Personal fear of death and grief in bereaved mothers

The Impact of Death Anxiety, Meaning and Coping on Posttraumatic Stress Disorder and Psychiatric Co-Morbidity Among Iraqi Civilians Exposed to a Car Bomb Attack A Latent Class Analysis

Much has been documented that the experience of a bombing is associated with posttraumatic stress disorder and psychiatric co-morbidity. Whether the co-existing relationship between death anxiety, meaning in life and coping styles would influence the aforementioned association is unknown. The present study aimed to identify latent classes of victims with different levels of death anxiety, meaning in life and coping styles, and to examine whether the severity of PTSD and co-morbid psychiatric symptoms differed between classes. One hundred and eighty-five victims who had experienced the first car bombing completed a demographic page, the Posttraumatic Stress Diagnosis Scale, General Health Questionnaire-28, Multidimensional Fear of Death Scale, Meaning in Life Questionnaire and Coping Responses Inventory. The results showed that 82% and 18% of the victims met the criteria for PTSD and no-PTSD, respectively. Four classes of victims were identified: Class 1 victims were approach copers with low levels of death anxiety and meaning. Class 2 victims were minimal copers with high levels of death anxiety and meaning. Class 3 victims were approach copers with a high level of death anxiety and meaning. Class 4 victims were avoidance copers with high levels of death anxiety. Individuals in Class 1 reported significantly lower levels of PTSD and psychiatric co-morbidity than the other three classes. Class 3 victims also reported significantly lower levels of psychiatric co-morbidity than Class 2 victims. To conclude, victims exposed to a car bombing were likely to exhibit posttraumatic stress symptoms in addition to other psychological symptoms. The severity of these symptoms tended to be lower among those who had little fear of death, did not search for meaning in life and approached their distress proactively.

Extending the Ring Theory of Personhood to the Care of Dying Patients in Intensive Care Units

It is evident, in the face of the COVID-19 pandemic that has physicians confronting death and dying at unprecedented levels along with growing data suggesting that physicians who care for dying patients face complex emotional, psychological and behavioural effects, that there is a need for their better understanding and the implementation of supportive measures. Taking into account data positing that effects of caring for dying patients may impact a physician's concept of personhood, or "what makes you, 'you'", we adopt Radha Krishna's Ring Theory of Personhood (RToP) to scrutinise the experiences of physicians working in intensive care units (ICU) using a fictional scenario that was inspired by real events. The impact of death and dying, its catalysts, internal constituents, external factors, dyssynchrony, and buffers, specific to ICU physicians, were identified and explored. Such a framework allows for ramifications to be considered holistically and facilitates the curation of strategies for conflict resolution. This evaluation of the RToP acknowledges the experience and wide-ranging effects it has on ICU physicians. As such, our findings provide insight into their specific needs and highlight the importance of support on a personal and organisational level. Although further research needs to be conducted, the RToP could serve as the basis for a longitudinal assessment tool supported by the use of portfolios or mentorship due to their provision of personalised, appropriate, specific, timely, accessible and long-term support.

Parental bereavement - impact of death of neonates and children under 12 years on personhood of parents: a systematic scoping review

BACKGROUND

Losing a child tragically impacts the well-being and functioning of parents. With these effects extending beyond emotional, physical morbidity and compromising self-perceptions, appropriate, longitudinal, timely and personalised support is key to effective care of bereaved parents. However, in the absence of a comprehensive understanding of parental bereavement, effective support of bereaved parents remains suboptimal. To address this gap, we scrutinise prevailing data on the effects of a child's death, aged 0-12 years, through the lens of the Ring Theory of Personhood (RToP).

METHODS

To study prevailing accounts of bereaved parents following the death of a child, we adopt Krishna's Systematic Evidence Based Approach (SEBA) to structure our Systematic Scoping Review (SSR in SEBA).

