1
|
Bottemanne H, English I, Bottemanne L, Torres P, Beauquier B, Joly L. From love to pain: is oxytocin the key to grief complications? L'ENCEPHALE 2024; 50:85-90. [PMID: 37993287 DOI: 10.1016/j.encep.2023.08.006] [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: 10/29/2021] [Revised: 07/20/2023] [Accepted: 08/05/2023] [Indexed: 11/24/2023]
Abstract
While most adults confronted with the death of a loved one manage to grieve, about 10-20% of individuals develop complicated grief, characterized by persistent distress and impaired social skills, or pathological grief, defined by the onset or decompensation of a psychiatric disorder. Little is known about the biological causes of these grief complications. Recent work suggests that oxytocin, a major neuroendocrine hormone regulating many neurocognitive mechanisms, may be involved in this process. Oxytocin is widely studied and well known for its impact on the mother-child bond and hormonal and brain systems related to attachment and social interactions. In this article, we propose a neurocognitive model of grief complications based on existing data on the role of oxytocin in interpersonal attachment and its impact on brain activity. We suggest that complicated grief is associated with dysfunctional cerebral oxytocinergic signaling and persistent hyperactivation of the nucleus accumbens. This mechanism is involved in limiting the reduction of interpersonal attachment to the deceased during acute phases and in searching for new interpersonal relationships during the recovery phase. We show how the exploration of cerebral oxytocinergic signaling would improve the understanding of physiological grief mechanisms in the general population and could allow the development of new therapeutic perspectives against the complications of grief.
Collapse
Affiliation(s)
- Hugo Bottemanne
- Paris Brain Institute - Institut du Cerveau (ICM), UMR 7225/UMRS 1127, CNRS, Inserm, Paris, France; Department of Psychiatry, Pitié-Salpêtrière Hospital, DMU Neuroscience, AP-HP, Sorbonne University, Paris, France; Department of Philosophy, SND Research Unit, UMR 8011, Sorbonne University, Paris, France.
| | - Isolde English
- Paris Brain Institute - Institut du Cerveau (ICM), UMR 7225/UMRS 1127, CNRS, Inserm, Paris, France
| | - Laure Bottemanne
- Paris Brain Institute - Institut du Cerveau (ICM), UMR 7225/UMRS 1127, CNRS, Inserm, Paris, France
| | - Paloma Torres
- Department of Psychiatry, Pitié-Salpêtrière Hospital, DMU Neuroscience, AP-HP, Sorbonne University, Paris, France
| | | | - Lucie Joly
- Paris Brain Institute - Institut du Cerveau (ICM), UMR 7225/UMRS 1127, CNRS, Inserm, Paris, France; Department of Psychiatry, Saint-Antoine Hospital, DMU Neuroscience, AP-HP, Sorbonne University, Paris, France
| |
Collapse
|
2
|
Thaqi Q, Riguzzi M, Blum D, Peng-Keller S, Lorch A, Naef R. End-of-life and bereavement support to families in cancer care: a cross-sectional survey with bereaved family members. BMC Health Serv Res 2024; 24:155. [PMID: 38303007 PMCID: PMC10832212 DOI: 10.1186/s12913-024-10575-2] [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: 05/24/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Losing a close other to cancer is an incisive experience that occurs after a long course of illness and intense family caregiving. Despite an evident need for family engagement and support and guidance on this, patients and family members may not receive the attention and support they need when a family unit is experiencing a disruption by death. A clear understanding of the quality of care that is currently provided and its ability to address family needs is necessary to improve end-of-life and bereavement support to families affected by cancer. The purpose of this study is to investigate the quality of support of end-of-life and bereavement care to families, their (un)met needs, grief experiences, and self-perceived health outcomes. METHODS A multi-center, cross-sectional observational survey study with family members (n = 35) whose close other died of cancer in a health institution or their own home in German-speaking Switzerland. RESULTS Bereaved family members were mostly satisfied with end-of-life care. Information on the grief process and services, and acknowledgment of their grief was experienced as helpful. Most coped with their grief drawing on family resources and exhibited resilience, but they reported unmet needs in relation to family togetherness and caregiving. CONCLUSION This study with a small number of family members indicates that support provided to families across settings and illness trajectories is perceived as helpful, with specific needs related to family support. The findings suggest that improvements should focus on ensuring care that addresses the family as a unit and enables togetherness, mutual reflection, meaningful relationships, preparedness for death, resilience, and benefit-finding. PROTOCOL REGISTRATION https://osf.io/j4kfh .
Collapse
Affiliation(s)
- Qëndresa Thaqi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - David Blum
- Competence Centre for Palliative Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Centre for Palliative Care, City Hospital Zurich, Zurich, Switzerland
| | - Simon Peng-Keller
- Spiritual Care, Faculty of Theology, University of Zurich, Zurich, Switzerland
| | - Anja Lorch
- Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006, Zurich, Switzerland.
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.
| |
Collapse
|
3
|
The Tenuous Role of Distress in the Diagnosis of Premature Ejaculation: A Narrative Review. Sex Med 2022; 10:100546. [PMID: 35905650 PMCID: PMC9537272 DOI: 10.1016/j.esxm.2022.100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Unlike the other 2 criteria for diagnosing premature ejaculation (PE), namely lack of ejaculatory control and short ejaculation latency (EL), the role of bother/distress has received only minimal consideration and investigation. AIM The specific aim was to determine both why distress is included in the PE diagnosis and whether such inclusion is advantageous to achieving better diagnostic outcomes. To this end, the review explored the historical and theoretical underpinnings of the inclusion of "bother/ distress" in the diagnosis of PE, with reference to the larger role that distress has played in the diagnosis of mental disorders, in an attempt to understand the utility (or lack thereof) of this construct in making a PE diagnosis. METHODS We reviewed the role of bother/distress across current professional definitions for PE and then expanded this discussion to include the role of distress in other sexual dysfunctions. We then included a brief historical perspective regarding the role that distress has played in the diagnosis of PE. This discussion is followed by a deeper look at 2 nosological systems, namely DSM and ICD, to allow perspective on the inclusion of the bother/distress construct in the diagnosis of mental and behavioral disorders, including the assumptions/arguments put forward to include or exclude bother/distress as an important criterion underlying various professional assumptions. OUTCOME Determination of the value and/or need of including bother/distress as a necessary criterion for the diagnosis of PE. RESULTS Based on the research literature, bother/distress does not appear to be as critical for a PE diagnosis as either the lack of ejaculatory control or short EL. It is the weakest of the differences among men with and without PE, and recent evidence suggests that its inclusion is generally redundant with the severity of the 2 other criteria for PE, ejaculatory control and EL. CLINICAL TRANSLATION Bother/distress appears to serve little purpose in the diagnosis of PE yet its assessment may be important for the treatment strategy and for assessing treatment effectiveness. STRENGTHS AND LIMITATIONS This review did not provide a critical analysis of the literature regarding the role of bother/distress in PE, but rather focused on its potential value in understanding and diagnosing PE. CONCLUSION Although bother/distress appears to add little to the improvement of accuracy for a PE diagnosis, understanding and assessing the man's or couple's experience of distress has important implications for the treatment strategy and focus, as well as for assessing treatment success. Rowland DL, Cooper SE. The Tenuous Role of Distress in the Diagnosis of Premature Ejaculation: A Narrative Review. Sex Med 2022;XX:XXXXXX.
Collapse
|
4
|
Wen FH, Chou WC, Prigerson HG, Shen WC, Hsu MH, Tang ST. Predictors of Family Caregivers' Depressive- and Prolonged-Grief-Disorder-Symptom Trajectories. J Pain Symptom Manage 2022; 63:476-484.e1. [PMID: 34971750 DOI: 10.1016/j.jpainsymman.2021.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 12/18/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Depression and prolonged grief disorder (PGD) are related but distinct constructs with different risk factors and treatments. We aimed to determine commonality and differences in factors predicting membership in depressive- and PGD-symptom trajectories to highlight uniqueness of each construct to guide further care and treatments. METHODS We previously identified four shared trajectories for depressive- and PGD-symptom trajectories (endurance, transient-reaction, resilience, and prolonged-symptomatic) with unique trajectories of chronically distressed and potential recurrence for depressive and PGD symptoms, respectively. This secondary-analysis study examined pre- and postloss factors predisposing 849 bereaved caregivers of cancer patients to membership in depressive- and PGD-symptom trajectories from the integrative framework of predictors for bereavement outcomes by a multinomial logistic regression model (the "endurance" trajectory as reference). RESULTS Common factors predicted membership in depressive- and PGD-symptom trajectories: higher postloss personal coping capacity protected from more distressing symptom trajectories, spousal relationship with the patient predicted membership in the transient-reaction trajectory, while financial hardship and preloss depressive symptoms predicted for the resilience trajectory. Yet, accurate prognostic awareness protected caregivers from more distressing depressive-symptom trajectories only. Higher preloss subjective caregiving burden protected caregivers from the four more distressing depressive-symptom trajectories but only from the transient-reaction and resilience trajectories for PGD symptoms. CONCLUSION Commonality and differences in factors predicting membership in PGD- and depressive-symptom trajectories confirm that PGD and depression are related but distinct constructs. Interventions should be tailored to caregivers' unique risk profile for depressive- and PGD-symptom trajectories to reduce the likelihood of suffering both or individual symptom trajectories.
