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Gillespie K, McConnell T, Roulston A, Potvin N, Ghiglieri C, Gadde I, Anderson M, Kirkwood J, Thomas D, Roche L, O 'Sullivan M, McCullagh A, Graham-Wisener L. Music therapy for supporting informal carers of adults with life-threatening illness pre- and post-bereavement; a mixed-methods systematic review. BMC Palliat Care 2024; 23:55. [PMID: 38408966 PMCID: PMC10898157 DOI: 10.1186/s12904-024-01364-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/19/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Music therapy interventions with informal carers of individuals with life-threatening illness at pre- and post-bereavement is an increasingly important clinical area. This systematic review is the first to synthesise and critically evaluate the international evidence associated with music therapy with adult informal carers pre- and post-bereavement. Specifically, the objectives were: i) to describe the characteristics and effectiveness of music therapy interventions which aim to improve health-related outcomes for adult informal carers of adults with life-threatening illness (pre- and post-bereavement), and ii) to describe the experience of music therapy for adult informal carers of adults with life-threatening illness (pre- and post-bereavement). METHODS Eligibility: adult informal carers of adults at end of life or bereaved; music therapy interventions for improving health-related outcomes; qualitative; mixed-method; and quantitative studies including comparators of any other intervention; published in English from 1998 onwards. Six databases were searched up to July 2022. A JBI mixed-methods systematic review approach was followed throughout, including quality appraisal, data extraction and a convergent segregated approach to synthesis and integration. RESULTS A total of 34 studies were included, published between 2003 and 2022. Most were conducted in North America (n = 13), Australia (n = 10), or Europe (n = 8). No studies were conducted in low- and middle-income countries or in the UK. The majority were qualitative (n = 17), followed by quasi-experimental (n = 8), mixed-methods (n = 7) and two RCTs. The majority focused on carers of individuals with dementia (n = 21) or advanced cancer (n = 7). Seventeen studies were purely quantitative or included a quantitative component. During meta-synthesis, findings were aligned to core outcomes for evaluating bereavement interventions in palliative care and previously identified risk factors for complicated grief. Commonly targeted outcomes in quantitative studies included quality of life and mental wellbeing, showing equivocal effectiveness of music therapy with significant and non-significant results. Twenty-two studies either purely qualitative or with a qualitative component underwent meta synthesis and suggested a diverse range of improved pre- and post-bereavement outcomes for informal carers across all core outcomes, and across all risk and protective factors, including psychological, spiritual, emotional, and social outcomes. CONCLUSIONS Qualitative studies provide moderate to strong evidence for improved health-related outcomes for adult informal carers of adults with life-threatening illness pre-bereavement. Limited studies including those bereaved negates conclusions for the bereavement phase. Comparisons and explanations for effectiveness across quantitative and qualitative studies are equivocal, with a high risk of bias and small samples in the limited number of quantitative studies, demonstrating a need for high-quality RCTs. SYSTEMATIC REVIEW PRE-REGISTRATION PROSPERO [CRD42021244859].
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Affiliation(s)
- K Gillespie
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK
| | - T McConnell
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, UK.
- Marie Curie Northern Ireland, Belfast, UK.
| | - A Roulston
- School of Social Sciences, Education & Social Work, Queen's University Belfast, Belfast, UK
| | - N Potvin
- Mary Pappert School of Music and School of Nursing, Music Therapy, Duquesne University, Pittsburgh, USA
| | - C Ghiglieri
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK
| | - I Gadde
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK
| | - M Anderson
- Cochrane Developmental, Psychosocial and Learning Problems, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - J Kirkwood
- Independent Researcher, Belfast, Northern Ireland, UK
| | - D Thomas
- CHROMA Therapies, Overross House, Ross Park, Ross On Wye, Herefordshire, UK
| | - L Roche
- MusiCARER Project Carer Advisory Group, Belfast, UK
- AIIHPC Voices4Care, Dublin, Ireland
| | - M O 'Sullivan
- MusiCARER Project Carer Advisory Group, Belfast, UK
- AIIHPC Voices4Care, Dublin, Ireland
| | - A McCullagh
- MusiCARER Project Carer Advisory Group, Belfast, UK
- Marie Curie Research Voices, Southampton, UK
| | - L Graham-Wisener
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK
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Shinada K, Kohno T, Fukuda K, Higashitani M, Kawamatsu N, Kitai T, Shibata T, Takei M, Nochioka K, Nakazawa G, Shiomi H, Miyashita M, Mizuno A. Depression and complicated grief in bereaved caregivers in cardiovascular diseases: prevalence and determinants. BMJ Support Palliat Care 2024; 13:e990-e1000. [PMID: 34686525 DOI: 10.1136/bmjspcare-2021-002998] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 09/28/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Despite the recommendation that patients with cardiovascular disease (CVD) receive bereavement care, few studies have examined the psychological disturbances in bereaved caregivers. We examined the prevalence and determinants of depression and complicated grief among bereaved caregivers of patients with CVD. METHODS We conducted a cross-sectional survey using a self-administered questionnaire for bereaved caregivers of patients with CVD who had died in the cardiology departments of nine Japanese tertiary care centres. We assessed caregiver depression and grief using the Patient Health Questionnaire-9 (PHQ-9) and Brief Grief Questionnaire (BGQ), respectively. The questionnaire also covered caregivers' perspectives toward end-of-life care and the quality of the deceased patient's death. RESULTS A total of 269 bereaved caregivers (mean age: 66 (57-73) years; 37.5% male) of patients with CVD were enrolled. Overall, 13.4% of the bereaved caregivers had depression (PHQ-9 ≥10) and 14.1% had complicated grief (BGQ ≥8). Depression and complicated grief's determinants were similar (ie, spousal relationship, unpreparedness for the death, financial and decision-making burden and poor communication among medical staff). Patients and caregivers' positive attitudes toward life-prolonging treatment were associated with complicated grief. Notably, in caregivers with complicated grief, there was less discussion with physicians about end-of-life care. Caregivers who felt that the patients did not receive sufficient treatment suffered more frequently from depression and complicated grief. CONCLUSIONS Approximately 15% of bereaved caregivers of patients with CVD suffered from depression and complicated grief. Cardiologists should pay particular attention to caregivers with high-risk factors to identify those likely to develop depression or complicated grief.
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Affiliation(s)
- Keitaro Shinada
- Division of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Takashi Kohno
- Division of Cardiology, School of Medicine, Keio University, Tokyo, Japan
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Division of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Michiaki Higashitani
- Department of Cardiology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Naoto Kawamatsu
- Department of Cardiology, Mito Saiseikai General Hospital, Ibaraki, Japan
| | - Takeshi Kitai
- Departments of Cardiovascular Medicine and Clinical Research Support, Kobe City Medical Center General Hospital, Hyogo, Japan
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Makoto Takei
- Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Gaku Nakazawa
- Department of Cardiology, School of Medicine, Tokai University, Kanagawa, Japan
- Department of Cardiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hiroki Shiomi
- Department of Cardiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Atsushi Mizuno
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Cardiovascular Medicine, St Luke's International University, Chuo-ku, Japan
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Matsuzaka S, Ohba A, Masukawa K, Aoyama M, Morita T, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Factors associated with the preparedness for bereavement in families of patients with cancer: A secondary analysis of a nationwide bereaved family survey. Psychooncology 2024; 33:e6276. [PMID: 38282233 DOI: 10.1002/pon.6276] [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: 07/05/2023] [Revised: 11/29/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Insufficient preparedness for bereavement can affect a family's psychological health status after bereavement. However, factors associated with preparedness remain unclear. This study aimed to identify factors associated with preparedness for bereavement in families of patients with cancer. METHODS We conducted a secondary analysis of a nationwide bereaved family survey in Japan, analyzing data from 9123 family members of patients with cancer. Logistic regression analysis was conducted to explore how sociodemographic factors, health status, and perceived care for patients and families were associated with preparedness for bereavement. RESULTS Of the 9123 families, 1338 (15.1%) were not prepared for bereavement. Factors associated with insufficient preparedness for bereavement (all p < 0.001) were found as follows: patients' spouses (OR = 2.54), receiving care in acute hospitals (OR = 1.83), worse psychological health status during caregiving (OR = 2.13), lower social support for family members (OR = 1.90), wrong patients' awareness of medical condition from family's perspective (OR = 1.75-2.12), family preference of more aggressive treatment rather than palliative care (OR = 1.71) or not sure (OR = 2.31), not wanting to know information about the patient's prognosis (OR = 1.64-1.77), end-of-life discussion with physician 1 month before patient's death (OR = 1.45), and late or early end-of-life discussions with physician and family (OR = 1.78-1.95). CONCLUSIONS This study's results might assist clinicians in assessing and identifying families who are not prepared for bereavement; however, preparedness for bereavement may have been associated with other factors.
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Affiliation(s)
- Sakiko Matsuzaka
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Akiho Ohba
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, Hamamtsu, Shizuoka, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative and Supportive Care, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Bybee S, Hebdon M, Cloyes K, Hiatt S, Iacob E, Reblin M, Clayton M, Ellington L. Cancer caregivers at the end-of-life: How much me vs. how much we? PEC INNOVATION 2023; 3:100193. [PMID: 37554722 PMCID: PMC10404724 DOI: 10.1016/j.pecinn.2023.100193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE This study explored cancer caregivers' individual and communal coping through their use of personal and communal pronouns during naturally occurring conversations. METHODS Nurse-home hospice visits involving cancer patients and their partner caregivers were audio recorded and then transcribed. Pronoun use was analyzed using Linguistic Inquiry Word Count (LIWC) software and descriptive statistics compared patient and partner caregivers' pronoun use. Personal and communal pronoun use was examined within six identified topics of caregiver speech: patient medical care, daily life, emotion, criticism/disagreement, relationships with family/friends, and asserting needs. RESULTS Dyads (N = 76) had an average of 35.8 years in their relationship. Caregivers used proportionately more first-person singular (I-talk) than first-person plural (we-talk). However, they used significantly less I-talk than patients and less I-talk than LIWC measures in naturally occurring speech. Caregivers were most likely to discuss patient medical care (41.9%) and least likely to discuss their own needs (3.8%). CONCLUSION Partner caregivers may find it easier to express emotions related to communal stressors, rather than their individual ability to cope with end-of-life caregiving. INNOVATION Examining personal and communal pronoun use by partner caregivers during nurse-home hospice visits may provide a more objective measure of caregiver coping than standard self-report measures.
