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Shevlin M, Redican E, Karatzias T, Hyland P. Testing the distinctiveness of prolonged grief disorder from posttraumatic stress disorder and depression in large bereaved community samples. J Affect Disord 2024; 363:214-220. [PMID: 39047948 DOI: 10.1016/j.jad.2024.07.127] [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] [Received: 04/10/2024] [Revised: 07/01/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND This study sought to test the distinctiveness of symptoms of prolonged grief disorder (PGD) from posttraumatic stress disorder (PTSD) and depression. METHODS Confirmatory factor analysis (CFA) and target exploratory factor analysis (EFA), were used to test the distinctiveness of PGD from PTSD and depression symptoms in a large sample of adults bereaved for at least six months (N = 1917). Identified factors were explored in relation to demographic (i.e., age, gender) and loss-related (i.e., time since bereavement, nature of death, relationship to deceased, age of deceased, and frequency of contact with deceased) correlates. RESULTS The CFA model provided a good fit to the data, while the target EFA provided a slightly improved fit. All items loading strongly and significantly onto their respectively factors, and the IGQ items had few significant cross-factor loadings. All demographic and loss-related variables (except for death of a sibling and death from other causes) were associated with each of the factors, however, these associations were strongest for the PGD factor. LIMITATIONS Participants were recruited using a non-probability sampling method and were from a relatively affluent Western nation. CONCLUSION Findings from the current study demonstrate that PGD reflects an empirically distinguishable albeit related disorder to PTSD and depression in a sample of bereaved adults. The identification of correlates common to PGD, PTSD, and depression, as well as those unique to PGD, affords a comprehensive understanding of the risk factors associated with bereavement-related psychopathology.
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Affiliation(s)
- Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland, UK.
| | - Enya Redican
- School of Psychology, Ulster University, Coleraine, Northern Ireland, UK.
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK.
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland.
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Wen FH, Prigerson HG, Chuang LP, Chou WC, Huang CC, Hu TH, Tang ST. Predictors of ICU Surrogates' States of Concurrent Prolonged Grief, Post-Traumatic Stress, and Depression Symptoms. Crit Care Med 2024:00003246-990000000-00372. [PMID: 39258967 DOI: 10.1097/ccm.0000000000006416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
OBJECTIVES Scarce research explores factors of concurrent psychologic distress (prolonged grief disorder [PGD], post-traumatic stress disorder [PTSD], and depression). This study models surrogates' longitudinal, heterogenous grief-related reactions and multidimensional risk factors drawing from the integrative framework of predictors for bereavement outcomes (intrapersonal, interpersonal, bereavement-related, and death-circumstance factors), emphasizing clinical modifiability. DESIGN Prospective cohort study. SETTING Medical ICUs of two Taiwanese medical centers. SUBJECTS Two hundred eighty-eight family surrogates. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Factors associated with four previously identified PGD-PTSD-depressive-symptom states (resilient, subthreshold depression-dominant, PGD-dominant, and PGD-PTSD-depression concurrent) were examined by multinomial logistic regression modeling (resilient state as reference). Intrapersonal: Prior use of mood medications correlated with the subthreshold depression-dominant state. Financial hardship and emergency department visits correlated with the PGD-PTSD-depression concurrent state. Higher anxiety symptoms correlated with the three more profound psychologic-distress states (adjusted odds ratio [95% CI] = 1.781 [1.562-2.031] to 2.768 [2.288-3.347]). Interpersonal: