attention since it has been proposed as a diagnostic category for the upcoming Diagnostic and Statistical Manual of Mental Disorders-V. The aim of this article is to critically examine construct validity in light of a proposed conceptual framework, with special emphasis on understanding late-life bereavement. METHOD This is a review article that critically examined current bereavement and grief models. We explored discriminant and convergent validity between CG and uncomplicated grief (UG) and other psychopathological constructs in terms of symptom intensity, symptom trajectories, bereavement outcomes, and treatment response. RESULTS The findings from this review show mixed support for differentiating CG from other outcomes of bereavement for the following reasons: (1) a clear boundary between CG and UG has not been adequately supported, (2) symptoms of CG and bereavement-related depression and anxiety overlap, although there is some evidence of incremental validity in that CG symptoms predict global functioning above and beyond symptoms of depression, and (3) the treatment literature demonstrated that general grief interventions and treatment targeted for improving depression are ineffective at treating symptoms of CG, whereas interventions specially tailored to treating CG have been moderately effective. The findings also emphasize the importance of considering pre-bereavement circumstances, such as preexisting depression, in the conceptualization of broader bereavement outcome. CONCLUSION There were mixed findings supporting the construct validation of CG. A comprehensive framework that emphasizes pre-bereavement circumstances was proposed in order to better predict various grief trajectories and outcomes of late-life loss.
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Affiliation(s)
- Shruti N Shah
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, USA
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Newson RS, Boelen PA, Hek K, Hofman A, Tiemeier H. The prevalence and characteristics of complicated grief in older adults. J Affect Disord 2011; 132:231-8. [PMID: 21397336 DOI: 10.1016/j.jad.2011.02.021] [Citation(s) in RCA: 161] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 02/21/2011] [Accepted: 02/21/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Complicated grief is a prolongation of the normal grieving process with distinct characteristics. It impairs mental and physical health and can potentially greatly impact the quality of life of sufferers and their families. The prevalence and characteristics of complicated grief in the general population are currently unclear. The aims of the present study were therefore to evaluate the prevalence of complicated grief in a population-based cohort, examine the overlap between anxiety and depression and identify common bereavement-related and socio-demographic characteristics. METHODS Based within the Rotterdam Study, 5741 older adults were evaluated. Complicated grief was assessed with a 17-item Inventory of Complicated Grief. RESULTS Prevalence within the general population was 4.8%. Current grief was reported by 1089 participants, and of these 277 (25.4%) were diagnosed with complicated grief. Inflated anxiety and depression rates were documented in people with complicated grief, but the vast majority remained free from co-morbidity. Time since bereavement and relationship to deceased, particularly when the source was a spouse or child, were predictive of complicated grief. People with complicated grief were older, had a lower level of education, and more cognitive impairment. CONCLUSIONS The prevalence of complicated grief in older adults in the general population was noteworthy. Several factors were predictive of complicated grief and it was demonstrated as a separate condition to anxiety and depression. These findings highlight the need for prevention, diagnosis and treatment options for older adults with complicated grief and for recognition of complicated grief as a distinct diagnosis.
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Affiliation(s)
- Rachel S Newson
- Department of Epidemiology, Erasmus University Medical Centre, The Netherlands
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Prevalence of complicated grief in a representative population-based sample. J Affect Disord 2011; 131:339-43. [PMID: 21216470 DOI: 10.1016/j.jad.2010.11.032] [Citation(s) in RCA: 369] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 11/25/2010] [Accepted: 11/26/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Complicated grief (CG) has been proposed as a distinct diagnostic category in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). However, few epidemiological studies to date have measured CG in the general population. METHODS Prevalence of CG, sociodemographic characteristics, and grief-related factors were examined in a representative population-based survey (N = 2520) through face-to-face contact. The sample included all bereaved subpopulations and all age groups from 14 to 95 years. RESULTS The conditional prevalence of developing CG after major bereavement was 6.7%; the prevalence of CG in the general sample was 3.7%. Predictors of higher risk for developing CG were female gender, lower income (< €1250/month), older age (> 61 years), having lost a child or a spouse, or cancer as the cause of death. LIMITATIONS The sample of bereaved people was small, and some categories contained very few cases. Psychiatric comorbidities were not assessed in this study. CONCLUSIONS The results indicate that CG is prevalent in the population, and risk factors were identified.
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Sormanti M, Ballan MS. Strengthening grief support for children with developmental disabilities. SCHOOL PSYCHOLOGY INTERNATIONAL 2011. [DOI: 10.1177/0143034311400831] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although a sizable literature investigates and describes children’s grief, the majority of information focuses on typically developing children. Far less has been published about the loss and grief of children with developmental disabilities (DD), even though this population experiences significant and multiple losses, increasing their vulnerability to negative outcomes. Addressing this gap in scholarship, this article explicates common losses and important grief-related challenges experienced by children with DD. An overview of practice guidelines is provided to enhance the efforts of school-based mental health professionals in supporting this vulnerable population.