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Affiliation(s)
- Sara Bybee
- University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112, United States of America
| | - Megan Hebdon
- UT Austin School of Nursing, 1710 Red River St, Austin, TX 78712, United States of America
| | - Kristin Cloyes
- Oregon Health & Science University, 3455 SW US Veterans Hospital Rd., Portland, OR 97239-2941, United States of America
| | - Shirin Hiatt
- University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112, United States of America
| | - Eli Iacob
- University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112, United States of America
| | - Maija Reblin
- University of Vermont College of Medicine, Given Medical Building, E-126, 89 Beaumont Ave, Burlington, VT 05405, United States of America
| | - Margaret Clayton
- University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112, United States of America
| | - Lee Ellington
- University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112, United States of America
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Thiemann P, Street AN, Heath SE, Quince T, Kuhn I, Barclay S. Prolonged grief disorder prevalence in adults 65 years and over: a systematic review. BMJ Support Palliat Care 2023; 13:e30-e42. [PMID: 33707297 DOI: 10.1136/bmjspcare-2020-002845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/03/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Prolonged grief disorder (PGD) is a recently recognised mental health disorder with an estimated prevalence of 10% in the bereaved adult population. This review aims to appraise and summarise evidence relating to PGD in older adults (≥65 years), a growing population group, most likely to experience bereavement and often assumed to cope well. METHOD Literature from Medline, PsycINFO, CINAHL, Cochrane Library and Web of Science was searched. Epidemiological and non-epidemiological studies including data on frequency of PGD in older adults bereaved by mainly natural causes were included and a descriptive analysis undertaken. RESULTS From 2059 records, three epidemiological and six non-epidemiological studies were included. Most studies had good internal but not external validity. Conditional prevalence for PGD ranged between 3.2% and 48.8%. Heterogeneity in sample characteristics and study methodology contributed to this variability resulting in a descriptive analysis. The prevalence rate of 9.1% by Kersting et al was the best available estimate for PGD in older adults for western countries. The small number of epidemiological studies and the use of varying PGD-constructs which did not match International Classification of Diseases 11th Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria were the main limiting factors. CONCLUSION This first review on PGD prevalence in older adults suggests that, despite studies' methodological short comings, a similar proportion of older adults experience PGD as the general bereaved adult population (1:10). With older adults forming the largest subgroup among the bereaved, health and social care systems need to adapt their provision of care to address the specific needs of older adults.
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Affiliation(s)
- Pia Thiemann
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Anna Naomi Street
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sarah Eleanor Heath
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thelma Quince
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Isla Kuhn
- Medical Library, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Filipponi C, Chichua M, Masiero M, Mazzoni D, Pravettoni G. Cancer Pain Experience Through the Lens of Patients and Caregivers: Mixed Methods Social Media Study. JMIR Cancer 2023; 9:e41594. [PMID: 37399067 PMCID: PMC10365594 DOI: 10.2196/41594] [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: 08/01/2022] [Revised: 05/12/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Cancer pain represents a challenge for cancer patients and their family members. Despite progression in pain management, pain is still underreported and undertreated, and there is limited information on the related needs that patients and caregivers may have. Online platforms represent a fundamental tool for research to reveal the unmet needs of these users and their emotions outside the medical setting. OBJECTIVE This study aimed to (1) reveal the unmet needs of both patients and caregivers and (2) detect the emotional activation associated with cancer pain by analyzing the textual patterns of both users. METHODS A descriptive and quantitative analysis of qualitative data was performed in RStudio v.2022.02.3 (RStudio Team). We analyzed 679 posts (161 from caregivers and 518 from patients) published over 10 years on the "cancer" subreddit of Reddit to identify unmet needs and emotions related to cancer pain. Hierarchical clustering, and emotion and sentiment analysis were conducted. RESULTS The language used for describing experiences related to cancer pain and expressed needs differed between patients and caregivers. For patients (agglomerative coefficient=0.72), the large cluster labeled unmet needs included the following clusters: (1A) reported experiences, with the subclusters (a) relationship with doctors/spouse and (b) reflections on physical features; and (1B) changes observed over time, with the subclusters (a) regret and (b) progress. For caregivers (agglomerative coefficient=0.80), the main clusters were as follows: (1A) social support and (1B) reported experiences, with the subclusters (a) psychosocial challenges and (b) grief. Moreover, comparison between the 2 groups (entanglement coefficient=0.28) showed that they shared a common cluster labeled uncertainty. Regarding emotion and sentiment analysis, patients expressed a significantly higher negative sentiment than caregivers (z=-2.14; P<.001). On the contrary, caregivers expressed a higher positive sentiment compared with patients (z=-2.26; P<.001), with trust (z=-4.12; P<.001) and joy (z=-2.03; P<.001) being the most prevalent positive emotions. CONCLUSIONS Our study emphasized different perceptions of cancer pain in patients and caregivers. We revealed different needs and emotional activations in the 2 groups. Moreover, our study findings highlight the importance of considering caregivers in medical care. Overall, this study increases knowledge about the unmet needs and emotions of patients and caregivers, which may have important clinical implications in pain management.
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Affiliation(s)
- Chiara Filipponi
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Mariam Chichua
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Marianna Masiero
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Davide Mazzoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Rosario-Ramos L, Peña-Vargas C, Torres-Blasco N. Acceptance of Caregiver-Patient Support to Latinx Coping with Advanced Cancer (CASA) Intervention: A Caregiver Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4996. [PMID: 36981903 PMCID: PMC10049334 DOI: 10.3390/ijerph20064996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
Latinos frequently assume caregiver roles when the need arises in their social nucleus. Because of their active role, caregivers are heavily involved in their family member's cancer trajectory. Therefore, there is a need for culturally adapted interventions that integrate the caregiver and cancer patient. The objective is to present a case study of a former caregiver's experience and acceptance of the cultural adaptation of Caregiver-Patient Support to Latinx Coping with Advanced Cancer (CASA) intervention. We conducted a case study with a male caregiver between the ages of 20 and 30. A male caregiver expressed his experience and acceptance of a psychosocial intervention. He conveyed moderate to high acceptance of intervention components through anecdotes and opinions based on his experiences as a caregiver for multiple family members. Finally, he reported distress, but he presented little to no symptoms of caregiver burden, depression, anxiety, and hopelessness. It is crucial to culturally adapt interventions that integrate caregivers when they play a big part in their loved one's cancer journey. Integrating their perspective when adapting an intervention may assist in providing essential information that will benefit the patient and caregiver.
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Affiliation(s)
- Lianel Rosario-Ramos
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico
| | - Cristina Peña-Vargas
- Ponce’s Research Institute, Ponce Health Sciences University, Ponce 00716, Puerto Rico
| | - Normarie Torres-Blasco
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico
- Ponce’s Research Institute, Ponce Health Sciences University, Ponce 00716, Puerto Rico
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Becker TD, Cagle JG. Bereavement Support Services in a National Sample of Hospices: A Content Analysis. OMEGA-JOURNAL OF DEATH AND DYING 2023; 86:1235-1253. [PMID: 33823699 DOI: 10.1177/0030222821997602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Although the Medicare Hospice Benefit mandates that hospices offer bereavement support services to families for at least 1 year following the death of a patient, it does not stipulate which services they should offer. As a result, little is known about what bereavement support services hospices provide, especially on a national scale. The current study recruited a national sample of hospice representatives who responded to an open-ended question that asked, "What types of bereavement support services does your hospice provide to families?" Seventy-six viable responses were recorded and content analyzed. Four overarching domains emerged: (a) timing of support, (b) providers of support, (c) targets of support, and (d) formats of support. Other notable findings included the underutilization of bereavement support services and the utility of informal support formats. These findings present implications for future study regarding which specific aspects of hospice bereavement support services are most beneficial to bereaved families.
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Affiliation(s)
- Todd D Becker
- 115980University of Maryland School of Social Work, Baltimore, MD, United States
| | - John G Cagle
- 115980University of Maryland School of Social Work, Baltimore, MD, United States
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Sardella A, Musetti A, Caponnetto P, Quattropani MC, Lenzo V. Prolonged Grief Disorder and Symptoms of Anxiety and Depression among Bereaved Family Caregivers in the Context of Palliative Home Care. Eur J Investig Health Psychol Educ 2023; 13:490-500. [PMID: 36826221 PMCID: PMC9955476 DOI: 10.3390/ejihpe13020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Background: This study aimed to investigate the prevalence and the psychological comorbidity of PGD among bereaved family caregivers of palliative care cancer patients. We also examined the discriminant validity of two simple and reliable tools in correctly categorized individuals with PGD. Methods: A cross-sectional study was conducted with 157 bereaved participants (77.1% females, mean age = 43.50 ± 14.04 years, mean time since the loss = 3.59 years) recruited from three palliative home care services. These participants completed the Prolonged Grief Scale (PG-13) and the Hospital Anxiety and Depression Scale (HADS). Results: The prevalence of PGD within the sample was 4.46% (i.e., = 7/157). Participants scored higher than the cut-off on the PG-13 and the HADS-D. Symptoms of PGD were positively correlated with depression levels. The ROC curve analysis showed that the HADS-D was outstanding in categorizing individuals with prolonged grief disorder from those without PGD. A HADS-D score of ≥7.5 was able to categorize participants with a sensitivity of 0.90 and a specificity of 0.73. Conclusions: Overall, these results highlight the relationship between grief and depression symptoms and their exceptional discriminant validity among correctly identified individuals with PGD.
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Affiliation(s)
- Alberto Sardella
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
- Correspondence:
| | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, 43121 Parma, Italy
| | - Pasquale Caponnetto
- Department of Educational Sciences, University of Catania, 95124 Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, 95123 Catania, Italy
| | | | - Vittorio Lenzo
- Department of Educational Sciences, University of Catania, 95124 Catania, Italy
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Lee YJ, Kweon YS, Hong HJ. Suicidal Ideation, Depression, and Insomnia in Parent Survivors of Suicide: Based on Korean Psychological Autopsy of Adolescent Suicides. J Korean Med Sci 2023; 38:e39. [PMID: 36747364 PMCID: PMC9902662 DOI: 10.3346/jkms.2023.38.e39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/27/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND This study aims to evaluate suicidal ideation, depression, and insomnia among parent survivors of adolescents who died by suicide and their relevant risk factors using psychological autopsy results from South Korea. METHODS The participants were 42 parent survivors (10 fathers and 32 mothers) of 35 adolescents who died by suicide. We used the Patient Health Questionnaire-9 and the Korean version of the Insomnia Severity Index to evaluate the mental health of the bereaved parents. We used the Korean Psychological Autopsy Checklist for Adolescents, the Korean Beck Depression Inventory, the Korean Version of the Barratt Impulsiveness Scale-II, and the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime-Korean versions to evaluate the mental health of deceased adolescents before their deaths. RESULTS The results showed that many parent survivors of suicide had developed clinically significant suicidal ideation, depression, and insomnia (75.6%, 73.2%, and 42.9%, respectively). Furthermore, the higher the incidence of traumatic events experienced by the deceased adolescents, the higher the severity of depression and insomnia experienced by surviving parents. CONCLUSION We should pay attention that parent survivors of suicide can suffer mental disorders after their offspring's death. In future studies, long-term follow-up studies with larger samples need to generalize our findings and clarify the causal relationship.
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Affiliation(s)
- Yeon Jung Lee
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yong-Sil Kweon
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Hyun Ju Hong
- Suicide and School Mental Health Institute, Hallym University, Anyang, Korea
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Korea.
