A systematic review of studies describing the influence of informal social support on psychological wellbeing in people bereaved by sudden or violent causes of death

Perceived social support and symptoms of prolonged grief after a drug-related death

Social network support can be important when adjusting to life after the death of a close family member or friend. However, research has yielded inconclusive results regarding the relationship between social support and complicated grief reactions. Persons bereaved after a drug-related death (DRD) are a group of people who are at high risk of developing bereavement complications. Based on a Norwegian study on DRD bereaved close family members and friends (n = 250), this study examines the association between perceived social support, societal stigma, own social withdrawal, and prolonged grief symptoms (PGS). Own social withdrawal predicts the most variance in PGS symptoms: 8%, perceived social support: 3%, and societal stigma: 1%. Together the three focal variables explain 17.5% of variations in PGS. Results from the study point to the importance of social network support, which could reduce bereavement complications after a DRD.

Grief participation rights and the social support hierarchy: Exploring the communicative role of the bereaved in a social support interaction

This article explores how bereaved individuals co-construct social support and social norms in the social interaction of 14 bereavement group meetings in Denmark. To study this, we used a discourse analytical approach focusing on how the participants position their social supporters. The results show that the participants designate, uphold, and presuppose two hierarchical positions to bereaved and non-bereaved supporters with different abilities to understand them. Based on this finding, the concepts of "grief participation rights" and "social support hierarchy" are proposed to supplement existing notions of "rights to grieve" and "grief hierarchy." These concepts suggest that non-bereaved supporters are not accorded the same participatory rights in social support conversations as bereaved individuals who have suffered a similar loss as the speaker. The concepts are discussed in relation to effective social support and in the context of research on social disconnection in grief.

Drug-Death Related Bereavement and Social Support

The loss of a close one to drug-related death (DRD) has been characterized as a form of stigmatized bereavement, and research has shown that there is a high risk of bereavement complications. Social support can be a buffer against bereavement complications, but because of stigma, DRD bereaved persons access to social support can be challenged. Based on data from a Norwegian sample of DRD bereaved persons (N = 252) the present study examines (1) bereaved persons' perceived access to different aspects of social support, and (2) the association between bereaved persons' experiences of societal stigma, own withdrawal, self-blame, and their perceptions of social support. Results show (1) that bereaved persons' access to contact with persons in the same situation is particularly low compared to other support aspects, and (2) that perceived stigma (4%) and own withdrawal (5%) predict variations in drug-related death bereaved persons' perception of social support.

Depression among incarcerated persons following the death of a loved one: Does social support mitigate grief?

The death of a loved one generates adverse and potentially damaging consequences for surviving family members and friends. The challenges of bereavement can be especially severe when experienced by incarcerated persons who must cope with and grieve the death while incarcerated. Yet, limited research evaluates bereavement among incarcerated persons and whether factors such as social support buffer against health-related consequences. Using data from the LoneStar Project-a study of 802 incarcerated men in Texas-we examine depressive symptoms among currently incarcerated persons with differential exposure to a loved one's death (i.e., immediate family, friends, extended family). Importantly, a high rate of death exists among incarcerated persons' loved ones, with 41% in the sample losing someone on the outside during their final year of incarceration. However, we find that external social support from family and friends and in-prison social cohesion from peers, significantly mitigate the harms of bereavement on depressive symptoms.

The Role of Perceived Social Support in the Grief Experiences of More Anxious and Self-Compassionate People

Past research showed that high trait anxiety and low self-compassion, along with lack of perceived social support, have been associated with experiencing stronger grief symptoms. However, research is yet to understand if and how these factors interact among grieving individuals. Results of a cross-sectional study (N = 539) showed that perceived social support interacted differently with trait anxiety and self-compassion to shape grief experiences. Unexpectedly, perceived social support did not buffer the association between higher trait anxiety and stronger grief symptoms. Instead, participants with higher trait anxiety reported stronger symptoms only when they perceived to have less social support. In contrast, participants with higher self-compassion reported less symptoms when they perceived to have more social support. These findings show that social support can emphasize the detrimental role of anxiety and the protective role of self-compassion when people are coping with a loss. Implications and suggestions for future research are discussed.

