Grief and bereavement of family and friends around medical assistance in dying: scoping review

OBJECTIVES

The increase in the number of jurisdictions legalising medical assistance in dying (MAiD) has contributed to a growth in the number of family and friends who may face unique elements of grief and bereavement. The aim of this study was to review the literature of grief and bereavement of family and friends following MAiD, and to summarise findings for the development of community resources and programming.

METHODS

We performed a scoping review with workshop consultation of stakeholders. Six electronic databases and the grey literature were searched for qualitative, quantitative and review articles. Content-analytical techniques and multidisciplinary discussions led to the development of concepts and a conceptual framework.

RESULTS

Twenty-eight articles met the inclusion criteria. We identified five concepts that impact the grief and bereavement of family/friends: relationships between family/friends and the patient as well as healthcare providers; aspects of MAiD grief which can include secrecy and/or anticipatory grief; preparations which may include family/friends and should be centralised and harmonised; end of life as an opportunity for ceremony; and the aftereffects during which mental health outcomes are studied.

CONCLUSION

This multidisciplinary scoping review incorporates stakeholder consultation to find that support is needed to address the complicated and changing emotions of family/friends before, during and after a MAiD death. Furthermore, additional societal normalisation of MAiD is necessary to reduce secrecy and stigma and improve the accessibility of resources for family/friends.

Disclosure of Sexual Victimization: Effects of Invalidation and Shame on Re-Disclosure

Research on disclosure of sexual victimization has consistently demonstrated that the act of disclosure and the disclosure recipient have a synergistic effect in facilitating either positive or negative post-assault outcomes. While negative judgments such as victim blame have been argued to serve a silencing function, experimental investigations of this claim are lacking. The current study investigated whether invalidating feedback in response to self-disclosure of a personally distressing event produced feelings of shame, and whether shame influenced subsequent decisions around re-disclosure. Feedback type (validating, invalidating, no feedback) was manipulated in a sample of 142 college students. Results partially supported the hypothesis that shame resulted from invalidation, however shame was better predicted by individual perceptions of invalidation than the experimental manipulation. Although few participants opted to make changes to the content of their narrative for re-disclosure, those who did had higher levels of state shame. Results suggest that shame may be the affective mechanism by which invalidating judgments silence victims of sexual violence. The present study also supports the distinction previously made between Restore and Protect motivations in managing this shame. This study provides experimental support for the notion that an aversion to being shamed, communicated via an individual's perception of emotional invalidation, features in judgments of re-disclosure. Perceptions of invalidation, however, vary individually. Professionals working with victims of sexual violence should be mindful of the importance of shame attenuation in facilitating and encouraging disclosure.

Factors promoting greater preoccupation with a secret

The secrets that are most taxing to one's health and well-being are those that are the most preoccupying to the secret-keeper. However, it is currently unclear what makes a secret preoccupying. We conducted a four-wave longitudinal study to assess four factors that should contribute to one's degree of preoccupation with a secret kept from one's spouse/romantic partner: perceived cost of revealing the secret, frequency of cues, fear of discovery, and individual differences in self-concealment. Multilevel modelling of data from an online sample of 143 adults (51% women, 49% men; M_age  = 39.9, SD = 9.3) keeping a secret from their spouse/partner indicated that all four factors independently and positively predict greater preoccupation with a secret. Further, the first three factors also significantly predicted how preoccupied one would be with one's secret two weeks later, taking into account how preoccupied one was with the secret at present. We conclude that the characteristics of the secret, as well as the secret-keeper, can contribute to how preoccupying a secret is to an individual.

Effects of a Sexual Health Interview among Arab American Women: An Experimental Disclosure Study

Although sexuality is an important aspect of peoples' health and well-being, many people-professionals and patients alike-find sexuality uncomfortable to discuss. In Arab culture, certain sexual thoughts and behaviors are taboo, particularly for women, and it is not known whether an interview in which Arab American women disclose their sexuality to a health professional would be well-received and beneficial or upsetting and harmful. This experimental study tested whether engaging in a disclosure-oriented sexual health interview affects Arab American women's sexual and psychological health. A sample of 134 Arab American women, ages 18-35 years (M = 20.6), completed self-report measures of sexual health and attitudes and psychological symptoms, and then were randomized to an interview or control (waitlist) condition. The 60-min disclosure interview inquired about sexual attitudes, experiences, and conflicts. Five weeks later, all participants completed follow-up measures. Post-interview reports suggest that participants responded favorably to the interview and generally benefited from participation. Analyses of covariance (controlling for baseline levels of the outcome measure) indicated that the interview led to significantly greater sexual satisfaction and less discomfort with sexual self-disclosure at 5-week follow-up, compared to controls; the two conditions did not differ on follow-up sexual self-schema, sexual self-esteem, or psychological symptoms. Moderation analyses revealed that participation in the interview differentially improved the sexual self-schema of women with no past sexual experience, compared to women with sexual experience. These experimental findings suggest the value, rather than the risk, of clinicians encouraging Arab American women to openly disclose and discuss their sexual experiences and attitudes in a confidential, empathic setting.

