Prolonged grief disorder in Chinese Shidu parents who have lost their only child

Sex and gender in psychotrauma research

Background: Posttraumatic stress disorder (PTSD) is two to three times more common in women than in men. To better understand this phenomenon, we need to know why men, women, and possibly individuals with other sex/gender identities respond differently to trauma. To stimulate sex and gender sensitive research, the European Journal of Psychotraumatology (EJPT) was the first journal to adopt a gender policy. In addition, a call for papers entitled Integrating and Evaluating Sex and Gender in Psychotrauma Research was announced.Objective: This special issue synthesizes the past five years of psychotrauma research with regard to sex/gender differences.Method: Seventy-seven articles were identified from EJPT archives, including five systematic reviews. These articles examined sex differences and/or gender differences in exposure to trauma, posttraumatic stress responses, or how sex and gender impacts (mental) health outcomes or treatment responses.Results: Findings from these studies outlined that: 1. sex and gender still need to be more clearly defined, also in relation to the context that codetermine trauma responses, like other 'diversity' variables; 2. in most studies, sex and gender are measured or reported as binary variables; 3. sex and gender are important variables when examining trauma exposure, responses to these events, symptoms trajectories, and mental and physical health outcomes across the life span; and 4. in PTSD treatment studies, including a meta-analysis and a systematic review, sex and gender were not significant predictors of treatment outcome.Conclusion: Future research must focus on sex and gender as important and distinct variables; they should include sex and gender in their statistical analyses plan to better clarify associations between these variables and (responses to) psychotrauma. To enhance reporting of comparable data across studies, we provide suggestions for future research, including how to assess sex and gender.

Prevalence of prolonged grief disorder and its symptoms among bereaved individuals in China: a systematic review and meta-analysis

Background

The prevalence of prolonged grief disorder (PGD) and its symptoms among the bereaved population in China vary considerably.

Aims

This meta-analysis aims to estimate the prevalence of PGD and its symptoms among bereaved individuals in China.

Methods

We conducted a literature search in major Chinese and English databases from their inception to 4 October 2023, for cross-sectional studies on the prevalence of PGD or its symptoms in bereaved Chinese individuals. The risk of bias of the included studies and certainty of the evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data ('JBI checklist') and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE), respectively. The 'metaprop' package in R V.4.1.2 was used to synthesise the prevalence.

Results

A total of 28 studies involving 10 994 bereaved individuals were included in the analysis, with JBI checklist scores between 3 and 7. The combined prevalence (95% confidence interval) of PGD and its symptoms was 8.9% (4.2% to 17.6%) and 32.4% (18.2% to 50.8%), respectively. PGD and its symptoms were most prevalent among those who had lost their only child (22.7%) and those bereaved by earthquakes (80.4%), respectively. The GRADE system assigned a very low certainty level to the evidence for the pooled prevalence of PGD and its symptoms.

Conclusions

The pooled prevalence of PGD and its symptoms indicate a potential high need for grief counselling services among bereaved individuals in China. This need is particularly pronounced in those who have lost their only child and those bereaved due to earthquakes. Further methodologically rigorous studies are needed to provide more accurate prevalence estimates.

PROSPERO registration number

CRD42023432553.

Risk factors for prolonged grief symptoms: A systematic review and meta-analysis

BACKGROUND

The diagnosis Prolonged Grief Disorder (PGD) has recently been included in ICD-11 and DSM-5-TR. To identify individuals who need help coping with grief, knowledge is needed about who is at risk of developing PGD. We, therefore, conducted a comprehensive systematic review and meta-analysis of the available literature on risk factors for prolonged grief symptoms (PGS).

METHODS

Based on a literature search in PsycInfo, PubMed, Web of Science, and CINAHL, we included the most frequently investigated risk factors in a meta-analysis. The effect size correlation was used as the standardized measure of the strength of the association between the risk factor and PGS.

