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Keser E, Çakmakçı E, Gökmen F, Şahin NE, Akyalçın R, Zeybek SG. The relationship between bereavement-related guilt and suicide ideation in Turkish bereaved adults. DEATH STUDIES 2024:1-8. [PMID: 39141580 DOI: 10.1080/07481187.2024.2390891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
This study investigates risk factors for suicidal ideation among Turkish bereaved adults, focusing on bereavement-related guilt. Utilizing the Prolonged Grief Scale, Bereavement Guilt Scale, and Beck Depression Inventory's suicide item, 570 bereaved participants were assessed. Suicidal ideation prevalence was found to be 20.2%. Higher rates of low income, single status, and unnatural death, as well as younger ages of the bereaved and deceased, were observed in the suicidal ideation group. Additionally, significantly elevated scores on the Prolonged Grief Scale and Bereavement Guilt Scale subscales were found in this group. After controlling for other risk factors, scores for survivor guilt and perceived responsibility for the death significantly increased the likelihood of belonging to the suicidal ideation group. These findings underscore the critical role of addressing feelings of guilt in psychological interventions aimed at mitigating suicidal ideation among bereaved individuals.
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Affiliation(s)
- Emrah Keser
- Department of Psychology, TED University, Ankara, Turkey
| | - Ecem Çakmakçı
- Department of Psychology, TED University, Ankara, Turkey
| | - Feyza Gökmen
- Department of Psychology, TED University, Ankara, Turkey
| | | | - Rabia Akyalçın
- Department of Psychology, TED University, Ankara, Turkey
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Keser E, Kahya Y. Perinatal grief creates vulnerability to anxiety in subsequent pregnancy: the mediating role of bereavement-related guilt. J Reprod Infant Psychol 2024:1-13. [PMID: 38529818 DOI: 10.1080/02646838.2024.2335176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/16/2024] [Indexed: 03/27/2024]
Abstract
AIM This study examines the associations among perinatal grief symptoms, bereavement-related guilt, and pregnancy-related anxiety in subsequent pregnancy within the framework of a hypothesised mourning model. METHOD Pregnant women with history of a perinatal loss were recruited using convenience sampling methods and completed a questionnaire set including the Perinatal Grief Scale, Bereavement Guilt Scale, and Pregnancy-related Anxiety Scale. RESULTS Mediation analysis was performed to evaluate the hypothesised model in a sample of pregnant women with history of a perinatal loss (N = 111). The results indicated that bereavement-related guilt functions as a mediator in the relationship between perinatal grief severity and pregnancy-related anxiety experienced in subsequent pregnancies. CONCLUSION These findings were evaluated in light of previous studies, providing a bereavement-based perspective on the potential transmission of the mental effects of perinatal loss to subsequent pregnancy.
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Affiliation(s)
- Emrah Keser
- Department of Psychology, TED University, Ankara, Turkey
| | - Yasemin Kahya
- Department of Psychology, Social Sciences University of Ankara, Ankara, Turkey
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Polakova K, Ahmed F, Vlckova K, Brearley SG. Parents' experiences of being involved in medical decision-making for their child with a life-limiting condition: A systematic review with narrative synthesis. Palliat Med 2024; 38:7-24. [PMID: 38053373 PMCID: PMC10798032 DOI: 10.1177/02692163231214414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Parental involvement in the decision-making processes about medical treatment for children with life-limiting conditions is recognised as good practice. Previous research highlighted factors affecting the decision-making process, but little is known about how parents experience their participation. AIM To explore how parents experience their participation in the process of decision-making about treatment and future care for their children with life-limiting conditions. DESIGN A systematically constructed review using narrative synthesis. The PRISMA guidelines were followed to report the findings. Databases Medline, EMBASE, SCOPUS, CINAHL and PsycINFO were searched up to December 2023. The study protocol was registered at PROSPERO (RN CRD42021215863). RESULTS From the initial 2512 citations identified, 28 papers met the inclusion criteria and were included in the review. A wide range of medical decisions was identified; stopping general or life-sustaining treatment was most frequent. Narrative synthesis revealed six themes: (1) Temporal aspects affecting the experience with decision-making; (2) Losing control of the situation; (3) Transferring the power to decide to doctors; (4) To be a 'good' parent and protect the child; (5) The emotional state of parents and (6) Sources of support to alleviate the parental experience. CONCLUSIONS Parental experiences with decision-making are complex and multifactorial. Parents' ability to effectively participate in the process is limited, as they are not empowered to do so and the circumstances in which the decisions are taking place are challenging. Healthcare professionals need to support parental involvement in an effective way instead of just formally asking them to participate.
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Affiliation(s)
- Kristyna Polakova
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
- Center for Palliative Care, Prague, Czech Republic
| | - Faraz Ahmed
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Sarah G Brearley
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Ferguson KA, Reitschuler-Cross EB, Stahl ST. A Multimethod Examination of Medical Students' Experiences With Bereavement and Complicated Grief. OMEGA-JOURNAL OF DEATH AND DYING 2023; 88:668-689. [PMID: 34590884 DOI: 10.1177/00302228211049678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Few studies have examined grief in medical students. This study used a multimethod approach to describe how bereavement and CG may impact medical students' educational experience and their perspectives on grief support and training. One hundred three medical students completed an online survey with quantitative and qualitative methods. Seventy-three (71%) students reported experiencing bereavement, of which 12 (18%) screened positive for CG. Medical students who screened positive for CG reported significantly more emotional and behavioral challenges (M = 3.58 [SD = 2.64]) compared to medical students without CG (M = 0.93 [SD = 1.58], p < .001). Qualitative analyses revealed that bereaved and nonbereaved students wanted more grief education and bereavement support from medical institutions. Therefore, it is crucial for medical institutions, to acknowledge that grief and bereavement may impact students' performance due to multifactorial causes.
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Affiliation(s)
- Kortni A Ferguson
- Department of Medicine, University of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Eva B Reitschuler-Cross
- Department of Medicine, University of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Sarah T Stahl
- Department of Psychiatry, University of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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The Impact of Lethal, Enforcement-Centred Cat Management on Human Wellbeing: Exploring Lived Experiences of Cat Carers Affected by Cat Culling at the Port of Newcastle. Animals (Basel) 2023; 13:ani13020271. [PMID: 36670811 PMCID: PMC9854822 DOI: 10.3390/ani13020271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/19/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023] Open
Abstract
In urban and peri-urban areas of the world, free-roaming cats often pose management challenges for authorities. Most are wandering owned or semi-owned cats (fed by people who do not perceive ownership). Some are lost or abandoned, or unowned cats who obtain food from humans unintentionally. Unidentified cats are classified as "stray" in shelter data, and by government agencies as "stray" or "feral" based on their behaviour. However, legally feral cats are usually considered to live and reproduce in the wild with no support from humans. Cats classified as feral in Australia can be managed using lethal methods, including shooting, poisoning, trapping, and blunt trauma. The impact of killing animals on shelter staff is well documented. However, no previous research has investigated psychological impacts of lethal cat management on citizens who care for free-roaming cats. Using semi-structured interviews, this study explored the lived experience of six cat caregivers affected by lethal management of cats by shooting, instigated by the Port of Newcastle in 2020. Results demonstrated strong relationships between the caregivers and cats, and negative impacts on caregiver psychological health and quality of life associated with lethal management. It is recommended that a care-centred approach to cat management be prioritized in future, whereby authorities aid neutering and, if possible, adoption, to improve cat welfare, minimize cat nuisance complaints, and reduce psychological hazards to caregivers. Further, a revision of relevant legislation used to distinguish between domestic and feral cats in Australia should be actioned to prevent unnecessary killing of domestic cats.