Secrets, Psychological Health, and the Fear of Discovery

Keeping secrets from one’s partner has been associated with lower well-being and relationship satisfaction. Previous research has suggested that individual differences in self-concealment account for these effects. However, we propose that the fear of discovery (FoD)—defined as the fear that one’s secret may be revealed by means other than deliberate disclosure—predicts the extent to which secrets affect well-being beyond the effects attributable to individual differences. Both a cross-sectional and a longitudinal survey (combined N = 471; 54.4% female; Mage = 39.5) of adults in romantic relationships confirmed that FoD predicted greater preoccupation with the secret, more negative affect, and less relationship satisfaction and commitment beyond that of self-concealment. Multilevel modeling in Study 2 indicated that changes in FoD predicted changes in preoccupation over time. The data are consistent with the notion that FoD promotes greater preoccupation, greater negative affect, and lower levels of relationship well-being.

The Effects of a Life Stress Emotional Awareness and Expression Interview for Women with Chronic Urogenital Pain: A Randomized Controlled Trial

OBJECTIVE

Women with chronic urogenital pain (CUP) conditions have elevated rates of lifetime trauma, relational stress, and emotional conflicts, but directly assessing and treating psychological stress is rarely done in women's health care settings. We developed and tested the effects on patients' somatic and psychological symptoms of a life stress interview that encourages disclosure about stressors and uses experiential techniques to increase awareness of links between stress, emotions, and symptoms.

METHODS

In this randomized trial, women with CUP recruited at a multidisciplinary women's urology center received either a single 90-minute life stress interview (N = 37) or no interview (treatment-as-usual control; N = 25). Self-report measures of pain severity (primary outcome), pain interference, pelvic floor symptoms, and psychological symptoms (anxiety and depression) were completed at baseline and six-week follow-up.

RESULTS

Differences between the life stress interview and control conditions at follow-up were tested with analyses of covariance, controlling for baseline level of the outcome and baseline depression. Compared with the control condition, the interview resulted in significantly lower pain severity and pelvic floor symptoms, but the interview had no effect on pain interference or psychological symptoms.

CONCLUSIONS

An intensive life stress emotional awareness expression interview improved physical but not psychological symptoms among women with CUP seen in a tertiary care clinic. This study suggests that targeting stress and avoided emotions and linking them to symptoms may be beneficial for this complex group of patients.

The Emotion Dynamics of Transitional Justice: An Emotion Sharing Perspective

Since the Nuremberg International Military Tribunal, transitional justice (TJ) procedures have been cast in terms of emotion: disgust, horror, revenge, and remorse. For contemporary TJ, claims are made that it contributes to the emotional recovery of individual victims and conflict-torn societies after mass atrocity crimes. Empirical support for such claims is mixed at best. This article proposes a framework of “emotion sharing” in order to enhance our understanding of the emotion dynamics in TJ settings. It will focus on processes of emotion sharing in TJ fora, and discuss the specific limitations and conditions of the TJ settings in which emotion sharing takes place. Conclusions are drawn as to the claims, realities, and prospects of emotion dynamics in TJ fora.

Evaluation of Quality of Life of Those Living near a Wind Farm

OBJECTIVES

Health-related quality of life (HRQoL) can serve as a multidimensional means of evaluating the relationship between the presence of wind turbines in residential areas and their consequence for health. The purpose of this study was to determine whether a relationship exists between the presence of wind farms at different stages of development and the HRQoL of people living in their vicinity in Poland.

METHOD

The instruments employed in this study were the SF-36v2, a questionnaire measuring self-reported health problems, and a sociodemographic questionnaire. The study involved 1277 people who lived within 2 km from a wind turbine.

RESULTS

The highest overall QoL scores were obtained by respondents living the closest to wind turbines. The mental health, role emotional, and social functioning scores were significantly higher among respondents living near wind farms and wind-farm construction sites than among those living close to locations where wind farms were planned but where construction had not yet begun. Positive correlations were found between physical and mental component scores and reactions to the news of plans to construct a wind farm. Significant differences in physical and mental component scores were observed between residents who reacted calmly and those who responded with apprehension. Residents who expected the improvement of their financial standing as a result of the wind farm assessed their general health higher than those who did not expect to receive any economic benefits. The lowest QoL scores corresponded to frequent headaches, stomach aches, and back pain over the previous three months, as well as recurrent problems with falling asleep, anxiety, and a lack of acceptance of the project.