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11
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Kazan J, Lyew T, Croswell E, Buysse DJ, Gebara MA, Karp JF, Krafty RT, Rashied AA, Reynolds CF, Rollman BL, Smagula SF, Stahl ST. A digital health intervention to stabilize the 24-hour rhythm of sleep, meals, and physical activity for reducing depression among older bereaved spouses: Protocol for a randomized controlled trial. Contemp Clin Trials 2023; 124:107016. [PMID: 36414207 PMCID: PMC9839623 DOI: 10.1016/j.cct.2022.107016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite the high prevalence of depression and disruption to 24-h sleep-wake routines following the death of a spouse in late-life, no bereavement interventions have been developed to re-entrain a regular sleep-wake routine among older widow(er)s. We describe the rationale and methodology of the NIH-funded WELL Study (Widowed Elders' Lifestyle after Loss), a randomized controlled trial (RCT) comparing the efficacy of a digital health intervention (DHI) to enhanced usual care (EUC) arm for reducing depression symptoms in older spousally-bereaved adults. METHODS We will randomize approximately 200 recently bereaved (<12 months) adults aged 60+ years to one of two 12-week interventions: digital monitoring of the timing and regularity of sleep, meals, and physical activity plus weekly motivational health coaching; or enhanced usual care consisting of weekly telephone calls and similar assessment schedules. Participants will complete self-report and clinical assessments at baseline, post-intervention, and 3-, 6-, and 12-months post-intervention, and objective actigraphic assessments of their 24-h rest-activity rhythm (RAR) at baseline and 1-, 2-, and 3-months during the intervention. The primary outcome is change in depression symptoms burden (using the Hamilton Rating Scale for Depression) from pre- to post-intervention and over 12 months of follow-up. DISCUSSION WELL Study findings will inform the development of widely generalizable and scalable technology-based interventions to support bereaved spouses in community-based settings. Clinical http://Trials.gov Identifier: NCT04016896.
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Affiliation(s)
- Joseph Kazan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thandi Lyew
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emilee Croswell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marie Anne Gebara
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jordan F Karp
- Department of Psychiatry, University of Arizona, Tucson, AZ, USA
| | - Robert T Krafty
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Ammar A Rashied
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | | | - Bruce L Rollman
- Center for Behavioral Health, Media, & Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen F Smagula
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah T Stahl
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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12
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Liljeroos M, Krevers B, Milberg A. Family members' long-term grief management: A prospective study of factors during ongoing palliative care and bereavement. Palliat Support Care 2022:1-12. [PMID: 36545770 DOI: 10.1017/s1478951522001687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Up to 10% of bereaved individuals can develop prolonged grief disorder. Several risk factors for prolonged grief symptom severity in family members have been identified, but there is a lack of knowledge regarding the multivariable effects between family members coping with loss and patient-related factors for prolonged grief symptom severity during bereavement. The aim was to identify risk factors for prolonged grief symptom severity in family members 1 year after patient death in relation to (1) the family member and the patient during ongoing palliative care and (2) the family member during bereavement. METHODS The participants consisted of family members (n = 99) of patients admitted to palliative home care in Sweden. The participants completed a survey during ongoing palliative care and at a follow-up 1 year after the patient's death. RESULTS The model selection chose 4 demographic and 4 preloss variables: family member's nervousness and stress, the patient's sense of security during palliative care, family members' sense of security during palliative care, and a family member attachment security anxiety dimension. Two postloss variables were positively associated with prolonged grief symptom severity: family members' continuing bond - internalized and continuing bond - externalized. SIGNIFICANCE OF RESULTS How family members coped depended on (i) variables linked to the family members themselves, (ii) the relationship to the patient, and (iii) some patient-specific variables. There was also a link between preloss variables and postloss prolonged grief symptom severity. Hence, it should be possible to identify family members with a heightened risk for longer-term prolonged grief symptoms.
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Affiliation(s)
- Maria Liljeroos
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Barbro Krevers
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna Milberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Advanced Home Care, Linköping University, Norrköping, Sweden
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13
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Moreira D, Azeredo A, Sá Moreira D, Fávero M, Sousa-Gomes V. Why Does Grief Hurt? EUROPEAN PSYCHOLOGIST 2022. [DOI: 10.1027/1016-9040/a000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract. Grief is a major physical and psychological health concern for adults, as well as a key risk factor for depression. The direct and indirect costs of depression in adults place heavy burdens on societal resources. Indeed, bereavement is a stressful and profound life experience, with the grieving process combining reactions to a loss that may originate in complications for bereaved individuals. The goal of this systematic review is to synthesize the findings regarding depression and grief. Studies related to the topic were obtained from multiple databases through rigorous exclusion and inclusion criteria. Only empirical studies with quantitative methodologies were included. Objectives, sample (type of sample, % male, and age), instruments, and main conclusions were extracted from each study. Overall, there are personality and contextual factors that, in addition to affecting depressive reactions following a loss, may also interface with one’s ability to grieve. Furthermore, after the patient’s death, there was a decrease in depressive symptoms over time, indicating that these symptoms are dynamic. Individuals who experience prolonged grief exhibit depressive symptoms, and those who suffer a loss may have depressive symptoms, but in a natural and non-pathological way, that is, sadness and not depression. Depression tends to decrease over time, with the existence of more children and a focus on occupation.
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Affiliation(s)
- Diana Moreira
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Portugal
- Centre for Philosophical and Humanistic Studies, Faculty of Philosophy and Social Sciences, Universidade Católica Portuguesa, Portugal
- Institute of Psychology and Neuropsychology of Porto – IPNP Health, Portugal
- Centro de Solidariedade de Braga/Projecto Homem, Portugal
| | - Andreia Azeredo
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Portugal
| | - Diana Sá Moreira
- Institute of Psychology and Neuropsychology of Porto – IPNP Health, Portugal
- Social and Behavioral Sciences Department, University Institute of Maia, Portugal
| | - Marisalva Fávero
- Social and Behavioral Sciences Department, University Institute of Maia, Portugal
- Unit I&D of the Justice and Governance Research Center of the Law School, University of Minho (JusGov/UM), Portugal
| | - Valéria Sousa-Gomes
- Institute of Psychology and Neuropsychology of Porto – IPNP Health, Portugal
- Social and Behavioral Sciences Department, University Institute of Maia, Portugal
- Unit I&D of the Justice and Governance Research Center of the Law School, University of Minho (JusGov/UM), Portugal
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14
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Hasdenteufel M, Quintard B. Psychosocial factors affecting the bereavement experience of relatives of palliative-stage cancer patients: a systematic review. Palliat Care 2022; 21:212. [PMID: 36451118 PMCID: PMC9713164 DOI: 10.1186/s12904-022-01096-y] [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: 04/21/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Cancer is one of the leading causes of death worldwide and a cancer death is a major risk factor for pathological bereavement. This systematic review of the literature aimed to identify biopsychosocial and existential determinants specific to the palliative phase of cancer that influence the grieving experience of the caregiving relative. METHOD A systematic review of the literature was conducted without language or time restrictions. The Cairn, Cochrane Library, PubMed, PsycArticle, PsychInfo, Psychology and Behavioral Sciences Collection databases were explored. All studies assessing pre- and post-death measures and focusing on friends and relatives caring for adults with cancer in palliative care services were included in the review. RESULTS Out of 645 articles identified, 18 full text studies were finally included in our systematic review of the literature. Many factors specific to the cancer palliative phase were identified as influencing the bereavement experience of caregivers, with factors relating to: 1) the caregiver (e.g. social support, psychological burden, preparation for loss, action and discussion related to death); 2) the patient (e.g. denial or acceptance); 3) the interactions between patient and their caregivers (e.g. tensions, communication difficulties, and presence at the time of death); and 4) the end-of-life context. The caregiver's grief experience can be described by the following terms: typical and pathological grief, anxiety, depression, guilt, psychological distress, post-traumatic stress disorder and post-traumatic growth, and life satisfaction. CONCLUSIONS Many contextual, sociodemographic, dispositional and transactional factors specific to the palliative cancer phase are involved in the caregiver's grieving experience. Avenues for reflection and recommendations are proposed including supporting communication and patient-relative relationships, evaluating the nature and degree of functionality of coping strategies, strengthening the robustness of methodologies, considering impact of COVID-19, and new lines of enquiry for research.
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Affiliation(s)
- Marie Hasdenteufel
- grid.412041.20000 0001 2106 639XLaboratoire de Psychologie EA 4139, Université de Bordeaux, Faculté de Psychologie, 3 Ter, Place de La Victoire, 33076 Bordeaux-Cedex, France
| | - Bruno Quintard
- grid.412041.20000 0001 2106 639XLaboratoire de Psychologie EA 4139, Université de Bordeaux, Faculté de Psychologie, 3 Ter, Place de La Victoire, 33076 Bordeaux-Cedex, France
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15
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López Pérez Y, Cruzado JA, Lacasta Reverte MA, Lallana-Frías E. Predictors of Complicated Grief in Caregivers of Palliative Care Patients. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221133437. [PMID: 36252273 DOI: 10.1177/00302228221133437] [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: 11/15/2022]
Abstract
Introduction: It is important to identify the factors s associated with complicated grief (CG) in order to prevent it. Objective: To determine the factors associated with CG in the end-of-life phase within the palliative care context. Method: The PRISMA model was followed for the review. We accessed the following databases: PUBMED, SCOPUS, and PsycoINFO, to review publications from 2006. Results: A total of 17 studies were obtained. A direct relationship between factors prior to bereavement and CG is established: intensity of anticipated grief, previous mental and physical health of the caregiver, social support; quality of patient care, communication at the end-of-life, preparation for death, spirituality, and sociodemographic factors. Conclusions: Previous mental health and level of anticipatory grief in the main caregiver are shown to be the most powerful predictors of CG. Patient age and quality of care are factors considered as strong predictors of CG in almost every study.
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Affiliation(s)
- Yolanda López Pérez
- EAPS Psychologist at the San Camilo Palliative Care Unit, Centro Asistencial San Camilo, Madrid, Spain
| | - Juan Antonio Cruzado
- Facultad de Psicología, Universidad Complutense de Madrid, Ciudad Universitaria Campus de Somosaguas, Madrid, Spain
| | - María Antonia Lacasta Reverte
- Clinical Psychologist, Unidad de Cuidados Paliativos y Equipo Soporte Hospitalario, Hospital Universitario La Paz, Madrid, Spain
| | - Elena Lallana-Frías
- Palliative Care EAPS Psychologist, Hospital Support Team in Hospital Universitario de Getafe, Home Support Team in ESAD Leganés, at Fundación Instituto San José, Madrid. Spain
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16
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Semenescu L, Drăcea A, Zimţa D, Crişan A. Anticipatory Grief in the Families of Patients with Palliative Requiring Metastatic Cancer. CURRENT HEALTH SCIENCES JOURNAL 2022; 48:317-323. [PMID: 36815082 PMCID: PMC9940926 DOI: 10.12865/chsj.48.03.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/23/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND/AIM When dealing with metastatic cancer patients, family distortions, such as anticipatory mourning, psychiatric and psychosocial disorders may occur. In the case of anticipatory mourning, there exists the risk of the patient being "given up" as if he is already gone, which will only make the patient feel lonely, with numerous problems occurring in the subsequent period of familial mourning. Currently, the importance of identifying the type of mourning affecting families of cancer patients has become more and more clear, as this allows not only for greater therapeutic success, but also avoids a high number of risks and complications that appear during the critical care period. Our paper aims to identify and assess these risk factors in order to contribute to the optimization and success of palliative therapy. MATERIAL AND METHOD We performed this study on a group of 78 subjects with metastatic cancer. We developed a questionnaire in order to assess the patient-family relationship, family profile and the patient's unique psychological traits, in order to identify potential risk factors. Data processing was performed using Microsoft Excel; the XLSTAT package was used to perform complex statistical tests (χ2 test, Spearman correlation coefficient). RESULTS AND CONCLUSIONS Women are more prone to fears related to developing cancer themselves. No risk factors leading to the development of significant pathological mourning were identified in our study group. However, the clinician who deals with the treatment of the terminally ill cancer patient will have to include the following objectives related to the relatives in the therapeutic plan: to motivate their involvement, but with the maintenance of a separation in order to maintain the individuality; to keep their realism and to distinguish between normal/pathological mourning.