Collapse
Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, ROC
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Holly G Prigerson
- Sociology in Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Wen-Chi Shen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Mei Huang Hsu
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC; School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, ROC; Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC.
| |
Collapse
|
5
|
Cynkier P. Problemy psychiczne po śmierci osoby bliskiej jako przedmiot ekspertyzy sądowej. ARCHIVES OF FORENSIC MEDICINE AND CRIMINOLOGY 2022. [DOI: 10.4467/16891716amsik.21.007.15617] [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] Open
Abstract
Wśród różnych form przeżywania śmierci osoby bliskiej wymienia się żałobę, jej powikłaną postać a także współwystępujące z nią zaburzenia psychiczne (najczęściej zespoły lękowe, depresja, uzależnienie od substancji psychoaktywnych, zespół stresu pourazowego). Omówiono przypadek, w którym rodzice wystąpili do sądu o odszkodowanie i zadośćuczynienie za śmierć syna, który zginął na skutek obrażeń doznanych w wypadku drogowym. U powoda po śmierci syna wystąpiła reakcja żałoby, a u powódki stan żałoby powikłanej, z którym współwystępowały objawy depresyjne. Odmienne obrazy kliniczne u każdego z powodów były uwarunkowane innymi cechami osobowości, odmiennymi modelami radzenia sobie w sytuacjach trudnych, a także schorzeniami somatycznymi. Doprowadziło to do różnych implikacji orzeczniczych u każdego z badanych. W sprawach odszkodowawczych (śmierć osób bliskich) konieczna jest diagnostyka różnicowa pomiędzy żałobą, jej powikłaną formą a zaburzeniami o charakterze reaktywnym i endogennym. Przydatna jest w tym ocena psychologiczna predyspozycji osobowościowych a także mechanizmów radzenia sobie w sytuacjach obciążających. Niekorzystanie z leczenia psychiatrycznego lub terapii psychologicznej nie może przesądzać o braku zaburzeń psychicznych. W tego rodzaju sprawach opiniowanie wymaga szczególnej ostrożności i wyważonych ocen. Należy unikać nadmiernej medykalizacji przeżyć po stracie osoby bliskiej, ale nie można też traktować stanów psychopatologicznych jedynie w kategoriach fizjologicznej reakcji na śmierć bliskiego.
Collapse
Affiliation(s)
- Przemysław Cynkier
- Faculty of Christian Philosophy, Cardinal Stefan Wyszyński University, Warsaw, Poland
| |
Collapse
|
6
|
Ang CS. Life Will Never be the Same: Experiences of Grief and Loss among Older Adults. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-021-02595-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
7
|
Lee HJ, Han SH, Boerner K. Psychological and Physical Health in Widowhood: Does Marital Quality Make a Difference? Res Aging 2022; 44:54-64. [PMID: 33511917 PMCID: PMC10704404 DOI: 10.1177/0164027521989083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We investigate how preloss marital quality is associated with changes in psychological distress and physical health among older widow(er)s. Using prospective data with a 2-year follow-up from the Health and Retirement Study, we selected 546 respondents who transitioned into widowhood. Respondents were classified as supportive, ambivalent, aversive, or neutral groups. The supportive and ambivalent group experienced greater increase in depressive symptoms compared to the aversive group, in widowhood. The aversive group showed greater increase in chronic conditions compared to the supportive group. Findings indicated that spousal loss may result in more psychological distress for those with supportive and ambivalent marital relationship. Yet, those with mostly negative accounts of their marriage may experience worsened physical health, albeit no increase in psychological distress. Understanding different benefits and challenges facing older individuals after a positive or negative marriage may help direct support and interventions efforts toward older couples during marriage and in widowhood.
Collapse
Affiliation(s)
- Hyo Jung Lee
- Department of Sociology, School of Social Sciences, Nanyang Technological University, Boston, Singapore
| | - Sae Hwang Han
- Department of Human Development and Family Sciences, School of Human Ecology, University of Texas at Austin, TX, USA
| | - Kathrin Boerner
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, MA, USA
| |
Collapse
|
8
|
Welzel FD, Löbner M, Quittschalle J, Pabst A, Luppa M, Stein J, Riedel-Heller SG. Loss and bereavement in late life (60+): Study protocol for a randomized controlled trial regarding an internet-based self-help intervention. Internet Interv 2021; 26:100451. [PMID: 34540595 PMCID: PMC8437767 DOI: 10.1016/j.invent.2021.100451] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The death of a close person is a highly stressful, yet common life event in later life. While most individuals seem to cope well with bereavement, a substantial proportion of older individuals suffer from prolonged grief symptoms. E-mental health interventions have been shown to be efficient for a variety of psychological illnesses. Yet, there is a large research gap of studies with a special focus on older adults. This study protocol describes a randomized controlled trial for an internet-based self-help intervention addressing bereavement and loss in adults aged 60 years and over. The self-management intervention is based on techniques of cognitive behavioral therapy and consists of 8 modules. The objective of the AgE-health study is to evaluate the effectiveness and acceptability of this intervention in comparison to a bibliotherapy control group. METHODS The AgE-health study aims at implementing a randomized controlled trial. Eligible participants aged 60+ years will be randomly allocated to an intervention group (access to the intervention) or to an active control group (access to bibliotherapy). Primary outcome is the reduction in grief symptoms (13-item Prolonged Grief Inventory); secondary outcomes are depression, social activity and network, quality of life, self-efficacy, satisfaction with the intervention/bibliotherapy, loneliness, acceptability, up-take and adherence. Assessments will take place before the intervention (baseline) as well as 4 months (follow-up 1) after the intervention. DISCUSSION This study addresses an under-recognized and understudied mental health burden in later life and may add valuable insight into our knowledge about the effectiveness of eHealth interventions for loss and bereavement in late life. To our knowledge, the AgE-health study will be the first randomized controlled trial to evaluate the effectiveness of an internet-based intervention targeting prolonged grief in adults aged 60 years and over. TRIAL REGISTRATION The study has been registered at the German Clinical Trials Register (Identifier: DRKS00020595, Registered 30th July 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00020595).
Collapse
Affiliation(s)
- Franziska D. Welzel
- Corresponding author at: Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany.
| | | | - Janine Quittschalle
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Germany
| | | | | |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Sekowski M, Prigerson HG. Associations between interpersonal dependency and severity of prolonged grief disorder symptoms in bereaved surviving family members. Compr Psychiatry 2021; 108:152242. [PMID: 33979631 DOI: 10.1016/j.comppsych.2021.152242] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/27/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Several studies have shown that interpersonal dependency is a risk factor for prolonged grief disorder (PGD), a disorder that has been recently approved by the American Psychiatric Association Assembly for inclusion in the Diagnostic and Statistical Manual of Mental Disorders-5-Text Revision (DSM-5-TR). Nevertheless, it remains unclear whether this relationship is independent of depression, which may also be related to both loss and interpersonal dependency. Furthermore, anaclitic dependency (maladaptive and immature) compared to relatedness (more adaptive and mature) dependency, and the relationships between these types of dependency and PGD, have not been examined. The aim of the present study was to determine how anaclitic and relatedness dependency are associated with PGD symptom severity, controlling for depressive symptom severity, over and above potential sociodemographic and loss-related confounder variables. METHODS Participants (N = 241) bereaved after the death of a family member from 0.5 to 8 years before the survey (M = 3.36, SD = 2.02) completed the Depressive Experiences Questionnaire, the Patient Health Questionnaire-9, and the Prolonged Grief Disorder-13 scale (PG-13). RESULTS A hierarchical regression analysis confirmed that anaclitic dependency is positively associated with PGD symptom severity, even when controlling for depression severity and other potential confounder variables. There was no significant association between relatedness dependency and PGD. CONCLUSIONS To assess the risk of PGD in individuals bereaved after the death of a family member, it is important to assess anaclitic dependency.
Collapse
Affiliation(s)
- Marcin Sekowski
- Department of Psychology, The Maria Grzegorzewska University, ul. Szczesliwicka 40, 02-353 Warsaw, Poland.
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Live Care, 321 Lasdon House, 420 East 70(th) Street, Weill Cornell Medicine, NY, New York 10021, United States of America; Department of Medicine, Division of Geriatrics and Palliative Medicine, Baker Pavilion 14(th) Floor, East 68(th) Street, Weill Cornell Medicine, NY, New York 10021, United States of America.
| |
Collapse
|
11
|
Aoun EG, Porta G, Melhem NM, Brent DA. Prospective evaluation of the DSM-5 persistent complex bereavement disorder criteria in adults: dimensional and diagnostic approaches. Psychol Med 2021; 51:825-834. [PMID: 31941562 DOI: 10.1017/s0033291719003829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND We examine the performance of the Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5) persistent complex bereavement-related disorder (PCBD) criteria in bereaved adults to identify prolonged grief cases determined prospectively. METHODS Bereaved adults (n = 138) were assessed at 8, 21, 32, 67, and 90 months after the sudden death of a spouse or close relative. We used latent class growth analysis to identify the longitudinal trajectories of grief assessed using the Inventory for Complicated Grief. To validate the trajectory that corresponded to prolonged grief, we examined the baseline predictors of these trajectories and their relationship with functional impairment. RESULTS We found three distinct trajectories of grief reactions. One of these trajectories (13.8%) showed high and sustained grief reactions that persisted for almost 7.5 years after the death. Participants with prolonged grief showed greater functional impairment [relative risk ratio (RRR) = 0.82, 95% confidence interval (CI): 0.70 to -0.97; p = 0.02] and higher self-reported depression (RRR = 1.21, 95% CI 1.09 to 1.96; p = 0.001) than participants whose grief reactions subsided over time. The original PCBD (requiring 6 criterion C symptoms) criteria correctly identified cases (57.9-94.7%) with perfect specificity (100%) but low to high sensitivity (5.6-81.3%); however, its sensitivity increased when revising criterion C to require ⩾3 (45.5-94.1%). The dimensional approach showed high sensitivity (0.50-1) and specificity (0.787-0.97). CONCLUSIONS We recommend revisions to the PCBD criteria, which are overly restrictive and may exclude cases with clinically significant grief-related distress and impairment. In the meantime, clinicians need to monitor grief symptoms over time using available dimensional approaches to reduce the burden of grief.