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Weber KM, Lemanski M, Lorenz M, Bingle C. What We said and what I wish We said: Regret during final conversations. DEATH STUDIES 2022:1-11. [PMID: 36519253 DOI: 10.1080/07481187.2022.2155886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Research indicates that final conversations with dying loved ones are significant but challenging relational events for survivors. Using a qualitative theme analysis, the present study documented survivors' (N = 44) retrospective reports of experiences of regret during final conversations. The analysis revealed experiences of validation regret, intersubjective regret, and encumbrance regret, and the use of regret management techniques. This knowledge is useful because it points to the impetus of regret experienced during final conversations and implicates communication patterns that could negatively impact bereavement.
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Affiliation(s)
- Kirsten M Weber
- Department of Communication, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Mark Lemanski
- Department of Communication, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Marni Lorenz
- Department of Communication, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Christine Bingle
- Department of Communication, Central Michigan University, Mount Pleasant, Michigan, USA
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Levi-Belz Y, Ben-Yaish T. Prolonged Grief Symptoms among Suicide-Loss Survivors: The Contribution of Intrapersonal and Interpersonal Characteristics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710545. [PMID: 36078261 PMCID: PMC9518413 DOI: 10.3390/ijerph191710545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/18/2022] [Accepted: 08/20/2022] [Indexed: 05/13/2023]
Abstract
BACKGROUND Suicide-loss survivors (SLSs) are a population with unique characteristics that place them at increased risk for developing grief complications and painful feelings of guilt that may impact their supportive social environment. However, no studies to date have examined the role of intrapersonal and interpersonal variables that may contribute to prolonged grief symptoms (PGS) as outlined by the new DSM-5 criteria. The present study aimed to extend knowledge regarding the role of interpersonal variables, such as perceived burdensomeness, thwarted belongingness, and self-disclosure, in determining the impact of guilt on the development of PGS among SLSs. METHOD This study is part of a longitudinal study, though, in this study, we used a cross-sectional examination of the recently completed fourth measurement. Study participants included 152 SLSs aged 22 to 76 who completed questionnaires measuring guilt, depression, perceived burdensomeness, thwarted belongingness, self-disclosure, and PGS using the Prolonged Grief-Revised Inventory. Participants' demographics and loss-related characteristics, such as time since suicide and participant's age at the time of suicide, were examined. RESULTS Confirming the hypotheses, intrapersonal variables (i.e., guilt and depression), as well as interpersonal variables (i.e., perceived burdensomeness, thwarted belongingness, and self-disclosure), contributed significantly to PGS beyond sociodemographic and loss-related factors. Perceived burdensomeness significantly moderated the contribution of guilt to PGS: for participants with high burdensomeness levels, guilt contributed to PGS more strongly than for participants with low burdensomeness. CONCLUSION Guilt is an important contributor to PGS among SLSs, and perceived burdensomeness plays a critical role in moderating this contribution. In light of these findings, it can be suggested that SLSs with high levels of guilt should receive special attention and may benefit from therapeutic interventions focusing on reducing maladaptive cognitions that elicit intense guilt or perceived burden.
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Affiliation(s)
- Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer 40250, Israel
- Correspondence: ; Tel.: +972-9-8983028; Fax: +972-9-8983022
| | - Tamir Ben-Yaish
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer 40250, Israel
- Clinical Psychology of Adulthood and Aging M.A. Program, Ruppin Academic Center, Emek Hefer 40250, Israel
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Luck T, Luck-Sikorski C. The wide variety of reasons for feeling guilty in adults: findings from a large cross-sectional web-based survey. BMC Psychol 2022; 10:198. [PMID: 35962455 PMCID: PMC9373443 DOI: 10.1186/s40359-022-00908-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Experiencing some sort of guilt is a common phenomenon in adulthood. As feeling guilty is usually unpleasant and may even lead to further negative psychological consequences like depression, the aim of this study was to provide comprehensive information on the reasons for such feelings in adults. METHODS A cross-sectional web-based survey was conducted between May 2019 and April 2020, collecting qualitative information on reasons for feeling guilty in n = 604 adults (mean/SD age = 45.3/16.4 years; n = 346/57.3% women, n = 255/42.2% men and n = 3/0.5% adults without identification with a particular gender). Stated reasons were inductively classified into (super-)/categories, and information on frequency and percentage (total, gender- and age-specific) for each of these (super-)/categories was provided. RESULTS Participants altogether stated 1515 reasons for feeling guilty that were classified into 12 supercategories and 49 categories. "Telling lies/withholding truth/information" followed by "Not spending (enough) time with family (members)/Not taking (enough) care of family (members)/not being there for family (members)" were the most frequent categories of reasons for feeling guilty in the sample. Guilt feelings explicitly referring to "religious beliefs" or a "subjectively perceived more general responsibility'" (e.g., for society, humankind, problems of the world), by contrast, were of minor importance. Male and female participants as well as participants of different ages showed similarities but also several differences in stated reasons for feeling guilty. Female participants, for example, more often experienced feelings of guilt related to family members, children and to some kind of general responsibility for the wellbeing of others, whereas male participants felt guilty more often because of some kind of misconduct/mistakes being made or because of difficulties in marriage/relationship. CONCLUSIONS Adults can feel guilty for a wide variety of different reasons. Most reasons seem to be rather concrete (e.g., related to concrete negative self-attributions/flaws or to concrete social situations with concrete individuals). There also seem to be some age- and gender-related differences in reasons for feeling guilty.
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Affiliation(s)
- Tobias Luck
- Faculty of Applied Social Sciences, University of Applied Sciences Erfurt, Altonaer Straße 25, 99085, Erfurt, Germany. .,Department of Economic and Social Sciences and Institute of Social Medicine, Rehabilitation Sciences and Healthcare Research (ISRV), University of Applied Sciences Nordhausen, Nordhausen, Germany.