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Affiliation(s)
| | - Amelia Drăcea
- Department of Biophysics, University of Medicine and Pharmacy of Craiova
| | - Daniel Zimţa
- Craiova Municipal Clinical Hospital "Filantropia", Oncology Clinic
| | - Anda Crişan
- Department of Oncology, University of Medicine and Pharmacy of Craiova
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17
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Cherblanc J, Gagnon C, Côté I, Bergeron-Leclerc C, Cadell S, Gauthier G, Boelen PA. French-Canadian validation of the Traumatic Grief Inventory-Self Report (TGI-SR). DEATH STUDIES 2022; 47:430-439. [PMID: 35686539 DOI: 10.1080/07481187.2022.2085347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The Traumatic Grief Inventory Self-Report (TGI-SR), which aims to assess both Persistent Complex Bereavement Disorder and Prolonged Grief Disorder, has been validated in several languages. This study sought to validate the French-Canadian version. We conducted an online survey exploring the impact of the COVID-19 pandemic on grief. With data from 728 participants, the scale demonstrated high internal consistency, correlated significantly with three other scales known to measure similar concepts, and distinguished between groups known to be different. This study supports the use of the TGI-SR French-Canadian version by clinicians and researchers to assess complications of grief.
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Affiliation(s)
- Jacques Cherblanc
- Humanities and Social Sciences, Université du Québec à Chicoutimi, Chicoutimi, Canada
| | - Cynthia Gagnon
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires, Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-St-Jean, Hôpital de Jonquière, Saguenay, Canada
| | - Isabelle Côté
- Humanities and Social Sciences, Université du Québec à Chicoutimi, Chicoutimi, Canada
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires, Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-St-Jean, Hôpital de Jonquière, Saguenay, Canada
| | | | - Susan Cadell
- School of Social Work, University of Waterloo, Waterloo, Canada
| | - Geneviève Gauthier
- Humanities and Social Sciences, Université du Québec à Chicoutimi, Chicoutimi, Canada
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
- ARQ National Psychotrauma Centre, Diemen, Netherlands
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18
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Hatano Y, Morita T, Mori M, Aoyama M, Yoshida S, Amano K, Terabayashi T, Oya K, Tsukuura H, Hiratsuka Y, Isseki M, Kizawa Y, Tsuneto S, Shima Y, Masukawa K, Miyashita M. Association between experiences of advanced cancer patients at the end of life and depression in their bereaved caregivers. Psychooncology 2022; 31:1243-1252. [DOI: 10.1002/pon.5915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Yutaka Hatano
- Department of Palliative Care Daini Kyoritsu Hospital Kawanishi Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division Seirei Mikatahara General Hospital Hamamatsu Japan
| | - Masanori Mori
- Palliative Care Team Seirei Mikatahara General Hospital Hamamatsu Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences Tohoku University Graduate School of Medicine Sendai Japan
| | - Saran Yoshida
- Graduate School of Education, Tohoku University Sendai Japan
| | - Koji Amano
- Department of Palliative Medicine National Cancer Center Hospital Tokyo Japan
| | | | - Kiyofumi Oya
- Department of Palliative and Transitional Care Aso Iizuka Hospital Iizuka Japan
| | | | - Yusuke Hiratsuka
- Department of Palliative Medicine Tohoku University School of Medicine Sendai Japan
- Department of Palliative Medicine Takeda General Hospital Aizu Wakamatsu Japan
| | - Maeda Isseki
- Department of Palliative Care Senri‐chuo Hospital Toyonaka Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Yasuo Shima
- Tsukuba Medical Center Foundation, Home Care Service, Tsukuba Medical Center Hospital, Department of Palliative Medicine Tsukuba Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences Tohoku University Graduate School of Medicine Sendai Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences Tohoku University Graduate School of Medicine Sendai Japan
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19
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Kustanti CY, Chu H, Kang XL, Huang TW, Jen HJ, Liu D, Shen Hsiao ST, Chou KR. Prevalence of grief disorders in bereaved families of cancer patients: A meta-analysis. Palliat Med 2022; 36:305-318. [PMID: 34965780 DOI: 10.1177/02692163211066747] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cancer caregiving is a distressing experience and loss of a loved one can lead to intense grief and other adverse effects. However, the prevalence of grief disorders among families associated with cancer-related deaths remains unknown. AIM This study aimed to determine the prevalence of grief disorders among families of patients with cancer to better inform clinicians, researchers, and policymakers. DESIGN Meta-analysis, PROSPERO number CRD42020209392. DATA SOURCES The databases of CINAHL, Embase, MEDLINE, PubMed, Scopus, PsycINFO, and Web of Science were comprehensively searched with no language restrictions. The quality of included studies was assessed with Hoy's criteria. RESULTS Among the 3046 records screened, 19 studies were eligible for meta-analysis, with a total of 14,971 participants. The pooled prevalence rate of grief disorders was estimated at 14.2% (95% CI, 11.7%-16.7%), ranging from 7% to 39%. The prevalence was higher in females (10%; 95% CI, 8.2%-12.1%), those who are religious (9.55%; 95% CI, 8.97%-10.16%), spouses of the deceased (7.78%; 95% CI, 6.08%-9.69%), and families of patients with neurological cancers (6.4%; 95% CI, 0.10%-19.9%). Educational levels, study locations, diagnosis tools, time post-after loss, and study methods seemed not to affect the prevalence of grief disorders in families of patients with cancer. CONCLUSIONS As the prevalence of grief disorders in cancer-related bereavement is substantial, therefore, support including palliative care is important to reduce the burden of caregiving. In addition, future studies are needed to identify and explore effective strategies that can help reduce the burden caused by grief disorders after the death of the patient.
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Affiliation(s)
- Christina Yeni Kustanti
- School of Nursing, College of Nursing, Taipei Medical University, Taipei.,Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum, Yogyakarta, Indonesia
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei.,Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei.,School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Tsai-Wei Huang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei.,Cochrane Taiwan, Taipei Medical University, Taipei
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei.,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei.,Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Shu-Tai Shen Hsiao
- School of Nursing, College of Nursing, Taipei Medical University, Taipei.,Department of Nursing, Taipei Medical University Hospital, Taipei
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei.,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei
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20
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Reply to K. Kajiwara et al. concerning “Caregiver bereavement outcomes in advanced cancer: associations with quality of death and patient age”. Support Care Cancer 2022; 30:2903-2904. [DOI: 10.1007/s00520-022-06843-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
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21
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Peña-Vargas C, Armaiz-Peña G, Castro-Figueroa E. A Biopsychosocial Approach to Grief, Depression, and the Role of Emotional Regulation. Behav Sci (Basel) 2021; 11:110. [PMID: 34436100 PMCID: PMC8389251 DOI: 10.3390/bs11080110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 12/27/2022] Open
Abstract
According to the field of affective neuroscience, grief has been identified as one of the seven primary emotions necessary for human survival. However, maladaptive grief could cause significant impairment in an individual's life, leading to psychopathologies such as major depressive disorder. Research on grief has shifted to a biopsychosocial approach, leaving behind outdated models-such as the Kübler-Ross theory-that have shown poor consistency. The field of psychoneuroimmunology has identified adverse life events such as social loss as being associated with major depressive disorder, and inflammatory processes in chronic health conditions. Likewise, scientists in the field of affective neuroscience have theorized that prolonged and sustained activation of the grief neurological pathway can cause a cascade of neurotransmitters that inhibits the reward-seeking system, causing symptoms of depression. The objective of this review is to highlight findings on the grief process using a biopsychosocial approach to explore grief's impact on psychopathophysiology.
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Affiliation(s)
- Cristina Peña-Vargas
- Ponce’s Research Institute, Ponce Health Sciences University, Ponce, PR 00716, USA
| | | | - Eida Castro-Figueroa
- School of behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, PR 00716, USA;
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22
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Shimizu Y, Hayashi A, Maeda I, Miura T, Inoue A, Takano M, Aoyama M, Matsuoka YJ, Morita T, Kizawa Y, Tsuneto S, Shima Y, Masukawa K, Miyashita M. Changes in depressive symptoms among family caregivers of patients with cancer after bereavement and their association with resilience: A prospective cohort study. Psychooncology 2021; 31:86-97. [PMID: 34343380 PMCID: PMC9292523 DOI: 10.1002/pon.5783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
Objectives To elucidate changes in depressive symptoms after bereavement and the impact of pre‐loss resilience on such changes and on the extent of complicated grief and posttraumatic growth. Methods Prospective cohort surveys were provided to family caregivers of patients with cancer in four palliative care units (PCUs) before and after bereavement. Pre‐loss Connor–Davidson Resilience Scale scores, pre‐ and post‐loss Patient Health Questionnaire‐9 scores, post‐loss Brief Grief Questionnaire scores, and the expanded Posttraumatic Growth Inventory scores were determined. Results Out of 186 bereaved family caregivers, 71 (38.2%) responses were analyzed, among which 47% pre‐loss and 15% post‐loss responses suggested to be a high risk for major depressive disorder (MDD). Approximately 90% of family caregivers at a high risk for post‐loss MDD were already at a high risk for pre‐loss MDD. Even after adjustment of the background variables as covariates, the interaction effect between family caregivers' pre‐loss depressive symptoms and resilience on post‐loss depressive symptoms was observed (F = 7.29; p < 0.01). Moreover, pre‐loss resilience was not associated with other bereavement outcome measures. Conclusions Among family caregivers of patients with cancer in PCUs, 47% and 15% had high risk for MDD before and after bereavement, respectively. Moreover, pre‐loss resilience mitigated post‐loss depressive symptoms among family caregivers who had high risk for MDD before bereavement. However, considering the study's small sample size, further research is needed.