Better perceived social support was associated with the subthreshold depression-dominant state. Bereavement-related: Spousal loss correlated with the PGD-dominant state. Death circumstances: Provision of palliative care (8.750 [1.603-47.768]) was associated with the PGD-PTSD-depression concurrent state. Surrogate-perceived quality of patient dying and death as poor-to-uncertain (4.063 [1.531-10.784]) correlated with the subthreshold depression-dominant state, poor-to-uncertain (12.833 [1.231-133.775]), and worst (12.820 [1.806-91.013]) correlated with the PGD-PTSD-depression concurrent state. Modifiable social-worker involvement (0.004 [0.001-0.097]) and a do-not-resuscitate order issued before death (0.177 [0.032-0.978]) were negatively associated with the PGD-PTSD-depression concurrent and the subthreshold depression-dominant state, respectively. Apparent unmodifiable buffering factors included surrogates' higher educational attainment, married status, and longer time since loss. CONCLUSIONS Surrogates' concurrent bereavement distress was positively associated with clinically modifiable factors: poor quality dying and death, higher surrogate anxiety, and palliative care-commonly provided late in the terminal-illness trajectory worldwide. Social-worker involvement and a do-not-resuscitate order appeared to mitigate risk.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taiwan, ROC
| | | | - Li-Pang Chuang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- College of Medicine, School of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Chung-Chi Huang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- Department of Respiratory Therapy, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Tsung-Hui Hu
- Department of Internal Medicine, Division of Hepato-Gastroenterology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, ROC
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- School of Nursing, Medical College, Chang Gung University, Tao-Yuan, Taiwan, ROC
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, ROC
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan, ROC
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Lenferink LIM, Eisma MC, Buiter MY, de Keijser J, Boelen PA. Online cognitive behavioral therapy for prolonged grief after traumatic loss: a randomized waitlist-controlled trial. Cogn Behav Ther 2023; 52:508-522. [PMID: 37341432 DOI: 10.1080/16506073.2023.2225744] [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] [Received: 02/27/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023]
Abstract
Prolonged grief disorder, a condition characterized by severe, persistent, and disabling grief, is newly included in ICD-11 and DSM-5-TR. Prolonged grief symptoms can be effectively treated with face-to-face or internet-delivered cognitive behavioral therapy. Traumatic losses may elicit higher prevalence of severe grief reactions. While face-to-face cognitive behavioral therapy appears efficacious in treating prolonged grief symptoms in traumatically bereaved individuals, it is not yet clear if internet-based cognitive behavioral therapy is efficacious for this population. Therefore, we investigated the efficacy of a 12-week internet-delivered cognitive behavioral therapy for people bereaved through traffic accidents in a randomized waitlist-controlled trial (registration number: NL7497, Dutch Trial Register). Forty adults bereaved though a traffic accident were randomized to internet-based cognitive behavioral therapy (n = 19) or a waitlist control condition (n = 21). Prolonged grief, post-traumatic stress, and depression symptoms were assessed at baseline, post-treatment, and 8-week follow-up. Dropout in the treatment condition was relatively high (42%) compared to the control condition (19%). Nevertheless, multilevel analyses showed that internet-based cognitive behavioral therapy strongly reduced prolonged grief, post-traumatic stress, and depression symptoms relative to the control condition at post-treatment and follow-up. We conclude that internet-based cognitive behavioral therapy appears a promising treatment for traumatically bereaved adults.