An Ecological Review of Homicide Bereavement's Risk Factors: Implications for Future Research

This literature review focused on homicide bereavement (HB) risk factors. A content analysis was conducted on 83 empirical papers published in English from January 2000 to December 2021 in peer-reviewed journals. Extracted HB risk factors were synthesized according to six main dimensions: individual level; situational homicide-related factors; and micro, meso, exo, and macro social levels. The review demonstrates that macro-level and situational homicide-related risk factors are in special need of further study. In addition, how HB risk factors interact with one another to influence HB also requires further study. Future research may benefit from examining whether and how individuals experiencing HB influence related factors at various social levels. Last, given that almost all reviewed studies were conducted in Western societies, the sociocultural and ethnic diversity in HB risk factors is in dire need of future study.

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.

Influence of loss- and restoration-oriented stressors on grief in times of COVID-19

This study aimed to examine the influence of COVID-specific stressors on cross-sectional and longitudinal bereavement outcomes. According to the Dual Process Model of grief these stress-inducing factors can relate to the loss (loss-oriented stressors) or to manage everyday life (restoration-oriented stressors) and require coping in the grief process. A total of 491 participants (94.1% female; 43.92 years on average; 44.4% loss of a parent) were included at the first measurement time point (T0), of whom 99 individuals also participated in a follow-up assessment 6 months later (T1). Participants frequently reported loss-oriented (on average 7.30 out of 21 queried) and restoration-oriented stressors (on average 6.99 out of 19 queried). Cross-sectionally, higher acute grief intensity was associated with a higher number of loss-oriented stressors, poorer mental well-being, and sociodemographic variables. This effect disappeared longitudinally, with only acute grief intensity and poorer mental well-being at T0 predicting higher prolonged grief at T1. Common resilience factors did not buffer the effects of the pandemic on grief. Loss-oriented stressors seem to be especially relevant for understanding grief and might be a mediator of higher long-term grief. The findings suggest that COVID-specific strains need to be specifically taken into account in the support of bereaved individuals.

The association between perceived social support and cognition in older adults with and without multiple sclerosis

BACKGROUND

Advances in treatments for Multiple Sclerosis (MS) have resulted in a growing number of aging individuals with MS. Research has shown that perceived social support has protective effects against age-related cognitive decline but no study to date has examined the relationship between perceived social support and cognition in older adults with MS. The current study addressed this gap in knowledge examining the association between perceived social support and cognition in older adults with and without MS.

METHODS

Participants were older adults with MS (n = 67, mean age = 64.75 years;%female =  64.2) and controls (n = 71, mean age = 68.25 years;%female = 57.7) Linear regression models examined the associations of total and domain scores of perceived social support with cognition in the entire sample, and then stratified by group status.

RESULTS

Analyses revealed that total perceived social support, emotional/informational support, and positive social interaction were associated with cognition in the total sample. In stratified analyses, emotional/informational support was significantly associated with cognition in the MS group; however, this association became insignificant when analyses adjusted for depressive symptoms. Positive social interaction was significantly associated with cognition in the control group. Notably, this association remained significant even after adjusting for depressive symptoms.

CONCLUSION

These findings suggest that distinct dimensions of perceived social support may have differential relationships with cognitive function in older adults with MS and healthy controls.

Assessing the validity and reliability of the International Anxiety Questionnaire and the International Depression Questionnaire in two bereaved national samples

The International Anxiety Questionnaire (IAQ) and International Depression Questionnaire (IDQ) are self-report measures of ICD-11 Generalized Anxiety Disorder (ICD-11 GAD) and ICD-11 Single Episode Depressive Disorder (ICD-11 DD). This study tested the psychometric properties of these scales in two samples of bereaved adults from the United Kingdom and the Republic of Ireland. Confirmatory factor analysis (CFA) was used to test the combined dimensionality and measurement invariance of the IAQ and IDQ across the United Kingdom (n = 1012) and Irish (n = 1011) samples. Differential item functioning (DIF) was tested using multiple indicator multiple cause (MIMIC) modelling while convergent validity was also assessed. CFA results supported a correlated two-factor model in both samples. The MIMIC model showed that the IDQ item "Had recurrent thoughts of death or suicide" showed DIF and the effect was small. Internal reliability of the scales were high and convergent validity was supported. The prevalence of ICD-11 GAD was 18.6% and 16.1% and ICD-11 DD was 13.8% and 10.5% in the United Kingdom and Irish samples, respectively. Findings of the study provide support for the validity, measurement invariance, and reliability of the IAQ and IDQ among two bereaved national samples.