| | - Claudia Luck-Sikorski
- Research Group COPE - Chronic Diseases and Psychological Health, SRH University of Applied Health Sciences, Gera, Germany.,Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Hospital Leipzig, Leipzig, Germany
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Muziki JD, Uwera T, Niyonsenga J, Nshimiyimana A, Sebatukura SG, Mutabaruka J. Negative emotions and personal well-being among incarcerated filicide mothers in Rwanda. PLoS One 2022; 17:e0271255. [PMID: 35895737 PMCID: PMC9328529 DOI: 10.1371/journal.pone.0271255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Despite the tremendous evidence of the harmful effects of maternal filicide on the lives of offenders, there is a scarcity on studies of their negative emotions and personal wellbeing especially in sub-Saharan Africa. Thus, this study was primarily aimed at assessing the prevalence of negative emotions experienced by filicide mothers and how they were associated with personal wellbeing in Rwanda. With an institutional-based cross-sectional study design, we measured the symptoms of anxiety, anger, shame, guilt, depression and personal well-being in a convenient sample of 55 filicidal mothers (mean age = 26.69; SD = 6.88) who were incarcerated in Nyarugenge prison. SPSS (version 24) was used to compute descriptive, Pearson correlation, independent t-test and regression analyses. The results indicated that the rates of shame were (100%), guilt (98.2%), anxiety (92.7%), depression (92.7%), low happiness and satisfaction with life (81.8%), and anger was (76.4%) in the current sample. Based on age category, there was no significant difference in anger scores, depression, guilt, shame and personal well-being scores between young and adult filicide mothers (p>.05). Young filicide mothers (M = 14.55, SD = 4.03), on the other hand, had higher anxiety scores than adult filicide mothers (M = 11.57, SD = 4.72), t = 2.52, p = .015. Finally, anxiety (β = -.507, t = -3.478, p = .001) and age (β = -.335, t = -2.685, p < .001) were negatively associated with personal well-being. The results emerged from this study highlight that filicide mothers experience substantial negative emotions and poor personal wellbeing regardless of their age category. However, poor personal wellbeing was associated with anxiety and age. Based on these results, mental health professionals should examine their mental state with respect to negative emotions and initiate programs that decrease the emotions as well as increase personal well-being.
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Affiliation(s)
- Jean d’Amour Muziki
- Department of Clinical Psychology, College of Medicine and Health Sciences of University of Rwanda, Kigali, Rwanda
- * E-mail:
| | - Thaoussi Uwera
- Department of Health Informatics, College of Medicine and Health Sciences of University of Rwanda, Kigali, Rwanda
| | - Japhet Niyonsenga
- Department of Clinical Psychology, College of Medicine and Health Sciences of University of Rwanda, Kigali, Rwanda
- Mental Health & Behaviour Research Group, College of Medicine and Health Sciences of University of Rwanda, Kigali, Rwanda
| | - Augustin Nshimiyimana
- Department of Clinical Psychology, College of Medicine and Health Sciences of University of Rwanda, Kigali, Rwanda
| | - Siméon Gitimbwa Sebatukura
- Department of Clinical Psychology, College of Medicine and Health Sciences of University of Rwanda, Kigali, Rwanda
- * E-mail:
| | - Jean Mutabaruka
- Department of Clinical Psychology, College of Medicine and Health Sciences of University of Rwanda, Kigali, Rwanda
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van Kempen MM, Kochen EM, Kars MC. Insight into the content of and experiences with follow-up conversations with bereaved parents in paediatrics: A systematic review. Acta Paediatr 2022; 111:716-732. [PMID: 34995378 PMCID: PMC9304260 DOI: 10.1111/apa.16248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 12/31/2022]
Abstract
Aim A follow‐up conversation with bereaved parents is a relatively well‐established intervention in paediatric clinical practice. Yet, the content and value of these conversations remain unclear. This review aims to provide insight into the content of follow‐up conversations between bereaved parents and regular healthcare professionals (HCPs) in paediatrics and how parents and HCPs experience these conversations. Methods Systematic literature review using the methods PALETTE and PRISMA. The search was conducted in PubMed and CINAHL on 3 February 2021. The results were extracted and integrated using thematic analysis. Results Ten articles were included. This review revealed that follow‐up conversations are built around three key elements: (1) gaining information, (2) receiving emotional support and (3) facilitating parents to provide feedback. In addition, this review showed that the vast majority of parents and HCPs experienced follow‐up conversations as meaningful and beneficial for several reasons. Conclusion An understanding of what parents and HCPs value in follow‐up conversations aids HCPs in conducting follow‐up conversations and improves care for bereaved parents by enhancing the HCPs' understanding of parental needs.
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Affiliation(s)
- Merel M. van Kempen
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Eline M. Kochen
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Marijke C. Kars
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
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Reflections on Experiencing Parental Bereavement as a Young Person: A Retrospective Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042083. [PMID: 35206275 PMCID: PMC8872611 DOI: 10.3390/ijerph19042083] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/06/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023]
Abstract
Background: It is estimated that approximately 41,000 children and young people experience the death of a parent each year. Grief responses, such as anxiety and depression, can follow. This research investigated the adult reflections of experiencing parental death as a young person. Methods: Semi-structured interviews were conducted with adults (N = 14; female n = 8) who experienced parental death as a young person, which occurred over 5 years ago (time since death, M = 12.9 years; age at death, M = 16.4 years; age at interview, M = 30.9 years). The data were analysed inductively using thematic analysis. Results: Seven themes revealed that parental bereavement can lead to (1) “Distance and isolation” and is an (2) “Emotional journey” with (3) a “Physical impact”. Many experienced (4) “Post-traumatic growth” but acknowledged that (5) “Life will never be the same”, highlighting the importance of (6) “Support and understanding” and triggers for (7) “Re-grief”. Conclusions: Parental bereavement has significant emotional and physical consequences, but can also lead to personal growth. Talking therapies were rarely accessed, often due to a lack of awareness or desire to engage, revealing a translational gap between existing support services and uptake. Enabling open conversations about grief and identifying suitable support is a public health priority. This need has been amplified since the start of the COVID-19 pandemic, which may be a trigger for grief empathy and re-grief in those who have already been bereaved.
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Abstract
Survivor guilt is a common experience following traumatic events in which others have died. However, little research has addressed the phenomenology of survivor guilt, nor has the issue been conceptualised using contemporary psychological models which would help guide clinicians in effective treatment approaches for this distressing problem. This paper summarises the current survivor guilt research literature and psychological models from related areas, such as posttraumatic stress disorder, moral injury and traumatic bereavement. Based on this literature, a preliminary cognitive approach to survivor guilt is proposed. A cognitive conceptualisation is described, and used as a basis to suggest potential treatment interventions for survivor guilt. Both the model and treatment strategies require further detailed study and empirical validation, but provide testable hypotheses to stimulate further research in this area.
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Ito Y, Tsubaki M, Kobayashi M. Families' experiences of grief and bereavement in the emergency department: A scoping review. Jpn J Nurs Sci 2021; 19:e12451. [PMID: 34490984 DOI: 10.1111/jjns.12451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/19/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
AIM Death is a frequent event in the emergency department, and many family members experience grief and bereavement. However, little is known about what families experience. The aim of this study was to explore previous findings about families' experiences of grief and bereavement in the emergency department to clarify and understand their experience. METHODS A scoping review was chosen as the design for this research. Studies were searched from four electronic databases. The obtained studies were screened independently by two reviewers and selected by mutual agreement of the entire team based upon the eligibility criteria. All relevant data were extracted, and thematic analysis was conducted to assess families' grief and bereavement experiences in the emergency department. RESULTS The database searches initially resulted in 982 studies; these were finally narrowed to 20 studies for data extraction. Publication years ranged from 1987 to 2020. The studies were conducted across nine countries; most were from the United States and had a qualitative research design. Analysis elicited the following themes: "lack of information," "breaking bad news," "being present during resuscitation," "chaotic environment," "psychosocial reaction in bereavement," and "support and care needs from healthcare professionals." CONCLUSION These themes reveal challenges in providing support and care from emergency nurses to bereaved families, including inadequate provision of information, poor design of the emergency department due to the lack of privacy, and families' unmet support and care needs. Emergency nurses need to better understand families' experience of grief and bereavement.