Collapse
Affiliation(s)
- Elie G Aoun
- Columbia University, Department of Psychiatry, Division of Law, Ethics and Psychiatry, New York, NY, USA
- New York University, Department of Psychiatry, New York, NY, USA
- Sex Offender Treatment Program, New York State Office of Mental Heath
| | - Giovanna Porta
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nadine M Melhem
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David A Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
12
|
Treml J, Linde K, Engel C, Glaesmer H, Hinz A, Luck T, Riedel-Heller S, Sander C, Kersting A. Loss and grief in elderly people: Results from the LIFE-Adult-Study. DEATH STUDIES 2020; 46:1621-1630. [PMID: 32972330 DOI: 10.1080/07481187.2020.1824203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We evaluated 2,865 elderly people to investigate the prevalence of prolonged grief disorder (PGD), examine predictors and mental health correlates. The conditional prevalence of PGD varied between 0.8% and 5.2% (diagnostic algorithm vs. cut-off). PG-13 scores were related to depressive symptoms, sleep disturbances, reduced life satisfaction, and quality of life. Predictors were female gender, less time since death, more losses, having lost a child, partner, or sibling, and less social support. PGD is associated with adverse mental health consequences. Practitioners should pay special attention to elderly women who lost a close loved one and lack social support.
Collapse
Affiliation(s)
- Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Katja Linde
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Tobias Luck
- Department of Economic and Social Sciences and Institute of Social Medicine, Rehabilitation Sciences and Healthcare Research, Nordhausen University of Applied Sciences, Nordhausen, Germany
| | - Steffi Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Christian Sander
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| |
Collapse
|
13
|
van Velsen L, Cabrita M, Op den Akker H, Brandl L, Isaac J, Suárez M, Gouveia A, Dinis de Sousa R, Rodrigues AM, Canhão H, Evans N, Blok M, Alcobia C, Brodbeck J. LEAVES (optimizing the mentaL health and resiliencE of older Adults that haVe lost thEir spouSe via blended, online therapy): Proposal for an Online Service Development and Evaluation. JMIR Res Protoc 2020; 9:e19344. [PMID: 32897238 PMCID: PMC7509633 DOI: 10.2196/19344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/17/2020] [Accepted: 06/30/2020] [Indexed: 12/20/2022] Open
Abstract
Background Loss of a spouse is a frequent occurrence in later life. While most older adults successfully process this loss and will return to a normal life, about 10% of the individuals are unable to cope, and progress to prolonged grief (PG). PG, in turn, can result in mental and physical problems including poor sleep, cardiovascular problems, depression, and suicidal tendencies. Objective LEAVES (optimizing the mentaL health and resiliencE of older Adults that haVe lost thEir spouSe via blended, online therapy) is an online bereavement program that will support the prevention and treatment of PG, so that elderly mourners can continue to lead an active, meaningful, and dignified life. LEAVES will cater to secondary end users (eg, family, informal caregivers) by reducing stress. Methods LEAVES will help older adults to process the loss of a spouse in an online environment, which consists of (1) an existing online grief self-help program LIVIA, (2) the Before You Leave program that allows for storing personal memories, (3) a virtual agent platform, and (4) an accessible front-end design. LEAVES can detect persons at risk for complications, reveal negative trends in their emotional life, and act to counter such trends. The service relies on online support whenever possible but is blended with telephone or face-to-face counseling when necessary. Results The project will take place between February 2020 and January 2023 and includes a real-life evaluation in which 315 end users will use the service across 3 countries (the Netherlands, Portugal, and Switzerland). The evaluation of LEAVES will focus on clinical effect, its business case, and technology acceptance. The results will pave the way for smooth integration into existing care paths and reimbursement schemes. Conclusions The LEAVES service aims to soften the mourning process, prevents depression or social isolation, strengthens widow(er)s resilience and well-being, and quickens one’s return to societal participation. International Registered Report Identifier (IRRID) DERR1-10.2196/19344
Collapse
Affiliation(s)
- Lex van Velsen
- eHealth group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Miriam Cabrita
- eHealth group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Harm Op den Akker
- eHealth group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Lena Brandl
- eHealth group, Roessingh Research and Development, Enschede, Netherlands
| | - Joana Isaac
- Unidade Local de Saúde do Baixo Alentejo, Beja, Portugal.,Comprehensive Health Research Center, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - María Suárez
- Unidade Local de Saúde do Baixo Alentejo, Beja, Portugal
| | - Afonso Gouveia
- Unidade Local de Saúde do Baixo Alentejo, Beja, Portugal
| | - Rute Dinis de Sousa
- Comprehensive Health Research Center, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Center, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Helena Canhão
- Comprehensive Health Research Center, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | | | | | - Marije Blok
- National Foundation for the Elderly, Amersfoort, Netherlands.,Department of Sociology, Vrije Universiteit, Amsterdam, Netherlands
| | | | - Jeannette Brodbeck
- School of Social Work, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland.,Department for Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| |
Collapse
|
14
|
Tay PKC, Lim KK. Psychological Resilience as an Emergent Characteristic for Well-Being: A Pragmatic View. Gerontology 2020; 66:476-483. [PMID: 32784301 DOI: 10.1159/000509210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 06/05/2020] [Indexed: 11/19/2022] Open
Abstract
Currently, there is no clear agreement on the definition and conceptualization for psychological resilience (PR) in old age. Adopting a pragmatic view, this article elucidates the definition and conceptualization of PR by (1) extracting existing PR concepts that are relevant to aging, and (2) elucidating the contributing and delimiting factors for developing and sustaining PR as guided by the biopsychosocial framework. In addition, a comprehensive review of the tools used to measure PR was conducted to examine how scholars have conceptualized PR. Consequently, the renewed understanding defines PR as an emergent construct which is malleable, enduring, and can be developed and sustained by a dynamic interplay of biological, psychological, spiritual, and social factors. Correlates in terms of physical and mental well-being in the context of aging are identified.
Collapse
Affiliation(s)
- Peter Kay Chai Tay
- Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore, .,Centre for Ageing Research and Education, Duke-NUS, Singapore, Singapore,
| | - Ka Keat Lim
- Health Services and Systems Research, Duke-NUS, Singapore, Singapore.,Department of Population Health Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| |
Collapse
|
15
|
Wen F, Chou W, Shen W, Tang ST. Distinctiveness of prolonged‐grief‐disorder‐ and depressive‐symptom trajectories in the first 2 years of bereavement for family caregivers of terminally ill cancer patients. Psychooncology 2020; 29:1524-1532. [DOI: 10.1002/pon.5441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/01/2020] [Accepted: 06/06/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Fur‐Hsing Wen
- Department of International Business Soochow University Taipei Taiwan
| | - Wen‐Chi Chou
- Division of Hematology‐Oncology Chang Gung Memorial Hospital at Linkou Tao‐Yuan Taiwan
- College of Medicine Chang Gung University Tao‐Yuan Taiwan
| | - Wen‐Chi Shen
- Division of Hematology‐Oncology Chang Gung Memorial Hospital at Linkou Tao‐Yuan Taiwan
- College of Medicine Chang Gung University Tao‐Yuan Taiwan
| | - Siew Tzuh Tang
- Division of Hematology‐Oncology Chang Gung Memorial Hospital at Linkou Tao‐Yuan Taiwan
- School of Nursing Chang Gung University Tao‐Yuan Taiwan
- Department of Nursing Chang Gung Memorial Hospital at Kaohsiung Taiwan
| |
Collapse
|
16
|
van Eersel JHW, Taris TW, Boelen PA. Complicated grief following job loss: Risk factors for its development and maintenance. Scand J Psychol 2020; 61:698-706. [PMID: 32567696 PMCID: PMC7607397 DOI: 10.1111/sjop.12650] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/07/2020] [Indexed: 11/27/2022]
Abstract
Increasing evidence shows that job loss can lead to symptoms of complicated grief (CG). However, little is known about which factors relate to the development and maintenance of CG symptoms following job loss. This study aimed to examine risk factors for the development and maintenance of job loss-related CG symptoms. For this study 485 Dutch workers who had lost their job were recruited (239 men and 246 women), with an average age of 50.2 years. A subsample of 128 participants also completed questionnaires at a six-month follow-up. We conducted correlational and multiple regression analyses (MRA) to examine the influence of the former work situation, coping strategies, and negative cognitions on job loss-related CG symptoms. MRA results showed that belief in an unjust world was related to job loss-related CG symptoms, cross-sectionally and longitudinally. Further, there was a significant relationship between CG symptoms following job loss and a preference for maladaptive coping over adaptive coping styles and a low level of self-esteem. This effect remained stable over time. These findings can inform the development of interventions for and early detection of job loss-related CG symptoms.
Collapse
Affiliation(s)
| | - Toon W Taris
- Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, the Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.,ARQ National Psychotrauma Centre, Diemen, the Netherlands
| |
Collapse
|
17
|
Meichsner F, O'Connor M, Skritskaya N, Shear MK. Grief Before and After Bereavement in the Elderly: An Approach to Care. Am J Geriatr Psychiatry 2020; 28:560-569. [PMID: 32037292 DOI: 10.1016/j.jagp.2019.12.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 02/01/2023]
Abstract
Grief is the natural response to the death of a loved one and is encountered frequently in clinical practice with the elderly; it can also precede the death. Knowledge about four distinct forms of grief can aid clinicians with the conceptualization of grief, and the assessment and care of grievers. First, predeath grief is experienced by many caregivers of terminally ill patients. Second, acute grief arises immediately after the death of a loved one; and third, this normally evolves to a permanent state of integrated grief after a process of adaptation. Finally, failure of adaptation results in Prolonged Grief Disorder (PGD) which has been recently included in ICD-11. The hallmark feature of PGD is intense longing for the deceased or persistent preoccupation with the deceased that lasts longer than 6 months after the death. Validated instruments are available to assist practitioners with assessment of predeath grief and screening for PGD, thereby enabling identification of patients in need of additional support. Increased risks of morbidity and mortality following bereavement are important health issues for clinicians to be aware of. All grievers can benefit from support focused on understanding their grief, managing emotional pain, thinking about the future, strengthening their relationships, telling the story of the death, learning to live with reminders of the deceased, and connecting with memories. A short-term evidence-based intervention for PGD is based upon these seven themes and is efficacious in the elderly. Caregivers of the terminally ill benefit from psychological support that validates and normalizes their grief experiences and helps them recognize and accept their losses.
