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Nordström EEL, Kaltiala R, Kristensen P, Thimm JC. Somatic symptoms and insomnia among bereaved parents and siblings eight years after the Utøya terror attack. Eur J Psychotraumatol 2024; 15:2300585. [PMID: 38214224 PMCID: PMC10791101 DOI: 10.1080/20008066.2023.2300585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024] Open
Abstract
Background: Levels of prolonged grief symptoms (PGS) and post-traumatic stress symptoms (PTSS) can be high, many years following bereavement after terror, but knowledge concerning somatic health is scarce. Terrorism is a serious public health challenge, and increased knowledge about long-term somatic symptoms and insomnia is essential for establishing follow-up interventions after terrorism bereavement.Objective: To study the prevalence of somatic symptoms and insomnia and their association with PGS, PTSS, and functional impairment among terrorism-bereaved parents and siblings.Methods: A cross-sectional quantitative study included 122 bereaved individuals from the Utøya terror attack in Norway in 2011. The sample comprised 88 parents and 34 siblings aged 19 years and above (Mage = 49.7 years, SDage = 13.8 years, 59.8% females). The participants completed questionnaires 8 years after the attack assessing somatic symptoms (Children's Somatic Symptoms Inventory) and insomnia (Bergen Insomnia Scale) along with measures of PGS (Inventory of Complicated Grief), PTSS (Impact of Event Scale-Revised), and functional impairment (Work and Social Adjustment Scale).Results: Fatigue was the most frequently reported somatic symptom (88% of females and 65% of males). Females reported statistically significantly more somatic symptoms than males. In total, 68% of the bereaved individuals scored above the cut-off for insomnia. There were no statistically significant gender differences for insomnia. Female gender, intrusion, and arousal were associated with somatic symptoms. Intrusion and somatic symptoms were associated with insomnia. Somatic symptoms, avoidance, and hyperarousal were associated with functional impairment.Conclusion: Many bereaved parents and siblings report somatic symptoms and insomnia eight years after the terror attack. Somatic symptoms are associated with functional impairment. Long-term follow-up and support after traumatic bereavement should focus on somatic symptoms and insomnia.
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Affiliation(s)
| | - Riittakerttu Kaltiala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
- Vanha Vaasa Hospital, Vaasa, Finland
| | - Pål Kristensen
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Jens C. Thimm
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
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2
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Marco P, Redolat R. Alzheimer’s Disease, Grieving Process, and Art Therapy: Case Study. ART THERAPY 2022. [DOI: 10.1080/07421656.2022.2066951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Walsh CP, Bovbjerg DH, Marsland AL. Glucocorticoid resistance and β2-adrenergic receptor signaling pathways promote peripheral pro-inflammatory conditions associated with chronic psychological stress: A systematic review across species. Neurosci Biobehav Rev 2021; 128:117-135. [PMID: 34116126 PMCID: PMC8556675 DOI: 10.1016/j.neubiorev.2021.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/11/2021] [Accepted: 06/06/2021] [Indexed: 12/26/2022]
Abstract
Activation of the HPA-axis and SNS are widely accepted to link chronic stress with elevated levels of peripheral pro-inflammatory markers in blood. Yet, empirical evidence showing that peripheral levels of glucocorticoids and/or catecholamines mediate this effect is equivocal. Recent attention has turned to the possibility that cellular sensitivity to these ligands may contribute to inflammatory mediators that accompany chronic stress. We review current evidence for the association of chronic stress with glucocorticoid receptor (GR) and β-adrenergic receptor (β-AR) signaling sensitivity. Across 15 mouse, 7 primate, and 19 human studies, we found that chronic stress reliably associates with downregulation in cellular GR sensitivity, alterations in intracellular β-AR signaling, and upregulation in pro-inflammatory biomarkers in peripheral blood. We also present evidence that alterations in GR and β-AR signaling may be specific to myeloid progenitor cells such that stress-related signaling promotes release of cells that are inherently less sensitive to glucocorticoids and differentially sensitive to catecholamines. Our findings have broad implications for understanding mechanisms by which chronic stress may contribute to pro-inflammatory phenotypes.
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Affiliation(s)
| | - Dana H Bovbjerg
- Department of Psychology, University of Pittsburgh, United States; Department of Psychiatry, University of Pittsburgh School of Medicine, United States.
| | - Anna L Marsland
- Department of Psychology, University of Pittsburgh, United States.
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Szuhany KL, Malgaroli M, Miron CD, Simon NM. Prolonged Grief Disorder: Course, Diagnosis, Assessment, and Treatment. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:161-172. [PMID: 34690579 PMCID: PMC8475918 DOI: 10.1176/appi.focus.20200052] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Losing a loved one is one of life's greatest stressors. Although most bereaved individuals navigate through a period of intense acute grief that lessens with time, approximately 10% will develop a prolonged grief condition. This review provides an overview of the course of grief and describes risk factors for developing prolonged grief disorder. The evolution of the prolonged grief disorder diagnosis, including the latest criteria sets for ICD-11 and DSM-5, as well as common comorbid conditions and differential diagnosis are discussed. Clinically useful self-report and clinician-rated measures for assessing symptom constructs and overall prolonged grief disorder severity, evidence-based psychotherapies (such as complicated grief treatment), as well as evidence about pharmacologic approaches are presented. Finally, the authors discuss important future directions, including a potential increase in prolonged grief disorder cases due to the COVID-19 pandemic.