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Affiliation(s)
- Yoshiyasu Ito
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
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Petrongolo M, Toothaker R. Nursing students perceptions of death and dying: A descriptive quantitative study. NURSE EDUCATION TODAY 2021; 104:104993. [PMID: 34098421 DOI: 10.1016/j.nedt.2021.104993] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 05/10/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Nurses are frequently present during the dying process as a support for the dying person and the family. Experiencing death in this capacity can cause emotional and psychological stress to the nursing staff as they work to help others. Nursing students as the upcoming generation of nurses, need the knowledge and self-awareness to support others through these often traumatic events. Many students may not have experience with death or dying and when combined with lack of knowledge will be a great barrier once students graduate. OBJECTIVES The purpose of this study is to determine how sophomore, junior, and senior undergraduate nursing students enrolled in one University setting perceive the concept of death and dying. DESIGN A descriptive quantitative study was designed to explore the various perceptions that sophomore, junior, and senior nursing students have about death and dying. RESULTS The Frommelt Attitudes Toward Care of the Dying scale showed students have a positive attitude toward caring for dying patients. The Death Attitudes Profile-Revised scale indicated the presence of all profiles, though most students identified with Neutral Acceptance profile. CONCLUSIONS Nursing students often fear caring for clients with death or dying. Additional targeted education along with end of life care simulations can improve students improve their attitudes and beliefs to better care for patients.
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Affiliation(s)
- Mary Petrongolo
- 400 E. 2nd Street, Nursing Department, Bloomsburg, PA 17815, United States of America.
| | - Rebecca Toothaker
- 400 E. 2nd Street, Nursing Department, Bloomsburg, PA 17815, United States of America.
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Wittkowski J, Scheuchenpflug R. Evidence on the Conceptual Distinctness of Normal Grief From Depression. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2021. [DOI: 10.1027/2512-8442/a000077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: The distinctness of grief from depression has been the subject of a long scholarly debate, even influencing definitions of diagnostic criteria. Aims: This study aims at clarifying the issue by a multifaceted analysis of data from a large German sample. Method: A community sample of 406 bereaved persons answered the Wuerzburg Grief Inventory (WGI), a multidimensional grief questionnaire designed to measure normal grief in the German language, and the General Depression Scale – Short Version (GDS-S), a self-report depression scale. Data were analyzed by factor analysis to identify structural (dis-)similarities of the constructs, and analysis of variance (ANOVA) to identify the influence of the factors relationship to the deceased, type of death, and time since loss on grief measures and depression scores. Results: Factor analysis clustered items referring to grief-related impairments and depression into one factor, items referring to other dimensions of grief on separate factors, however. Relationship to the deceased influenced the grief measures impairments and nearness to the deceased, but not depression scores if controlled for impairments. Type of death showed specific effects on grief scores, but not on depression scores. Time since loss influenced grief scores, but not depression scores. Limitations: The analysis is based on a self-selected community sample of grieving persons, self-report measures, and in part, on cross-sectional data. Conclusion: Factor analysis and objective data show a clear distinction of dimensions of grief and depression. The human experience of grief contains a sense of nearness to the lost person, feelings of guilt, and positive aspects of the loss experience in addition to components resembling depression.
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Affiliation(s)
- Joachim Wittkowski
- Institute of Psychology, Julius-Maximilians-Universität of Würzburg, Germany
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16
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Joa B, Newberg AB. Neuropsychological Comparison of Guilt and Grief: A Review of Guilt Aspects in Prolonged Grief Disorder. OMEGA-JOURNAL OF DEATH AND DYING 2021; 87:591-613. [PMID: 34152877 DOI: 10.1177/00302228211024111] [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: 11/17/2022]
Abstract
Taking an integrative approach toward developmental psychology and neurophysiology, this review selects findings from the psychological and medical literature on guilt and bereavement that are relevant to considering whether and how guilt contributes to the development of prolonged grief disorder (PGD) in bereaved persons. Mention of guilt is ubiquitous in literature on general grief and PGD, including 54 articles related to the neuropsychological development and manifestations of guilt and grief, as well as their neuroimaging correlates, that met scoping review criteria. However, mechanisms connecting guilt to development of PGD are scarce. Aspects of guilt are conceptually connected to many PGD criteria, opening avenues to explore treatment of PGD by targeting guilt. Positive and prosocial aspects of guilt are especially neglected in the treatment of psychiatric disorders, and consideration of these aspects may improve interventions for PGD such as complicated grief treatment.
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Affiliation(s)
- Brandon Joa
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Andrew B Newberg
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States
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17
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Wagner B, Hofmann L, Grafiadeli R. The relationship between guilt, depression, prolonged grief, and posttraumatic stress symptoms after suicide bereavement. J Clin Psychol 2021; 77:2545-2558. [PMID: 34081784 DOI: 10.1002/jclp.23192] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/30/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE A profound feeling of guilt and its role in complicating psychological reactions are accepted as central issues in suicide bereavement. However, research examining the relationship of guilt with mental disorders commonly following suicide bereavement is still lacking. This study aimed to examine the association between guilt and symptoms of depression, prolonged grief disorder, and posttraumatic stress disorder (PTSD) after suicide bereavement, as well as its moderating role in the association between the time which elapsed since bereavement and psychopathological symptoms. METHODS 154 self-selected adult German participants bereaved by suicide completed online questionnaires assessing sociodemographics, characteristics related to the loss, guilt, depression, prolonged grief, and PTSD. RESULTS Significant positive correlations were found between guilt and all assessed psychopathological symptoms. Further, guilt was a significant correlate with symptoms of depression, prolonged grief, PTSD over and above sociodemographic factors, and time that elapsed since the loss. Guilt furthermore moderated the link between the time which elapsed since bereavement and depressive symptoms, while this effect was not observed for prolonged grief and posttraumatic stress symptoms. CONCLUSION Our findings replicate theoretical frameworks linking feelings of guilt with mental disorders after suicide bereavement. Accordingly, they highlight the necessity to adapt psychotherapeutic interventions according to the specific needs of this population to maximize treatment effectiveness.
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Affiliation(s)
- Birgit Wagner
- Department of Clinical Psychology, Medical School Berlin, Berlin, Germany
| | - Laura Hofmann
- Department of Clinical Psychology, Medical School Berlin, Berlin, Germany
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18
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Wang E, Hu H, He Y, Xu Y. Can social support matter? The relationship between social support and mental health among bereaved parents in an only-child society: Evidence from China. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:476-486. [PMID: 32701221 DOI: 10.1111/hsc.13108] [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] [Received: 01/03/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
Shidu parents (parents who lost their only child) experience poor mental health, and social support is expected to alleviate mental stress and facilitate mental adaptation of bereaved parents. However, the literatures on the effects of social support on mental health of bereaved parents have yield mixed outcomes, and the relationship between social support and mental health among Shidu parents has been unexplored in China. The purpose of this study was to examine the relationship between social support and mental health among Shidu parents in China. Multistage stratified random sampling was conducted to collect data in 2017, and a total of 1,750 Shidu parents were employed as the analytical sample. The Ordinary Least Squares Model and Instrumental Variables (IV) Method were both employed. The variable of community services for the aged provided by the market was employed as the IV of the study considering death taboo inveterately rooted in philosophies and religions in Chinese culture. The results indicated that there was a positive relationship between social support and mental health among Shidu parents, specifically, objective social support and social support utilisation were significantly related to mental health of Shidu parents, while subjective social support was not. Implications of the study include the following: First, it is crucial to help spouse and friends gain appropriate social support skills. Mutual associations can be an important source of social support. Second, objective social support should be given a top priority, and suitable amount, timing, source and structure of social support should be paid more attention to strengthen the 'goodness of fit' between the needs of Shidu parents and support provided. Third, some other social services such as community care, social work services and professional consulting services can be appropriate alternatives to alleviate mental stress of Shidu parents.