Associations between constructs related to social relationships and mental health conditions and symptoms: an umbrella review

BACKGROUND

Loneliness and social isolation are increasingly recognised as prevalent among people with mental health problems, and as potential targets for interventions to improve quality of life and outcomes, as well as for preventive strategies. Understanding the relationship between quality and quantity of social relationships and a range of mental health conditions is a helpful step towards development of such interventions.

PURPOSE

Our aim was to give an overview of associations between constructs related to social relationships (including loneliness and social isolation) and diagnosed mental conditions and mental health symptoms, as reported in systematic reviews of observational studies.

METHODS

For this umbrella review (systematic review of systematic reviews) we searched five databases (PsycINFO, MEDLINE, EMBASE, CINAHL, Web of Science) and relevant online resources (PROSPERO, Campbell Collaboration, Joanna Briggs Institute Evidence Synthesis Journal). We included systematic reviews of studies of associations between constructs related to social relationships and mental health diagnoses or psychiatric symptom severity, in clinical or general population samples. We also included reviews of general population studies investigating the relationship between loneliness and risk of onset of mental health problems.

RESULTS

We identified 53 relevant systematic reviews, including them in a narrative synthesis. We found evidence regarding associations between (i) loneliness, social isolation, social support, social network size and composition, and individual-level social capital and (ii) diagnoses of mental health conditions and severity of various mental health symptoms. Depression (including post-natal) and psychosis were most often reported on, with few systematic reviews on eating disorders or post-traumatic stress disorder (PTSD), and only four related to anxiety. Social support was the most commonly included social construct. Our findings were limited by low quality of reviews and their inclusion of mainly cross-sectional evidence.

CONCLUSION

Good quality evidence is needed on a wider range of social constructs, on conditions other than depression, and on longitudinal relationships between social constructs and mental health symptoms and conditions.

Factors Associated With Symptoms of Prolonged Grief and Psychological Distress Among Bereaved Family Members of Persons Who Died From Sudden Cardiac Arrest

BACKGROUND

Death from sudden cardiac arrest implies a stressful and challenging situation for bereaved family members with an increased risk of prolonged grief disorder and psychological distress.

OBJECTIVES

The aims of this study were (1) to explore the associations between symptoms of prolonged grief and psychological distress and (2) to identify factors associated with symptoms of prolonged grief and psychological distress among bereaved family members of persons who died from sudden cardiac arrest.

METHODS

This cross-sectional survey included bereaved adult family members. Demographic data and measures of prolonged grief (Prolonged Grief Disorder-13), anxiety and depression (Hospital Anxiety and Depression Scale), posttraumatic stress (Posttraumatic Stress Disorder Checklist for DSM-5), and perceived social support (Multidimensional Scale of Perceived Social Support) were analyzed using Spearman's correlations ( r s ) as well as univariate and multiple linear regression analyses.

RESULTS

In total, 108 family members participated. Significant associations between symptoms of prolonged grief, anxiety, depression, and posttraumatic stress were identified ( r s = 0.69-0.79, P < .001). Offered, sought, and/or received professional support from healthcare, lower levels of perceived social support, being a spouse of the deceased, female sex, younger age, and family presence during resuscitation were significantly associated with higher symptom levels of prolonged grief, anxiety, depression, and/or posttraumatic stress.

CONCLUSIONS

The results indicate that family members with higher levels of symptoms were offered, sought, and/or received professional support. However, because a minority are offered professional support after deaths from cardiac arrest, future interventions need to proactively identify family members in need of support. Furthermore, perceived social support seems to be an important factor for family members of persons who died from cardiac arrest.

Low Rates of Grief and Bereavement Support Pre- and Post-Death for Those Who Died Within 72 hours of Admission to a Quaternary Teaching Hospital

Grief and bereavement support are crucial to good palliative and end-of-life care. Support models differ between and within services. In addition, while patient and family needs vary based on risk and resilience factors, acute or unexpected death is associated with complicated grief. Our study was a retrospective review of 159 patients who died within 72 hours of hospital admission. We found a high proportion of unexpected and traumatic deaths and low grief and bereavement support rates. Further work is needed to streamline policies to optimize patient and family-centred grief and bereavement support in the acute hospital setting.