RESULTS

Based on 120 studies of 61.580 participants published between 1989 and 2023, 19 risk factors were included in the meta-analysis. For the adjusted associations, the strongest associations with PGS were pre-loss grief symptoms (ESr = 0.39, 95%CI[0.24-0.53]) and depression (ESr = 0.30, 95%CI[0.13-0.44]). Small, but statistically significant associations were observed for unexpected death, violent/unnatural death, low educational level, low income, female gender, anxious attachment style, and death of a child or partner.

CONCLUSIONS

An updated overview of risk factors for PGS is presented, including their predictive strength. The results offer knowledge that can aid prevention and early identification of people at risk of PGD.

Association Between Family Context and Sleep Trajectory in Middle-Aged and Elderly Chinese Adults

Objective

The study aims to reveal the association between family context and sleep trajectories in middle-aged and elderly Chinese adults.

Methods

Subjects (n=7777) aged between 40 and 65 years were selected from the China Family Panel Studies (CFPS). Latent class analysis and the multi-trajectory method were used to identify the family context and sleep trajectories from 2010 to 2018. Multinomial (polytomous) logistic regression was performed to explore the relationship between family context and sleep trajectories.

Results

Five family context classes were identified according to family demographic characteristics. Simultaneously, four sleep trajectories were determined based on three sleep-related indexes. Subjects from family that had only sons or multiple-child are liable to shorten or prolong sleep duration and increase midday nap ratios compare with subjects who from family that had one or more daughters, and in future public health prevention and control, more attention could be paid to such families.

Conclusion

The study found that family context is associated with sleep trajectories among middle and old Chinese adults. Subjects from families with only girls seemed to have more stable sleep trajectories, while those with one or more boys' families had unstable sleep trajectories. Further interventions would be carried out for sleep disorders, it is necessary to pay more attention to the family context, especially the number and gender of children.

Subtypes of Chinese Shidu parents' (parents who have lost their only child) depressive symptoms and their relationships with resilience and coping styles

We aimed to examine the subtype classification characteristics of depressive symptoms in Shidu parents (SDPs, parents who have lost their only child) and their associations with resilience and coping styles. The sample comprised 182 SDPs (Mean age = 59.93 ± 7.41 years, 61.5% females). Latent profile analysis and logistic regression analysis were used to analyze the data. Three subgroups of depressive symptoms in SDPs were identified: the depression and pessimism group (38.4%), the low depression symptoms group (30.8%), and the well-adapted group (30.8%). The low depression symptoms group had a lower education level and higher family monthly income than the depression and pessimism group. The low depression symptoms group and the well-adapted group scored significantly higher in resilience, and lower in negative coping style than the depression and pessimism group. The results highlighted that target intervention is needed for SDPs with high education levels, low family monthly income, high negative coping style, and low resilience in the depression and pessimism group.

The relationship between culture-related grief beliefs, prolonged grief disorder and suicide ideation among Shidu parents in rural China

BACKGROUND

There are many one-child families in China due to the one-child policy. Parents who have lost their only child and are unable to conceive another child or unwilling to adopt a child are called Shidu parents in China. The death of an only child puts Shidu parents at the risk of mental illness and even suicide. Few studies have explored the influence of cultural beliefs and prolonged grief disorder on suicide ideation.

METHODS

This study involved rural Shidu parents from Sujiatun district of Shenyang, China. Questionnaires consisted of the Prolonged Grief questionnaire - 13 (PG-13), the Culture-related Grief Beliefs of Shidu Parents Questionnaire (CBSQ), one question from the baseline National Comorbidity Survey (NCS) to measure suicide ideation and demographic and bereavement-related information. Bivariate logistic regression analyses were conducted to explore associated factors of suicide ideation.

RESULTS

Sixty-nine (28.8%) of the 240 Shidu parents reported having suicide ideation. Having chronic disease (OR = 5.509, p < 0.01), having religious belief (OR = 3.923, p < 0.05) and having a grandchild (OR = 2.552, p < 0.05) were associated with an increased risk of suicide ideation. Destiny belief (a subscale of CBSQ) was negatively associated with suicide ideation (OR = 0.818, p < 0.05). Prolonged grief disorder (OR = 9.280, p < 0.01) and perceived stigma (a subscale of CBSQ) (OR = 1.200, p < 0.05) was positively associated with suicide ideation after adjusting for controlling variables.