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Affiliation(s)
- Enjian Wang
- School of Humanities and Social Sciences, North China Electric Power University, Baoding, P.R. China
| | - Hongwei Hu
- School of Public Administration and Policy, Renmin University of China, Beijing, P.R. China
| | - Yongjia He
- School of Social and Behavioral Sciences, Nanjing University, Nanjing, P.R. China
| | - Yang Xu
- College of Humanity and Law, Huazhong Agricultural University, Wuhan, P.R. China
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19
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Exploring the components of the quality of death in Japanese emergency departments: A qualitative study. Appl Nurs Res 2020; 56:151371. [PMID: 33280790 DOI: 10.1016/j.apnr.2020.151371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/25/2020] [Accepted: 10/09/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The need to care for patients who die in the emergency department is increasing in Japan, and emergency nurses are required to provide end-of-life care to ensure that patients experience a good death. However, the components of the quality of death and what constitutes a good death for patients dying in the emergency department are unclear. AIM This study aimed to explore the components of the quality of death for patients who die in emergency departments of Japanese hospitals. METHODS This study employed a qualitative design. An inductive content analysis was conducted based on semi-structured interviews with 26 participants, which included 15 emergency nurses, five emergency physicians, and six bereaved families. RESULTS Seven components of quality of death were identified: (1) transition to the end-of-life phase after receiving the best treatment, (2) dying without suffering, (3) having the patient's wishes respected, (4) having a loved one nearby, (5) maintaining human dignity, (6) having no change in appearance, and (7) not making the family feel guilty. CONCLUSION These components suggested that emergency nurses should: support patients' receipt of the best treatment and foster their smooth transition to the end-of-life phase at the appropriate time, ensure that the patients in the end-of-life phase spend time with their loved ones immediately before their death, enable the maintenance of human dignity and patient identity of end-of-life patients, and make sure that the families of end-of-life patients do not feel guilt.
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20
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Baird K, Wolfe J, Davies R. The traumatic sequelae of surviving the AIDS crisis: A case report. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2020. [DOI: 10.1080/19359705.2020.1811555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Kyle Baird
- Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Julie Wolfe
- Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robert Davies
- Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado, USA
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21
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Dantas CDR, Azevedo RCSD, Vieira LC, Côrtes MTF, Federmann ALP, Cucco LDM, Rodrigues LR, Domingues JFR, Dantas JE, Portella IP, Cassorla RMS. O luto nos tempos da COVID-19: desafios do cuidado durante a pandemia. REVISTA LATINOAMERICANA DE PSICOPATOLOGIA FUNDAMENTAL 2020. [DOI: 10.1590/1415-4714.2020v23n3p509.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este artigo pretende discutir aspectos universais e peculiares da vivência de luto no contexto da pandemia por COVID-19, a partir da escuta clínica de familiares que perderam seus parentes que se encontravam internados. O trajeto para atingir este objetivo inicia-se com a descrição do espaço de escuta fornecido pelo APEM-COVID no Hospital de Clínicas da Unicamp; segue com uma apresentação sobre o luto na perspectiva de alguns reconhecidos autores e continua discutindo elementos observados no processo de luto inserido numa conjuntura sem precedente na história recente. As falas recortadas dos atendimentos dialogam e desafiam aspectos teóricos, pelo inédito do momento em que se inserem, valorizando a importância do cuidado ofertado e seu potencial de construção de saber.
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22
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Verdery AM, Smith-Greenaway E, Margolis R, Daw J. Tracking the reach of COVID-19 kin loss with a bereavement multiplier applied to the United States. Proc Natl Acad Sci U S A 2020; 117:17695-17701. [PMID: 32651279 PMCID: PMC7395491 DOI: 10.1073/pnas.2007476117] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to a large increase in mortality in the United States and around the world, leaving many grieving the sudden loss of family members. We created an indicator-the COVID-19 bereavement multiplier-that estimates the average number of individuals who will experience the death of a close relative (defined as a grandparent, parent, sibling, spouse, or child) for each COVID-19 death. Using demographic microsimulation-based estimates of kinship networks in the United States, the clear age gradient in COVID-19 mortality seen across contexts, and several hypothetical infection prevalence scenarios, we estimate COVID-19 bereavement multipliers for White and Black individuals in the United States. Our analysis shows that for every COVID-19 death, approximately nine surviving Americans will lose a grandparent, parent, sibling, spouse, or child. These estimates imply, for example, that if 190,000 Americans die from COVID-19, as some models project, then ∼1.7 million will experience the death of a close relative. We demonstrate that our estimates of the bereavement multiplier are stable across epidemiological realities, including infection scenarios, total number of deaths, and the distribution of deaths, which means researchers can estimate the bereavement burden over the course of the epidemic in lockstep with rising death tolls. In addition, we provide estimates of bereavement multipliers by age group, types of kin loss, and race to illuminate prospective disparities. The bereavement multiplier is a useful indicator for tracking COVID-19's multiplicative impact as it reverberates across American families and can be tailored to other causes of death.
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Affiliation(s)
- Ashton M Verdery
- Department of Sociology and Criminology, Pennsylvania State University, University Park, PA 16802;
| | | | - Rachel Margolis
- Department of Sociology, University of Western Ontario, London, ON N6A 5C2, Canada
| | - Jonathan Daw
- Department of Sociology and Criminology, Pennsylvania State University, University Park, PA 16802
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23
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Geležėlytė O, Gailienė D, Latakienė J, Mažulytė-Rašytinė E, Skruibis P, Dadašev S, Grigienė D. Factors of Seeking Professional Psychological Help by the Bereaved by Suicide. Front Psychol 2020; 11:592. [PMID: 32322225 PMCID: PMC7156641 DOI: 10.3389/fpsyg.2020.00592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/12/2020] [Indexed: 11/15/2022] Open
Abstract
Background Studies show that people bereaved by suicide often feel a strong need for professional help. It is hypothesized that aspects related to suicide bereavement, such as stigmatization, shame or guilt, hinder help-seeking process of the bereaved. However, little is known about help-seeking behaviors of people who has lost someone due to suicide. Aims This study was conducted to attain a better understanding of the contributing factors, including the specific features of grief following suicide, to help-seeking behaviors of the bereaved by suicide. Methods The sample consisted of 82 adults bereaved by suicide (64 female; average age 37.79, SD = 14.33). Instruments assessing stigmatization, shame, guilt levels, well-being, tendency to disclose emotional distress and attitudes toward seeking professional psychological help were used. The participants were also asked an open-ended question what professional help-seeking barriers they had encountered. Comparisons between the groups, logistic regression analysis and thematic analysis of the qualitative data were performed. Results The findings revealed that bereaved participants who sought professional psychological help reported experiencing stigmatization and feeling guilty after the loss significantly more often. Also the results showed that attitudes toward mental health specialists had the highest prognostic value in predicting help-seeking behaviors of the bereaved. The participants themselves identified the gaps in the health care system as main barriers to seeking help. Conclusion The results challenge previously spread notion that stigmatization, guilt and shame after suicide can act only as help-seeking barriers.