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Affiliation(s)
- Yoichi Shimizu
- Department of Nursing, National Cancer Center Hospital, Tokyo, Japan.,Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akitoshi Hayashi
- Department of Palliative Care, St. Luke's International Hospital, Tokyo, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mayuko Takano
- Department of Nursing, St. Luke's International Hospital, Tokyo, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yutaka J Matsuoka
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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23
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Wu EX, Collins A, Briggs S, Stajduhar KI, Kalsi A, Hilliard N. Prolonged Grief and Bereavement Supports Within a Caregiver Population Who Transition Through a Palliative Care Program in British Columbia, Canada. Am J Hosp Palliat Care 2021; 39:361-369. [PMID: 34259023 PMCID: PMC8847765 DOI: 10.1177/10499091211030442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the prevalence of prolonged grief disorder (PGD), and self-reported resilience among bereaved caregivers within a palliative care program that serves a large region of the Lower Mainland in British Columbia, Canada. Additionally, to discern effective bereavement supports utilized by caregivers following the loss of a loved one. METHODS A descriptive study using both quantitative and qualitative methods. Sociodemographic information (n = 427) was collected from bereaved caregivers 3 months after their loss. PGD and resilience were prospectively assessed 12 months post-loss using the prolonged grief scale (PG-13, n = 212) and brief resilience scale (BRS, n = 215), respectively. A qualitative thematic analysis was conducted on responses to the open-ended question on what bereavement services or activities caregivers found helpful in coping with the loss of a loved one. RESULTS Of the 212 individuals that completed the PG-13, 4.7% met diagnostic criteria for PGD, 27.4% were moderate risk, and 67.9% were low risk for PGD. Of the 215 caregivers that completed the BRS, 48.4% had low resilience, 51.6% had normal resilience, and 0% had high resilience. The major themes of formal supports, informal supports, and self-care activities emerged from caregiver comments regarding effective bereavement supports. CONCLUSION The incidence of PGD in caregivers is low within the Fraser Health Palliative Care program. Bereaved caregivers mainly utilize existing social networks and activities to cope with their loss. Focusing on a community-based approach to supports may improve bereavement experiences and lower rates of prolonged grief.
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Affiliation(s)
- Elizabeth X Wu
- Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Collins
- Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Palliative Medicine, Fraser Health Authority, British Columbia, Canada
| | - Shelley Briggs
- Department of Palliative Medicine, Fraser Health Authority, British Columbia, Canada
| | - Kelli I Stajduhar
- School of Nursing & Institute on Aging and Lifelong Health, University of Victoria, British Columbia, Canada
| | - Asha Kalsi
- Health Information Science University of Victoria, Victoria, British Columbia, Canada
| | - Neil Hilliard
- Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Palliative Medicine, Fraser Health Authority, British Columbia, Canada
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Pan H, Chen Z. Cultural capital and mediatory role of meaning-making in post-bereavement depression among older adults in rural China. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01819-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Leplus-Habeneck J, Kirakosyan V, Fasse L, Soulié O. Le processus du deuil, du normal au pathologique : une observation clinique pour présenter le référentiel AFSOS à destination des soignants. PSYCHO-ONCOLOGIE 2021. [DOI: 10.3166/pson-2021-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Le deuil est un processus naturel réactionnel à la perte d’un être cher. Il s’agit d’un phénomène psychique complexe tributaire de facteurs tant socioculturels qu’individuels. Un groupe de travail a élaboré un référentiel AFSOS à l’usage des soignants dans le but d’aider à mieux appréhender les dynamiques de ce processus et de savoir distinguer les deuils « normaux » des deuils compliqués. Une situation clinique nous permettra d’observer les différents facteurs de vulnérabilité et de protection impliqués au cours de l’évolution complexe d’un deuil. Nous proposerons des pistes de réflexion et d’action d’aide à l’accompagnement des endeuillés.
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26
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El-Jawahri A, Greer JA, Park ER, Jackson VA, Kamdar M, Rinaldi SP, Gallagher ER, Jagielo AD, Topping CEW, Elyze M, Jones B, Temel JS. Psychological Distress in Bereaved Caregivers of Patients With Advanced Cancer. J Pain Symptom Manage 2021; 61:488-494. [PMID: 32882355 PMCID: PMC7914132 DOI: 10.1016/j.jpainsymman.2020.08.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 12/23/2022]
Abstract
CONTEXT Individuals caring for patients with advanced cancer (caregivers) experience psychological distress during the patient's illness course. However, data on the prevalence of bereaved caregivers' psychological distress and its relationship with the quality of patient's end of life (EOL) care are limited. OBJECTIVES To describe rates of depression and anxiety symptoms in bereaved caregivers of patients with advanced cancer and to understand the relationship between these outcomes and patient distress at the EOL. METHODS We conducted a secondary analysis of 168 caregivers enrolled in a supportive care trial for patients with incurable lung and gastrointestinal cancers and their caregivers. We used the Hospital Anxiety and Depression Scale to assess caregivers' depression and anxiety symptoms at three months after the patient's death. Caregivers also rated the patient's physical and psychological distress in the last week of life on a 10-point scale three months after the patient death. We used linear regression adjusting for caregiver age, sex, randomization, and cancer type to explore the relationship between bereaved caregivers' depression and anxiety symptoms and their ratings of physical and psychological distress in patients at the EOL. RESULTS Of the 168 bereaved caregivers, 30.4% (n = 51) and 43.4% (n = 73) reported clinically significant depression and anxiety symptoms, respectively. Caregiver ratings of worse physical (B = 0.32; P = 0.009) and psychological (B = 0.50; P < 0.001) distress experienced by the patient at the EOL were associated with worse depression symptoms in bereaved caregivers. Only caregiver rating of worse psychological distress experienced by the patient at the EOL (B = 0.42; P < 0.001) was associated with worse bereaved caregivers' anxiety symptoms. CONCLUSION Many bereaved caregivers of patients with advanced cancer experience symptoms of depression and anxiety, which are associated with their perceptions of distress in their loved ones at the EOL.
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Affiliation(s)
- Areej El-Jawahri
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - Joseph A Greer
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Elyse R Park
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Vicki A Jackson
- Harvard Medical School, Boston, Massachusetts, USA; Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mihir Kamdar
- Harvard Medical School, Boston, Massachusetts, USA; Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Simone P Rinaldi
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily R Gallagher
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Annemarie D Jagielo
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Carlisle E W Topping
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Madeleine Elyze
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Bailey Jones
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
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Igarashi N, Aoyama M, Ito M, Nakajima S, Sakaguchi Y, Morita T, Shima Y, Miyashita M. Comparison of two measures for Complicated Grief: Brief Grief Questionnaire (BGQ) and Inventory of Complicated Grief (ICG). Jpn J Clin Oncol 2021; 51:252-257. [PMID: 33125072 DOI: 10.1093/jjco/hyaa185] [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: 05/27/2020] [Accepted: 09/16/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE No prior studies have used a single sample of bereaved families of cancer patients to compare multiple scales for assessing Complicated Grief. Here, we compare the two measures. METHODS We sent a questionnaire to the bereaved families of cancer patients who had died at 71 palliative care units nationwide. RESULTS The analysis included 3173 returned questionnaires. Prevalence of Complicated Grief was 7.8% by Brief Grief Questionnaire (with a cutoff score of 8) and 15.5% for Inventory of Complicated Grief (with a cutoff score of 26). The Spearman's correlation coefficient between the Brief Grief Questionnaire and the Inventory of Complicated Grief was 0.79, and a ceiling effect was seen for the distribution of the Brief Grief Questionnaire scores. Although 6.4% of respondents scored both 8 or higher on the Brief Grief Questionnaire and 26 or higher on the Inventory of Complicated Grief, only 1.4% scored both 8 or higher on the Brief Grief Questionnaire and <26 on the Inventory of Complicated Grief. In contrast, 9.1% scored <8 on the Brief Grief Questionnaire but 26 or higher on the Inventory of Complicated Grief. CONCLUSION The prevalence of Complicated Grief was estimated to be higher by the Inventory of Complicated Grief than by the Brief Grief Questionnaire in this sample. Patients with severe Complicated Grief might be difficult to discriminate their intensity of grief by the Brief Grief Questionnaire. Once the diagnostic criteria of Complicated Grief are established, further research, such as optimization of cutoff points and calculations of sensitivity and specificity, will be necessary.
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Affiliation(s)
- Naoko Igarashi
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Masaya Ito
- National Center of Neurology and Psychiatry, National Center for Cognitive Behavior Therapy and Research, Tokyo, Japan
| | - Satomi Nakajima
- Department of Human Scienecs, Musashino University, Tokyo, Japan
| | - Yukihiro Sakaguchi
- Department of Holistic Human Sciences, School of Human Welfare Studies, Kwansei Gakuin University, Hyogo, Japan
| | - Tatsuya Morita
- Palliative Care Team, Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Yasuo Shima
- Department of Palliative, Tsukuba Medical Center Foundation, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
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28
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Buck HG, Lyons K, Barrison P, Cairns P, Mason T, Tofthagen C, Kip K. Caregivers' Loss of the Dyadic Experience after Their Care Partners' Death. West J Nurs Res 2021; 44:133-140. [PMID: 33514300 DOI: 10.1177/0193945921990426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about the experience of family caregivers when their care partner dies and their dyadic relationship comes to an end. This study qualitatively examined and characterized the loss of the dyadic experience for the caregiver after the death of their care partner. Data was accrued as part of a randomized clinical trial in 29 older hospice caregivers. Iterative thematic analysis focused on dyadic processes before, during and post death. Using two relational parameters from Relational Turbulence Theory resulted in a preliminary characterization of a new concept-dyadic dissolution as a cognitive and affective process whereby a remaining member of a dyad experiences relational uncertainty and partner interference while adapting (or not) to the death of their care partner. Findings suggest that asking several open-ended questions about the dyadic relationship will enable assessment for any continuing impact of relational uncertainty and partner interference on bereaved caregivers.
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Affiliation(s)
| | | | | | | | - Tina Mason
- H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | | | - Kevin Kip
- University of South Florida, Tampa, FL, USA
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29
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Bell JM, Mason TM, Buck HG, Tofthagen CS, Duffy AR, Groër MW, McHale JP, Kip KE. Challenges in Obtaining and Assessing Salivary Cortisol and α-Amylase in an Over 60 Population Undergoing Psychotherapeutic Treatment for Complicated Grief: Lessons Learned. Clin Nurs Res 2020; 30:680-689. [PMID: 33218253 DOI: 10.1177/1054773820973274] [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: 11/15/2022]
Abstract
Biomarkers may serve as objective measures in complicated grief (CG) potentially capturing responses to stress reduction treatment. This paper reports challenges in obtaining and assessing salivary cortisol and α-amylase (sAA) for a recent randomized clinical trial. Within-session changes in salivary cortisol and sAA for 54 older adults with CG who received Accelerated Resolution Therapy were compared with perceived stress measured by Subjective Units of Distress Scale. Bivariate correlations and multiple regressions examined changes in biomarkers. Protocols, study logs, and audit reports identified challenges. Challenges included obtaining unstimulated passive drool salivary samples and their analyses. Our sample of older females on multiple medications may have resulted in a perfect storm of moderating and intervening variables which affected the stress response. This paper contributes to the discussion on designing clinical trials for older adults which must account for physiologic changes, multimorbidity, and polypharmacy common in this population and makes recommendations moving forward.