RESULTS

Three thousand seventy-four abstracts were reviewed, 160 full text articles were evaluated, and 111 articles were included and analysed using thematic and content analysis. Four themes/categories were identified relating to the four rings of the RToP. Findings reveal that static concepts of protective and risk factors for grief are misplaced and that the support of healthcare professionals is key to assisting bereaved parents.

CONCLUSION

In the absence of consistent support of bereaved parents, this study highlights the need for effective training of healthcare professionals, beginning with an appreciation that every aspect of an individual parent's personhood is impacted by the loss of their child. Acknowledging grief as a complex, evolving and personalised process subjected to parental characteristics, settings, context and available support, this SSR in SEBA calls attention to effective nurturing of the relationship between parents and healthcare professionals, and suggests use of the RToP to assess and direct personalised, timely, specific support of parents in evolving conditions. We believe the findings of this review also call for further studies to support healthcare professionals as they journey with bereaved parents.

Posttraumatic stress disorder and death anxiety among Iraqi civilians exposed to a suicide car bombing: the role of religious coping and attachment

BACKGROUND

Posttraumatic stress disorder (PTSD) as a result of a bombing has been studied in the literature. Limited studies have focused attention on PTSD following a suicide car bombing. However, more research is needed to explore the risk factors for this psychological response.

AIMS

To examine a hypothesised model that death anxiety would be associated with PTSD and psychiatric comorbidity following a suicide car bombing, and that attachment styles and religious coping would influence the impact of this anxiety on distress outcomes.

METHODS

185 Iraqi civilians exposed to the first suicide car bombing completed questionnaires measuring PTSD, psychiatric comorbidity, death anxiety, religious coping, and attachment experiences.

RESULTS

82% met diagnostic criteria for PTSD, the remainder did not. Path analysis showed that death anxiety was significantly correlated with psychiatric comorbidity; it was also correlated with attachment, which was correlated with psychiatric comorbidity. Death anxiety was also significantly correlated with religious coping, which was correlated with both distress outcomes.

CONCLUSIONS

Although Iraqi civilians reported increased death anxiety following a suicide car bombing, those who used religion to cope with the traumatic experience and had functional attachment experiences in the past reported low levels of psychological distress.

Residential proximity to roadways and placental-associated stillbirth: a case-control study

We conducted a retrospective case-control study of 1,097 women in Massachusetts and Rhode Island, USA, to examine the association between stillbirth related to placental abruption or placental insufficiency and maternal exposure to traffic-related air pollution. We utilized distance to nearest roadway proximity metrics as a proxy for traffic-related air pollution exposure. No meaningful increase in the overall odds of placental-associated stillbirths was observed (adjusted OR: 1.1, 95% CI: 0.5-2.8). However, mothers living within 50 m of a roadway had a 60% increased odds of experiencing a stillbirth related to placental abruption compared to mothers living greater than 200 m away. This suggestive finding was imprecise due to the small case number in the highest exposure category (95% CI: 0.6-4.0). Future studies of placental abruption with more precise exposure assessments are warranted.

Fear of Death and Death Acceptance Among Bereaved Adults: Associations With Prolonged Grief

This study aimed to analyze fear of death and neutral acceptance of death after a significant loss and their associations with prolonged grief. The sample of the study included 239 bereaved participants. Time since the loss ranged from 6 to 72 months. We found that neutral acceptance of death was associated with older age, a natural cause of death, and the ability to find meaning in the death of a close one. Fear of death was negatively associated with the frequency of practicing religion. We found that fear of death but not neutral acceptance was significantly associated with prolonged grief symptoms.

Investigation of the Experiences of Mothers Living Through Prenatal Loss Incidents: A Qualitative Study

BACKGROUND

Fetal death causes women to experience negative feelings after the loss. These lived experiences influence the future pregnancies and maternal health of women negatively.

PURPOSE

The aim of this study was to investigate the experiences of women whose pregnancies were terminated because of medical indications.

METHODS

A "design for definitive status study" type of qualitative research design was used. Ten women who were hospitalized between April and July 2017 at the Akdeniz University Clinic of Obstetrics and Gynecology and had subsequently experienced pregnancy loss during their hospitalization were enrolled as participants. Thematic analysis was used to analyze the data.