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Affiliation(s)
- Odeta Geležėlytė
- Suicide Research Centre, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Danutė Gailienė
- Suicide Research Centre, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Jolanta Latakienė
- Suicide Research Centre, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Eglė Mažulytė-Rašytinė
- Suicide Research Centre, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Paulius Skruibis
- Suicide Research Centre, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Said Dadašev
- Suicide Research Centre, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Dovilė Grigienė
- Suicide Research Centre, Institute of Psychology, Vilnius University, Vilnius, Lithuania
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24
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LeBlanc NJ, Toner ER, O’Day EB, Moore CW, Marques L, Robinaugh DJ, McNally RJ. Shame, guilt, and pride after loss: Exploring the relationship between moral emotions and psychopathology in bereaved adults. J Affect Disord 2020; 263:405-412. [PMID: 31969271 PMCID: PMC7307182 DOI: 10.1016/j.jad.2019.11.164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/20/2019] [Accepted: 11/30/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Self-blame following bereavement has been implicated in the development of post-loss psychopathology. However, prior studies have not distinguished between the emotions of shame versus guilt. This study examined the cross-sectional associations among bereavement-related shame, bereavement-related guilt, and two mental disorders that commonly arise after bereavement: complicated grief and depression. In addition, exploratory analyses examined the associations between bereavement-related pride and post-loss psychopathology. METHODS Participants included 92 bereaved adults who experienced the death of a family member at least one year prior to the study. Participants completed self-report measures of complicated grief symptoms, depression symptoms, shame, guilt, and pride. RESULTS Shame and guilt were positively correlated with complicated grief and depression symptoms. When controlling for their shared variance, only shame remained a significant predictor of post-loss psychopathology. Follow-up analyses indicated that the effect of guilt on psychopathology depended on the level of shame, and vice versa. At low shame, guilt predicted psychopathology; however guilt did not predict psychopathology at moderate to high shame. At low to moderate guilt, shame predicted psychopathology; however shame did not predict psychopathology at high guilt. Pride negatively predicted depression symptoms, but not complicated grief symptoms, when we controlled for shame and guilt. LIMITATIONS Limitations include the cross-sectional design and modest sample size. CONCLUSIONS Our analyses identify shame as the more pathogenic moral emotion for bereaved adults. However, whereas guilt in the absence of shame is often considered adaptive, we found that guilt predicted greater psychological distress at low levels of shame in this sample.
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Affiliation(s)
- Nicole J. LeBlanc
- Department of Psychology, Harvard University,Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital
| | - Emma R. Toner
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital
| | | | - Cynthia W. Moore
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School
| | - Luana Marques
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School,Community Psychiatry Program for Research in Implementation and Dissemination of Evidence-Based Treatments, Massachusetts General Hospital
| | - Donald J. Robinaugh
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School
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25
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Shi G, Wen J, Xu X, Zhou N, Wang J, Shi Y, Liu H, Wang J, Stelzer EM. Culture-related grief beliefs of Chinese Shidu parents: Development and psychometric properties of a new scale. Eur J Psychotraumatol 2019; 10:1626075. [PMID: 31303970 PMCID: PMC6609346 DOI: 10.1080/20008198.2019.1626075] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/24/2019] [Accepted: 05/15/2019] [Indexed: 12/19/2022] Open
Abstract
Background: In China, parents whose only-child dies and who have no living or adopted child are called Shidu parents. Negative thinking is assumed to contribute to the development of emotional problems in bereavement. Because grief cognitions are likely influenced by the concepts of Chinese traditional culture (e.g., family continuation), Shidu parents may hold specific culture-related grief beliefs about themselves or the world, which, in turn, could impede their recovery. Objective: This study developed a questionnaire assessing the culture-related grief beliefs of Shidu parents and examined its psychometric properties. Methods: This newly developed questionnaire was administered to the combined sample of 313 Shidu parents. Exploratory (n = 164) and confirmatory factor analysis (n = 149) were conducted. Psychometric properties of the questionnaire were evaluated. Results: Exploratory factor analysis revealed three distinct factors (filial piety belief, destiny belief and perceived stigma), generating a nine-item culture-related grief beliefs of Shidu parents questionnaire (CBSQ). Confirmatory factor analysis verified the three-factor structure (χ2(24) = 39.103, p = 0.027, χ2/df = 1.630, CFI = .980, TLI = .970, RMSEA = .065, SRMR = .052). Internal consistency and temporal stability were adequate. Convergent, discriminant and concurrent validity were supported. Conclusions: This study highlights the importance of extending the concept of grief cognitions to include culture-specific beliefs, and provides a first measurement tool to assess culture-related grief beliefs after only-child loss, which can be used in future research with Shidu parents.
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Affiliation(s)
- Guangyuan Shi
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
| | - Jun Wen
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
| | - Xin Xu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
| | - Ningning Zhou
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
| | - Jiani Wang
- Department of Psychology, Queen’s University, Kingston, Canada
| | - Yuqing Shi
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
| | - Han Liu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
- Students Affairs Division, Shanxi University, Shanxi, P. R. China
| | - Jianping Wang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
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26
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Camacho D, Pérez-Nieto MÁ, Gordillo F. The role of rumination in the guilt associated with bereavement according to cause of death. Psychiatry Res 2018; 270:1053-1058. [PMID: 30196977 DOI: 10.1016/j.psychres.2018.04.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 02/05/2018] [Accepted: 04/27/2018] [Indexed: 10/16/2022]
Abstract
The purpose of this study was to analyse the role rumination plays in the relationship between cause of death and the guilt present during bereavement. The sample consisted of 90 people that had suffered a loss due to an expected or unexpected natural death, suicide or accident. The results suggest that rumination increases the levels of guilt felt by people that had suffered a loss due to suicide compared to those whose loss was due to an expected natural death. These findings contribute to a better understanding of the mechanisms with an influence on bereavement.
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Affiliation(s)
- Dulce Camacho
- Alaia Association. C/ Fernández de los Ríos, 87. 28015 Madrid, Spain.
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27
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Camacho D, Pérez-Nieto MÁ, Gordillo F. Cause of Death and Guilt in Bereavement: The Role of Emotional Regulation and Kinship. JOURNAL OF LOSS & TRAUMA 2018. [DOI: 10.1080/15325024.2018.1485277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Dulce Camacho
- Director of Alaia Association, Clinical Psychologist, Madrid, Spain
| | | | - Fernando Gordillo
- Department of Psychology, Camilo José Cela University, Madrid, Spain
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28
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Abstract
The death of a child is a heart-wrenching experience that can have a significant impact on parents, siblings, and families while also often having ripple effects throughout the child's community. Pediatric loss has an impact on family structure and dynamics, individual identity formation, and conceptualization as well as professional practice. This article explores bereavement after a child's death through the lens of the family, the parent, the sibling, the forgotten grievers, and the provider.