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Affiliation(s)
- Jesse M Bell
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Tina M Mason
- College of Nursing, University of South Florida, and Department of Nursing Research, Moffitt Cancer Center, Tampa, FL, USA
| | - Harleah G Buck
- College of Nursing, University of South Florida, Tampa, FL, USA
| | | | - Allyson R Duffy
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Maureen W Groër
- College of Nursing and Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - James P McHale
- Department of Psychology, USF St. Petersburg Family Study Center, University of South Florida, Tampa, FL, USA
| | - Kevin E Kip
- Health Services Division, Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
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30
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Digital Monitoring of Sleep, Meals, and Physical Activity for Reducing Depression in Older Spousally-Bereaved Adults: A Pilot Randomized Controlled Trial. Am J Geriatr Psychiatry 2020; 28:1102-1106. [PMID: 32265094 PMCID: PMC7483357 DOI: 10.1016/j.jagp.2020.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate the feasibility and acceptability of a behavioral intervention and explore its impact on depression symptom burden among older spousally-bereaved adults. METHODS Participants were age ≥60 years, bereaved ≤8 months, and at high risk for depression. Participants were randomized to 12 weeks of digital monitoring of sleep, meals, and physical activity; digital monitoring plus health coaching; or enhanced usual care and followed for 9 months for new-episode depression. RESULTS We enrolled 57 participants, 85% of eligible adults and 38% of all adults screened. We observed high levels of adherence in both digital monitoring (90%) and health coaching (92%); 88% of participants were retained. In linear mixed-effects models, depression symptoms significantly decreased, but the interaction between time and intervention was not significant. CONCLUSION A behavioral intervention that uses both digital monitoring and motivational health coaching is feasible and acceptable to older bereaved adults.
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31
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Axelsson L, Alvariza A, Holm M, Årestedt K. Intensity of Predeath Grief and Postdeath Grief of Family Caregivers in Palliative Care in Relation to Preparedness for Caregiving, Caregiver Burden, and Social Support. Palliat Med Rep 2020; 1:191-200. [PMID: 34223476 PMCID: PMC8241336 DOI: 10.1089/pmr.2020.0033] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The intensity of predeath grief is associated with postdeath grief in family caregivers of patients in palliative care. Different factors during caregiving may influence this association. Objective: To examine (1) the intensity of grief in relation to preparedness for caregiving, caregiver burden, and social support, and (2) if these variables moderate associations between predeath and postdeath grief. Methods: This prospective correlational study used unpaired t-test to compare grief in relation to preparedness for caregiving, caregiver burden, and social support. Hierarchical multiple linear regression analysis investigated moderation effects. Family caregivers were recruited from 10 palliative homecare facilities. The Anticipatory Grief Scale, Texas Revised Inventory of Grief, Preparedness for Caregiving Scale, Caregiver Burden Scale, and Multidimensional Scale of Perceived Social Support were used. Ethical approval for the study was granted by the Regional Ethical Review Board in Stockholm, Sweden. Results: In total, 128 family caregivers participated. Those with high caregiver burden scored significantly higher intensity of predeath but not postdeath grief. Caregiver burden and social support moderated the association between intensity of predeath grief and postdeath grief. There was a stronger association between predeath and postdeath grief among caregivers with low caregiver burden or low social support. Preparedness for caregiving had no moderating effect. Discussion: Attention should be directed to caregiver burden and social support during family caregiving, as these variables seem to be significant for the intensity of grief before and after the patient's death. Acknowledging predeath grief during caregiving and recognizing pre- and postdeath grief as parts of the same process are of importance in clinical practice and when designing supportive interventions.
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Affiliation(s)
- Lena Axelsson
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Maja Holm
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,The Research Section, Region Kalmar County, Kalmar, Sweden
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32
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Hamano J, Morita T, Igarashi N, Shima Y, Miyashita M. The association of family functioning and psychological distress in the bereaved families of patients with advanced cancer: a nationwide survey of bereaved family members. Psychooncology 2020; 30:74-83. [PMID: 32881126 DOI: 10.1002/pon.5539] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/31/2020] [Accepted: 08/25/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Family conflict and family functioning were regarded as changeable factors associated with complicated grief (CG) and major depressive disorder (MDD) in the bereaved families of patients with advanced cancer, although the evidence is limited. We explored the family functioning associated with CG and MDD developing either independently or co-morbidly in the bereaved families of patients with advanced cancer who died in palliative care units (PCUs). METHODS This study comprised a nationwide cross-sectional questionnaire survey of bereaved family members of cancer patients who died in Japanese PCUs participating in evaluation of the quality of end-of-life care. RESULTS A total of 529 questionnaires (69.2%) were returned, and we analyzed a total of 458 responses. A total of 14.2% of participants were considered as having CG, 22.5% as having moderate to severe depression, and 9.6% as having co-morbid symptoms. Multivariate logistic regression analysis revealed that many family members insulted or yelled at one another (odd ratio [OR]: 2.99, p = 0.046; OR:2.57, p = 0.033), and conflict regarding what is meant by a good death (OR:3.60, p = 0.026; OR:4.06, p = 0.004) was significantly positively associated with CG, MDD, and co-morbid symptom. CONCLUSIONS Specific family conflicts may increase the incidence of CG, MDD, and co-morbid symptoms in the bereaved families of patients with advanced cancer. Our results may encourage health care providers to approach discussions about end-of-life issue with the patient and their family in advance, especially focusing on what is considered a good death for the patient, which may prevent or resolve the family conflict.
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Affiliation(s)
- Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tatsuya Morita
- Palliative Care Team, Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamtsu, Shizuoka, Japan
| | - Naoko Igarashi
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yasuo Shima
- Hospice Palliative Care Japan, Ashigarakami, Kanagawa, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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33
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Ghesquiere A, Bagaajav A, Ito M, Sakaguchi Y, Miyashita M. Investigating associations between pain and complicated grief symptoms in bereaved Japanese older adults. Aging Ment Health 2020; 24:1472-1478. [PMID: 31002011 DOI: 10.1080/13607863.2019.1594166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: About 10% of those who lose a loved one in hospice or palliative care settings will experience a mental health condition characterized by severe, prolonged grief responses. Criteria for this condition have evolved; we refer to this condition as Complicated Grief (CG) because it is one of the more common names. While there are some indications of associations between CG and poor physical health, explorations of the association between CG and pain is limited. The main objective of this study was to explore whether pain levels are higher in those with CG than those without, using a large population-based samples of Japanese older adults.Method: The study analyzed data from the Japan HOspice and Palliative care Evaluation (J-HOPE) study, a cross sectional study conducted in 2008 that examined the experiences and outcomes among adults throughout Japan who had lost a loved one within a palliative department or hospice setting, via self-report survey. We examined a subsample sample of 324 individuals aged 50 and above who completed a measure of CG.Results: Family members with high pain group had statistically significantly higher CG symptoms than those with low pain group (M = 66.95 vs. M = 52.05), an association which remained when controlling for demographic and loss-related factors.Conclusion: We found preliminary evidence of an association between CG symptoms and pain, which should be explored in additional samples. Should this finding be replicated, the mechanism of this association could be explored and treatment could potentially address both CG and pain.
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Affiliation(s)
- Angela Ghesquiere
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, New York, USA
| | - Ariunsanaa Bagaajav
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, New York, USA
| | - Masaya Ito
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, New York, USA
| | - Yukihiro Sakaguchi
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, New York, USA
| | - Mitsunori Miyashita
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, New York, USA
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34
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Raggi A, Leonardi M, Mellor-Marsá B, Moneta MV, Sanchez-Niubo A, Tyrovolas S, Giné-Vázquez I, Haro JM, Chatterji S, Bobak M, Ayuso-Mateos JL, Arndt H, Hossin MZ, Bickenbach J, Koskinen S, Tobiasz-Adamczyk B, Panagiotakos D, Corso B. Predictors of pain in general ageing populations: results from a multi-country analysis based on ATHLOS harmonized database. J Headache Pain 2020; 21:45. [PMID: 32375641 PMCID: PMC7201730 DOI: 10.1186/s10194-020-01116-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/24/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people, and with increasing trends in general populations. Different risk factors for pain have been identified, but generally from studies with limited samples and a limited number of candidate predictors. The aim of this study is to evaluate the predictors of pain from a large set of variables and respondents. METHODS We used part of the harmonized dataset of ATHLOS project, selecting studies and waves with a longitudinal course, and in which pain was absent at baseline and with no missing at follow-up. Predictors were selected based on missing distribution and univariable association with pain, and were selected from the following domains: Socio-demographic and economic characteristics, Lifestyle and health behaviours, Health status and functional limitations, Diseases, Physical measures, Cognition, personality and other psychological measures, and Social environment. Hierarchical logistic regression models were then applied to identify significant predictors. RESULTS A total of 13,545 subjects were included of whom 5348 (39.5%) developed pain between baseline and the average 5.2 years' follow-up. Baseline risk factors for pain were female gender (OR 1.34), engaging in vigorous exercise (OR 2.51), being obese (OR 1.36) and suffering from the loss of a close person (OR 1.88) whereas follow-up risk factors were low energy levels/fatigue (1.93), difficulties with walking (1.69), self-rated health referred as poor (OR 2.20) or average to moderate (OR 1.57) and presence of sleep problems (1.80). CONCLUSIONS Our results showed that 39.5% of respondents developed pain over a five-year follow-up period, that there are proximal and distal risk factors for pain, and that part of them are directly modifiable. Actions aimed at improving sleep, reducing weight among obese people and treating fatigue would positively impact on pain onset, and avoiding vigorous exercise should be advised to people aged 60 or over, in particular if female or obese.
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Affiliation(s)
- Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Blanca Mellor-Marsá
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
| | - Maria V Moneta
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
| | - Albert Sanchez-Niubo
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Stefanos Tyrovolas
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Iago Giné-Vázquez
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Josep M Haro
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Somnath Chatterji
- Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Martin Bobak
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Jose L Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | | | - Muhammad Z Hossin
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Jerome Bickenbach
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Seppo Koskinen
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Beata Tobiasz-Adamczyk
- Department of Epidemiology and Population Studies, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Barbara Corso
- National Research Council, Neuroscience Institute, Padova, Italy
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Ting A, Lucette A, Carver CS, Cannady RS, Kim Y. Preloss Spirituality Predicts Postloss Distress of Bereaved Cancer Caregivers. Ann Behav Med 2020; 53:150-157. [PMID: 30052710 DOI: 10.1093/abm/kay024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Although spirituality has been identified as a psychological resource relevant to coping with caregiving stress, little is known about the differential roles of spirituality's facets in bereaved caregivers' adjustment. Purpose This study examined this question with regard to bereavement-specific and general distress in cancer caregivers. Methods Cancer caregivers provided data at 2 years after their relative's diagnosis when all the patients were alive (Time 1, preloss) and 3 years later, after the patient had died (Time 2, postloss: N = 128). Demographics and three facets of spirituality (meaning, peace, and faith) were measured at Time 1. Psychological distress and time since the death were measured at Time 2. Results Younger age, less education, and being a spousal caregiver of the patient related to greater bereavement-specific and general distress (ts ≥ 2.02, ps < .05, partial η2 ≥ .15). Above and beyond these demographic factors, two preloss spirituality facets related to postloss distress. Specifically, a greater sense of inner peace at preloss was prospectively associated with less bereavement-specific distress (both intrusive thoughts and hyperarousal, ts ≥ 2.24, ps < .05, partial η2 ≥ .41). Greater reliance on faith at preloss was also prospectively associated with lower intrusive thoughts (t = 2.24, p < .05, partial η2 = .34). Conclusion Findings highlight the importance of preloss sense of peace as a predictor of psychological distress during bereavement. Programs and interventions might be designed to help caregivers find inner peace while caregiving, in an effort to augment their resiliency against psychological distress when facing the loss of the patient.
