Grieving During the COVID-19 Pandemic: In-Person and Virtual "Goodbye"

This study examined the relationship between having an opportunity to say goodbye to a dying family member or friend in person or virtually, as well as attending their funeral services in person or virtually, and the bereaved individuals' psychological distress and complicated grief during the COVID-19 pandemic. Five hundred and nineteen US adults who had lost a family member or a friend between January 2020 and June 2021 completed an online survey for this study. Only a small proportion of participants were able to say goodbye to their dying family member or friend in person, and saying goodbye virtually was associated with higher levels of complicated grief and psychological distress. Those who physically attended a formal, in-person funeral or memorial service reported lower levels of psychological distress. The findings suggest a complicated process of saying goodbye in different formats during the pandemic.

When does disruption of meaning in bereavement become debilitating? Screening for deleterious outcomes with the ISLES-SF

Meaning reconstruction is a central process in bereavement adaptation. However, clinical measures or means for identifying individuals whose struggles with meaning making have become dysfunctional have yet to be developed for clinicians to readily use in practice. Therefore, the objective of this study was to evaluate the diagnostic effectiveness of the Integration of Stressful Life Experiences Scale-Short Form (ISLES-SF) for measuring clinically significant struggles with meaning making of loss. The results of this study of 118 bereaved adults support the diagnostic use of the ISLES-SF (sensitivity of 83% and specificity of 73%), as well as an identified cut-score (≥ 14) that researchers and clinicians can employ to accurately and efficiently identify those whose difficulties with making meaning of loss have become debilitating. The results also showed that those who scored in the clinical range of the ISLES-SF displayed higher levels of anxiety, depression and prolonged grief than those not struggling with meaning making.

Validation of the Portuguese version of the Integration of Stressful Life Experiences Scale (ISLES) in a sample of bereaved individuals

The Integration of Stressful Life Experiences Scale (ISLES) evaluates the ability to integrate stressful experiences into one's meaning system. The present study developed and validated a version of this scale for a bereaved Portuguese-speaking population, utilizing a sample of 242 adults who had lost a significant other to diverse causes of death. The sample was predominantly female, educated, married, or in consensual unions, and actively employed. Confirmatory factor analysis revealed a two-factor structure, consisting of 13 items, showing adequate local and global goodness-of-fit and supporting the proposed original structure. Convergent evidence based on internal structure was found for the two dimensions (Comprehensibility and Footing in the World). Regarding reliability, Cronbach's alpha and McDonald's omega computed for each factor showed good internal consistency and the average inter-item correlation was considered satisfactory. This psychometric support for ISLES underscores its relevance in enhancing the knowledge of meaning-making processes in the Portuguese context.

Do insecure attachment styles predict prolonged grief symptoms? Significant null findings

Insecure attachment is proposed to be a risk factor in the development and persistence of severe grief. Although prior research demonstrates positive cross-sectional and longitudinal correlations between attachment styles and prolonged grief symptoms, controlled longitudinal analyses yield fewer convincing results. Therefore, we sought to further clarify the concurrent and longitudinal associations between these constructs. A sample of 225 bereaved Dutch adults (87% women; Mean age: 48.86 years) participated in a three-wave longitudinal survey including measures of attachment anxiety and attachment avoidance at baseline and prolonged grief symptoms at baseline and 6- and 12-month follow-up. Attachment anxiety and attachment avoidance were significantly positively correlated with prolonged grief symptoms at all time-points. However, multiple regressions, controlling for baseline symptoms, showed that attachment anxiety, attachment avoidance, and their interaction did not predict residual change in prolonged grief symptoms. These findings cast doubt on the proposed role of insecure attachment styles in prolonged grief.

Understanding evidence and provision of services around social isolation and loneliness of military widow/ers: A scoping review

BACKGROUND

Whilst the uniqueness of loneliness and social isolation is now recognised for members of the Armed Forces Community, there is currently a lack of evidence examining these experiences within the Military Widow/er population. Therefore, this scoping review aimed to search and synthesise the current evidence base exploring experiences of loneliness and social isolation in this community.

METHOD

Six databases were searched; ASSIA; CINAHL; ProQuest Dissertation & Theses Global; PsycArticles; Medline; Web of Science. Any article type was included if they focused on UK or international Military Widows and loneliness and social isolation. In the absence of loneliness and social isolation, related aspects were included, for example, social support.

RESULTS

A thematic synthesis was completed on the nine eligible papers, where key findings were coded and generated into four themes; Experiences of Loneliness and Social Isolation, The Uniqueness of the Military, Access to Social Support, and The Importance of Peer Support.

CONCLUSIONS

Evidence supports the need for military-specific support services with peers who recognise the individuals' unique experiences of loneliness and social isolation. None of the available evidence focused specifically on social isolation, however this was often prevalent in the results. All of the studies were carried out in the USA and Israel, with none including the views of widowers. Further evidence is required, particularly relating to a UK-context.

