What Exactly Is "Complicated" Grief? A Scoping Research Literature Review to Understand Its Risk Factors and Prevalence

Humor: A Grief Trigger and Also a Way to Manage or Live With Your Grief

In 2020-2021, a qualitative study was undertaken using an interpretive description methodology to identify what triggers grief in the first 2 years following the death of a beloved family member, and to gain other helpful insights about grief triggers from bereaved Canadian adult volunteers. In that study, a purposive sampling method was used to select 10 bereaved Canadian adult volunteers for in-depth, semi-structured interviews. This paper reports on the humor findings, as revealed to be a particularly complex grief trigger for many participants, as well as a periodic way for most to manage or live with their grief. Participant quotes and an extended discussion are included to illustrate the importance of these humor findings in relation to grief, and to inform bereaved people, bereavement service providers, and the general public about both helpful aspects and some cautionary considerations about humor.

On the Classification and Reporting of Prolonged Grief: Assessment and Research Guidelines

LEARNING OBJECTIVES AFTER PARTICIPATING IN THIS CME ACTIVITY, THE PSYCHIATRIST SHOULD BE BETTER ABLE TO

• Explain the steps required for diagnosis of mental disorders in diagnostic handbooks.• Identify current procedures for classifying and reporting prolonged grief disorder.

ABSTRACT

Prolonged grief disorder (PGD) was added to the 11th edition of the International Classification of Diseases in 2018 and to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders in its 2022 text revision. Thus, reporting and classifying PGD according to established guidelines has become fundamental for scientific research and clinical practice. Yet, PGD assessment instruments and criteria are still being developed and debated. The purpose of this article is to examine the adequacy of current procedures for classifying and reporting PGD in research and to suggest guidelines for future investigation and dissemination of knowledge. We outline the standard steps required for diagnosis and assessment of a mental disorder (notably, the administration of clinical interviews). In order to illustrate reporting about the presence/prevalence of PGD in recent scientific articles, we conducted a search of Scopus that identified 22 relevant articles published between 2019 and 2023. Our review of the literature shows that standard classification procedures are not (yet) followed. Prevalences of PGD are based on self-reported symptomatology, with rates derived from percentages of bereaved persons reaching a certain cutoff score on a questionnaire, without clinical interviewing. This likely results in systematic overestimation of prevalences. Nevertheless, the actual establishment of PGD prevalence was often stated in titles, abstracts, and results sections of articles. Further, the need for structured clinical interviews for diagnostic classification was frequently mentioned only among limitations in discussion sections-but was not highlighted. We conclude by providing guidelines for researching and reporting self-reported prolonged grief symptoms and the presence/prevalence of PGD.

Grief in School-Aged Youth

Grief is an expected response to an internalized sense of loss, regardless of age. This response occurs after experiencing the death of a loved one or a drastic life change that creates a sense of loss. Children and adolescents move through the grief process according to their age and stage of development. Proper support is essential to promote healthy coping and acceptance in youth experiencing grief. The interprofessional school team can support students experiencing grief to enhance student learning outcomes and overall health and well-being.

Complicated Grief Following the Traumatic Loss of a Child: A Systematic Review

Complicated grief is a disabling condition that occurs when the natural grief process is disturbed or prolonged. Research demonstrates that complicated grief is more prevalent following the sudden or violent loss of a child. Despite the high incidence of accidental death worldwide, little research has focused on parental grief trajectories following this form of traumatic loss. A systematic review was conducted to explore parental bereavement outcomes following accidental death. Studies were included if they specifically examined complicated grief in parents bereaved by the accidental death of their child. A total of 767 articles were identified and seven studies met the eligibility criteria for review. Poorer outcomes were identified in relation to the mode of death, relationship type, time post-loss, perceived support, perceived justice and comorbidities. Results of the current study may be used to inform the development of clinical practice guidelines for the treatment of complicated grief.

Impacts of the COVID-19 Pandemic on the Bereaved

The COVID-19 pandemic has killed millions across the world in only two years. Government health restrictions aimed at preventing transmission have impacted typical mourning practices such as funeral gatherings and in-person grief support services. This research examines the potential impacts that the pandemic may have had on people's ability to grieve. We employed a mixed methods study design to ask those who have lost a loved one during this time to reflect on their mourning practices with an anonymous survey. Our results present themes of complicated grief, the uncertainty of who to blame for frustrations, and common needs requested by the bereaved to help them mourn during these unprecedented times. These findings may help inform grief support and bereavement services during current and future mass death and pandemic health concerns.