CONCLUSION

The lowest overall QoL and general health scores were noted among residents of places where wind-farm developments were either at the stage of planning or under construction. In order to find ways of reducing environmental stress and its adverse effects on health, it is necessary to conduct research on residents of places where a wind farm is either planned or under construction, or has just been completed.

Technology addiction's contribution to mental wellbeing: The positive effect of online social capital

This research examines the effect of online social capital and Internet use on the normally negative effects of technology addiction, especially for individuals prone to self-concealment. Self-concealment is a personality trait that describes individuals who are more likely to withhold personal and private information, inhibiting catharsis and wellbeing. Addiction, in any context, is also typically associated with negative outcomes. However, we investigate the hypothesis that communication technology addiction may positively affect wellbeing for self-concealing individuals when online interaction is positive, builds relationships, or fosters a sense of community. Within these parameters, increased communication through mediated channels (and even addiction) may reverse the otherwise negative effects of self-concealment on wellbeing. Overall, the proposed model offers qualified support for the continued analysis of mediated communication as a potential source for improving the wellbeing for particular individuals. This study is important because we know that healthy communication in relationships, including disclosure, is important to wellbeing. This study recognizes that not all people are comfortable communicating in face-to-face settings. Our findings offer evidence that the presence of computers in human behaviors (e.g., mediated channels of communication and NCTs) enables some individuals to communicate and fos ter beneficial interpersonal relationships, and improve their wellbeing.

Putting the positive in health psychology: A content analysis of three journals

This content analysis investigated the inclusion of positive psychological constructs in research published in three leading health psychology journals. A list of positive constructs relevant to health psychology was compiled and their inclusion in these journals was examined. It was found that although there has been a sharp increase in recent years, only 3 percent of all articles published (114 of 3789) included the study of overtly positive constructs. The constructs that have been most and least studied in health psychology were identified and are discussed. This analysis provides insight into the foundations of positive health psychology and identifies future directions.

Secret Romantic Relationships: Consequences for Personal and Relational Well-Being

Previous research on romantic secrecy found that hiding one’s relationship from others predicted lower levels of relationship quality. The present research built on this work by exploring the potential consequences of relationship concealment on partners’ commitment level and personal health. Study 1 found that greater secrecy was associated with reduced commitment to one’s relationship, lower self-esteem, and more reported health symptoms. Study 2 tested a theoretical model of the effects of secrecy using structural equation modeling. This model was well supported and suggests that romantic secrecy (a) undermines relational commitment by means of constraining cognitive interdependence (i.e., by limiting psychological closeness to one’s partner) and (b) poses a threat to partners’ personal health as a result of generating negative affect (e.g., nervousness and fear). These findings indicate that romantic secrecy may have harmful consequences for both the relationship itself and the health of the partners involved.

What parents don't know and how it may affect their children: qualifying the disclosure-adjustment link

Recent research has identified adolescent disclosure to parents as a powerful predictor of adolescent adjustment. We propose, however, that the common operationalization of adolescent disclosure incorporates the two separate constructs of disclosure and secrecy, and predicted that the disclosure-adjustment link can largely be explained by the unique contribution of secrecy from parents. A four-wave survey study among 309 adolescents tested these predictions. Factor analyses confirmed that disclosure and secrecy should be distinguished as two separate constructs. Moreover, in cross-lagged path analyses, only secrecy was a longitudinal predictor of adolescent internalizing (i.e., depression) and externalizing (i.e., delinquency) problems, disclosure was not. Secrecy consistently contributed to the longitudinal prediction of delinquency from early to middle adolescence, whereas it contributed to the prediction of depression only in early adolescence. Findings thus attest the importance of distinguishing between disclosure and secrecy and suggest that the disclosure-adjustment link may actually reflect a secrecy-maladjustment link.

Longitudinal associations between keeping a secret and psychosocial adjustment in adolescence

Increasing bodies of evidence suggest that keeping secrets may be detrimental to well-being and adjustment, whereas confiding secrets may alleviate the detriments of secrecy and benefit well-being and adjustment. However, few studies have addressed the consequences of keeping and confiding secrets simultaneously, and even fewer have done so longitudinally. This article reports on a two-wave longitudinal survey study among 278 adolescents (aged 13—18 years) that examined the associations of keeping and confiding a specific secret with psychosocial adjustment. Results confirmed a hypothesized longitudinal contribution of keeping a secret all to oneself to psychosocial problems, including depressive mood, low self-concept clarity, low self-control, loneliness, and poor relationship quality. Furthermore, confiding versus continuing to keep a secret all to oneself was associated with decreased psychosocial problems after six months, whereas starting to keep a secret versus not doing so was associated with increased psychosocial problems. These results suggest that the keeping or confiding of secrets may affect adolescents' psychosocial well-being and adjustment.