Collapse
Affiliation(s)
- Franziska Meichsner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt (FM), Frankfurt, Germany.
| | - Monique O'Connor
- Perth Clinic Medical Suites (MO), West Perth, Western Australia, Australia
| | - Natalia Skritskaya
- Center for Complicated Grief, Columbia School of Social Work (NS, MKS), New York, NY
| | - M Katherine Shear
- Center for Complicated Grief, Columbia School of Social Work (NS, MKS), New York, NY
| |
Collapse
|
18
|
Two Cases of Persistent Complex Bereavement Disorder Diagnosed in the Acute Inpatient Unit. Case Rep Psychiatry 2020; 2020:3632060. [PMID: 32309001 PMCID: PMC7154980 DOI: 10.1155/2020/3632060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 03/23/2020] [Indexed: 11/17/2022] Open
Abstract
Pathological grief has been noted to have considerable adverse effects on affected individuals. In the DSM-5, the diagnosis of complicated grief is included under conditions for further study as Persistent Complex Bereavement Disorder (PCBD). PCBD can be easily missed because it is a relatively new and developing diagnosis. It can also be overlooked when it is comorbid with more common psychiatric disorders. We present 2 patients with PCBD diagnosed in the inpatient unit, while the patients were admitted for comorbid disorders. PCBD contributed immensely to both patients' suffering and decline in functioning. This report highlights the presentation, diagnoses, and management of these patients. We theorize that paying attention to separation distress, reactive distress to loss, and identity disruption in individuals who have been bereaved for over 12 months will enhance treatment specificity and lead to better patient outcomes.
Collapse
|
19
|
Santivasi WL, Partain DK, Whitford KJ. The role of geriatric palliative care in hospitalized older adults. Hosp Pract (1995) 2020; 48:37-47. [PMID: 31825689 DOI: 10.1080/21548331.2019.1703707] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023]
Abstract
Take-Away Points:1. Geriatric palliative care requires integrating the disciplines of hospital medicine and palliative care in pursuit of delivering comprehensive, whole-person care to aging patients with serious illnesses.2. Older adults have unique palliative care needs compared to the general population, different prevalence and intensity of symptoms, more frequent neuropsychiatric challenges, increased social needs, distinct spiritual, religious, and cultural considerations, and complex medicolegal and ethical issues.3. Hospital-based palliative care interdisciplinary teams can take many forms and provide high-quality, goal-concordant care to older adults and their families.
Collapse
Affiliation(s)
- Wil L Santivasi
- Center for Palliative Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Daniel K Partain
- Center for Palliative Medicine & Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kevin J Whitford
- Center for Palliative Medicine & Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
20
|
Pan H. Response to spousal death according to faith in traditional Chinese culture among older Chinese: Moderation by occupation. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1224-1231. [PMID: 30993804 DOI: 10.1111/hsc.12763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/04/2018] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
This study aims to enrich the knowledge of the effects of traditional Chinese culture on bereavement outcomes among older Chinese, and to examine the moderating role of occupation in the relationship between traditional culture and bereavement outcomes. A sample of 352 older Chinese in widowhood was interviewed by quota sampling. A scale of faith in traditional Chinese culture was developed and confirmed by factor analysis. Complicated grief (CG) functioned as the outcome variable. Results showed that faith in traditional culture did affect CG among the sample, and previous occupation moderated the effect of traditional culture on CG. That is, the effect of faith in Chinese culture on CG is stronger in the non-peasant group than the peasant group. The results broaden the knowledge of spousal bereavement in a Chinese context. Services such as death education and occupational therapy were recommended according to this study.
Collapse
Affiliation(s)
- Haimin Pan
- School of Sociology and Anthropology, Xiamen University, Xiamen, China
- Department of Applied Social Science, City University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
21
|
Förster F, Pabst A, Stein J, Röhr S, Löbner M, Heser K, Miebach L, Stark A, Hajek A, Wiese B, Maier W, Angermeyer MC, Scherer M, Wagner M, König HH, Riedel-Heller SG. Are older men more vulnerable to depression than women after losing their spouse? Evidence from three German old-age cohorts (AgeDifferent.de platform). J Affect Disord 2019; 256:650-657. [PMID: 31301630 DOI: 10.1016/j.jad.2019.06.047] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/24/2019] [Accepted: 06/30/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Old age is accompanied by a higher risk of losing a spouse. This study aims to longitudinally investigate the effect of widowhood on depression severity with a special focus on sex differences. We examine depression before and after widowhood in men and women separately to investigate which sex is at greater risk after losing a spouse. METHODS Data came from the AgeDifferent.de platform, which includes three pooled old age cohort studies. In order to examine factors associated with depression over time, we applied a linear hybrid mixed-effects regression model for the overall sample and analysed additional separate models for men and women. RESULTS Of 2470 respondents (mean age at baseline 79.2 (SD 3.64) years), 1256 were men. In total, 209 men and 332 women experienced spousal bereavement after baseline. In general, both sexes showed higher depression severity after widowhood. However, there were significant sex differences. Widowed men were more prone to subsequent depression than widowed women. In terms of depression severity, widowed men differed significantly compared to non-widowed men; however, this was not the case for women. LIMITATION We harmonized three cohort studies which used different measurement scales for depression and different recruitment procedures. CONCLUSION Our study showed that although both genders suffer from losing a spouse, men are more prone to subsequently develop depressive symptoms. Raising the awareness among practitioners for sex-specific differences as well as developing tailored interventions for both widowed men and women should be considered.
Collapse
Affiliation(s)
- Franziska Förster
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Germany.
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Germany
| | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Germany
| | - Kathrin Heser
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Lisa Miebach
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany; DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Anne Stark
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Germany
| | - Birgitt Wiese
- Institute of General Practice, Hannover Medical School, Hannover, Germany
| | - Wolfgang Maier
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany; DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Matthias C Angermeyer
- Center for Public Mental Health, Gösing am Wagram, Austria; Dipartimento di Sanità Pubblica, Università degli Studi di Cagliari, Italy
| | - Martin Scherer
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Wagner
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany; DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Germany
| |
Collapse
|
22
|
Pan H, Hu R. Grief Experience Patterns Among Older Adults in Rural China: A Latent Profile Analysis. OMEGA-JOURNAL OF DEATH AND DYING 2019; 83:898-913. [PMID: 31455155 DOI: 10.1177/0030222819870408] [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 present work sought to explore grief patterns among Chinese older people in rural areas as well as the factors influencing the diverse bereavement results. Participants were 352 older residents who lived in rural areas in China. Latent profile analysis was used to identify subtypes of class membership in combing complicated grief, depression, anxiety, and meaning in life. One-way analysis of variance, chi-square analysis, and multinomial regression analysis were performed together to examine the predictor best distinguishing between classes. The latent profile analysis model best fitting the data was a three-class solution comprised of adaptive (n = 235; 66.8%), moderate maladaptive (n = 83; 23.6%), and severe maladaptive groups (n = 34; 9.7%). Compared to the severe maladaptive and moderate maladaptive groups, participants in the adaptive group had better physical functioning. Participants in the moderate maladaptive group had longer bereavement duration than those in the severe maladaptive group. Future replication is desirable for validating these subgroups.
Collapse
Affiliation(s)
- Haimin Pan
- School of Sociology and Anthropology, Xiamen University, Xiamen, China
| | - Rong Hu
- School of Sociology and Anthropology, Xiamen University, Xiamen, China
| |
Collapse
|
23
|
Kuo SC, Wen FH, Chen JS, Chou WC, Shen WC, Tang ST. Preloss Psychosocial Resources Predict Depressive Symptom Trajectories Among Terminally Ill Cancer Patients' Caregivers in Their First Two Years of Bereavement. J Pain Symptom Manage 2019; 58:29-38.e2. [PMID: 30999066 DOI: 10.1016/j.jpainsymman.2019.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 01/13/2023]
Abstract
CONTEXT Postloss depressive symptom trajectories are heterogeneous and predicted by preloss psychosocial resources, but this evidence was from one old study on caregivers of patients with terminal cancer for whom these issues are highly relevant. OBJECTIVES To identify depressive symptom trajectories among cancer patients' bereaved caregivers and examine if they are predicted by preloss psychosocial resources while considering caregiving burden. METHODS Preloss psychosocial resources (sense of coherence and social support) were measured among 282 caregivers. Depressive symptoms were measured by the Center for Epidemiological Studies-Depression scale at one, three, six, 13, 18, and 24 months after loss (Center for Epidemiological Studies-Depression scores ≥16 indicate severe depressive symptoms). Distinct depressive symptom trajectories and their predictors were identified by latent-class growth analysis. RESULTS We identified five depressive symptom trajectories (prevalence): endurance (47.2%), resilience (16.7%), transient reaction (20.2%), prolonged symptomatic (11.7%), and chronically distressed (4.2%). Over two years after loss, the endurance group never experienced severe depressive symptoms. Severe depressive symptoms lasted six, seven to 12, and 18 months for the resilience, transient-reaction, and prolonged-symptomatic groups, respectively. The chronically distressed group's severe depressive symptoms persisted. The endurance and chronically distressed groups had the best and weakest psychological resources, respectively. Endurance-group caregivers perceived the greatest social support, whereas the resilience and transient-reaction groups had higher social support than the prolonged-symptomatic group. CONCLUSIONS Most (84.1%) caregivers' depressive symptoms subsided within one year after loss. Preloss psychosocial resources predicted depressive symptom trajectories for bereaved caregivers. Health care professionals can help caregivers adjust their bereavement by providing support to enhance their sense of coherence and encouraging social contacts while they are providing end-of-life care.