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Affiliation(s)
- L I M Lenferink
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, Groningen 9712, The Netherlands
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, Utrecht 3508, The Netherlands
- Department of Psychology, Health, & Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Drienerlolaan 5, Enschede 7522, The Netherlands
| | - M C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, Groningen 9712, The Netherlands
| | - M Y Buiter
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, Groningen 9712, The Netherlands
| | - J de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, Groningen 9712, The Netherlands
| | - P A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, Utrecht 3508, The Netherlands
- ARQ National Psychotrauma Centre, Nienoord 5, Diemen 1112, The Netherlands
- Foundation Centrum '45, Nienoord 5, Diemen 1112, The Netherlands
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Reitsma L, Boelen PA, de Keijser J, Lenferink LIM. Self-guided online treatment of disturbed grief, posttraumatic stress, and depression in adults bereaved during the COVID-19 pandemic: A randomized controlled trial. Behav Res Ther 2023; 163:104286. [PMID: 36906949 PMCID: PMC9985540 DOI: 10.1016/j.brat.2023.104286] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE This randomized-waitlist controlled trial is the first study examining short-term effects of a self-guided online grief-specific cognitive behavioral therapy (CBT) in reducing early persistent complex bereavement disorder (PCBD), posttraumatic stress disorder (PTSD), and depression symptoms in adults bereaved during the COVID-19 pandemic. METHOD Sixty-five Dutch adults, bereaved at least three months earlier during the pandemic, with clinically-relevant PCBD, PTSD, and/or depression symptoms, were allocated to a treatment (n = 32) or waitlist condition (n = 33). Telephone interviews were conducted to assess PCBD, PTSD, and depression symptoms (using validated instruments) at baseline, post-treatment, and post-waiting period. Participants received an eight-week self-guided online grief-specific CBT including exposure, cognitive restructuring, and behavioral activation assignments. Analyses of covariance were performed. RESULTS Intention-to-treat analyses indicated that people in the intervention condition showed significantly lower PCBD (d = 0.90), PTSD (d = 0.71), and depression (d = 0.57) symptom-levels post-treatment relative to waitlist controls post-waiting, while taking baseline symptom-levels and use of professional psychological co-intervention into account. CONCLUSIONS The online CBT proved to be an effective intervention, reducing PCBD, PTSD, and depression symptoms. Pending replication of these findings, early online interventions may be widely implemented in practice to improve treatments for distressed bereaved people.
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Affiliation(s)
- L Reitsma
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, the Netherlands.
| | - P A Boelen
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, the Netherlands; ARQ National Psychotrauma Centre, Nienoord 5, 3508 TC, Diemen, the Netherlands
| | - J de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands
| | - L I M Lenferink
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, the Netherlands; Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands; Department of Psychology, Health & Technology, Faculty of Behavioural Management and Social Sciences, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
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Nævestad TO, Orru K, Nero K, Schieffelers A, Olson A, Ludvigsen J, Airola M, Savadori L, Krüger M, Gabel F, Hesjevoll I. Self-imposed social isolation among clients of social care organisations in the COVID-19 pandemic. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2022; 82:103360. [PMID: 36248321 PMCID: PMC9551110 DOI: 10.1016/j.ijdrr.2022.103360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 06/20/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
Although self-imposed social isolation is an important way of reducing the risk of COVID-19 infection, previous research indicates that this behaviour varies substantially between different groups and individuals. Socially marginalized people are generally less involved in protective health behaviours, but there are few studies of their COVID-19 protective behaviours. The aims of the paper are therefore to: 1) compare self-imposed social isolation to avoid COVID-19 among socially marginalized groups, and to 2) examine factors influencing this, focusing especially on the role of social capital, risk awareness and sources of information about COVID-19. The study is based on survey data (N = 173) from people who are clients of social care organisations in Estonia, Norway, Hungary and Portugal. The sample involves clients living: a) in their homes, b) in facilities, and c) on the street or under temporary arrangements. Results indicate that the level of social isolation among the marginalized groups is comparable to that of the general population in previous studies. As hypothesized, we find that respondents living on the street or under temporary arrangements engage in less self-imposed social isolation than e.g. the respondents living in their homes. We also find lower levels of risk awareness, social capital and trust in authorities' information about COVID-19 among people living on the street or under temporary arrangements. Only linking social capital and trust in authorities' information was significantly related to respondents' social isolation, and not worry for COVID-19 infection. Thus, it seems that respondents largely self-isolated because of "duty" and not worry for infection.