RESULTS

The pregnancy loss experiences of participants were investigated under the five main themes of (a) lived experiences before the termination of pregnancy, (b) lived experiences after pregnancy termination, (c) willingness to see the baby after termination, (d) posttermination care requirements, and (e) physical condition of hospital rooms during hospitalization. The participants expressed feelings of hope, fear, and worry over being unsuccessful before fetal death and feelings of loneliness, disappointment, blame, and avoidance after fetal death.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

In the aftermath of fetal death, health professionals should use insightful and empathic communication skills to help mothers cope with their loss. In addition, some of the participants wanted to see their babies, and some did not. Thus, individualized care is very important for women who experience pregnancy loss.

To grieve or not to grieve (online)? Interactions with deceased Facebook friends

Besides seeking social support, connecting with bereaved others, and maintaining relationships with the deceased, bereaved Facebook users may express their grief on Facebook to reduce their death anxiety. Notably, research has not yet explored the psychological outcomes of expressing grief on Facebook. This study undertook quantitative analysis of survey data from an initial community sample of 409 bereaved Facebook users (77.8% survey completion rate, n = 312; M_age = 34.46, SD = 12.38; 90% women) to ascertain whether expressions of grief on Facebook had negative psychological outcomes, and whether terror management theory (TMT) provided an appropriate lens for understanding Facebook grief expressions (FBGE). The aims of this study were three-fold: to clarify rates at which Facebook profiles of deceased users are deactivated, memorialized, unchanged, or managed; frequency and types of FBGE; and prevalence of/visitation to commemorative groups. Results-though insufficient to support TMT as an explanatory theoretical framework for FBGE-indicated that individuals who participated in FBGE reported higher anxiety and stress compared to bereaved individuals who did not express their grief on Facebook. Results provide a useful starting point for future research regarding online grieving behaviors and psychological wellbeing.

Ethical issues in using the internet to engage participants in family and child research: A scoping review

BACKGROUND

The internet is an increasingly popular tool in family and child research that is argued to pose new ethical challenges, yet few studies have systematically assessed the ethical issues of engaging parents and children in research online. This scoping review aims to identify and integrate evidence on the ethical issues reported when recruiting, retaining and tracing families and children in research online, and to identify ethical guidelines for internet research.

METHODS

Academic literature was searched using electronic academic databases (Scopus, PsycINFO, Embase, ERIC, CINAHL and Informit) and handsearching reference lists for articles published in English between January 2006 and February 2016. Grey literature was searched using Google to identify relevant ethical guidelines.

RESULTS

Sixty-five academic articles were included after screening 3,537 titles and abstracts and 205 full-text articles. Most articles reported using the internet to recruit participants (88%) with few reporting online retention (12%) or tracing (10%). Forty percent commented on ethical issues; the majority did not discuss ethics beyond general consent or approval procedures. Some ethical concerns were specific to engaging minors online, including parental consent, age verification and children's vulnerability. Other concerns applied when engaging any research participant online, including privacy and confidentiality, informed consent and disparities in internet access. Five professional guidelines and 10 university guidelines on internet research ethics were identified. Few academic articles (5%) reported using these guidelines.

CONCLUSIONS

Engaging families and children in research online introduces unique challenges requiring careful consideration. While researchers regarded themselves as responsible for ensuring research is conducted ethically, lack of use of available guidelines and limited academic literature suggests internet research is occurring without suitable guidance. We recommend broad dissemination of ethical guidelines and encourage researchers to report the methodological and ethical issues of using the internet to engage families and children in research.

The poetics of mourning and faith-based intervention in maladaptive grieving processes in Ethiopia

The paper is an inquiry into the poetics of mourning and faith-based intervention in maladaptive grieving processes in Ethiopia. The paper discusses the ways that loss is signified and analyzes the meanings of ethnocultural and psychospiritual practices employed to deal with maladaptive grief processes and their psychological and emotional after-effects. Hermeneutics provided the methodological framework and informed the analysis. The thesis of the paper is that the poetics of mourning and faith-based social interventions are interactionally based meaning making processes. The paper indicates the limitations of the study and their implications for further inquiry.