Collapse
Affiliation(s)
- Su-Ching Kuo
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao-Yuan, Taiwan; Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan
| | - Jen-Shi Chen
- Division of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
| | - Wen-Chi Chou
- Division of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
| | - Wen-Chi Shen
- Division of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
| | - Siew Tzuh Tang
- Division of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan; Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; School of Nursing, Chang Gung University, Tao-Yuan, Taiwan.
| |
Collapse
|
24
|
Dooley CM, Carroll B, Fry LE, Seamon-Lahiff G, Bartone PT. A Model for Supporting Grief Recovery Following Traumatic Loss: The Tragedy Assistance Program for Survivors (TAPS). Mil Med 2019; 184:166-170. [PMID: 31132122 PMCID: PMC6614836 DOI: 10.1093/milmed/usz084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/11/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Chantel M Dooley
- Tragedy Assistance Program for Survivors, 3033 Wilson Blvd, 3rd Floor, Arlington, VA
| | - Bonnie Carroll
- Tragedy Assistance Program for Survivors, 3033 Wilson Blvd, 3rd Floor, Arlington, VA
| | - Laura E Fry
- Tragedy Assistance Program for Survivors, 3033 Wilson Blvd, 3rd Floor, Arlington, VA
| | - Grace Seamon-Lahiff
- Tragedy Assistance Program for Survivors, 3033 Wilson Blvd, 3rd Floor, Arlington, VA
| | - Paul T Bartone
- Institute for National Strategic Studies, National Defense University, Fort Lesley J. McNair, Washington, DC
| |
Collapse
|
25
|
Zheng Y, Wuest LG. Assessing the impact of factors on parental grief among older Chinese parents. DEATH STUDIES 2019; 45:110-118. [PMID: 31122149 DOI: 10.1080/07481187.2019.1616854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A sample of 206 older Chinese bereaved parents was recruited and the effects of attachment style, coping strategy, social support, and spirituality on parental grief were investigated utilizing structural equation modeling. The results revealed problem-focused and dysfunctional coping strategy, insecure attachment style, less social support from family and friends would likely lead to higher levels of parental grief. The study explored how the unique context of Chinese culture and policies may shape the severity and duration of parental grief. It provides a baseline to understand the complexity of parental grief in China and to design and improve future interventions.
Collapse
Affiliation(s)
- Yongqiang Zheng
- School of Social Work, George Fox University, Newberg, Oregon, USA
| | - Leslie G Wuest
- School of Social Work, George Fox University, Newberg, Oregon, USA
| |
Collapse
|
26
|
Schwartz LE, Howell KH, Jamison LE. Effect of time since loss on grief, resilience, and depression among bereaved emerging adults. DEATH STUDIES 2018; 42:537-547. [PMID: 29393839 DOI: 10.1080/07481187.2018.1430082] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Grief research has typically centered on one time point, without considering the impact of multiple losses over time. In this study, 546 bereaved emerging adults were divided into three groups: those who experienced a recent loss (0-2 years ago), a past loss (>2 years ago), or a combination of both recent and past losses. Differences between the groups on resilience, depression, and grief symptomatology were examined. Those who had experienced both losses (recent and past) and recent losses endorsed significantly more grief symptoms than those in the past loss group. Findings highlight how multiple losses impact grief.
Collapse
Affiliation(s)
- Laura E Schwartz
- a Department of Psychology , The University of Memphis , Memphis , TN , USA
| | - Kathryn H Howell
- a Department of Psychology , The University of Memphis , Memphis , TN , USA
| | - Lacy E Jamison
- a Department of Psychology , The University of Memphis , Memphis , TN , USA
| |
Collapse
|
27
|
Shahane AD, Fagundes CP, Denny BT. Mending the heart and mind during times of loss: A review of interventions to improve emotional well-being during spousal bereavement. BEREAVEMENT CARE : FOR ALL THOSE WHO HELP THE BEREAVED 2018; 37:44-54. [PMID: 31548757 PMCID: PMC6756769 DOI: 10.1080/02682621.2018.1493640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Spousal loss is one of life's greatest stressors. Bereaved spouses are at risk for aberrant cognitive and affective processing. Recent work in psychoneuroimmunology and cognitive neuroscience reveals physiological biomarkers and neural mechanisms underlying acute distress and grief during bereavement that may represent targets for future interventions. We review evidence from existing pharmacological and psychotherapeutic treatment approaches for normal bereavement, complicated grief, and bereavement-related depression. We propose promising future directions, namely the development and empirical validation of novel, personalised cognitive and neurostimulatory interventions to promote adaptive emotion regulation and reduce depressive symptoms following spousal loss. Future work may substantiate which interventions to improve emotional and physical health will be best matched to the needs of a particular surviving spouse.
Collapse
Affiliation(s)
| | - Christopher P. Fagundes
- Rice University, Houston, TX
- The University of Texas MD Anderson Cancer Center, Houston, TX
- Baylor College of Medicine, Houston, TX
| | | |
Collapse
|
28
|
Yi X, Gao J, Wu C, Bai D, Li Y, Tang N, Liu X. Prevalence and risk factors of prolonged grief disorder among bereaved survivors seven years after the Wenchuan earthquake in China: A cross-sectional study. Int J Nurs Sci 2018; 5:157-161. [PMID: 31406818 PMCID: PMC6626251 DOI: 10.1016/j.ijnss.2018.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 03/12/2018] [Accepted: 04/02/2018] [Indexed: 11/25/2022] Open
Abstract
Background This study aimed to determine the prevalence and predictive factors of prolonged grief disorder (PGD) among those bereaved by the Wenchuan earthquake in Southwestern China seven years after the event. Methods A cross-sectional survey based on census tracts was conducted on the bereaved earthquake survivors. Responses to the questionnaire regarding PGD and its potential associated factors were obtained either through face-to-face or telephone interview. PGD was screened by a validated Chinese version of the PGD questionnaire-13 (PG-13). Bivariate and multivariate regression analyses were used to determine the prevalence and associated risk factors of PGD. Results A total of 1464 bereaved earthquake survivors, with a response rate of 97.6%, were included in the study. Of the 1464 respondents studied, 124 (8.47%) were diagnosed with PGD. Multivariate regression analysis demonstrated that PGD in the bereaved earthquake individuals was significantly associated with several factors, including age, economic burden, close kinship with the deceased, and living with the deceased before the loss. Wenchuan earthquake bereaved aged 41–60 years were more likely to develop PGD compared to those aged younger than 40 or older than 60 (OR = 2.075, 95%CI = 1.297–3.319). Those who had a close kinship with the deceased had a higher tendency to develop PGD (OR = 5.144, 95%CI = 2.716–9.740). The odds of PGD among the earthquake bereaved with economic burdens were higher relative to those who did not experience an economic burden (OR = 8.123, 95%CI = 2.657–24.831). Those who living with the deceased before loss also had a higher tendency to develop PGD (OR = 0.179, 95%CI = 0.053–0.602). Conclusions This study revealed that a significantly high proportion (8.47%) of the Wenchuan earthquake-bereaved remain grieving seven years after the event. Those diagnosed with PGD should receive appropriate interventions from clinical psychologists. The risk factors identified in this study are crucial for the early screening and prevention of PGD in future nursing and psycho-clinical practices.
Collapse
Affiliation(s)
- Xin Yi
- Academy of Nursing, Chengdu University of Traditional Chinese Medicine, Sichuan, China.,Academy of Medicine and Nursing, Chengdu University, Sichuan, China
| | - Jing Gao
- Academy of Nursing, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Chenxi Wu
- Academy of Nursing, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Dingxi Bai
- Academy of Nursing, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Yingchun Li
- Academy of Nursing, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Ni Tang
- Academy of Nursing, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Xiaoyun Liu
- Academy of Nursing, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| |
Collapse
|
29
|
Hoffmann R, Große J, Nagl M, Niederwieser D, Mehnert A, Kersting A. Internet-based grief therapy for bereaved individuals after loss due to Haematological cancer: study protocol of a randomized controlled trial. BMC Psychiatry 2018; 18:52. [PMID: 29482525 PMCID: PMC5827988 DOI: 10.1186/s12888-018-1633-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/12/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Approximately 10% of the individuals experiencing the death of a loved one develop prolonged grief disorder (PGD) after bereavement. Family members of haematological cancer patients might be particularly burdened since their loss experience is preceded by a very strenuous time of disease and aggressive treatment. However, support needs of relatives of cancer patients often remain unmet, also after the death of the patient. Therapeutic possibilities are enhanced by providing easily available and accessible Internet-based therapies. This study will adapt and evaluate an Internet-based grief therapy for bereaved individuals after the loss of a significant other due to haematological cancer. METHODS The efficacy of the Internet-based grief therapy is evaluated in a randomized controlled trial with a wait-list control group. Inclusion criteria are bereavement due to hematological cancer and meeting the diagnostic criteria for PGD. Exclusion criteria are severe depression, suicidality, dissociative tendency, psychosis, posttraumatic stress disorder, substance use disorder, and current psychotherapeutic or psychopharmacological treatment. The main outcome is PGD severity. Secondary outcomes are depression, anxiety, somatization, posttraumatic stress, quality of life, sleep quality, and posttraumatic growth. Data is collected pre- and posttreatment. Follow-up assessments will be conducted 3, 6, and 12 months after completion of the intervention. The Internet-based grief therapy is assumed to have at least moderate effects regarding PGD and other bereavement-related mental health outcomes. Predictors and moderators of the treatment outcome and PGD will be determined. DISCUSSION Individuals bereaved due to haematological cancer are at high risk for psychological distress. Tailored treatment for this particularly burdened target group is missing. Our study results will contribute to a closing of this healthcare gap. TRIAL REGISTRATION German Clinical Trial Register UTN: U1111-1186-6255 . Registered 1 December 2016.