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Affiliation(s)
| | - Kati Orru
- Institute of Social Sciences, University of Tartu, Tartu, Estonia
| | - Kristi Nero
- Institute of Social Sciences, University of Tartu, Tartu, Estonia
| | | | - Alexandra Olson
- The Salvation Army European Affairs Office, Brussels, Belgium
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Buiter MY, Boelen PA, Kunst M, Gerlsma C, de Keijser J, Lenferink LIM. The mediating role of state anger in the associations between intentions to participate in the criminal trial and psychopathology in traumatically bereaved people. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 85:101840. [PMID: 36274496 DOI: 10.1016/j.ijlp.2022.101840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Victims of crimes have been granted increasing procedural rights to participate in the juridical process since the mid 1990s. However, knowledge about the (anti)-therapeutic effect of participation is limited. We examined the associations between symptom levels of persistent complex bereavement disorder (PCBD), posttraumatic stress disorder (PTSD), and depression and the intention to participate in a criminal trial. Furthermore, we investigated the mediating role of state anger in these associations. People who lost loved ones after a plane disaster with flight MH17 (N = 203) completed questionnaires within three weeks before the start of the criminal trial. Mediation analyses indicated that people, who did not intend to actively participate in the trial by delivering a written or oral victim statement, were less likely to experience anger, which is, in turn, associated with attenuated psychopathology levels. State anger explains 68% of the effect of the intention to exercise the right to speak on PCBD levels. An important limitation is the cross-sectional study design, which precludes conclusions about temporal associations. More research is needed to improve preparation and support of bereaved people when they intend to exercise their victim rights during a criminal trial.
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Affiliation(s)
- M Y Buiter
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712, TS, Groningen, the Netherlands
| | - P A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, 3508, TC, Utrecht, the Netherlands; Foundation Centrum' 45, Nienoord 5, 1112 XE Diemen, the Netherlands; ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE Diemen, the Netherlands
| | - M Kunst
- Institute for Criminal Law and Criminology, Faculty of Law, Leiden University, P.O. Box 9520, 2300, RA, Leiden, the Netherlands
| | - C Gerlsma
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712, TS, Groningen, the Netherlands
| | - J de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712, TS, Groningen, the Netherlands
| | - L I M Lenferink
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712, TS, Groningen, the Netherlands; Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, 3508, TC, Utrecht, the Netherlands; Department of Psychology, Health & Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands.
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Grafiadeli R, Glaesmer H, Wagner B. Loss-Related Characteristics and Symptoms of Depression, Prolonged Grief, and Posttraumatic Stress Following Suicide Bereavement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610277. [PMID: 36011928 PMCID: PMC9408305 DOI: 10.3390/ijerph191610277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/13/2022] [Accepted: 08/14/2022] [Indexed: 05/13/2023]
Abstract
(1) Background: The aim of the present study was to examine symptom classes of major depressive disorder (MDD), prolonged grief disorder (PGD), and posttraumatic stress disorder (PTSD) in a sample of suicide-bereaved individuals, while accounting for loss-related characteristics. (2) Methods: A latent class analysis was conducted to identify classes of the suicide bereaved, sharing symptom profiles, in a German suicide-bereaved sample (N = 159). (3) Results: Our analyses revealed three main classes: a resilient class (16%), a class with high endorsement probability for PGD symptoms (50%), and a class with high endorsement probability for combined PGD/PTSD symptoms (34%). Prolonged grief and intrusive symptoms emerged across all classes, while MDD showed low endorsement probability. Our results indicate an association between class membership and time passed since the loss; however, this applies only to the comparison between the PGD and the resilient class, and not for the PGD/PTSD class. (4) Conclusions: Our results may provide information about the predictability of symptom clusters following suicide bereavement. The findings also represent a significant step towards tailoring treatments based on the needs of relevant suicide-bereaved subgroups through a symptom-level approach. Time passed since loss might explain differences between symptom clusters.