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Affiliation(s)
- Danielle Jonas
- Division of Comfort and Palliative Care, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Caitlin Scanlon
- Integrated Care Management, Palliative Care Team, Riley Hospital for Children, Indiana University Health, Indianapolis, IN, USA
| | - Rachel Rusch
- Division of Comfort and Palliative Care, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Janie Ito
- Spiritual Care and Clinical Pastoral Education, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Marsha Joselow
- Pediatric Advance Care Team, Boston Children's Hospital, Dana Farber Cancer Institute, Boston, MA, USA
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29
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Supporting Parent Caregivers of Children with Life-Limiting Illness. CHILDREN-BASEL 2018; 5:children5070085. [PMID: 29949926 PMCID: PMC6069074 DOI: 10.3390/children5070085] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/20/2018] [Indexed: 11/17/2022]
Abstract
The well-being of parents is essential to the well-being of children with life-limiting illness. Parents are vulnerable to a range of negative financial, physical, and psychosocial issues due to caregiving tasks and other stressors related to the illness of their child. Pediatric palliative care practitioners provide good care to children by supporting their parents in decision-making and difficult conversations, by managing pain and other symptoms in the ill child, and by addressing parent and family needs for care coordination, respite, bereavement, and social and emotional support. No matter the design or setting of a pediatric palliative care team, practitioners can seek to provide for parent needs by referral or intervention by the care team.
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30
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Li J, Tendeiro JN, Stroebe M. Guilt in bereavement: Its relationship with complicated grief and depression. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2018; 54:454-461. [PMID: 29508381 DOI: 10.1002/ijop.12483] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 02/02/2018] [Indexed: 11/10/2022]
Abstract
This study investigated the relationship between guilt and well-being of bereaved persons, and explored potential differences in the associations between guilt-complicated grief (CG) and guilt-depression. In total, 1358 Chinese bereaved adults were recruited to fill out questionnaires. Participants (N = 194) who had been bereaved within 2 years of the first survey, filled out the same questionnaires 1 year later. Higher guilt was associated with higher degrees of both CG and depression. The level of guilt predicted CG and depression symptoms 1 year later. Bereavement-related guilt has a closer association with CG than depression. Responsibility guilt, indebtedness guilt and degree of guilt feeling are more prominent aspects of guilt in CG than in depression. These findings demonstrate the significant role of guilt (perhaps a core symptom) in mental health of the bereaved, having implications for identifying persons with grief complications and depression.
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Affiliation(s)
- Jie Li
- Department of Psychology, Renmin University of China, Beijing, China
| | - Jorge N Tendeiro
- Department of Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
| | - Margaret Stroebe
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
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Trevino KM, Litz B, Papa A, Maciejewski PK, Lichtenthal W, Healy C, Prigerson HG. Bereavement Challenges and Their Relationship to Physical and Psychological Adjustment to Loss. J Palliat Med 2017; 21:479-488. [PMID: 29182478 DOI: 10.1089/jpm.2017.0386] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The psychosocial challenges confronted by bereaved survivors may contribute to poor bereavement adjustment. Measures of the challenges of bereavement are limited. This study is a preliminary examination of the factor structure of a new measure of bereavement challenges and their relationships to quality of life and mental illness in bereaved cancer caregivers. This measure was designed to identify intervention targets to reduce the likelihood of prolonged grief. METHODS Caregivers of advanced cancer patients were administered measures of bereavement challenges (Bereavement Challenges Scale, BCS), quality of life (Medical Outcomes Study Short Form-36), prolonged grief (PG-13), and mental disorders (Structured Clinical Interview for the DSM-IV). Principal component factor analyses identified the underlying factor structure of the BCS. We examined associations between the factors and caregiver quality of life, prolonged grief, and rates of mental disorders. RESULTS A factor analysis identified five factors: "Challenges with Connecting with Others," "Challenges with Change," "Challenges Imagining a Hopeful Future," "Challenges with Accepting the Loss," and "Challenges with Guilt." Greater endorsement of bereavement challenges was associated with worse quality of life, more severe symptoms of prolonged grief, and greater likelihood of meeting criteria for a mental disorder. CONCLUSIONS Assessing the challenges associated with bereavement is important to understanding barriers to bereaved individuals' adjustment. The five factors of the BCS point to potential targets for clinical intervention. Additional research on the BCS is needed, including validation in larger more diverse samples, and confirmation that reduction of these challenges is associated with less psychiatric morbidity and, specifically, symptoms of prolonged grief.
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Affiliation(s)
- Kelly M Trevino
- 1 Cornell Center for Research on End-of-Life Care , Weill Cornell Medicine, New York, New York.,2 Department of Medicine, Weill Cornell Medicine , New York, New York
| | - Brett Litz
- 3 VA Boston Healthcare System , Jamaica Plain, Massachusetts.,4 Department of Psychiatry, Boston University Medical Center , Bosten, Massachusetts
| | - Anthony Papa
- 5 Department of Psychology, University of Nevada , Reno, Reno, Nevada
| | - Paul K Maciejewski
- 1 Cornell Center for Research on End-of-Life Care , Weill Cornell Medicine, New York, New York.,6 Department of Radiology, Weill Cornell Medicine , New York, New York
| | - Wendy Lichtenthal
- 7 Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Charlotte Healy
- 8 Department of Professional Studies, Columbia University , New York, New York
| | - Holly G Prigerson
- 1 Cornell Center for Research on End-of-Life Care , Weill Cornell Medicine, New York, New York.,2 Department of Medicine, Weill Cornell Medicine , New York, New York
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Gold KJ, Sen A, Leon I. Whose Fault Is It Anyway? Guilt, Blame, and Death Attribution by Mothers After Stillbirth or Infant Death. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1054137317740800] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Parents who experience stillbirth or infant death often struggle with postpartum guilt. This may be an adaptive response or can become chronic and maladaptive. We surveyed bereaved mothers in Michigan with perinatal death 15 months after loss to evaluate guilt, blame, and potential covariates. Self-report information was linked with data from State of Michigan vital records of births and deaths. Respondents included 311 mothers. Most reported guilt or self-blame at 15 months. In multinomial logistic analysis, depression and interpersonal violence predicted greater guilt. Nearly half of women blamed their medical team for the loss, and about a fifth reported feeling blamed by others. Both of these attributions were associated with greater guilt. The majority of mothers report persistent guilt after perinatal loss. Depression at either 9 or 15 months was a strong predictor of greater guilt.
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Affiliation(s)
- Katherine J. Gold
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Irving Leon
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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Camacho D, Pérez Nieto M, Gordillo F. Guilt and Bereavement: Effect of the Cause of Death, and Measuring Instruments. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1054137316686688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Guilt is a common reaction in bereavement. Our aim is to explore the guilt in bereavement depending on the cause of death. The sample involved 73 participants who had lost a family member to a terminal illness, suicide, sudden illness, accident, or perinatal death. Guilt was measured using the items of self-blame and regret in the Tübingen Bereavement Symptoms Questionnaire, the SC-35, and the Bereavement Guilt Scale (BGS). The results reveal significant differences in suicide bereavement on the self-blame subscale compared with unexpected natural death. Further there are significant differences in suicide bereavement in the regret subscale compared with unexpected natural death, and in the BGS as regards both an expected and an unexpected natural death. There are no significant differences in guilt when it is measured through the SC-35. These data suggest that the measurement of guilt in bereavement calls for the use of specific scales for this context.