Collapse
Affiliation(s)
- Rahel Hoffmann
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Julia Große
- 0000 0001 2230 9752grid.9647.cDepartment of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Michaela Nagl
- 0000 0001 2230 9752grid.9647.cDepartment of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Dietger Niederwieser
- 0000 0001 2230 9752grid.9647.cDivision of Haematology and Medical Oncology, University of Leipzig, Johannisallee 32A, 04103 Leipzig, Germany
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, University Medical Centre Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| | - Anette Kersting
- 0000 0001 2230 9752grid.9647.cDepartment of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| |
Collapse
|
30
|
Ghesquiere A, Theresa Schwartz, Wang Y, Mauro C, Skritskaya N, Shear MK. Performance and psychometric properties of the Interpersonal Support Evaluation List (ISEL) in older adults with Complicated Grief. J Affect Disord 2017; 218:388-393. [PMID: 28501738 DOI: 10.1016/j.jad.2017.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/02/2016] [Accepted: 05/06/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Complicated Grief (CG) is a recently recognized bereavement-related mental health disorder. Social support is commonly measured with the Interpersonal Support Evaluation List (ISEL), a 40-item, 4-factor, self-report measure. Though the ISEL has been well-studied, no identified research has examined its psychometric properties or performance in older adults with CG. METHODS We examined the psychometric properties of the ISEL in adults age ≥60 who enrolled in a psychotherapy treatment study for CG in New York City. We also examined the association of ISEL scores with CG severity, and with clinical and sociodemographic variables. RESULTS Internal consistency of the ISEL was high (α=0.95). Confirmatory factor analysis indicated that most of the ISEL items loaded strongly (>0.45) on the original 4 factors. Mean ISEL score was 68.1, which indicated lower social support than population norms. ISEL scores were significantly but modestly negatively correlated with grief severity. ISEL total scores also varied by sociodemographic and clinical variables; never being married, depression or anxiety diagnosis, and living alone were all associated with lower ISEL scores. LIMITATIONS A clinical help-seeking sample, with low sociodemographic and geographic variability, may limit the generalizability of the findings. Also, analyses were cross-sectional and directionality of associations could not be determined. CONCLUSIONS The 40-item ISEL may be a useful measure for those studying social support in the context of CG. Given the strikingly low levels of social support, intervention strategies for CG should include components addressing social support.
Collapse
Affiliation(s)
- Angela Ghesquiere
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, USA.
| | - Theresa Schwartz
- Department of Biostatistics, Mailman School of Public Health, Columbia at time of study, USA
| | - Yuanjia Wang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, USA
| | - Christine Mauro
- Department of Biostatistics, Mailman School of Public Health, Columbia University, USA
| | | | - M Katherine Shear
- Columbia University School of Social Work and Columbia University College of Physicians and Surgeons, USA
| |
Collapse
|
31
|
Milic J, Muka T, Ikram MA, Franco OH, Tiemeier H. Determinants and Predictors of Grief Severity and Persistence: The Rotterdam Study. J Aging Health 2017; 29:1288-1307. [PMID: 28720010 PMCID: PMC5680907 DOI: 10.1177/0898264317720715] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aimed to explore correlates and predictors of bereavement severity and persistence (triggered by "loss of a loved one"; referent group partner loss) in the Rotterdam cohort. METHOD We used linear regression to examine factors associated with grief severity using a cross-sectional analysis and logistic regression to determine prospective associations. RESULTS Cross-sectionaly, females, child-lost, higher depressive symptoms, lower education, and difficulties in daily activities were independently associated with a higher bereavement severity. Prospectively (6 years; response rate 71%), the baseline value of the grief severity was the single predictor significantly associated with grief persistence. DISCUSSION Our results suggest that only grief severity is independently associated with grief persistence. Further studies are needed to confirm our findings.
Collapse
Affiliation(s)
- Jelena Milic
- 1 Department of Epidemiology, Erasmus Medical Center Rotterdam, the Netherlands
| | - Taulant Muka
- 1 Department of Epidemiology, Erasmus Medical Center Rotterdam, the Netherlands
| | - M Arfan Ikram
- 1 Department of Epidemiology, Erasmus Medical Center Rotterdam, the Netherlands
| | - Oscar H Franco
- 1 Department of Epidemiology, Erasmus Medical Center Rotterdam, the Netherlands
| | - Henning Tiemeier
- 1 Department of Epidemiology, Erasmus Medical Center Rotterdam, the Netherlands.,2 Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands.,3 Department of Child- and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
32
|
Abstract
OBJECTIVES Advanced age is a time shaped by the current experience of physical, social and psychological characteristics associated with living into an eighth decade and beyond and also by reflection upon past experiences. Understanding the specific factors that contribute to ageing well is increasingly important as greater numbers of older people remain living independently in the community and may require targeted and sustainable support to do so. This paper offers a conceptualisation of resilience for advanced age (age 85+), a life stage currently under-researched. METHOD We utilise a developmental and socio-historical context to develop key arguments about adversity, resources and positive outcomes that affect the experience of resilient ageing. RESULTS Very late life is characterised by a unique balance between losses, associated with vulnerability and resource restrictions, and potential gains based upon wisdom, experience, autonomy and accumulated systems of support, providing a specific context for the expression of resilience. Post-adversity growth is possible, but maintenance of everyday abilities may be more relevant to resilience in advanced age. CONCLUSION An increasing life-span globally necessitates creative and conscientious thought about wellbeing, and resilience research has the important aim to focus health and wellness on success and what is possible despite potential limitations.
Collapse
Affiliation(s)
- Karen J Hayman
- a Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences , The University of Auckland , Auckland , New Zealand
| | - Ngaire Kerse
- a Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences , The University of Auckland , Auckland , New Zealand
| | - Nathan S Consedine
- b Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences , The University of Auckland , Auckland , New Zealand
| |
Collapse
|
33
|
Feigelman W, Rosen Z, Joiner T, Silva C, Mueller AS. Examining longer-term effects of parental death in adolescents and young adults: Evidence from the national longitudinal survey of adolescent to adult health. DEATH STUDIES 2017; 41:133-143. [PMID: 27813715 PMCID: PMC7219956 DOI: 10.1080/07481187.2016.1226990] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Using longitudinal data spanning a 7-year period, we investigated the behavioral and psycho-social effects resulting from a parent's death during early childhood or teenage years on adolescent and early adulthood functioning. Findings confirmed previous work demonstrating various behavioral problems and social-psychological adjustment deficits during adolescence. Results suggested that most detrimental adjustment behaviors among parentally bereaved youth fade as they entered into young adulthood. Yet, premature school withdrawals and diminished interests in college attendance at Wave 1 left many of these young adults with diminished academic accomplishments, lingering economic disadvantages and for females a hesitancy to marry as their lives progressed into adulthood.
Collapse
Affiliation(s)
- William Feigelman
- a Department of Sociology , Nassau Community College , Garden City , New Jersey , USA
| | - Zohn Rosen
- b Mailman School of Public Health , Columbia University , New York , New York , USA
| | - Thomas Joiner
- c Department of Psychology , Florida State University , Tallahassee , Florida , USA
| | - Caroline Silva
- c Department of Psychology , Florida State University , Tallahassee , Florida , USA
| | - Anna S Mueller
- d Comparative Human Development , University of Chicago , Chicago , Illinois , USA
| |
Collapse
|
34
|
Kuo SC, Sun JL, Tang ST. Trajectories of depressive symptoms for bereaved family members of chronically ill patients: a systematic review. J Clin Nurs 2017; 26:3784-3799. [DOI: 10.1111/jocn.13720] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Su Ching Kuo
- Graduate Institute of Clinical Medical Sciences; Chang Gung University; Taoyuan Taiwan
- Department of Nursing; Yuanpei University of Medical Technology; Hsinchu Taiwan
| | - Jia Ling Sun
- Department of Nursing; National Taichung University of Science and Technology; Taichung Taiwan
| | - Siew Tzuh Tang
- School of Nursing; Chang Gung University; Taoyuan Taiwan
- Department of Nursing; Chang Gung Memorial Hospital at Kaohsiung; Kaohsiung Taiwan
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| |
Collapse
|
35
|
Abstract
Previous literature reveals a high prevalence of grief in dementia caregivers before physical death of the person with dementia that is associated with stress, burden, and depression. To date, theoretical models and therapeutic interventions with grief in caregivers have not adequately considered the grief process, but instead have focused on grief as a symptom that manifests within the process of caregiving. The Dementia Grief Model explicates the unique process of pre-death grief in dementia caregivers. In this paper we introduce the Dementia Grief Model, describe the unique characteristics of dementia grief, and present the psychological states associated with the process of dementia grief. The model explicates an iterative grief process involving three states- separation, liminality, and re-emergence-each with a dynamic mechanism that facilitates or hinders movement through the dementia grief process. Finally, we offer potential applied research questions informed by the model.