CONCLUSIONS

Suicide ideation is prevalent in rural Shidu parents. Reducing perceived stigma and alleviating prolonged grief disorder may decrease the risk of suicide among rural Shidu parents.

Prevalence of prolonged grief disorder and its symptoms in Chinese parents who lost their only child: A systematic review and meta-analysis

Background

Parents who lost their only child and cannot have a second child ("Shidu") have been a large population in China. Prolonged grief disorder (PGD) in Shidu parents is of clinical and public health concern but the reported PGD prevalence varies widely. To facilitate the planning of grief counseling services, this meta-analysis estimated prevalence of PGD and its symptoms and identified subgroups at elevated risk for PGD.

Methods

We searched English and Chinese literature databases to identify cross-sectional surveys reporting prevalence of PGD or PGD symptoms in Chinese Shidu parents. The Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data ("JBI") was used to assess risk of bias of included studies.

Results

Seven studies with a total of 2,794 Shidu parents were included and their JBI scores ranged from five to eight. The pooled prevalence of PGD and PGD symptoms was 20.9% and 75.0%, respectively. Greater risk of PGD was observed in mothers [vs. fathers, OR (odds ratio) = 1.89, P = 0.001] and in parents with religious beliefs (vs. without religious beliefs, OR = 1.65, P = 0.040). More severe PGD symptoms were presented in parents whose only child died from accidents [vs. illness, MD (mean difference) = 3.99, P < 0.001]. Deceased children of PGD parents were older than those of non-PGD parents (MD = 1.64, P = 0.035) and PGD parents had a shorter duration since the loss than non-PGD parents (MD = -3.26, P = 0.013).

Conclusions

PGD is prevalent among Shidu parents. Grief counseling services for Shidu parents would be more effective if they target those who are mothers and have religious beliefs and those whose children died from accidents, lost children are older, and loss occurs more recently.

Psychometric properties, stability, and predictive validity of the Korean version of the Prolonged Grief Disorder Scale (PG-13-K): A longitudinal study among bereaved Koreans

This study aims to investigate the psychometric properties, stability, and predictive validity of the PG-13-K. Two subsamples were used: the first subsample (N = 153), participated at Time 1 only, and the second subsample (N = 184) participated at both Time 1 and Time 2. At each time point, reliability, test-retest reliability, and validity were adequate, and the hypothesized two-factor model indicated good to excellent fit. Moreover, the PG-13-K was able to predict the correlation between prolonged grief disorder (PGD) and negative psychological factors. The PG-13-K is a useful and valid instrument for measuring PGD symptoms in Korean settings.

Predictors of prolonged grief disorder in Chinese elderly shidu parents: The role of perceived stigma and perceived stress

INTRODUCTION

Parents who have lost their only child and over the age of 60 are known as elderly shidu parents. This study aimed to investigate predictors of prolonged grief disorder (PGD) among Chinese elderly shidu parents.

METHODS

Two hundred and ninety-eight elderly shidu parents from Shenyang were included in this cross-sectional study. Participants completed a questionnaire including the Prolonged Grief questionnaire-13 (PG-13), the PTSD (post-traumatic stress disorder) Checklist for DSM-5 (PCL-5), the Center for Epidemiologic Studies Depression Scales (CES-D), the Self-Rating Anxiety Scale (SAS), and the Perceived Stress Scale-10 (PSS-10). Multiple linear regression was used to examine socio-demographic, bereavement-related and perceived stress associated with PGD symptoms.

RESULTS

The prevalence of PGD among Chinese elderly shidu parents was 13.8%. Among the 41 PGD patients, 29, 39, 36 patients had comorbidity of PTSD, depressive symptoms and anxiety, respectively. Perceived stress, higher educational level, lower annual household income, perceived stigma, violent death of the child, and being in debt were associated with severer PGD symptoms.