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Affiliation(s)
- Amanda Ting
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Aurelie Lucette
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Charles S Carver
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Youngmee Kim
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Mason TM, Tofthagen CS, Buck HG. Complicated Grief: Risk Factors, Protective Factors, and Interventions. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2020; 16:151-174. [PMID: 32233740 DOI: 10.1080/15524256.2020.1745726] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Complicated grief (CG) poses significant physical, psychological, and economic risks to bereaved family caregivers. An integrative review of the literature published 2009-2018 on CG associated with caregiving was performed using PubMed, PsychINFO, and Web of Science. The search returned 1428 articles, of which 32 were included in the review. Sixteen studies described risk and protective factors and 16 described interventions for CG. Caregiver-related risk factors included fewer years of education, depression, anxiety, poor physical health, and maladaptive dependency and attachment traits. Additional risk factors included lower perceived social support, family conflict at end-of-life, and family having difficulty accepting death. Care recipient-related risk factors are younger age, fear of death, and place of death. Protective factors included hospice utilization in reducing fear of death, high pre-bereavement spiritualty, and satisfaction with palliative care. Complicated grief treatment was the most widely-studied intervention. Social Workers and other clinicians can use this information to identify family caregivers at increased risk for CG and refer or implement an early intervention to lessen its impact.
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Affiliation(s)
- Tina M Mason
- College of Nursing, University South Florida, Tampa, Florida, USA
| | | | - Harleah G Buck
- College of Nursing, University South Florida, Tampa, Florida, USA
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Abstract
Family caregivers provide substantial care for patients with advanced cancer, while suffering from hidden morbidity and unmet needs. The objectives of this review were to examine risk factors associated with caregiving for patients with advanced cancer, evaluate the evidence for pertinent interventions, and provide a practical framework for palliative care of caregivers in oncology settings. We reviewed studies examining the association of factors at the level of the caregiver, patient, caregiver-patient relationship, and caregiving itself, with adverse outcomes. In addition, we reviewed randomized controlled trials of interventions targeting the caregiver, the caregiver-patient dyad, or the patient and their family. Risk factors for adverse mental health outcomes included those related to the patient's declining status, symptom distress, and poor prognostic understanding; risk factors for adverse bereavement outcomes included unfavorable circumstances of the patient's death. Among the 16 randomized trials, the most promising results showed improvement of depression resulting from early palliative care interventions; results for quality of life were generally nonsignificant or showed an effect only on some subscales. Caregiving outcomes included burden, appraisal, and competence, among others, and showed mixed findings. Only three trials measured bereavement outcomes, with mostly nonsignificant results. On the basis of existent literature and our clinical experience, we propose the CARES framework to guide care for caregivers in oncology settings: Considering caregivers as part of the unit of care, Assessing the caregiver's situation and needs, Referring to appropriate services and resources, Educating about practical aspects of caregiving, and Supporting caregivers through bereavement. Additional trials are needed that are powered specifically for caregiver outcomes, use measures validated for advanced cancer caregivers, and test real-world interventions.
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Affiliation(s)
- Sorayya Alam
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Breffni Hannon
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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Breen LJ, Aoun SM, O'Connor M, Johnson AR, Howting D. Effect of caregiving at end of life on grief, quality of life and general health: A prospective, longitudinal, comparative study. Palliat Med 2020; 34:145-154. [PMID: 31659934 DOI: 10.1177/0269216319880766] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Determining the effect of caregiving and bereavement remains a challenge. To date, no study has employed a comparison group to investigate caregivers' grief, quality of life and general health in relation to non-caregivers. AIM We aimed to determine how caregivers' grief, quality of life and general health changed following death compared to non-caregivers and whether pre-death grief predicted these outcomes. DESIGN A prospective, longitudinal study of family caregivers and a comparison group matched for age, gender and postcode was conducted. All participants completed questionnaires at four points - once pre-death and three times post-death (3-4 months, 6-7 months and 9-10 months). SETTING/PARTICIPANTS Participants (N = 70) were family caregivers of persons receiving palliative care, mostly for cancer, recruited from three palliative care providers in Western Australia and matched comparisons recruited from advertisements. RESULTS There were significant differences between the caregivers' and comparisons' grief, general health and quality of life at pre-death, 3-4 months and 6-7 months post-death, but not at 9-10 months post-death. The rate of progression in these constructs following death was independent from the intensity of pre-death grief. However, caregiver prolonged grief score significantly predicted prolonged grief score at 6-7 and 9-10 months post-death. CONCLUSION It took 9-10 months for the caregivers' grief, general health and quality of life to correspond to the comparison group. These findings present an opportunity for palliative care research and practice to consider how best to support the majority of caregivers without grief complications so that their pre- and post-death support needs are realised.
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Affiliation(s)
- Lauren J Breen
- School of Psychology, Curtin University, Perth, WA, Australia
| | - Samar M Aoun
- Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.,The Perron Institute for Neurological and Translational Science, Perth, WA, Australia
| | - Moira O'Connor
- School of Psychology, Curtin University, Perth, WA, Australia
| | | | - Denise Howting
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia.,Centre for Medical Research, The University of Western Australia, Perth, WA, Australia.,Harry Perkins Institute of Medical Research, Perth, WA, Australia
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Karikawa M, Nakatani H. Development of a home-visit nursing scale for helping spousal caregivers of terminal cancer patients develop positive perspectives of their caregiving experiences: a cross-sectional study. BMJ Open 2019; 9:e031057. [PMID: 31843825 PMCID: PMC6924790 DOI: 10.1136/bmjopen-2019-031057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Home-visit nurses play a key role in supporting the spouses of terminal cancer patients and encouraging positive perspectives of the caregiving experience. This study aimed to develop a scale to support nurses in self-assessing their practice around this important role. DESIGN Cross-sectional questionnaire study. SETTING The Home Nursing Scale to Help Spousal Caregivers (HNS-HSC) questionnaire for self-assessment of home-visit nursing to spouses was developed based on interviews with spouses and literature reviews. PARTICIPANTS Overall, 1500 home-visit nurses nationwide who had experience in supporting spousal caregivers and their patients in the predeath and postdeath periods were approached for participation. MAIN OUTCOME MEASURE Planned exploratory and confirmatory factor analyses were used to assess the underlying dimensions of the HNS-HSC; Cronbach's α was used to determine the reliability. The Japanese version of Frommelt Attitude Toward Care of the Dying Scale Form B (FAT-COD-B-J) and Grief Care scale were administered to assess convergent and discriminant validity. RESULTS Exploratory and confirmatory factor analyses identified 26 items on five factors: 'helping spouses plan their futures' 'helping caregivers alleviate any regrets regarding their care', 'understanding the bond between a couple', 'providing support for anticipatory grief', and 'addressing spousal caregivers' emotions after their spouses' deaths'. The final model showed acceptable goodness-of-fit indices. The Cronbach's α for the entire scale was 0.949 and exceeded 0.822 for each factor. The correlation coefficient with the FAT-COD-B-J, which served as an external validation, was 0.35. The correlation coefficients for the three grief care scales were 0.64, 0.45 and 0.72, respectively. CONCLUSIONS This scale is a reliable and valid tool for visiting nurses to self-assess their knowledge, skills and practice around helping spousal caregivers. By using this scale, it is expected to change nursing practice in pursuit of improving quality of life of spouses.
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Affiliation(s)
- Mari Karikawa
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hisae Nakatani
- Graduate School of Biomedical & Health Sciences,Division of Nursing Science, Hiroshima University, Hiroshima, Japan
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Choi J, Son YJ, Tate JA. Exploring positive aspects of caregiving in family caregivers of adult ICU survivors from ICU to four months post-ICU discharge. Heart Lung 2019; 48:553-559. [DOI: 10.1016/j.hrtlng.2019.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/02/2019] [Accepted: 09/05/2019] [Indexed: 10/26/2022]
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Abstract
Grieving is a normal reaction to loss; however, not everyone is able to recover from grief and adjust to a life after the loss. "Complicated grief" (CG) is a term used to describe intense and prolonged bereavement after the loss of a loved one that interferes with normal activities accompanied by destructive thoughts and behaviors. In practice and research, the concept of CG varies in definition and instruments used to measure. This concept analysis examines relevant research related to CG experienced by caregivers to provide a clear, comprehensive definition. Implications for nursing practice and research are explored.
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Limonero JT, Maté-Méndez J, Mateo D, Gómez-Romero MJ, González-Barboteo J, Cladellas R, Ferris FD, Gómez-Batiste X. Caregiver emotional distress: external open-behaviour signs. BMJ Support Palliat Care 2019; 12:e585-e591. [PMID: 31239258 DOI: 10.1136/bmjspcare-2019-001774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/02/2019] [Accepted: 05/29/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine whether specific external signs of emotional distress (ESED) can be an indirect measure of emotional distress in caregivers. METHODS A cross-sectional multicentre design was used. 148 primary caregivers of advanced cancer patients attended in four Spanish palliative care units participated in this study. The emotional distress of caregivers was measured using both the Emotional Distress of Caregivers Scale and a psychological interview. Health professionals collected data using a standard clinical interview process after a brief training period. RESULTS More than half the caregivers (60%) presented with emotional distress. A positive correlation (r=0.566) was found between the intensity of ESED and emotional distress per se. Caregivers who presented emotional distress showed more ESED than those that did not (p<0.01). The study found significant differences for the categories 'visible signs of sadness, fear, crying, feeling overwhelmed' (p<0.001), 'difficulty in separating from the patient: family refuses to let the patient make decisions and insists on care' (p<0.001) and 'visible signs of anger, irritability or frequent disagreement with therapeutic measures' (p<0.001). No significant differences were found with respect to gender. The set of items to measure these external signs presented an adequate reliability assessed using Cronbach's alpha (α=0.773). CONCLUSIONS The assessment of ESED in caregivers could serve as a useful method to assess their emotional distress. Incorporating the systematic assessment of these external signs as part of the assessment of the emotional distress of primary caregivers could improve the overall assessment and treatment provided to these caregivers.
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Affiliation(s)
- Joaquín T Limonero
- School of Psychology. Stress and Health Research Group, Universitat Autonoma de Barcelona Facultat de Psicologia, Bellaterra, Spain
| | - Jorge Maté-Méndez
- School of Psychology. Stress and Health Research Group, Universitat Autonoma de Barcelona Facultat de Psicologia, Bellaterra, Spain.,Psycho-oncology Care Unit, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Spain
| | - Dolors Mateo
- Palliative Care Unit, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - María José Gómez-Romero
- School of Psychology. Stress and Health Research Group, Universitat Autonoma de Barcelona Facultat de Psicologia, Bellaterra, Spain.,Psychology Unit, Egarsat, Mutua Colaboradora con la Seguridad Social nº 276, Terrassa, Spain
| | | | - Ramon Cladellas
- School of Psychology. Stress and Health Research Group, Universitat Autonoma de Barcelona Facultat de Psicologia, Bellaterra, Spain
| | - Frank D Ferris
- Palliative Medicine, Research & Education, OhioHealth, Columbus, Ohio, USA
| | - Xavier Gómez-Batiste
- The 'Qualy' Observatory. WHO Collaborating Centre for Public Health Palliative Care Programmes, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Spain.,Chair of Palliative Care, University of Vic, Vic, Spain
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Reblin M, Baucom BRW, Clayton MF, Utz R, Caserta M, Lund D, Mooney K, Ellington L. Communication of emotion in home hospice cancer care: Implications for spouse caregiver depression into bereavement. Psychooncology 2019; 28:1102-1109. [PMID: 30883985 DOI: 10.1002/pon.5064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/21/2019] [Accepted: 03/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Family caregivers of cancer hospice patients likely benefit from clinician provision of verbal support and from expression of positive emotions. Our aim was to identify the effects of hospice nurse supportive communication as well as caregiver-nurse exchange of positive emotions on family caregiver depression during bereavement. METHODS This prospective, observational longitudinal study included hospice nurses (N = 58) and family caregivers of cancer patients (N = 101) recruited from 10 hospice agencies in the United States. Digitally recorded nurse home visit conversations were coded using Roter interaction analysis system to capture emotion-focused caregiver-nurse communication and supportive nurse responses. Caregivers completed the Hospital Anxiety and Depression Scale Anxiety Subscale and Geriatric Depression Scale-Short Form at study enrollment and at 2, 6, and 12 months after patient death. RESULTS Caregivers had moderate levels of depression at study enrollment and throughout bereavement. Multilevel modeling revealed that caregiver positive emotion communication and nurse emotional response communication are associated with caregiver depression in bereavement. There was no significant association between caregiver distress communication and depression in bereavement. CONCLUSIONS This is the first study to demonstrate that communication demonstrating emotional expression between cancer spouse caregivers and nurses during home hospice may have implications for caregiver depression up to a year after patient death. Our findings may help identify caregivers who may be coping well in the short term but may struggle more over time.