Collapse
Affiliation(s)
- Kesstan Blandin
- The Dartmouth Centers for Health and Aging, Lebanon, NH, USA
| | - Renee Pepin
- The Dartmouth Centers for Health and Aging, Lebanon, NH, USA; Geisel School of Medicine, The Dartmouth Institute, Lebanon, NH, USA
| |
Collapse
|
36
|
Nam I. Complicated Grief Treatment for older adults: The critical role of a supportive person. Psychiatry Res 2016; 244:97-102. [PMID: 27479098 DOI: 10.1016/j.psychres.2016.07.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/12/2016] [Accepted: 07/22/2016] [Indexed: 10/21/2022]
Abstract
In the wake of the increased interest in treatment for complicated grief (CG) symptoms, research has reported the promising effect of CG treatment (CGT) on CG symptoms. This study compared CGT with supportive counseling (SC) in terms of improvement in CG symptoms. A randomized trial design was used to compare the effectiveness of CGT with that of SC in treating CG symptoms, depressive symptoms, and social impairments. The primary outcome was the Inventory of Complicated Grief. Relative to SC, CGT resulted in improved CG symptoms and depressive symptoms. Among those receiving CGT, participants with a supportive person in their sessions showed more beneficial results in CG and depressive symptoms than those without a supportive person did. This suggests that CGT is superior to SC in reducing CG symptoms and depressive symptoms, and in improving work and social functions during bereavement. Moreover, having a supportive person plays a critical role in the effectiveness of CGT sessions.
Collapse
Affiliation(s)
- Ilsung Nam
- Department of Social Welfare, Sungkonghoe University, Seoul, South Korea.
| |
Collapse
|
37
|
Ghesquiere AR, Bazelais KN, Berman J, Greenberg RL, Kaplan D, Bruce ML. Associations Between Recent Bereavement and Psychological and Financial Burden in Homebound Older Adults. OMEGA-JOURNAL OF DEATH AND DYING 2016. [DOI: 10.1177/0030222815590709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Bereavement is common in older adults, but it remains unknown whether bereavement contributes to poor outcomes in the vulnerable population of older adults receiving home-based services. We examine whether recent bereavement was associated with worse physical or mental health, presence of abuse or neglect, and financial strain. Research Design Cross-sectional analyses of an assessment of functional and social vulnerabilities collected by the New York City Department for the Aging (DFTA), the largest Area Agency on Aging in New York. Assessments were completed on 5,576 New York City Department for the Aging long-term care program, recipients aged ≥60 who received services in 2012. Assessment also collected data on partner or child death in the last year. Results Logistic regression indicated that the recently bereaved were more likely than the nonbereaved to report both depression symptoms and financial strain. Conclusion Enhanced efforts to identify and address mental health and financial concerns in bereaved homebound older adults may be warranted.
Collapse
Affiliation(s)
- Angela R. Ghesquiere
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, NY, USA
| | - Kisha N. Bazelais
- University of Miami, Student Counseling Center, Coral Gables, FL, USA
| | | | | | - Daniel Kaplan
- Department of Psychiatry, Weill Cornell Medical College, NY, USA
| | - Martha L. Bruce
- Department of Psychiatry, Weill Cornell Medical College, NY, USA
| |
Collapse
|
38
|
Abstract
This research examines how do bereaved wives and partners resemble and differ from their nonbereaved counterparts. Guided by the Two-Track Model of Bereavement, we focused on biopsychosocial functioning and the nature of the ongoing relationship to their partner. The sample included 85 bereaved women who were compared with 87 nonbereaved women currently married or in a stable pair-bond relationship. As predicted, the results demonstrated the continuing impact of bereavement years after the loss, but the pattern of similarities and differences between the groups sheds additional light on the loss experience. The discussion of these findings and their implications conclude the article.
Collapse
Affiliation(s)
- Ofri Bar-Nadav
- International Center for the Study of Loss, Bereavement and Human Resilience, Department of Psychology, University of Haifa, Haifa, Israel
| | - Simon Shimshon Rubin
- International Center for the Study of Loss, Bereavement and Human Resilience, Department of Psychology, University of Haifa, Haifa, Israel
| |
Collapse
|
39
|
Spahni S, Bennett KM, Perrig-Chiello P. Psychological adaptation to spousal bereavement in old age: The role of trait resilience, marital history, and context of death. DEATH STUDIES 2016; 40:182-190. [PMID: 26745606 DOI: 10.1080/07481187.2015.1109566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This research examined the effect of marital status and gender on various indicators of psychological adaptation, namely depressive symptoms, loneliness, and life satisfaction. It further explores the role of trait resilience, marital history, and context of death for predicting these outcomes in bereaved individuals. Four hundred eighty widowed individuals aged between 60 and 89 were compared with 759 married peers. Main effects were found for marital status and gender for all indicators. The regression analyses illustrate the multifaceted structure of psychological adaptation. Trait resilience is a key factor in adapting to spousal bereavement, whereas marital history and the context are secondary.
Collapse
Affiliation(s)
- Stefanie Spahni
- a Department of Psychology , University of Bern , Bern , Switzerland
| | - Kate M Bennett
- b Department of Psychological Sciences and School of Psychology , University of Liverpool , Liverpool , UK
| | | |
Collapse
|
40
|
Vesnaver E, Keller HH, Sutherland O, Maitland SB, Locher JL. Food behavior change in late-life widowhood: A two-stage process. Appetite 2015; 95:399-407. [PMID: 26232138 PMCID: PMC4589507 DOI: 10.1016/j.appet.2015.07.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/14/2015] [Accepted: 07/26/2015] [Indexed: 11/22/2022]
Abstract
Widowhood is a common life event for married older women. Prior research has found disruptions in eating behaviors to be common among widows. Little is known about the process underlying these disruptions. The aim of this study was to generate a theoretical understanding of the changing food behaviors of older women during the transition of widowhood. Qualitative methods based on constructivist grounded theory guided by a critical realist worldview were used. Individual active interviews were conducted with 15 community-living women, aged 71-86 years, living alone, and widowed six months to 15 years at the time of the interview. Participants described a variety of educational backgrounds and levels of health, were mainly white and of Canadian or European descent, and reported sufficient income to meet their needs. The loss of regular shared meals initiated a two-stage process whereby women first fall into new patterns and then re-establish the personal food system, thus enabling women to redirect their food system from one that satisfied the couple to one that satisfied their personal food needs. Influences on the trajectory of the change process included the couple's food system, experience with nutritional care, food-related values, and food-related resources. Implications for research and practice are discussed.
Collapse
Affiliation(s)
- Elisabeth Vesnaver
- Department of Family Relations & Applied Human Nutrition, University of Guelph, 50 Stone Road E, Guelph, Ontario, N1G 2W1, Canada.
| | - Heather H Keller
- Schlegel-UW Research Institute for Aging, Applied Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Olga Sutherland
- Department of Family Relations & Applied Human Nutrition, University of Guelph, 50 Stone Road E, Guelph, Ontario, N1G 2W1, Canada
| | - Scott B Maitland
- Department of Family Relations & Applied Human Nutrition, University of Guelph, 50 Stone Road E, Guelph, Ontario, N1G 2W1, Canada
| | - J L Locher
- School of Medicine Faculty, University of Alabama at Birmingham, 1530 3rd Avenue South, Birmingham, AL 35294-2041, USA
| |
Collapse
|
41
|
Spahni S, Morselli D, Perrig-Chiello P, Bennett KM. Patterns of Psychological Adaptation to Spousal Bereavement in Old Age. Gerontology 2015; 61:456-68. [DOI: 10.1159/000371444] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 12/09/2014] [Indexed: 11/19/2022] Open
|
42
|
Bruinsma SM, Tiemeier HW, Verkroost-van Heemst J, van der Heide A, Rietjens JAC. Risk factors for complicated grief in older adults. J Palliat Med 2015; 18:438-46. [PMID: 25671395 DOI: 10.1089/jpm.2014.0366] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Older adults grieving the death of a spouse have been found to have a higher risk of complicated grief compared with younger adults. OBJECTIVE The study objective was to find out whether personal characteristics of the patient and the bereaved partner, or characteristics of the patient's illness, end-of-life care, and the nature of death are risk factors for complicated grief in older adults. METHODS We performed a nested case-control study within the Rotterdam Study. We selected 100 couples of which one person had deceased and the other person experienced "complicated grief," and 100 control couples of which one person had deceased and the other person experienced "normal grief." Complicated grief was assessed with a 17-item Inventory of Complicated Grief (ICG). Determinants were assessed using several sources of information that were available for all participants of the Rotterdam Study. Additionally, medical files of the deceased were manually screened. Logistic regression analysis was performed. RESULTS Only depression at baseline was significantly associated with complicated grief. Bereaved partners with depression at baseline had a higher risk of complicated grief compared to bereaved partners without depression (OR=3.48; 95% CI=1.40-8.68). CONCLUSIONS Our results suggest that complicated grief in older adults is not clearly related to the circumstances of dying of the deceased partner. Preexisting conditions such as depression seem to be more important in explaining the occurrence of complicated grief.
Collapse
Affiliation(s)
- Sophie M Bruinsma
- 1 Department of Public Health, Erasmus University Medical Centre , Rotterdam, the Netherlands
| | | | | | | | | |
Collapse
|
43
|
Supiano KP, Andersen TC, Haynes LB. Sudden-On-Chronic Death and Complicated Grief in Bereaved Dementia Caregivers: Two Case Studies of Complicated Grief Group Therapy. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2015; 11:267-282. [PMID: 26654061 DOI: 10.1080/15524256.2015.1107810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Caring for a person with Alzheimer's disease is challenging and often has negative health and mental health effects that, for 7-20% of caregivers, persist into bereavement in the form of complicated grief. Complicated grief is a state of prolonged and ineffective mourning. An under-recognized phenomenon in dementia care and bereavement is "sudden-on-chronic death." In these situations, the caregiver is preparing for a gradual dying process from dementia, but the care recipient dies instead from a sudden death. In this study, an application of complicated grief group therapy for bereaved dementia caregivers with complicated grief is presented, and the effect of therapy with two bereaved caregivers who experienced the sudden death of their spouses who had a diagnosis of dementia is described. The unique treatment elements of complicated grief group therapy facilitated resolution of the 'trauma-like" features of bereavement and progression to a healthy grief process.