Examining psychometric properties of the Iranian version of exclusive breastfeeding social support scale (EBFSS)

BACKGROUND

The exclusive breastfeeding (EBF) is undeniably proven significant in mothers' health and infants' growth and survival. Its persistence has many familial, social, and economical benefits. Social support is known to be an effective factor in EBF's success and sustainability. However, Exclusive breastfeeding social support (EBFSS) scale validity and reliability is not evaluated in Iran. This study aimed to determine the psychometric properties of EBFSS during postpartum period in Tabriz city, Iran.

METHODS

It is a cross-sectional study with descriptive survey method performed between March 2021 and August 2022. Psychometric properties were determined for the Persian version of EBFSS in six stages: translation process, evaluating content validity, face validity, construct validity, discriminant validity, and reliability. A group of experts (n = 10), followed by a group of women with EBF (n = 10), evaluated the instrument's items based on content and face validities, respectively. A cross-sectional study using the multi-stage cluster random sampling method on 348 women with EBF in the first four months after delivery was conducted to determine the construct validity. The internal consistency and repeatability (test-retest on 30 women, 2 weeks apart) were used to find out the reliability.

RESULTS

Content validity ratio (CVR), content validity index (CVI), and impact score were 0.98, 0.98, and 3.54 for EBFSS, respectively. This indicates a good content and face validity. Exploratory factor analysis (EFA) was performed on 16 items to examine the construct validity identified emotional, instrumental, and informational factors. These factors explained 59.26% of the cumulative variance. The fit indices (CFI = 0.98، TLI = 0.95، χ2/df = 4.20، RMSEA = 0.07 and SRMSEA = 0.05) confirmed the validity of the model in a confirmatory factor analysis (CFA). The internal consistency was examined through Cronbach's alpha and McDonald's omega coefficients that were 0.90 and 0.92, respectively. Finally, Repeatability and reproducibility were found 0.97 (95% CI: 0.92 to 0.99) using Intra-class correlation. This shows an appropriate reliability of the instrument.

CONCLUSIONS

The research findings indicate that the Persian version of the EBFSS has appropriate psychometric properties for evaluating the social support in Iranian women with EBF. This means healthcare providers can use it for screening social support in EBF. Researchers also can use it as a valid instrument.

Death attitudes and Chinese college students' mental health: A latent profile analysis

Death attitudes can have significant impacts on individuals' mental health. The present study used a person-centered approach to identify 588 Chinese college students' profiles of death attitudes (i.e., fear of death, death avoidance, neutral acceptance, escape acceptance, and approach acceptance), as well as their associations with socio-demographic factors and mental health outcomes. Latent profile analysis identified five subgroups of students: healthy (28.8%), acceptant (11.7%), indifferent (43.5%), paradoxical (10.7%), and avoidant (5.3%). The healthy profile had the most favorable mental health outcomes, whereas the paradoxical profile had the least favorable mental health outcomes. Moreover, women and students from better-resourced universities were more likely to report adaptive patterns of death attitudes. Our findings demonstrated the advantages of using a person-centered approach to achieve a more nuanced understanding of Chinese college students' death attitudes in relation to their mental health. The findings can inform death-related education and mental health interventions for college students.

Complicated grief and related factors among nursing staff during the Covid-19 pandemic: a cross-sectional study

BACKGROUND

The challenging working conditions during the Covid-19 pandemic created a perfect storm that can seriously impact nurses' physical and psychological well-being. Our study aimed to investigate complicated grief and its related factors among nursing staff during the Covid-19 pandemic.

METHODS

This is a cross-sectional study. The participants comprised 375 nurses selected by the convenience sampling method from designated wards for patients with Covid-19 in 3 hospitals in Tabriz, Iran. Participants completed a survey containing demographic and clinical questions, the Inventory of Complicated Grief, and the Multidimensional Scale of Perceived Social Support. Multiple regression analysis was used to identify the associates of nurses' grief. The STROBE guidelines were followed in reporting the study's findings.