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Affiliation(s)
| | - M.A. Pérez Nieto
- Department of Psychology. Camilo José Cela University, Madrid, Spain
| | - Fernando Gordillo
- Department of Psychology. Camilo José Cela University, Madrid, Spain
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Fasse L, Zech E. Dual Process Model of Coping With Bereavement in the Test of the Subjective Experiences of Bereaved Spouses. OMEGA-JOURNAL OF DEATH AND DYING 2016. [DOI: 10.1177/0030222815598668] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Dual Process Model of Coping With Bereavement (DPM) was developed to better understand the dynamic coping processes adopted by bereaved people. In the present study, we investigated the daily subjective experiences of widowed people and examined whether they recognized themselves in the model. Thirteen out of the 16 interviewed widowed persons reported that their bereavement experience basically fitted the model. However, they also identified discrepancies. Interviews with six bereaved spouses were subjected to an interpretative phenomenological analysis. Three main issues were identified: (a) the interdependence versus distinctiveness of coping processes, (b) the conscious and intentional nature of coping strategies, and (c) the very nature of respite in the grief experience. The results indicated that, although relevant, the DPM did not always match the grieving experiences reported by the widowed individuals. Clinical and research perspectives are discussed.
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Affiliation(s)
- Léonor Fasse
- Unité de Psycho-Oncologie, Hôpital Gustave Roussy, Villejuif Cedex, France
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Li J, Chen S. A new model of Social Support in Bereavement (SSB): An empirical investigation with a Chinese sample. DEATH STUDIES 2015; 40:223-228. [PMID: 26678537 DOI: 10.1080/07481187.2015.1127296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Bereavement can be an extremely stressful experience while the protective effect of social support is expected to facilitate the adjustment after loss. The ingredients or elements of social support as illustrated by a new model of Social Support in Bereavement (SSB), however, requires empirical evidence. Who might be the most effective providers of social support in bereavement has also been understudied, particularly within specific cultural contexts. The present study uses both qualitative and quantitative analyses to explore these two important issues among bereaved Chinese families and individuals. The results show that three major types of social support described by the SSB model were frequently acknowledged by the participants in this study. Aside from relevant books, family and friends were the primary sources of social support who in turn received support from their workplaces. Helping professionals turned out to be the least significant source of social support in the Chinese cultural context. Differences by gender, age, and bereavement time were also found. The findings render empirical evidence to the conceptual model of Social Support in Bereavement and also offer culturally relevant guidance for providing effective support to the bereaved.
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Affiliation(s)
- Jie Li
- a Department of Psychology , Renmin University of China , Beijing , China
| | - Sheying Chen
- b Department of Public Administration , Pace University , New York , New York , USA
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Li J, Stroebe M, Chan CLW, Chow AYM. The Bereavement Guilt Scale. OMEGA-JOURNAL OF DEATH AND DYING 2015; 75:166-183. [DOI: 10.1177/0030222815612309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The rationale, development, and validation of the Bereavement Guilt Scale (BGS) are described in this article. The BGS was based on a theoretically developed, multidimensional conceptualization of guilt. Part 1 describes the generation of the item pool, derived from in-depth interviews, and review of the scientific literature. Part 2 details statistical analyses for further item selection (Sample 1, N = 273). Part 3 covers the psychometric properties of the emergent-BGS (Sample 2, N = 600, and Sample 3, N = 479). Confirmatory factor analysis indicated that a five-factor model fit the data best. Correlations of BGS scores with depression, anxiety, self-esteem, self-forgiveness, and mode of death were consistent with theoretical predictions, supporting the construct validity of the measure. The internal consistency and test–retest reliability were also supported. Thus, initial testing or examination suggests that the BGS is a valid tool to assess multiple components of bereavement guilt. Further psychometric testing across cultures is recommended.
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Affiliation(s)
- Jie Li
- Department of Psychology, Renmin University of China, China
| | - Magaret Stroebe
- Department of Clinical & Health Psychology, Utrecht University, Utrecht, The Netherlands
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Cecilia L. W. Chan
- Centre on Behavioral Health and Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong (SAR), China
| | - Amy Y. M. Chow
- Centre on Behavioral Health and Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong (SAR), China
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Male DA, Fergus KD, Stephen JE. The Continuous Confrontation of Caregiving as Described in Real-Time Online Group Chat. J Palliat Care 2015; 31:36-43. [PMID: 26399089 DOI: 10.1177/082585971503100106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To date, our understanding of the caregiver experience has been informed primarily by guided inquiry in the form of interviews and surveys, yielding information that is limited by the scope of researchers questions. The intent of this study was to explore the experience of caring for a loved one with advanced-stage cancer by means of participant-determined communication, using interactive, text-based transcripts from synchronous online support groups. Grounded theory analysis of the group transcripts yielded the core category continuous confrontation, characterized by major challenges (unrelenting assault, a new us, and the costs of caregiving) and minor triumphs (refuelling and living more intentionally). This unique method of data collection allowed for an especially candid, intersubjective group account of what it is to be a caregiver for an ill loved one without compromising the details that caregivers themselves consider important.
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Stroebe M, Stroebe W, van de Schoot R, Schut H, Abakoumkin G, Li J. Guilt in bereavement: the role of self-blame and regret in coping with loss. PLoS One 2014; 9:e96606. [PMID: 24819238 PMCID: PMC4018291 DOI: 10.1371/journal.pone.0096606] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 04/09/2014] [Indexed: 11/19/2022] Open
Abstract
Despite the apparent centrality of guilt in complicating reactions following bereavement, scientific investigation has been limited. Establishing the impact of specific components associated with guilt could enhance understanding. The aim of this study was to examine the relationships between two guilt-related manifestations, namely self-blame and regret, with grief and depression. A longitudinal investigation was conducted 4–7 months, 14 months and 2 years post-loss. Participants were bereaved spouses (30 widows; 30 widowers); their mean age was 53.05 years. Results showed that self-blame was associated with grief at the initial time-point and with its decline over time. Such associations were not found for depression. Initial levels of regret were neither associated with initial levels of grief and depression, nor were they related to the decline over time in either outcome variable. These results demonstrate the importance of examining guilt-related manifestations independently, over time, and with respect to both generic and grief-specific outcome variables. A main conclusion is that self-blame (but not regret) is a powerful determinant of grief-specific difficulties following the loss of a loved one. Implications for intervention are considered.
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Affiliation(s)
- Margaret Stroebe
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
- Department of Psychology, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Wolfgang Stroebe
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
- Department of Psychology, University of Groningen, Groningen, The Netherlands
| | - Rens van de Schoot
- Department of Methods and Statistics, Utrecht University, Utrecht, The Netherlands
- Optentia Research Program, Faculty of Humanities, North-West University, Mahikeng, South Africa
| | - Henk Schut
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Georgios Abakoumkin
- Department of Early Childhood Education, University of Thessaly, Volos, Greece
| | - Jie Li
- Department of Psychology, Renmin University of China, Beijing, China
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