Parent Grief 1-13 Months After Death in Neonatal and Pediatric Intensive Care Units

OBJECTIVE

Describe changes in mothers' and fathers' grief from 1 to 13 months after infant/child neonatal/pediatric intensive care unit death and identify factors related to their grief.

METHODS

Mothers (n = 130) and fathers (n = 52) of 140 children (newborn-18 years) completed the Hogan Grief Reaction Checklist at 1, 3, 6, and 13 months post-death.

RESULTS

Grief decreased from 3 to 13 months for mothers and from 3 to 6 months for fathers. Grief was more intense for: mothers of deceased adolescents and mothers whose child was declared brain dead.

CONCLUSION

Mothers' and fathers' grief intensity may not coincide, resulting in different needs during the 13 months after infant/child death.

Disgust Sensitivity Accounts for Some But Not All Gender Differences in Death Attitudes

The present study investigated whether gender differences in death attitudes could be attributable to social desirability, locus of control, and disgust sensitivity. A total of 238 university students completed the Multidimensional Fear of Death Scale and the Revised Death Attitude Profile in addition to measures of social desirability, locus of control, and disgust sensitivity. Women scored higher than men on many of the fear dimensions and also on approach and escape acceptance. There were no gender differences on locus of control or social desirability, but women reported more disgust sensitivity than did men. Locus of control was unrelated to any death attitudes. Social desirability was associated only with less reported fear of premature death. Disgust sensitivity was associated with all death attitudes except neutral acceptance. Some but not all of the gender differences in death attitudes were no longer significant when controlling for disgust sensitivity.

Exploring the intangible economic costs of stillbirth

BACKGROUND

Compared to other pregnancy-related events, the full cost of stillbirth remains poorly described. In the UK one in every 200 births ends in stillbirth. As a follow-up to a recent study which explored the direct costs of stillbirth, this study aimed to explore the intangible costs of stillbirth in terms of their duration and economic implication.

METHODS

Systematic searches identified relevant papers on the psychological consequences of stillbirth. A narrative review of the quantitative studies was undertaken. This was followed by a qualitative synthesis using meta-ethnography to identify over-arching themes common to the papers. Finally, the themes were used to generate questions proposed for use in a questionnaire to capture the intangible costs of stillbirth.

RESULTS

The narrative review revealed a higher level of anxiety and depression in couples with stillbirth compared to those without stillbirth. The qualitative synthesis identified a range of psychological effects common to families that have experienced stillbirth. Both methods revealed the persistent nature of these effects and the subsequent economic burden.

CONCLUSIONS

The psychological effects of stillbirth adversely impacts on the daily functioning, relationships and employment of those affected with far-reaching economic implications. Knowledge of the intangible costs of stillbirth is therefore important to accurately estimate the size of the impact on families and health services and to inform policy and decision making.

Infant and child deaths: Parent concerns about subsequent pregnancies

PURPOSE

Examine parents' concerns about subsequent pregnancies after experiencing an infant or child death (newborn to 18 years).

DATA SOURCES

Thirty-nine semistructured parent (white, black, Hispanic) interviews 7 and 13 months post infant/child death conducted in English and/or Spanish, audio-recorded, transcribed, and content analyzed. Mothers' mean age was 31.8 years, fathers' was 39 years; 11 parents were white, 16 black, and 12 Hispanic.

CONCLUSIONS

Themes common at 7 and 13 months: wanting more children; fear, anxiety, scared; praying to God/God's will; thinking about/keeping the infant's/child's memory and at 7 months importance of becoming pregnant for family members; and at 13 months happy about a new baby. Parents who lost a child in neonatal intensive care unit (NICU) commented more than those who lost a child in pediatric intensive care unit (PICU). Black and Hispanic parents commented more on praying to God and subsequent pregnancies being God's will than white parents.