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Affiliation(s)
- Raphaela Grafiadeli
- Department of Psychology, Medical School Berlin, Rüdesheimerstraße 50, 14197 Berlin, Germany
- Correspondence:
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Birgit Wagner
- Department of Psychology, Medical School Berlin, Rüdesheimerstraße 50, 14197 Berlin, Germany
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Kizub D, Melnitchouk N, Beznosenko A, Shabat G, Semeniv S, Nogueira L, Watson PJ, Berg K, Trapido EJ, Espinel Z, Shultz JM. Resilience and perseverance under siege: providing cancer care during the invasion of Ukraine. Lancet Oncol 2022; 23:579-583. [DOI: 10.1016/s1470-2045(22)00189-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 12/27/2022]
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Carmassi C, Dell’Oste V, Barberi FM, Bertelloni CA, Pedrinelli V, Dell’Osso L. Mental Health Symptoms among General Practitioners Facing the Acute Phase of the COVID-19 Pandemic: Detecting Different Reaction Groups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074007. [PMID: 35409690 PMCID: PMC8998411 DOI: 10.3390/ijerph19074007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/13/2022] [Accepted: 03/24/2022] [Indexed: 01/13/2023]
Abstract
During the 2020 first wave of the COVID-19 pandemic, general practitioners (GPs) represented the first line of primary care and were highly exposed to the pandemic risks, with a consequent risk of developing a wide range of mental health symptoms. However, scant data are still available on factors associated with a worse outcome. The aim of the present study was to investigate mental health symptoms in 139 GPs in the aftermath of the first COVID-19 national lockdown in Italy, detecting groups of subjects with different depressive, anxiety, and post-traumatic stress symptom severity. The impact of the mental health symptoms on quality of life and individual functioning were also evaluated. A cluster analysis identified three groups with mild (44.6%), moderate (35.3%), and severe psychopathological burden (20.1%). Higher symptom severity was related to younger age, fewer years in service as GPs, working in a high incidence area for the pandemic, having a relative at risk of medical complications due to COVID-19, besides more severe global functioning impairment, burnout, and secondary traumatic stress. The present findings showed that GPs, forced to perform their professional activity in extremely stressful conditions during the COVID-19 pandemic, were at high risk of developing mental health problems and a worse quality of life.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.C.); (F.M.B.); (C.A.B.); (V.P.); (L.D.)
| | - Valerio Dell’Oste
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.C.); (F.M.B.); (C.A.B.); (V.P.); (L.D.)
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 53100 Siena, Italy
- Correspondence: ; Tel.: +39-050-2219760; Fax: +39-050-2219787
| | - Filippo Maria Barberi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.C.); (F.M.B.); (C.A.B.); (V.P.); (L.D.)
| | - Carlo Antonio Bertelloni
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.C.); (F.M.B.); (C.A.B.); (V.P.); (L.D.)
| | - Virginia Pedrinelli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.C.); (F.M.B.); (C.A.B.); (V.P.); (L.D.)
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 53100 Siena, Italy
| | - Liliana Dell’Osso
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.C.); (F.M.B.); (C.A.B.); (V.P.); (L.D.)
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Blackburn AM, Xu B, Gibson L, Wright EC, Ohye BY. The effect of intimate partner violence on treatment response in an intensive outpatient program for suicide-bereaved military widows. MILITARY PSYCHOLOGY 2022. [DOI: 10.1080/08995605.2022.2040918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Allyson M. Blackburn
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Bingyu Xu
- Home Base: A Massachusetts General Hospital and Boston Red Sox Foundation Program
| | - Lauren Gibson
- Home Base: A Massachusetts General Hospital and Boston Red Sox Foundation Program
- Department of Psychiatry, Harvard Medical School
- Corporal Michael J. Crescenz Philadelphia VA Medical Center
| | - Edward C. Wright
- Home Base: A Massachusetts General Hospital and Boston Red Sox Foundation Program
- Department of Psychiatry, Harvard Medical School
| | - Bonnie Y. Ohye
- Home Base: A Massachusetts General Hospital and Boston Red Sox Foundation Program
- Department of Psychiatry, Harvard Medical School