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Affiliation(s)
- Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Brian R W Baucom
- Department of Psychology, University of Utah, Salt Lake City, Utah
| | | | - Rebecca Utz
- Department of Sociology, University of Utah, Salt Lake City, Utah
| | - Michael Caserta
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Dale Lund
- Department of Sociology, California State University San Bernardino, San Bernardino, California
| | - Kathi Mooney
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah
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Ware OD, Cagle JG. Informal Caregiving Networks for Hospice Patients With Cancer and Their Impact on Outcomes: A Brief Report. Am J Hosp Palliat Care 2019; 36:235-240. [DOI: 10.1177/1049909118792011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This prospective study investigates informal care networks and their impact on hospice outcomes. Primary caregivers (N = 47) were the main source of data from 2 time points: within a week of enrollment in hospice and bereavement. Data were also collected from 42 secondary caregivers. Intraclass correlation coefficients (ICCs) determined correspondence between primary and secondary caregivers regarding informal care network size. Correlations were used to test associations between variables. Nonparametric paired sample tests were used to analyze change in anger and guilt. The ICC found poor correspondence (−0.13) between primary and secondary caregivers’ network descriptions. Correlational analyses found a strong/moderate negative association between quality of dying (QOD) and grief ( r = −0.605, P < .05). Study participants reported increased anger (0.4, P < .05, range 1-5) and guilt (0.4, P < .05, range 1-5), particularly among caregivers with high levels of support. Findings suggest that improving QOD may facilitate postdeath coping for caregivers.
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Affiliation(s)
- Orrin D. Ware
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - John G. Cagle
- University of Maryland School of Social Work, Baltimore, MD, USA
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Romero MM. Meaning Reconstruction in Bereaved Family Caregivers of Person's With Alzheimer's Disease: A Mixed-Methods Study. OMEGA-JOURNAL OF DEATH AND DYING 2018; 82:548-569. [PMID: 30590989 DOI: 10.1177/0030222818821024] [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: 11/15/2022]
Abstract
The purpose of this descriptive study was to identify whether meaning reconstruction was associated with indicators of bereavement adaptation in 66 spouses and adult child caregivers of person's with Alzheimer's disease. A cross-sectional mixed-methods design was used. Hierarchical regression models were used to examine whether meaning making predicted grief, depression, and positive and states of mind in the sample. Qualitative interviews were conducted to gain further knowledge about ways in which Alzheimer's disease caregivers construct meaning during bereavement. The majority of participants reported experiencing positive aspects of meaning reconstruction. Benefit-finding and identity change contributed to reductions in grief, and benefit-finding contributed to positive states of mind. Being a spouse and female gender contributed to increased grief and depression. Bereaved caregivers who are at risk for high levels of grief should be targeted for grief therapy interventions that foster meaning making.
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Cohn J. Advanced serious illness, multimorbidity, and multibeneficence: The role of communication. J Eval Clin Pract 2018; 24:1279-1281. [PMID: 28205360 DOI: 10.1111/jep.12706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 12/19/2016] [Indexed: 12/17/2022]
Abstract
Sturmberg et al write about multimorbidity as "several diagnosable diseases within the same individual." They posit that this syndrome is the result of multiple interconnected disturbances reflecting scale-free, fractal signs of pathology ranging from biochemical/hormonal alterations at one end of a spectrum to community and societal ills at the other. In this commentary, I will be focusing on 3 perspectives: 1) a preterminal phase of multimorbidity that is indicative of that loss of reparative or even homeokinetic properties, known by some as "advanced serious illness"; 2) the manifestations of advanced serious illness multimorbidity that, using the same networks that connect into the patient, are signs of this syndrome at the levels of the immediate family/friend social network, the broader community, and society at large; and 3) the potential for these same networks that transmit pathological forces to convey the positive effects of therapeutic interventions in a scale-free manner, with a focus on how conversation can lead to what I'm calling "multibeneficence."
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Affiliation(s)
- Jeffrey Cohn
- Common Practice, 1227 N. 4th Street, Philadelphia, Pennsylvania, 19122, USA
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Ghesquiere A, Bagaajav A, Metzendorf M, Bookbinder M, Gardner DS. Hospice Bereavement Service Delivery to Family Members and Friends With Bereavement-Related Mental Health Symptoms. Am J Hosp Palliat Care 2018; 36:370-378. [PMID: 30428680 DOI: 10.1177/1049909118812025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES: A sizable minority of those who lose a loved one in hospice will experience symptoms of bereavement-related mental health disorders. Though hospices offer services to bereaved informal caregivers (family members or friends) of patients, little is known about services offered or interest in them. Therefore, we sought to assess services offered by hospice staff and interest expressed by bereaved informal caregivers with symptoms of depression, anxiety, or complicated grief (CG). METHODS: De-identified electronic bereavement care charts of 3561 informal caregivers who lost someone in a large urban metropolitan hospice from October 1, 2015, to June 30, 2016, were reviewed. RESULTS: Of bereaved informal caregivers in the sample, 9.4% (n = 333) were positive for symptoms of depression, anxiety, or CG. The symptom-positive family members/friends were more likely than other family members/friends to be offered mailings, one-to-one counseling, telephone calls, and reference material. However, interest in most services by symptom-positive caregivers was low, with only 6% interested in one-to-one counseling and 7% interested in outside referral. DISCUSSION: The findings suggest that hospices offer a range of services to family members or friends with symptoms of anxiety, depression, and CG, but that there can be a gap between what is offered and in the interest levels of the bereaved. Engagement with symptomatic family members and friends could be enhanced in future work.
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Affiliation(s)
- Angela Ghesquiere
- 1 Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, NY, USA
| | - Ariunsanaa Bagaajav
- 2 Silberman School of Social Work, Hunter College of the City University of New York, New York, NY, USA
| | - Marguerite Metzendorf
- 3 Bereavement and Creative Art Services, MJHS Hospice and Palliative Care, New York, NY, USA
| | | | - Daniel S Gardner
- 2 Silberman School of Social Work, Hunter College of the City University of New York, New York, NY, USA
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Hirooka K, Fukahori H, Taku K, Izawa S, Ogawa A. Posttraumatic growth in bereaved family members of patients with cancer: a qualitative analysis. Support Care Cancer 2018; 27:1417-1424. [DOI: 10.1007/s00520-018-4440-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
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Shen HS, Chen SY, Cheung DST, Wang SY, Lee JJ, Lin CC. Differential Family Experience of Palliative Sedation Therapy in Specialized Palliative or Critical Care Units. J Pain Symptom Manage 2018; 55:1531-1539. [PMID: 29474938 DOI: 10.1016/j.jpainsymman.2018.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/08/2018] [Accepted: 02/11/2018] [Indexed: 11/26/2022]
Abstract
CONTEXT No study has examined the varying family experience of palliative sedation therapy (PST) for terminally ill patients in different settings. OBJECTIVES To examine and compare family concerns about PST use and its effect on the grief suffered by terminally ill patients' families in palliative care units (PCUs) or intensive care units (ICUs). METHODS A total of 154 family members of such patients were recruited in Taiwan, of whom 143 completed the study, with 81 from the PCU and 62 from the ICU. Data were collected on their concerns regarding PST during recruitment. Grief levels were assessed at three days and one month after the patient's death with the Texas Revised Inventory of Grief. RESULTS Families' major concern about sedated patients in the PCU was that "there might be other ways to relieve symptoms" (90.2%), whereas families of ICU sedated patients gave the highest ratings to "feeling they still had something more to do" (93.55%), and "the patient's sleeping condition was not dignified" (93.55%). Family members recruited from the ICU tended to experience more grief than those from the PCU (P = 0.005 at Day 3 and < 0.001 at Month 1). PST use predicted higher levels of grief in family members recruited from the PCU (P < 0.001 at Day 3 and Month 1). CONCLUSION Family experiences with the use of PST in terminally ill patients varied in different settings. Supportive care should address family concerns about PST use, and regular attention should be paid to the grief of individuals at higher risk.
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Affiliation(s)
- Hui-Shan Shen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Szu-Yin Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Respiratory Care Center, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Shu-Yi Wang
- Loretto Heights School of Nursing, Regis University, Denver, Colorado, USA
| | - Jung Jae Lee
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chia-Chin Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong; Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Hong Kong.
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Prevalence and predictors of major depressive disorder in bereaved caregivers at 6 and 13 months. Palliat Support Care 2018; 17:300-305. [PMID: 29806573 DOI: 10.1017/s1478951518000366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Depressive symptoms are common in bereaved caregivers; however, there have been few prospective studies using a structured interview. This study investigated the prevalence and preloss predictors of major depressive disorder (MDD) in bereaved caregivers of patients in a palliative care unit. METHOD This prospective cohort study collected caregiver sociodemographic and psychological data before the death of a palliative care unit patient, including MDD, care-burden, coping style, and hopeful attitude. Postloss MDD was assessed 6 and 13 months after death, and a multivariate logistic regression analysis was conducted to identify its predictors.ResultOf 305 caregivers contacted, 92 participated in this study. The prevalence of preloss MDD was 21.8%; the prevalences of postloss MDD were 34.8% and 24.7% at 6 and 13 months, respectively. Preloss MDD predicted postloss MDD at 6 months (odds ratio [OR] = 5.38, 95% confidence interval [CI95%] = 1.29, 22.43); preloss nonhopeful attitude and unemployment status of caregivers predicted postloss MDD at 13 months (OR = 8.77, CI95% = 1.87, 41.13 and OR = 7.10, CI95% = 1.28, 39.36, respectively).Significance of resultsApproximately 35% of caregivers suffered from MDD at 6 months postloss, but the prevalence of MDD decreased to about 25% at 13 months. Preloss MDD significantly predicted postloss MDD at 6 months, whereas hopeful attitude and unemployment at baseline were significantly associated with postloss MDD at 13 months.
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