RESULTS

A significant proportion of participants (57.6%) were found to be suffering from complicated grief. Gender, educational background, type of ward, type of nursing role, type of working shift, years of nursing work experience, and experience working in the Covid-19 settings remained the significant associates of nurses' grief in the regression analysis.

CONCLUSION

Due to frequent exposure to patients' deaths, healthcare providers are at increased risk of suffering from complicated grief during the Covid-19 and post-pandemic. If it remains unresolved, complicated grief can result in significant health problems and the experience of burnout among nurses. Governments, health authorities, and nursing managers should support nurses who work in Covid-19 settings to reduce the adverse impact of the pandemic on nurses' health and well-being.

Home Alone: Widows' Well-Being and Time

Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE, 2004-17) and time diaries from Poland (2013), the U.S. (2006-16), the U.K. (2014-15) and France (2009-10), we examine differences between widowed and partnered older women in well-being and its development in widowhood. Most importantly, our analysis accounts for time use, an aspect which has not been studied previously. We trace the evolution of well-being of women who become widowed by comparing them with their matched non-widowed 'statistical twins' and examine the role of an exceptionally broad set of potential moderators of widowhood's impact on well-being. We confirm a dramatic decrease in mental health and life satisfaction after the loss of partner, followed by a slow partial recovery over a 5-year period. An extensive set of controls recorded prior to widowhood, including detailed family ties and social networks, provides little help in explaining the deterioration in well-being. Unique data from time-diaries kept by older women in several European countries and the U.S. tell us why: the key factor behind widows' reduced well-being is increased time spent alone.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10902-023-00622-w.

Medical outcomes study social support survey (MOS-SSS) in patients with chronic disease: A psychometric assessment

Purpose

Currently, information on the psychometric properties of the Medical outcomes study-social support survey (MOS-SSS) for patients with chronic disease in primary health care, suggests problems in the dimensionality, specifically predominant unidimensionality in a multidimensional measure. The aim of this study was to determine the internal structure (dimensionality, measurement invariance and reliability) and association with other variables.

Methods

A total of 470 patients with chronic disease from a Family Medicine Unit at the Instituto Mexicano del Seguro Social, IMSS, with a mean age of 51.51 years were included. Participants responded to the Questionnaire of Sociodemographic Variables (Q-SV), SF-36 Health-Related Quality of Life Scale-version 1.1, and MOS-SSS.

Results

Non-parametric (Mokken scaling analysis) and parametric (confirmatory factor analysis) analyses indicated unidimensionality, and three-factor model was not representative. A new 8-item version (MOS-S) was developed, where measurement invariance, equivalence with the long version, reliability, and relationship with the SF-36 were satisfactory.

Conclusion

The MOS-SSS scale is unidimensional, and the shortened version yields valid and reliable scores for measuring social support in patients with chronic disease at the primary health care.

Peer support experiences among Chinese parents who lost their only child: A qualitative study

Chinese parents who lost their only child are at high risk of mental health problems. Peer support seems to be a crucial resource for their adaptation. Semi-structured interviews were conducted with 15 participants to explore peer support experiences in this population. Three forms of peer support were identified, namely, online groups, offline activities, and one-to-one contacts. The functions of support included emotional, instrumental, and informational support. Some unique characteristics emerged (e.g., negative experiences). Certain challenges were identified (e.g., lacking professional guidance). The findings indicate that future interventions focused on peer support should be developed.

Grief trajectories among bereaved parents after the 2011 Utøya terror attack: A qualitative analysis

This study took a qualitative approach to explore terror-bereaved parents' long-term experiences with grief. Data were drawn from a larger, longitudinal study, and interviews with 10 bereaved parents were selected based on their reported change in scores on Inventory of Complicated Grief (ICG) over a period of 6.5 years, including the five parents with the largest change (group 1) and the five parents with the least change (group 2). Reflexive thematic analysis of the interview transcripts resulted in four main themes: "I felt completely lost and helpless, like I was stuck in a whirlwind" and "I have been fighting to get back to my everyday life", which both groups contributed to. Participants in group 1 contributed to the theme "I have found a way to a new life," while participants in group 2 contributed to the theme "I cannot seem to find a way to a new life." Findings suggest that sense of control, acceptance, and social support enhanced experienced coping following terror-related bereavement, while comorbid mental health problems, difficulties with acceptance, and repetitive thoughts about the death was experienced as contributing to long-term struggles following terror-related bereavement.