Bereavement Experiences of Families of Elderly Individuals Who Died Due to COVID-19

This study was conducted to evaluate the bereavement experiences of families of elderly individuals who died due to the COVID-19 pandemic. One of the qualitative research methods, the case study method, was used in the study. The sample of the research consisted of 19 people who agreed to participate in the research between April and July 2022. The research data were collected using a Personal Information Form and a Semi-Structured Interview Form, which was created to conduct individual in-depth interviews. As a result of the descriptive analysis, four main themes, the ability to perform religious rituals related to the bereavement experience, feelings and thoughts about death, attitudes of those around after death, and coping strategies in the COVID-19 process. It was determined that individuals had difficulty accepting death, felt inadequate about spirituality due to limited religious rituals, had feelings of despair and guilt, and limitedly utilized social support systems.

Adaptation of the Spanish Grief and Meaning Reconstruction Inventory: An Initial Validation and Network Analysis

The current study was conducted to adapt the Grief and Meaning Reconstruction Inventory (GMRI) into Spanish and to establish its psychometric properties in a group of 202 mourners seeking treatment in Spain. A confirmatory factor analysis established that the Spanish GMRI yielded eight factors, displaying strong reliability and convergent validity, through the scale's inverse correlation with the Inventory of Complicated Grief and various measures of psychological distress, explaining a 48% of the variance of the former measure. A network analysis suggested that sense-making could play a central role in meaning-making during bereavement.

I can't believe they are dead. Death and mourning in the absence of goodbyes during the COVID-19 pandemic

The circumstances surrounding the deaths during the COVID-19 pandemic and the subsequent mourning process transpired in completely atypical conditions. This study analyses the experience of losing a loved one without traditional, culture-specific rituals for saying goodbye, explores the different factors affecting the onset of mourning by family members and studies the existence of complicating risk factors associated with grief from this distinct type of loss. A qualitative, phenomenological and interpretive research study was undertaken through in-depth interviews of 48 informants, key and general, in the autonomous Community of Madrid. The interviews were conducted between July and November of 2020 and were followed by an interpretive categorical qualitative analysis. The principal results include (a) the finding that deaths caused by the pandemic are, due to their characteristics, a complicating factor for bereavement, (b) evidence that the professionals who supported these deaths with a holistic approach, facilitating the process for the family members, have been a determining factor in enabling the beginning of the mourning process and reducing anguish for the family members and (c) the conclusion that a need exists for a resignification of the funeral rite. Finally, before future crises, it is recommended that access protocols be developed for relatives, including methods that permit them to say goodbye to their loved ones, no matter the situation.

An examination and proposed definitions of family members' grief prior to the death of individuals with a life-limiting illness: A systematic review

BACKGROUND

Research has extensively examined family members' grief prior to the death of an individual with a life-limiting illness but several inconsistencies in its conceptualization of related constructs, yet significant conceptualization issues exist.

AIM

This study aimed to identify and characterize studies published on family members grief before the death of an individual with a life-limiting illness, and propose definitions based on past studies in order to initiate conceptual clarity.

DESIGN

A mixed-method systematic review utilized six databases and was last conducted July 10, 2021. The search strategy was developed using Medical Subject Headings. This study was prospectively registered on PROSPERO (CRD42020166254).

RESULTS

One hundred thirty-four full-text articles met inclusion criteria. This review revealed across studies a wide variation in terminology, conceptualization, and characterization of grief before the death. More than 18 terms and 30 definitions have been used. In many cases, the same term (e.g. anticipatory grief) was defined differently across studies.

CONCLUSIONS

We found grief occurring before the death of a person with a life-limiting illness, which we termed pre-death grief, is comprised of two distinct constructs: anticipatory grief and illness-related grief. Anticipatory grief is future-oriented and is characterized by separation distress and worry about a future without the person with the life-limiting illness being physically present. Illness-related grief is present-oriented and is characterized by grief over current and ongoing losses experienced during the illness trajectory. These definitions provide the field with uniform constructs to advance the study of grief before the death of an individual with a life-limiting illness.

Mourning During Corona: A Phenomenological Study of Grief Experience Among Close Relatives During COVID-19 Pandemics

Considering the need for observing health protocols, the experience of the loss and the grieving process has changed in nature during this disease. Therefore, this study aims to gain a deep understanding of the experience of mourning during COVID-19 pandemic by exploring the experiences of survivors of the death of their loved. During COVID-19 pandemic, the inability to hold the usual ceremonies for mourning and receive the social support needed in this period, the relatives of the deceased encounter various conditions that disrupt the grieving process and may lead to the spread of unresolved grief in future.

Pre-loss group therapy for dementia family care partners at risk for complicated grief

INTRODUCTION

Dementia family caregiving may span more than a decade and places many family care partners (CPs) at risk for poor bereavement outcomes; estimates of complicated grief in bereaved dementia family CPs range from 10% to 20%. We adapted our efficacious complicated grief group therapy intervention for bereaved dementia caregivers for soon-to-be bereaved dementia CPs at risk for complicated grief to facilitate healthy death preparedness and eventual bereavement-pre-loss group therapy (PLGT).