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Mancini AD, Prati G, Bonanno GA. Do Shattered Worldviews Lead to Complicated Grief? Prospective and Longitudinal Analyses. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2011. [DOI: 10.1521/jscp.2011.30.2.184] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Shear MK, Simon N, Wall M, Zisook S, Neimeyer R, Duan N, Reynolds C, Lebowitz B, Sung S, Ghesquiere A, Gorscak B, Clayton P, Ito M, Nakajima S, Konishi T, Melhem N, Meert K, Schiff M, O'Connor MF, First M, Sareen J, Bolton J, Skritskaya N, Mancini AD, Keshaviah A. Complicated grief and related bereavement issues for DSM-5. Depress Anxiety 2011; 28:103-17. [PMID: 21284063 PMCID: PMC3075805 DOI: 10.1002/da.20780] [Citation(s) in RCA: 532] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Bereavement is a severe stressor that typically incites painful and debilitating symptoms of acute grief that commonly progresses to restoration of a satisfactory, if changed, life. Normally, grief does not need clinical intervention. However, sometimes acute grief can gain a foothold and become a chronic debilitating condition called complicated grief. Moreover, the stress caused by bereavement, like other stressors, can increase the likelihood of onset or worsening of other physical or mental disorders. Hence, some bereaved people need to be diagnosed and treated. A clinician evaluating a bereaved person is at risk for both over-and under-diagnosis, either pathologizing a normal condition or neglecting to treat an impairing disorder. The authors of DSM IV focused primarily on the problem of over-diagnosis, and omitted complicated grief because of insufficient evidence. We revisit bereavement considerations in light of new research findings. This article focuses primarily on a discussion of possible inclusion of a new diagnosis and dimensional assessment of complicated grief. We also discuss modifications in the bereavement V code and refinement of bereavement exclusions in major depression and other disorders.
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Quarantini LC, Netto LR, Andrade-Nascimento M, Almeida AGD, Sampaio AS, Miranda-Scippa A, Bressan RA, Koenen KC. [Comorbid mood and anxiety disorders in victims of violence with posttraumatic stress disorder]. BRAZILIAN JOURNAL OF PSYCHIATRY 2010; 31 Suppl 2:S66-76. [PMID: 19967202 DOI: 10.1590/s1516-44462009000600005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To review studies that have evaluated the comorbidity between posttraumatic stress disorder and mood disorders, as well as between posttraumatic stress disorder and other anxiety disorders. METHOD We searched Medline for studies, published in English through April, 2009, using the following keywords: 'posttraumatic stress disorder', 'PTSD', 'mood disorder', 'major depressive disorder', 'major depression', 'bipolar disorder', 'dysthymia', 'anxiety disorder', 'generalized anxiety disorder', 'agoraphobia', 'obsessive-compulsive disorder', 'panic disorder', 'social phobia', and 'comorbidity'. RESULTS Major depression is one of the most frequent comorbid conditions in posttraumatic stress disorder individuals, but individuals with posttraumatic stress disorder are also more likely to present with bipolar disorder, other anxiety disorders and suicidal behaviors. These comorbid conditions are associated with greater clinical severity, functional impairment, and impaired quality of life in already compromised individuals with posttraumatic stress disorder. Depression symptoms also mediate the association between posttraumatic stress disorder and severity of pain among patients with chronic pain. CONCLUSION Available studies suggest that individuals with posttraumatic stress disorder are at increased risk of developing affective disorders compared with trauma-exposed individuals who do not develop posttraumatic stress disorder. Conversely, pre-existing affective disorders increase a person's vulnerability to the posttraumatic stress disorder--inducing effects of traumatic events. Also, common genetic vulnerabilities can help to explain these comorbidity patterns. However, because the studies addressing this issue are few in number, heterogeneous and based on a limited sample, more studies are needed in order to adequately evaluate these comorbidities, as well as their clinical and therapeutic implications.
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Affiliation(s)
- Lucas C Quarantini
- Serviço Psiquiátrico, Hospital-Escola, Universidade Federal da Bahia, Salvador, BA, Brasil.
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O'Connor M, Lasgaard M, Shevlin M, Guldin MB. A confirmatory factor analysis of combined models of the Harvard Trauma Questionnaire and the Inventory of Complicated Grief-Revised: are we measuring complicated grief or posttraumatic stress? J Anxiety Disord 2010; 24:672-9. [PMID: 20510576 DOI: 10.1016/j.janxdis.2010.04.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 02/26/2010] [Accepted: 04/18/2010] [Indexed: 10/19/2022]
Abstract
The aim of this study was to assess the factorial structure of complicated grief (CG) and investigate the relationship between CG and posttraumatic stress disorder (PTSD) through the assessment of models combining both constructs. The questionnaire was completed by elderly, married respondents with a history of at least one significant, interpersonal loss (145 males and 147 females, 60-81 years). Confirmatory factor analysis (CFA) supported a two-factor model of separation and traumatic distress in CG. To investigate the relationship between CG and PTSD three combined models were specified and estimated using CFA. A model where all five factors, the two factors of CG and the three factors of PTSD, as defined by the DSM-IV, were allowed to correlate provided the best fit. The results indicated a considerable overlap between the dimensions of CG and PTSD, and complicated grief is construct that appears to be largely accounted for by especially the intrusive component of PTSD.
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Affiliation(s)
- Maja O'Connor
- Department of Psychology, Aarhus University, Jens Chr. Skousvej 4, 8000 Arhus C, Denmark.
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