"We are the forgotten grievers": Bereaved family members' experiences of support and mental ill-health following a road traffic collision

Road traffic collisions (RTCs) are a global public health concern; however, research on the impact of bereavement on families remains limited. A critical realist approach was adopted to explore experiences of families suffering bereavement following RTCs, using interviews with 14 participants in the United Kingdom (UK) who have lost a family member. Three key themes were identified: (1) worsening mental health following bereavement, (2) negative impact of an RTC-related bereavement upon family members, (3) limited support following an RTC. Findings highlighted the requirement for appropriate support for bereaved families, and outlined significant flaws within the UK legal system, sentencing, and treatment of families.

Factors Associated With Higher Levels of Grief and Support Needs Among People Bereaved During the Pandemic: Results from a National Online Survey

We identified factors associated with higher levels of grief and support needs among 711 people bereaved during the COVID-19 pandemic in the UK (deaths 16 March 2020-2 January 2021). An online survey assessed grief using the Adult Attitude to Grief (AAG) scale, which calculates an overall index of vulnerability (IOV) (range 0-36), and practical and emotional support needs in 13 domains. Participants' mean age was 49.5 (SD 12.9); 628 (88.6%) female. Mean age of deceased 72.2 (SD 16.1). 311 (43.8%) deaths were from confirmed/suspected COVID-19. High overall levels of grief and support needs were observed; 28.2% exhibited severe vulnerability (index of vulnerability ≥24). Grief and support needs were higher for close relationships with the deceased (vs. more distant) and reported social isolation and loneliness (p < 0.001), and lower when age of deceased was above 40-50. Other associated factors were place of death and health professional support post-death (p < 0.05).

Trajectories of Instrumental and Emotional Social Support and the Associated Risk of Mortality in Bereaved Older Adults in Taiwan

This study identified the trajectories of instrumental and emotional perceived social support (PSS) from 1996 to 2003 and investigated the associated risk of mortality in bereaved older adults in Taiwan. The study analyzed 1,188 bereaved older adults who had experienced loss of a spouse, a child, or both before 1996 from the Taiwan Longitudinal Study on Aging. More favorable trajectories of PSS are associated with lower mortality risk in bereaved older adults. Compared with the spousal or dual bereavement, the parental bereavement benefited more from consistently high instrumental PSS. The present study revealed that consistently high emotional PSS had a stronger protective effect on mortality risk for a widow or widower than did consistently high instrumental support. The findings of this study can serve as an empirical reference to inform social policies and clinical practices for bereaved older adults in culturally similar societies.

The social health domain of people bereaved by a drug-related death and associations with professional help: A cross-sectional study

People bereaved by traumatic deaths are vulnerable to long-lasting impairments in social health, including the quality of social relationships and the capacity to manage their social lives. In this Norwegian study involving 255 participants bereaved by a drug-related death, we aimed to investigate their social health and associations with professional help. The results of a cross-sectional survey showed that participants on average rated their social health as poor, though with large variations within the group. Participants who reported high satisfaction with professional help reported significantly higher scores on most social health-related variables. More research is needed on professional help focusing on the social health of traumatically bereaved people.

Grief reactions in relation to professional and social support among family members of persons who died from sudden cardiac arrest: A longitudinal survey study

BACKGROUND

The loss of a close person from sudden cardiac arrest (CA) leaves family members at risk of developing grief reactions such as symptoms of prolonged grief, anxiety, depression, and posttraumatic stress. The aim was to describe longitudinal variations in grief reactions and its association with professional and social support among bereaved family members after a close person's death from sudden CA.

METHODS

This longitudinal multimethod survey included 69 bereaved family members who completed a questionnaire 6 and 12-months after the CA, including the Prolonged Grief Disorder-13, Hospital Anxiety and Depression Scale, PTSD Checklist for DSM-5, and Multidimensional Scale of Perceived Social Support. Qualitative data were collected by open-ended questions. Quantitative data was analyzed using Wilcoxon signed-rank test and linear regression analysis while written comments were analyzed using qualitative content analysis.