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Treml J, Brähler E, Kersting A. Prevalence, Factor Structure and Correlates of DSM-5-TR Criteria for Prolonged Grief Disorder. Front Psychiatry 2022; 13:880380. [PMID: 35664467 PMCID: PMC9159802 DOI: 10.3389/fpsyt.2022.880380] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/28/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prolonged Grief Disorder (PGD) is now included in Section II of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR). To understand the health burden and then allocate economic and professional resources, it is necessary to provide epidemiological data for this new disorder. This is especially relevant since the new diagnostic criteria differ from its predecessors, which may affect the generalizability of previous findings. More information on the characteristics of people suffering from PGD is also beneficial to better identify individuals at risk. This study, therefore, aimed to estimate the prevalence of the new PGD criteria in a representative population-based sample, evaluate the factor structure, sociodemographic, and loss-related correlates of PGD caseness and explore possible predictors. METHODS Out of a representative sample of the German general population (N = 2,531), n = 1,371 (54.2%) reported to have experienced a significant loss throughout lifetime. Participants provided sociodemographic data and loss-related characteristics. PGD symptoms were measured using items from the German versions of the Prolonged Grief Scale (PG-13) and the Inventory of Complicated Grief (ICG), which could be matched to the DSM-5-TR criteria for PGD. RESULTS The conditional prevalence of PGD was 3.4% (n = 47). The most frequently reported symptoms were intense emotional pain and intense yearning or longing for the deceased. The confirmatory factor analysis confirmed a unidimensional model of PGD. Regression analysis demonstrated that time since the death, the relationship to the deceased, and unpreparedness for the death were significant predictors of PGD. CONCLUSION Although the prevalence of 3.4% using the new diagnostic criteria is lower than the prevalence previously suggested by a meta-analysis, PGD remains a substantial disorder in the general population. In particular, the loss of a partner or child increases the risk for PGD, as does unpreparedness for the death of a loved one. Clinicians should pay particular attention to these high-risk groups. Further clinical implications are discussed.
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Affiliation(s)
- Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Psychiatry and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
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Heeke C, Franzen M, Hofmann H, Knaevelsrud C, Lenferink LIM. A Latent Class Analysis on Symptoms of Prolonged Grief, Post-Traumatic Stress, and Depression Following the Loss of a Loved One. Front Psychiatry 2022; 13:878773. [PMID: 35693969 PMCID: PMC9184516 DOI: 10.3389/fpsyt.2022.878773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/05/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The loss of a significant other can lead to variety of responses, including prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression. The aim of this study was to replicate and extend previous research that indicated that three subgroups of bereaved individuals can be distinguished based one similar post-loss symptom profiles using latent class analysis (LCA). The second aim was to examine whether sociodemographic and loss-related characteristics as well as the extent of meaning making were related to classes with more pervasive psychopathology. METHODS Telephone-based interviews with 433 Dutch and German speaking persons who had lost a significant other at last 6 months earlier were conducted. Self-rated PGD, PTSD, and depression symptoms were assessed. LCA was conducted and correlates of class-membership were examined using the 3step approach. RESULTS The LCA resulted in three distinct classes: a no symptoms class (47%), a moderate PGD, low depression/PTSD class (32%), and a high PGD, moderate depression/PTSD class (21%). A multivariate analysis indicated that female gender, a shorter time since loss, an unexpected loss and less meaning made to a loss were significantly associated with membership to the moderate PGD, low depression/PTSD and high PGD, moderate depression/PTSD class compared to membership to the no symptom class. Losing a child or spouse, a shorter time since loss, and having made less meaning to the loss further distinguished between the high PGD, moderate depression/PTSD symptom class and the moderate PGD, low depression/PTSD class. DISCUSSION We found that the majority of individuals coped well in response to their loss since the no symptom class was the largest class. Post-loss symptoms could be categorized into classes marked by different intensity of symptoms, rather than qualitatively different symptom patterns. The findings indicate that perceiving the loss as more unexpected, finding less meaning in the loss, and loss-related factors, such as the recentness of a loss and the loss of a partner or child, were related to class membership more consistently than sociodemographic factors.
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Affiliation(s)
- Carina Heeke
- Department of Clinical-Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Minita Franzen
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Hendrik Hofmann
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Christine Knaevelsrud
- Department of Clinical-Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Lonneke I M Lenferink
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands.,Department of Psychology, Health, and Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, Netherlands.,Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands
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