METHODS

In this Stage IB pilot intervention study, we implemented and evaluated PLGT in three psychotherapy group cohorts with family CPs at-risk for complicated grief whose person living with dementia (PLWD) had a life expectancy of 6 months or less and resided in a nursing home. PLGT is a 10-session multi-modal psychotherapy administered by social workers.

RESULTS

Participants in PLGT realized significant improvement in their pre-loss grief and in reported preparedness for the death of their family member, and participants evidenced lowered pre-loss grief severity and improvement, as measured by facilitators. Participants also realized significant improvement in meaning making, particularly as a sense of peace and a reduction of loneliness.

DISCUSSION

The process and treatment elements of the PLGT intervention affirm the value of specialized care for those dementia family CPs at risk for complicated grief, as the PLGT groups demonstrated a steady progression toward improvement collectively and individually. PLGT participants realized statistical and clinical improvement across pre-loss grief measures suggesting that their risk for complicated grief risk was mitigated, and they were better prepared for the death of their PLWD.

Predictive Factors of Depression Among Relatives of Brain-Dead Persons: A Descriptive Correlational Study

This study aimed to determine the predictive factors of depression among relatives of person deceased by brain death. In this study, 106 first-degree relatives of people who died of due to brain death were studied. Of the study units, 72.64% had levels of depression (severe, moderate, and mild). Among the dependent variables concerning deceased person, age and gender of the deceased were significantly correlated with the depression of their relatives. Among the variables concerning relatives, low level of education, unemployment and time elapsed after brain death have significant role in the incidence or prediction of their depression (p < 0.05). The results indicated a high prevalence of depression among relatives of men aged 30-50 who died because of brain death. It is recommended to consider this fact in planning to care relatives, especially among the low-educated, the unemployed and experiencing the first year of death, of people deceased by brain death.

If we knew then what we know now: The preparedness experience of pre-loss and post-loss dementia caregivers

We evaluated the relationship between grief preparedness and grief experience in 106 family caregivers anticipating or who had experienced the death of a family member with dementia. Using a phenomenological lens to discern a process of meaning-making in narratives, we found preparation that included positive construction of memories, death as the end of suffering, relationship resolution, and shared construction of meaning were associated with positive grief. Those caregivers who experienced the family member's decline as traumatic, caregiver role loss, unavailable support, and difficulties creating a new life reported inadequate death preparation, and difficulty making meaning of the illness and death.

Inventory of Complicated Spiritual Grief 2.0 (ICSG 2.0): Validation of a revised measure of spiritual distress in bereavement

Spirituality has long served as a source of solace for many grievers following a loss. For other mourners, whose bereavement experience has been significantly challenged by struggles in their relationship with God and/or their faith community, the opposite is true. Complicated spiritual grief (CSG) is a spiritual crisis following the loss of a loved one. To assess CSG in samples of bereaved adults, a simple-to-use, multidimensional measure of spiritual crisis following loss called the Inventory of Complicated Spiritual Grief (ICSG) was previously developed and validated. However, subsequent research providing greater clarity about the construct of CSG supported the need to revise and update the ICSG. The goal of the present study was to establish the psychometric validity of a revised measure of CSG, called the Inventory of Complicated Spiritual Grief 2.0 (ICSG 2.0), with a large, diverse cohort of bereaved Christian adults (N = 440). Analyses of the bifurcated sample supported a three-factor model measuring insecurity with God, estrangement from the spiritual community, and disruption in religious practices. Further analyses supported the convergent and incremental validity of a 28-item scale relative to other theoretically similar instruments and measures of poor bereavement outcome, indicating the instrument's research and clinical usefulness.

Meaning reconstruction in bereavement: Development of a research program

The death of a significant person, especially when it comes tragically or prematurely, can shake the foundations of our assumptive and relational world and lead to anguished attempts to find meaning in the loss and in our lives in its aftermath. In this article, I review one program of research focused on this attempt at meaning reconstruction, describe recently developed measures of meaning in mourning, and discuss several therapeutic techniques for helping clients make sense of the death and rework their attachment relationship to the deceased. I conclude by illustrating some of this work in my therapy with a couple grieving the loss of not one but two children to tragic accidents, as they try to adapt to a compound traumatic bereavement.

Distinguishing the meaning making processes of survivors of suicide loss: An expansion of the meaning of loss codebook

Suicide loss represents particularly a difficult form of bereavement due to the challenges that volitional death poses to survivors. Understanding these challenges requires recognition of the idiosyncratic processes of meaning reconstruction for this specific group of grievers. The current study investigates such processes in survivors of suicide loss (SOSL) by utilizing the Meaning of Loss Codebook (MLC) to analyze the narratives of eight SOSL. The findings contribute to a broader understanding of meaning making following suicide, strengthen the validity of the MLC by demonstrating its appropriateness for SOSL, and illuminate unique challenges faced by SOSL, resulting in the proposal of supplemental MLC codes. Research and clinical implications are discussed.