DISCUSSION

The present study revealed the prevalence of PGD and the important role of PGD in diagnosing other mental disorders in Chinese elderly shidu parents. Providing financial help, eliminating social stigma, and stress should be included in PGD prevention among Chinese elderly shidu parents.

Network analysis of PGD, PTSD and insomnia symptoms in Chinese shidu parents with PGD

Background

Chinese shidu parents (bereaved parents over the age of 49 who have lost their only child) are potentially at a high risk of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD) and insomnia.

Objective

The current study aimed to estimate three network models in 310 shidu parents who met the ICD-11 criteria for PGD: (1) a PGD network to identify central symptoms; (2) a comorbidity network to explore bridge symptoms between PGD and PTSD; (3) a comorbidity network to examine the associations between PGD and insomnia symptoms.

Methods

The R-packages bootnet, qgraph and networktools were used to investigate the structure of network models and centrality indices of symptoms. In addition, robustness and significance analyses for the edge weights and the order of centrality were performed.

Results

Emotional pain and numbness emerged as the most central symptoms in the PGD network. In the PGD-PTSD comorbidity network, the highest bridge strength symptoms were inability to trust others (PGD) and feeling upset (PTSD). Inability to trust others (PGD), avoidance (PGD), and impairment of life quality (insomnia) were possible bridge symptoms connecting PGD and insomnia.

Conclusions

Reducing emotional pain and numbness may be a viable target in PGD interventions for shidu parents. Additionally, findings suggest that future studies could examine the role of inability to trust others and avoidance in PGD comorbidities.

HIGHLIGHTS

• Emotional pain and numbness were the most influential symptoms in shidu parents with PGD. The role of PGD symptoms of inability to trust others and avoidance in the comorbidities of PGD with PTSD and insomnia might be worthy of further study.

PTSD Among Shidu Parents in China: The Roles of Personality Types and Social Support

Background: The psychological problems of Shidu Parents (SDP) under the China's One-Child Policy have been documented. The purpose of this study was to investigate the relationships among personality types, social support, and post-traumatic stress disorder (PTSD) in SDP. Methods: The PTSD Checklist-Civilian Version (PCL-C), The Big Five Personality Traits (NEO), and Social Support Revalued Scale (SSRS) were administered to the sample of 149 SDP who were over 50 years old and had lost their only child more than one year ago. Results: Among SDP, mothers were more likely to develop PTSD than fathers (χ² = 11.16, p < 0.01). Parents who were extraverted had a lower risk of developing PTSD-related symptoms (χ² = 8.58, p < 0.01), and the effect of neuroticism was significant (χ² = 23.73, p < 0.01). The more social support parents utilized, the lower the incidence of PTSD (t = 4.56, p < 0.01). The result of multilevel linear regression showed that sex, neuroticism, and objective social support remained significantly different after combining all personality types and social support systems in the same model. Social support partially mediated the relationship between neuroticism and PTSD. Meanwhile, it was a complete mediator between extraversion and PTSD. Conclusions: Female sex/gender, neuroticism, and introversion were risk factors of developing PTSD, while receiving social support protected SDP from developing PTSD symptoms. Losing an only child is undoubtedly an enormous disaster for the family, which has become a huge, unavoidable social problem that must be addressed in China.

Who suffered most after deaths due to COVID-19? Prevalence and correlates of prolonged grief disorder in COVID-19 related bereaved adults

BACKGROUND

Deaths by COVID-19 have left behind nearly 12 million recent bereaved individuals worldwide and researchers have raised concerns that the circumstances of COVID-19 related deaths will lead to a rise prevalence of prolonged grief disorder (PGD) cases. However, to date, no studies have examined the prevalence of PGD among people bereaved due to COVID-19. This study aimed to estimate the prevalence of PGD and investigated demographic and loss-related factors associated with prolonged grief symptoms among Chinese individuals bereaved due to COVID-19.