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Affiliation(s)
- Kristin L Szuhany
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Matteo Malgaroli
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Carly D Miron
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Naomi M Simon
- Department of Psychiatry, New York University Grossman School of Medicine, New York
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5
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Kang M, Bohorquez-Montoya L, McAuliffe T, Claesges SA, Blair NO, Sauber G, Reynolds CF, Hillard CJ, Goveas JS. Loneliness, Circulating Endocannabinoid Concentrations, and Grief Trajectories in Bereaved Older Adults: A Longitudinal Study. Front Psychiatry 2021; 12:783187. [PMID: 34955928 PMCID: PMC8692767 DOI: 10.3389/fpsyt.2021.783187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Loneliness is one of the most distressing grief symptoms and is associated with adverse mental health in bereaved older adults. The endocannabinoid signaling (ECS) system is stress-responsive and circulating endocannabinoid (eCB) concentrations are elevated following bereavement. This study examined the association between loneliness and circulating eCB concentrations in grieving older adults and explored the role of eCBs on the association between baseline loneliness and grief symptom trajectories. Methods: A total of 64 adults [grief with high loneliness: n = 18; grief with low loneliness: n = 26; and healthy comparison (HC): n = 20] completed baseline clinical assessments for the UCLA loneliness scale. In grief participants, longitudinal clinical assessments, including the Inventory of Complicated Grief and 17-item Hamilton Depression Rating scales, were collected over 6 months. Baseline circulating eCB [N-arachidonoylethanolamine (AEA) and 2-arachidonoylglycerol (2-AG)] concentrations were quantified in the serum using isotope dilution, liquid chromatography-mass spectrometry; cortisol concentrations were measured in the same samples using radioimmunoassay. Results: Circulating AEA concentrations were higher in severely lonely grieving elders than in HC group; cortisol concentrations were not different among the groups. Cross-sectionally, loneliness scores were positively associated with AEA concentrations in grievers; this finding was not significant after accounting for depressive symptom severity. Grieving individuals who endorsed high loneliness and had higher 2-AG concentrations at baseline showed faster grief symptom resolution. Conclusions: These novel findings suggest that in lonely, bereaved elders, increased circulating eCBs, a reflection of an efficient ECS system, are associated with better adaptation to bereavement. Circulating eCBs as potential moderators and mediators of the loneliness-grief trajectory associations should be investigated.
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Affiliation(s)
- Minhi Kang
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Luisa Bohorquez-Montoya
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Timothy McAuliffe
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Stacy A Claesges
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Nutta-On Blair
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Garrett Sauber
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI, United States.,Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Cecilia J Hillard
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI, United States.,Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joseph S Goveas
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States.,Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, United States
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Lenger MK, Neergaard MA, Guldin MB, Nielsen MK. Poor physical and mental health predicts prolonged grief disorder: A prospective, population-based cohort study on caregivers of patients at the end of life. Palliat Med 2020; 34:1416-1424. [PMID: 32830615 PMCID: PMC7543026 DOI: 10.1177/0269216320948007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The health of caregivers can be affected during end-of-life caregiving. Previous cross-sectional studies have indicated an association between poor health status and prolonged grief disorder, but prospective studies are lacking. AIM To describe physical and mental health status in caregivers of patients at the end of life, and to investigate whether caregivers' health status during caregiving predict prolonged grief disorder. DESIGN A population-based prospective survey was conducted. Health status was measured in caregivers during caregiving (SF-36), and prolonged grief disorder was assessed 6 months after bereavement (Prolonged Grief-13). We calculated mean scores of health status and explored the association with prolonged grief disorder using logistic regression adjusted for age, gender and education. SETTING/PARTICIPANTS The health in caregivers of patients granted drug reimbursement due to terminal illness in Denmark in 2012 was assessed during caregiving and 6 months after bereavement (n = 2125). RESULTS The SF-36 subscale 'role-physical' concerning role limitations due to physical health, the 'mental health' component score, and all 'mental health' subscales showed significantly worse health in the participants than in the general population. Both poor physical health (adjusted OR: 1.05 (95% CI: 1.04-1.07)) and poor mental health (adjusted OR: 1.09 (95% CI: 1.07-1.11)) predicted prolonged grief disorder. CONCLUSION Caregivers scored lower on one physical subscale and all mental health measures than the general population. Prolonged grief disorder was predicted by poor physical and mental health status before bereavement. Future research is needed on the use of health status in systematic assessment to identify caregivers in need of support.
