Predictors of complicated grief

Conflicted or close: Which relationships to the deceased are associated with loss-related psychopathology?

OBJECTIVES

Prior studies have shown that pre-loss closeness and conflict with a deceased person are associated with the severity of symptoms of prolonged grief and/or depression. Nevertheless, mechanisms underlying these relationships are not well understood. We propose a theoretical model in which past closeness and conflict are related to prolonged grief and depression via concrete and symbolic continuing bonds (CB). The aim of our study was to test this model in a sample of bereaved family members.

METHODS

Individuals (N = 244) who had lost a family member from 0.5 to 8.0 years before the survey completed the Quality of Relationships Inventory-Bereavement Version, the Continuing Bonds Scale, the Prolonged Grief Disorder-13 scale, and the Patient Health Questionnaire-9.

RESULTS

The findings partially confirmed our model. Closeness was positively and moderately associated with symptoms of prolonged grief but not with symptoms of depression. Conflict was positively and weakly associated with symptoms of depression and prolonged grief. All of these relationships were only partially mediated by concrete/maladaptive and symbolic/adaptive CB.

CONCLUSIONS

The differences in the relationship of past closeness and conflict to prolonged grief and depression symptoms suggest that inter- and intrapersonal mechanisms of prolonged grief and depressive symptoms may be distinct. If future, especially longitudinal studies, confirm our model, CB would be a possible target for interventions for bereaved persons who had a close and/or conflicted relationship with a deceased family member and experience loss-related psychopathology.

PRACTITIONER POINTS

Continuing bonds (CB) are a potential target of interventions for bereaved persons who had a close and/or conflicted relationship with a deceased family member and experience symptoms of prolonged grief and/or depression. Internalization of the capacity to care for yourself and feel autonomous in a safe and stable therapeutic relationship may lead to increased self-confidence, promote working through past experiences in the relationship with the deceased, and gradual reduction of concrete forms of CB. Increasing awareness and acceptance of emotional experiences may contribute to the appreciation of past relationship with a deceased person and the growth of symbolic forms of CB. Future research should focus on verifying the effectiveness of the attachment-informed therapeutic approach to working with CB.

Polish adaptation of the quality of relationships inventory-Bereavement version

We examined the psychometric properties of the Polish version of the Quality of Relationships Inventory-Bereavement Version (QRI-B) in a sample of 241 persons bereaved after the death of a family member from 0.5 to 8 years (M = 3.36, SD = 2.02) before the survey. A good fit of the original two-factor (Closeness and Conflict) model of the QRI-B was determined by confirmatory factor analysis. Cronbach's alpha was .91 for Closeness and .84 for Conflict. Closeness correlated negatively with attachment avoidance and Conflict correlated positively with attachment anxiety. The Polish version of the QRI-B is a valid and reliable measure of the quality of the pre-loss relationship with the deceased.

Maternal Resilience and Chronic Depression in Mourning for a Child: A Preliminary Case-Based Analysis

This article reports a retrospective comparative study of 10 mothers whose loss of a child caused chronic major depression despite medication followed by psychotherapy. The mothers were compared to 10 other mothers who participated in a longitudinal study conducted over the time period between the occurrence of the tragedy and complete recovery. The mothers were compared on the basis of life-event data, a semidirective interview, and a projective inquiry using the Rorschach Test. Some important differences were found between the two groups of mothers, from the standpoint of the support offered by their therapist, the elaboration of guilt feelings following the loss, their ability to mentally represent the trauma as assessed by the Rorschach Test, and their capacity to disinvest the lost object. Two factors that were not considered at the beginning of the research seem to fulfill a crucial function from the preventive standpoint: (1) the possibility of offering mourning mothers psychological support in addition to medication immediately after the loss, and (2) the possibility for the mother of freeing herself from a strong oedipal link with the deceased child.

Complicated grief as a stress response disorder: evaluating diagnostic criteria in a German sample

BACKGROUND

Complicated grief has been described as a diagnosis candidate for DSM-V. On the basis of the stress response theory, Horowitz et al. [Am J Psychiatry 154 (1997) 904-10] characterized complicated grief as a combination of sustained intrusion, avoidance, and maladaptation symptoms following the loss of a close person. This study aimed at evaluating diagnostic criteria based on the stress response model of complicated grief.

METHODS

We administered a symptom list derived from Horowitz et al.'s operationalization to a sample of bereaved persons and evaluated the psychometric properties of the symptom criteria and symptom category subscales. Using this symptom list and other self-report measures of psychopathology and normal grief reactions, we examined a German sample consisting of 75 participants who had lost either siblings, children, parents, or spouses, on average, 5.4 years prior to the study.

RESULTS

Analyses confirmed the classification of symptoms into intrusion, avoidance, and failure-to-adapt categories with only minimal reordering (two symptom criteria). The symptom category subscales showed favourable psychometric characteristics, receiver operating characteristic (ROC) analyses indicated high diagnostic accuracy of the symptom criteria, and predictive validation revealed a meaningful correlational pattern to standard measures of divergent psychopathology and normal grief reactions.

CONCLUSIONS

The application of a stress response operationalization of complicated grief is supported.