Evaluation of Bereavement Assessment Within Inpatient Palliative Care Consultation

It is crucial for palliative care teams to evaluate practices in assessing the risk of developing complicated grief among family members and caregivers of patients. A retrospective chart review of 99 patients seen by an inpatient palliative care team at an academic medical center was conducted to assess for documentation and prevalence of complicated grief risk factors. Factors included patients whose family are their primary caregiver, involvement of young children, mental health or substance use diagnoses in patients or their family members, a history of multiple losses, traumatic or sudden death. 64% of charts did not formally document bereavement assessment while 45% of families exhibited at least one risk factor for prolonged grief. This work suggests the need for increased education for PC providers on grief risk factors as well as the implementation of a formal screening assessment in order to best utilize limited psychosocial support resources to address needs.

Quality of Life of Older Adults With Complicated Grief: A Mixed Methods Exploration

The current mixed methods study investigated what changes in quality of life (QOL) mean to older adults with complicated grief treated with Accelerated Resolution Therapy (ART) post-hospice services. An informational matrix, which included select patient characteristics (e.g., number of comorbidities, single versus multiple deaths, relationship role), four identified qualitative themes, end of study QOL scores measured by the Centers for Disease Control and Prevention Health-Related QOL Healthy Days Module, and changes in scores from baseline to end of study, was created to analyze the data. Results showed that although a history of multiple deaths may contribute to greater improvements in QOL with therapy, having at least one comorbidity resulted in a richer description and endorsement of QOL in response to treatment. This is the first longitudinal, randomized controlled trial using a mixed methods approach to examine QOL of hospice family caregivers with complicated grief who are receiving ART. This study identifies potential links of QOL and caregiver characteristics, providing nurses with foundational knowledge for assessment, care, and further research on the experiences of complicated grief. [Journal of Gerontological Nursing, 48(5), 19-26.].

Consulting the Oracle: A Delphi study for determining parameters for a mental health user profile and personalization strategy for an online service to aid grieving older adults

While much effort has been devoted to the development of mental e-health interventions, the tailoring of these applications to user characteristics and needs is a comparatively novel field of research. The premise of personalizing mental e-health interventions is that personalization increases user motivation and (thereby) mitigates intervention dropout and enhances clinical effectiveness. In this study, we selected user profile parameters for personalizing a mental e-health intervention for older adults who lost their spouse. We conducted a three-round Delphi study involving an international and interdisciplinary expert panel (N = 16) with two objectives. The first aim was to elicit adaptation strategies that can be used to dynamically readjust the intervention to the user's needs. The second aim was to identify a set of meaningful indicators for monitoring the user from within the grief intervention to escalate from self-help to blended care, whenever advisable. This Delphi study used as starting point an evaluated, text-based grief intervention composed of ten modules, including psychoeducation about grief and cognitive-behavioral exercises to support the user in adjusting their lives after bereavement. Every user follows this grief intervention in a linear fashion from beginning to end. The resulting conceptual adaptation model encompasses dynamic adjustments, as well as one-time adjustments performed at the initialization of the service. On the level of the application structure, the adaptations affect when which topic module is presented to the user. The adaptations further provide strategies for adjusting the text-based content of individual intervention modules dependent on user characteristics and for selecting appropriate reactions to user input. Eighteen monitoring parameters were elicited and grouped into four categories: clinical, behavioral/emotional, interactive, and external. Parameters that were perceived as most urgent to attend to for escalation were Suicidality, Self-destructive behavior, Client-initiated escalation, Unresponsiveness and (Complicated) Grief symptoms.

A scoping research literature review to explore bereavement humor

The death of a loved one is extremely impactful. Although much of the focus now on helping people who are experiencing bereavement grief is oriented to distinguishing complicated from non-complicated grief for early pharmaceutical or psychiatric treatment, lay bereavement support comprises a more common and thus highly important but often unrecognized consideration. A wide variety of lay bereavement programs with diverse components have come to exist. This scoping research literature review focused on bereavement humor, one possible component. Humor has long been recognized as an important social attribute. Researchers have found humor is important for lifting the spirits of ill people and for aiding healing or recovery. However, humor does not appear to have been recognized as a technique that could benefit mourners. A multi-database search revealed only 11 English-language research articles have been published in the last 25 years that focused in whole or in part on bereavement humour. Although minimal evidence exists, these studies indicate bereaved people often use humor and for a number of reasons. Unfortunately, no investigations revealed when and why bereavement humor may be inappropriate or unhelpful. Additional research, multi-cultural investigations in particular, are needed to establish humor as a safe and effective bereavement support technique to apply or to use. Bereavement humor could potentially be used more often to support grieving people and bereaved people should perhaps be encouraged to use humor in their daily lives.