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Affiliation(s)
| | | | - Mai-Britt Guldin
- Research Unit for General Practice, Aarhus, Denmark
- Palliative Care Unit, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Kjaergaard Nielsen
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Bell JM, Mason TM, Buck HG, Tofthagen CS, Duffy AR, Groër MW, McHale JP, Kip KE. Challenges in Obtaining and Assessing Salivary Cortisol and α-Amylase in an Over 60 Population Undergoing Psychotherapeutic Treatment for Complicated Grief: Lessons Learned. Clin Nurs Res 2020; 30:680-689. [PMID: 33218253 DOI: 10.1177/1054773820973274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Biomarkers may serve as objective measures in complicated grief (CG) potentially capturing responses to stress reduction treatment. This paper reports challenges in obtaining and assessing salivary cortisol and α-amylase (sAA) for a recent randomized clinical trial. Within-session changes in salivary cortisol and sAA for 54 older adults with CG who received Accelerated Resolution Therapy were compared with perceived stress measured by Subjective Units of Distress Scale. Bivariate correlations and multiple regressions examined changes in biomarkers. Protocols, study logs, and audit reports identified challenges. Challenges included obtaining unstimulated passive drool salivary samples and their analyses. Our sample of older females on multiple medications may have resulted in a perfect storm of moderating and intervening variables which affected the stress response. This paper contributes to the discussion on designing clinical trials for older adults which must account for physiologic changes, multimorbidity, and polypharmacy common in this population and makes recommendations moving forward.
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Affiliation(s)
- Jesse M Bell
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Tina M Mason
- College of Nursing, University of South Florida, and Department of Nursing Research, Moffitt Cancer Center, Tampa, FL, USA
| | - Harleah G Buck
- College of Nursing, University of South Florida, Tampa, FL, USA
| | | | - Allyson R Duffy
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Maureen W Groër
- College of Nursing and Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - James P McHale
- Department of Psychology, USF St. Petersburg Family Study Center, University of South Florida, Tampa, FL, USA
| | - Kevin E Kip
- Health Services Division, Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
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Hopf D, Eckstein M, Aguilar-Raab C, Warth M, Ditzen B. Neuroendocrine mechanisms of grief and bereavement: A systematic review and implications for future interventions. J Neuroendocrinol 2020; 32:e12887. [PMID: 32754965 DOI: 10.1111/jne.12887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 05/26/2020] [Accepted: 06/14/2020] [Indexed: 12/20/2022]
Abstract
Bereavement is associated with many negative behavioural, psychological and physiological consequences and leads to an increased risk of mortality and morbidity. However, studies specifically examining neuroendocrine mechanisms of grief and bereavement have yet to be reviewed. This systematic review is a synthesis of the latest evidence in this field and aims to draw conclusions about the implications of neurobiological findings on the development of new interventions. PRISMA guidelines for systematic reviews were used to search for articles assessing neuroendocrine correlates of grief. Findings were qualitatively summarised. The National Heart, Lung, and Blood Institute Study Assessment Tool was used to assess the quality of the included studies. Out of 460 papers, 20 met the inclusion criteria. However, most were of fair quality only. As a neuroendocrine marker, the majority of the studies reported cortisol as the outcome measure and found elevated mean cortisol levels, flattened diurnal cortisol slopes and higher morning cortisol in bereaved subjects. Cortisol alterations were moderated by individual differences such as emotional reaction to grief, depressive symptoms, grief severity, closeness to the deceased and age or gender. Research on neuroendocrine mechanisms of grief is still in its early stages regarding grief measures and the use and timing of neuroendocrine assessments. Most of the studies focus on cortisol as outcome, and only limited data exist on other biomarkers such as oxytocin. Future research might consider assessing a broader range of neuroendocrine markers and use longitudinal designs with a focus on the psychobiological reactions to loss. Based on this, individually tailored psychosocial interventions, possibly in the palliative care context, might be developed to prevent prolonged grief disorder.
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Affiliation(s)
- Dora Hopf
- Institute of Medical Psychology, Heidelberg University Hospital, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Monika Eckstein
- Institute of Medical Psychology, Heidelberg University Hospital, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Corina Aguilar-Raab
- Institute of Medical Psychology, Heidelberg University Hospital, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Marco Warth
- Institute of Medical Psychology, Heidelberg University Hospital, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Heidelberg University Hospital, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
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9
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Ennis J, Majid U. "Death from a broken heart": A systematic review of the relationship between spousal bereavement and physical and physiological health outcomes. DEATH STUDIES 2019; 45:538-551. [PMID: 31535594 DOI: 10.1080/07481187.2019.1661884] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The loss of a loved one is often associated with "death from a broken heart" for the survivor, and there is evidence that shows that widowers and widows are at risk for higher morbidity and mortality than the general population. This systematic review will summarize the physical and physiological health outcomes of spousal bereavement. A systematic database search was conducted, and 38 studies were analyzed. The majority of studies found a statistically significant and positive association between spousal bereavement and adverse physical and physiological health outcomes such as inflammation, cardiovascular risk, chronic pain, and mortality.
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Affiliation(s)
- Jeffrey Ennis
- Ennis Centre for Pain Management, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Umair Majid
- Ennis Centre for Pain Management, Hamilton, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Division of Clinical Decision-Making and Healthcare, University Health Network, Toronto, Canada
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