Emotion Elicits the Social Sharing of Emotion: Theory and Empirical Review

This review demonstrates that an individualist view of emotion and regulation is untenable. First, I question the plausibility of a developmental shift away from social interdependency in emotion regulation. Second, I show that there are multiple reasons for emotional experiences in adults to elicit a process of social sharing of emotion, and I review the supporting evidence. Third, I look at effects that emotion sharing entails at the interpersonal and at the collective levels. Fourth, I examine the contribution of emotional sharing to emotion regulation together with the relevant empirical evidence. Finally, the various functions that the social sharing of emotion fulfills are reviewed and the relevance of the social sharing of emotion for emotion scientists is discussed.

Is Keeping a Secret or Being a Secretive Person Linked to Psychological Symptoms?

This prospective study explored whether keeping a major secret, self-concealment (i.e., the predisposition to keep secrets), and social support at Time 1 predicted symptomatology levels 9 weeks later (Time 2) among a sample of 86 undergraduates. The results showed that the process of keeping a secret actually predicted fewer symptoms, whereas the personality variable of self-concealment predicted more symptoms at Time 2, even when the analyses controlled for social support. However, the predictive effects of both secret keeping and self-concealment were wiped out when the analyses statistically controlled for initial symptomatology, which was positively linked to self-concealment from the outset. These findings challenge conventional wisdom about the dangers of keeping a major secret and suggest that, instead, the kind of person who is secretive simply might be more vulnerable to symptoms.

Hope, social support, and behavioral problems in at-risk children

This study investigated the effects of hope, social support, and stress on behavioral problems in a high-risk group of 65 children of incarcerated mothers. Children with low levels of hope had more externalizing and internalizing problems. Children who perceived less social support had more externalizing problems, and children who had experienced more life stressors reported more internalizing problems. Regression analyses indicated that hope contributed unique variance to both internalizing and externalizing behavioral problems after social support and stress were controlled. These findings suggest that being confident in one's ability to overcome challenges and having a positive outlook function as protective factors, whereas being less hopeful may place a child at risk for developing adjustment problems. Whether it is possible to foster agency and teach pathways to children with lower levels of hope is discussed.

Intra- and interpersonal consequences of experimentally induced concealment

Secrecy, concealment, and thought suppression are assumed to be important aspects of psychopathology. However, most studies address these from an intrapersonal perspective. This study investigates both the intra- as well as the interpersonal consequences of experimentally induced concealment. Two experiments are described in which non-clinical participants were given a concealment instruction (i.e. avoid talking about a certain topic) in a conversation with an interviewer. In the neutral condition there was no such restraint. Interviewees were more tense and more aware during the concealment condition than during the neutral condition, whereas the interviewers were not aware of the participants' avoidance of the concealment topic. The second counterbalanced experiment replicated the results from the initial experiment. The hypotheses were supported that concealment can be induced experimentally leading to thought suppression and elevated levels of discomfort in the concealing individuals, without their conversation partners noticing. Implications for clinical practice are discussed.

Emotion regulation during social remembering: differences between emotions elicited during an event and emotions elicited when talking about it

This paper examines emotion regulation as a function of autobiographical remembering in social contexts. Two studies (n = 38 and 123, respectively) are presented that provide evidence that autobiographical remembering in social settings can result in changes in the emotions associated with an experience. However, the results also suggest that whether changes occur depends on features of the recall context, including the gender of participants, and the responses of their listeners. Across both studies, men showed greater emotional benefits from talking about events than women. Moreover, greater listener agreement was associated with greater benefits for emotion. The results are discussed in terms of functions of autobiographical remembering, gender, social support, and emotion regulation.

Quality of life and its correlates in a community population in a Japanese rural area

Correlations of three aspects of quality of life (QOL) (health perception, life satisfaction, and self-confidence) with personality traits and early experiences were examined. Quality of life aspects were examined using 220 inhabitants in a rural community in Japan. Health perception was better among men than among women. Life satisfaction and self-confidence were better in people aged 55 or over than in those under 55. Among the current predictor variables, the Eysenck Personality Questionnaire neuroticism score was correlated with poor life satisfaction in the younger women; the extraversion score with the older women's health perception, the older men's life satisfaction, and the women's self-confidence; and the psychoticism score with the older men's life satisfaction. Among early life predictors, self-confidence was lower among those older men who had reported early parental loss. Childhood paternal overprotection was correlated with poor health perception in younger people and with good health perception in older women. Some negative life events experienced during childhood were correlated with poorer QOL measures in some subgroups, while positive life experiences were correlated with the older women's life satisfaction. These findings suggest that the three aspects of the QOL are discrete in their psychosocial correlates and that interventions on health education and care should take into account individual's psychosocial attributes.