IMPLICATIONS FOR PRACTICE

Loss of an infant/child is a significant stressor on parents with documented negative physical and mental health outcomes. Assessing parents' subsequent pregnancy plans, recognizing the legitimacy of their fears about another pregnancy, discussing a plan should they encounter problems, and carefully monitoring the health of all parents who lost an infant/child is an essential practitioner role.

Evaluating a bereavement follow-up intervention for grieving mothers after the death of a child

AIM

The aim of this study was to produce information about parental grief intervention and its impacts on maternal grief.

BACKGROUND

The grief after death of a child is a lifelong process. Social support is often stated as the most important factor in coping after the death of a child.

DESIGN

A single measure post-test control group design was used to evaluate whether there are differences in the grief reactions between the mothers in the intervention program (n = 83) and the mothers in the control group (n = 53).

METHOD

The data were collected by using a questionnaire which included background variables and Hogan Grief Reactions Checklist 6 months after the child's death. The data were analysed by statistical methods.

RESULTS

There were no significant differences in the grief reactions between the intervention group and the control group. However, greater support from the healthcare professionals was associated with stronger personal growth. The mothers' age, self-perceived health status and the age of deceased child were associated with the grief reactions. This study emphasises the importance of social support to grieving mothers.

CONCLUSION

Health care professionals are in an important role when considering support for grieving mothers; the given support may relieve the mothers' grief reactions.

Accepting death as part of life: meaning in life as a means for dealing with loss among bereaved individuals

The purpose of this study was to investigate the relationship between the 3 dimensions of death acceptance (i.e., neutral, approach, and escape) and grief symptomatology, as well as whether the relationship between neutral acceptance and grief symptoms was mediated by meaning in life. Data were collected from 160 bereaved individuals. Only neutral acceptance was significantly associated with grief symptomatology; the relationship between the 2 variables was mediated by meaning in life. Participants who perceived death as a natural part of life reported having a greater sense of meaning in their lives, which, in turn, predicted lower grief symptomatology.

Mothers' experience of their contact with their stillborn infant: an interpretative phenomenological analysis

Background

Guidelines surrounding maternal contact with the stillborn infant have been contradictory over the past thirty years. Most studies have reported that seeing and holding the stillborn baby is associated with fewer anxiety and depressive symptoms among mothers of stillborn babies than not doing so. In contrast, others studies suggest that contact with the stillborn infant can lead to poorer maternal mental health outcomes. There is a lack of research focusing on the maternal experience of this contact. The present study aimed to investigate how mothers describe their experience of spending time with their stillborn baby and how they felt retrospectively about the decision they made to see and hold their baby or not.

Method

In depth interviews were conducted with twenty-one mothers three months after stillbirth. All mothers had decided to see and the majority to hold their baby. Qualitative analysis of the interview data was performed using Interpretive Phenomenological Analysis.

Results

Six superordinate themes were identified: Characteristics of Contact, Physicality; Emotional Experience; Surreal Experience; Finality; and Decision. Having contact with their stillborn infant provided mothers with time to process what had happened, to build memories, and to ‘say goodbye’, often sharing the experience with partners and other family members. The majority of mothers felt satisfied with their decision to spend time with their stillborn baby. Several mothers talked about their fear of seeing a damaged or dead body. Some mothers experienced strong disbelief and dissociation during the contact.

Conclusions

Results indicate that preparation before contact with the baby, professional support during the contact, and professional follow-up are crucial in order to prevent the development of maternal mental health problems. Fears of seeing a damaged or dead body should be sensitively explored and ways of coping discussed. Even in cases where mothers experienced intense distress during the contact with their stillborn baby, they still described that having had this contact was important and that they had taken the right decision. This indicates a need for giving parents an informed choice by engaging in discussions about the possible benefits and risks of seeing their stillborn baby.