METHODS

This was a cross-sectional online survey conducted between September 1 and October 3, 2020. A total of 422 Chinese participants (55.5% males; 32.73 [9.31] years old) who lost a close person due to COVID-19 participated in the study. Demographic and loss-related information was collected, and self-reported prolonged grief symptoms were measured by a 13-item International Prolonged Grief Disorder Scale (IPGDS: 1-65) and a 17-item Traumatic Grief Inventory Self Report (TGI-SR: 1-85). Multiple linear regression analysis was used to determine the associated factors of levels of grief symptoms.

RESULTS

Prevalence of PGD was 37.8% screened by IPGDS and 29.3% by TGI-SR. No difference was found in levels of grief symptoms between participants whose close one died more than 6 months ago and those who experienced the loss less than 6 months ago. More severe prolonged grief symptoms assessed by IPGDS was associated with losing a close person by COVID-19 rather than complications (B: 5.35; 95% CI: 0.54-10.05), losing a partner (B: 7.80; 95% CI: 3.24-12.37), child (B: 8.15; 95% CI: 1.03-15.26), and parent (B: 5.49; 95% CI: 1.49-9.48) rather than losing a relative or a person with other relationship, feeling more traumatic about the loss (B: 1.71; 95% CI: 0.52-2.90), being closer with the deceased (B: 1.60; 95% CI: 0.34-2.86). Moreover, Losing a grandparent (B: 6.62; 95% CI: 0.53-12.71) and having more conflicts with the deceased (B: 1.05; 95% CI: - 0.008-2.11) were related to higher levels of grief symptoms assessed by TGI-SR.

CONCLUSIONS

Echoing researchers' concerns, the prevalence of PGD is high among people bereaved due to COVID-19. Individuals with a higher risk of developing PGD should be identified and bereavement support should be offered as early as possible.

Culture-related grief beliefs and social support influence depressive symptoms of Shidu parents in rural China

BACKGROUND

Parents who have lost their only child are known as Shidu parents in China. Losing an only child is an enormous tragedy for parents that can trigger severe depressive symptoms. Few studies have explored the influence of cultural beliefs and social support on depressive symptoms.

OBJECTIVE

This study aimed to explore the relationship between culture-related grief beliefs, social support and depressive symptoms among Shidu parents in rural China.

METHOD

This cross-sectional study was conducted in Sujiatun district of Shenyang, China. Data were collected from November 2019 to February 2020 from 228 rural Shidu parents. Questionnaires consisted of the Center for Epidemiologic Studies Depression Scales (CES-D), the Culture-related Grief Beliefs of Shidu Parents Questionnaire (CBSQ), the Social Support Rating Scale (SSRS), and demographic and bereavement-related information. Hierarchical multiple linear regression analysis was conducted to examine the associations among culture-related grief beliefs, social support and depressive symptoms.

RESULTS

Of the 228 Shidu parents, 87.0% reported depressive symptoms (CES-D ≥ 16). The mean age of the participants was 62.91 years, ranging from 50 to 86. Regression analysis indicated that parents' younger age, lower education level and debts were prominent risk factors for depressive symptoms. Perceived stigma (a subscale of CBSQ) was positively associated with depressive symptoms. Social support was negatively associated with depressive symptoms.

CONCLUSIONS

Given the high prevalence of depressive symptoms in rural Shidu parents, there is a critical need to reduce perceived stigma and increase social support to alleviate depressive symptoms among Shidu parents in rural China.

Top Ten Tips Palliative Care Clinicians Should Know About Bereavement and Grief

Palliative care (PC) focuses on caring for the whole person, from birth to death, while managing symptoms and helping to navigate medical complexities. Care does not stop at the time of death, however, as assisting patients, families, and fellow clinicians through grief and bereavement is within PC's purview. Unfortunately, many clinicians feel unprepared to deal with these topics. In this article, PC and hospice clinicians define and explain bereavement, distinguish normative grief from pathological grief, offer psychometrically sound scales to screen and follow those suffering from grief, and discuss the interaction between grief and bereavement and the physical and mental health of those who are left behind after the death of a loved one.