Collapse
Affiliation(s)
| | - Troy C Andersen
- b University of Utah College of Social Work , Salt Lake City , Utah , USA
| | - Lara Burns Haynes
- a University of Utah College of Nursing , Salt Lake City , Utah , USA
| |
Collapse
|
44
|
Mancini AD, Bonanno GA, Sinan B. A Brief Retrospective Method for Identifying Longitudinal Trajectories of Adjustment Following Acute Stress. Assessment 2014; 22:298-308. [DOI: 10.1177/1073191114550816] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research increasingly indicates that prototypical trajectories of resilience, recovery, delayed, and chronic distress characterize reactions to acute adversity. However, trajectory research has been limited by the practical and methodological difficulties of obtaining pre-event and longitudinal data. In two studies, we employed a novel method in which trained interviewers provided a graphical depiction of prototypical stress trajectories to participants and asked them to select the one that best described their experience. In Study 1, self-identified trajectories from 21 high-exposure survivors of the September 11th World Trade Center attacks distinguished variation in posttraumatic stress disorder and depression symptoms at 7 and 18 months, and were consistent with trajectories based on longitudinal outcomes and friend/relative ratings. In Study 2, we examined self-identified trajectories from 115 bereaved spouses at 1.5 to 3 years. Persons who identified a resilient trajectory, compared with recovery and chronic distress trajectories, had fewer interviewer-rated symptoms of grief, depression, and posttraumatic stress disorder were rated as functioning more effectively by friends, reported higher life satisfaction, and had fewer somatic complaints. The present results provide initial evidence for the construct validity of a cross-sectional and less demanding method for identifying acute stress trajectories.
Collapse
|
45
|
Pfoff MK, Zarotney JR, Monk TH. Can a function-based therapy for spousally bereaved seniors accrue benefits in both functional and emotional domains? DEATH STUDIES 2014; 38:381-386. [PMID: 24666144 PMCID: PMC3970179 DOI: 10.1080/07481187.2013.766658] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Late-life spousal bereavement has detrimental effects in daily functioning and emotional distress. This study tested the hypothesis that a therapy based exclusively upon functioning issues (sleep and daily lifestyle regularity) would accrue benefits in both functional and emotional domains. A comparison was made with a control therapy that concentrated on emotional issues, and specifically avoided discussing sleep or lifestyle regularity. Thirty-eight spousally bereaved seniors were randomly assigned to either functional or control therapy. Assessments were made before, during, and after a 6-month, 10-session individual therapy. The functional therapy assisted in both functional and emotional domains and the hypothesis was confirmed.
Collapse
Affiliation(s)
| | - Joette R. Zarotney
- Sleep and Chronobiology Center, University of Pittsburgh Department of Psychiatry
| | - Timothy H. Monk
- Sleep and Chronobiology Center, University of Pittsburgh Department of Psychiatry
| |
Collapse
|
46
|
Penman EL, Breen LJ, Hewitt LY, Prigerson HG. Public attitudes about normal and pathological grief. DEATH STUDIES 2014; 38:510-516. [PMID: 24738705 DOI: 10.1080/07481187.2013.873839] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Determining public expectations of grief is an important contributor to the debate differentiating normal from pathological grief. An international sample of 348 participants was randomly allocated to 1 of 12 conditions comprising a bereavement vignette and self-report items measuring grief expectations and social distance. Participants expected grief to decrease steadily between 2 weeks and 6 months then stabilize; however, time did not affect social distance. Gender of the bereaved and circumstances of death did not influence expectations, but did interact to influence social distance. These factors must be accounted for in determining a deviation from the norm in diagnostic nosology.
Collapse
Affiliation(s)
- Emma L Penman
- a School of Psychology and Speech Pathology , Curtin University , Perth , Western Australia , Australia
| | | | | | | |
Collapse
|
47
|
Shuter P, Beattie E, Edwards H. An Exploratory Study of Grief and Health-Related Quality of Life for Caregivers of People With Dementia. Am J Alzheimers Dis Other Demen 2014; 29:379-85. [PMID: 24381138 PMCID: PMC10852965 DOI: 10.1177/1533317513517034] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
The aim of this qualitative study was to explore key positive and negative factors that impact on grief resolution and health outcomes of caregivers who were caring, or had cared, for a family member with dementia who had died. The study was a scoping study and involved face-to-face interviews with these family caregivers (N = 13). Results indicated a complex interaction of issues (many unique to dementia caregiving) which in different combinations acted as protective or risk factors for caregiver outcomes. Interaction of individual characteristics, role appraisal, value of intrinsic and extrinsic resources, and experiences with health professionals during the caregiving period and around the death of their relative were shown to have the most influence on caregiver outcomes. Psychological resilience and satisfaction with caregiving were protective against negative outcomes while unresolved grief was a risk factor. These findings highlight the potential benefits of multicomponent, holistic dementia caregiver interventions.
Collapse
Affiliation(s)
- Patricia Shuter
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Elizabeth Beattie
- School of Nursing, Dementia Collaborative Research Centre: Carers and Consumers, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Helen Edwards
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
48
|
Sikorski C, Luppa M, Heser K, Ernst A, Lange C, Werle J, Bickel H, Mösch E, Wiese B, Prokein J, Fuchs A, Pentzek M, König HH, Brettschneider C, Scherer M, Maier W, Weyerer S, Riedel-Heller SG. The role of spousal loss in the development of depressive symptoms in the elderly - implications for diagnostic systems. J Affect Disord 2014; 161:97-103. [PMID: 24751315 DOI: 10.1016/j.jad.2014.02.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 02/24/2014] [Accepted: 02/26/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the revised version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) the Mood Disorder Workgroup for DSM-V the bereavement exclusion criterion for the diagnosis of major depression has been eliminated. AIM To investigate the impact of bereavement on the incidence of depression and depressive symptoms in the elderly. METHOD Participants over 75 years from the longitudinal German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe) that were still married at baseline were investigated (n=1,193). Data from four follow-ups (time frame: 6 years) were investigated. The response rate at baseline was 50.3%. Three clinical endpoints were analyzed: depressive symptoms according to Geriatric Depression Scale (1) GDS≥6, (2) GDS≥10, and (3) Major Depression (MD). The effect of loss was investigated using random-effects regression models. RESULTS Experiencing a loss of spouse was predictive of a higher incidence in GDS≥6 (OR 4.52, 95% CI 2.6-7.9) and 10 (OR 5.59, 95% CI 1.8-17.0) even after adjusting for age, gender, impairment at baseline, and GDS score at baseline. Associations with MD were not significant (OR 1.77, 96% CI 0.9-3.5). CONCLUSIONS Older adults experiencing the loss of their spouse are more likely to display elevated levels of depressive symptoms, that may reach a concerning level of severity.
Collapse
Affiliation(s)
- Claudia Sikorski
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany.
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| | - Kathrin Heser
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - Annette Ernst
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Carolin Lange
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Horst Bickel
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Edelgard Mösch
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Birgitt Wiese
- Institute for Biometrics, Hannover Medical School, Hannover, Germany
| | - Jana Prokein
- Institute for Biometrics, Hannover Medical School, Hannover, Germany
| | - Angela Fuchs
- Institute of General Practice, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Michael Pentzek
- Institute of General Practice, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| |
Collapse
|
49
|
Winegard BM, Reynolds T, Baumeister RF, Winegard B, Maner JK. Grief Functions as an Honest Indicator of Commitment. PERSONALITY AND SOCIAL PSYCHOLOGY REVIEW 2014; 18:168-86. [DOI: 10.1177/1088868314521016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Grief is a puzzling phenomenon. It is often costly and prolonged, potentially increasing mortality rates, drug abuse, withdrawal from social life, and susceptibility to illness. These costs cannot be repaid by the deceased and therefore might appear wasted. In the following article, we propose a possible solution. Using the principles of social selection theory, we argue that an important selective pressure behind the human grief response was the social decisions of other humans. We combine this with insights from signaling theory, noting that grief shares many properties with other hard-to-fake social signals. We therefore contend that grief was shaped by selective forces to function as a hard-to-fake signal of (a) a person’s propensity to form strong, non-utilitarian bonds and (b) a person’s current level of commitment to a group or cause. This theory explains many of the costly symptoms of grief and provides a progressive framework for future research.
Collapse
|
50
|
Kaplow JB, Howell KH, Layne CM. Do circumstances of the death matter? Identifying socioenvironmental risks for grief-related psychopathology in bereaved youth. J Trauma Stress 2014; 27:42-9. [PMID: 24478197 DOI: 10.1002/jts.21877] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We examined bereaved children's and surviving caregivers' psychological responses following the death of the other caregiver as a function of the stated cause of death. Participants included 63 parentally bereaved children and 38 surviving caregivers who were assessed using self-report instruments and in-person interviews. Surviving caregivers reported the causes of death as resulting from sudden natural death (34.9%), illness (33.3%), accident (17.5%), and suicide (14.3%). Results revealed differences between caregiver-reported versus child-reported cause of death, particularly in cases of suicide. Children who lost a caregiver due to a prolonged illness exhibited higher levels of both maladaptive grief (d = 3.13) and posttraumatic stress symptoms (PTSS; d = 3.33) when compared to children who lost a caregiver due to sudden natural death (e.g., heart attack). In contrast, surviving caregivers did not differ in their levels of maladaptive grief and PTSS as a function of the cause of death; however, caregivers bereaved by sudden natural death reported higher levels of depression than those bereaved by prolonged illness (d = 1.36). Limited sample size prevented analysis of outcomes among those bereaved by suicide or accident. These findings suggest that anticipated deaths may contain etiologic risk factors for maladaptive grief and PTSS in children.
Collapse
Affiliation(s)
- Julie B Kaplow
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | | |
Collapse
|