The assessment of cyberstalking: an expanded examination including social networking, attachment, jealousy, and anger in relation to violence and abuse

Because the first antistalking statute was enacted in California in 1990, stalking research has been expanded immensely, yet been largely confined to exploring traditional pursuit tactics. This study instead examined the prevalence and correlates of cyberstalking behaviors while examining the phenomenon in a more inclusive manner than previous studies focusing on cyberstalking by including social networking avenues. In addition to a measure assessing cyberstalking-related behaviors, questionnaires assessing pathological aspects of personality, including attachment style, interpersonal jealousy, interpersonal violence, and anger were also provided to participants. Results indicate that, given preliminary evidence, cyberstalking-related behaviors are related to past measures of traditional stalking and cyberstalking, although prior attachment, jealousy, and violence issues within relationships are significant predictors of cyberstalking-related behaviors. In addition, unexpected gender differences emerged. For example, women admitted greater frequencies of cyberstalking perpetration than males, signaling that further research on frequency and motivation for cyberstalking among the sexes is necessary.

A traumatic death support group program: applying an integrated conceptual framework

This article describes an 8-week, curriculum-based traumatic death support group program that is offered at Bo's Place, a grief and bereavement center in Houston, Texas. The program was implemented in 2006 in an effort to help family members who had experienced a death in the family by suicide, murder, accident, or sudden medical problem. The program provides the opportunity for families to come to the center and engage in selected activities as a unit, while also providing adults and children the opportunity to participate in separate support groups with curricula adapted to different age levels. The program uses an integrated conceptual framework that draws upon elements from a variety of theoretical and conceptual models related to grief. The purpose of the program is to provide multiple paths for progress in the grief journey for the bereaved. In 2008, Bo's Place incorporated a brief questionnaire into the weekly meetings, in an effort to gain a better understanding of the perceptions of adult participants of the program and their own progress in their grief. The questionnaire asked adults to provide self-ratings of their perceptions of support from the program and of their progress in their grief journey. The positive results from this pilot study have encouraged Bo's Place to develop plans for more rigorous research into the mechanisms that contribute to progress in the grief journey for bereaved adults and children.

Death and dying anxiety among bereaved and nonbereaved elderly parents

This study examines differences in death and dying anxiety between bereaved and nonbereaved elderly Israeli parents, as well as correlates of these factors among bereaved parents. A total of 97 parents (49 bereaved, 48 nonbereaved) completed measures of death and dying anxiety and religiosity. Bereaved parents reported significantly higher dying anxiety scores than nonbereaved parents, but there were no significant differences between the 2 groups in death anxiety. Religiosity was unrelated to death and dying anxiety. Dying anxiety was higher among bereaved mothers than bereaved fathers. Death and dying anxiety were not associated with the length of time since the loss of the child or the nature of the child's death. Results are discussed in light of the difficulties that bereaved parents experience after the loss of their child. Implications for theory, for health and welfare professionals, and for policy are suggested.

Complicated grief symptoms in caregivers of persons with lung cancer: the role of family conflict, intrapsychic strains, and hospice utilization

Guided by a stress process conceptual model, this study examines social and psychological determinants of complicated grief symptoms focusing on family conflict, intrapsychic strains, and the potential moderating effect of care quality and hospice utilization. Relying on data from 152 spouse and adult child lung cancer caregiver survey respondents, drawn from an ancillary study of the Assessment of Cancer CarE and SatiSfaction (ACCESS) in Wisconsin, hierarchical multiple regression analysis was used to examine determinants of complicated grief. After controlling for contextual factors and time since death, complicated grief symptoms were higher among caregivers with less education, among families with lower prior conflict but higher conflict at the end-of-life, who had family members who had difficulty accepting the illness, and who were caring for patients with greater fear of death. Additionally, hospice utilization moderated the effect of fear of death on complicated grief. Findings suggest that family conflict, intrapsychic strains, and hospice utilization may help to explain the variability found in complicated grief symptoms among bereaved caregivers. Implications for enhancing complicated grief assessment tools and preventative interventions across the continuum of cancer care are highlighted.