RESULTS

The median age was 62 years, 67 % were women, and 38 % had been present during the resuscitation attempts. Using the cut-off scores at the 6- and 12-month assessments respectively, 14 % and 17 % reported symptoms of prolonged grief, 32 % and 26 % symptoms of anxiety, 14 % and 9 % depression, and 4 % and 1 % posttraumatic stress. Professional and social support at the 6-month assessment were significantly associated with symptoms of prolonged grief, anxiety, depression, and/or posttraumatic stress at the 12-month assessments but could not predict any changes in the grief reactions.

CONCLUSIONS

Family members' grief reactions point to the importance of proactive and available support over time to meet family members' needs.

Support Received and Provided by Older Adults who Lost a Child: A Qualitative Content Analysis

BACKGROUND

Despite the vulnerability of older adults and the importance of social support following the death of a child, little research has been conducted on the Iranian older population. This study aimed to explore perceived support among older adults after the death of a child.

MATERIALS AND METHODS

This study was carried out in Iran in 2020-2021 using a qualitative content analysis method. Semi-structured interviews with older adults who had experienced child death were used to collect data. To ensure the data's trustworthiness, Guba and Lincoln's criteria were applied. The Graneheim and Lundman method was used to analyze the data.

RESULTS

The participants' mean age was 70.41 years. The findings were organized into one theme, two main categories, and five subcategories based on 352 initial codes. Two main categories emerged from the participants' experiences: "supporting networks" and "giving support to others" with the theme of "healing emotional pain." Following the death of a child, the older parents perceived support as recuperation from their hurt feelings.

CONCLUSIONS

Receiving support from family, entourages, and society, as well as providing support to the family and parents with the same experience were protective factors against the effects of child death among older parents. To reduce the consequences of child death, older parents' health should be monitored through home care provided by nurses.

Receiving Notification of Unexpected and Violent Death: A Qualitative Study of Italian Survivors

(1) Background: The loss of a significant person can be especially traumatic when death comes without warning and is due to causes such as suicide, murder and accidents. The way an individual is informed about the loss can affect the way of adapting to the loss and the quality of life of survivors. Communication modalities of the notifier may deeply influence the bereavement process. Aim: The present investigation aimed to explore the experience of those who received communication of such a type of death by a professional figure. (2) Method: Snowball sampling was used to recruit the participants to this qualitative study. Social networks, word of mouth and researchers' acquaintances were used, including clients of the NGO De Leo Fund. A total of 52 Italian people (eight males and forty four females, mean age = 49.44; SD = 14.23) who received notification of the death of a loved one by police officers or by health professionals participated in the study. Deaths involved cases of suicide, murder, road accident and mountain accident. (3) Results: The following four key themes were identified: (a) how the communication took place; (b) reactions; (c) support; and (d) coping strategies. Only 22 participants reported having received clear information about the dynamics of what happened; the rest of the sample obtained only poor or ambiguous information. The majority of participants sought or received informal support from family and friends immediately after notification; however, some participants experienced a total lack of support. The opportunity to see the body of the loved one for the last farewell, when denied, caused discomfort in recipients of the news. (4) Conclusions: Even the impactful notification of a traumatic death such as suicide or road accident can be mitigated by the appropriate behaviour and attitude of notifiers, who should always avoid providing generic or ambiguous information about what happened. The notification process should not end with the simple transmission of the communication, but should also look at the following phases by including referral to supportive networks or bereavement services, aimed at assisting individuals in the immediate aftermath but also in the long term.

Paths to positive growth in parents bereaved by drug-related death: A mixed-method study

Introduction

Drug-related deaths (DRDs) are a major public health challenge. Losing a child to a DRD can be a very stressful life event, which places parents at risk of mental and physical health problems. However, traumatic experiences like losing a child to DRD can paradoxically also lead to positive psychological changes. A mixed-method approach was used to understand the complexity of the phenomenon of post-traumatic growth experienced by parents following a DRD.

Method

By combining data from a survey (n = 89) and interviews (n = 14), we explored positive growth experiences among Norwegian parents. We conducted descriptive analyses of the sample’s demographic characteristics and mean scores for Post-traumatic Growth Inventory (PTGI-SF) items. Hierarchical multiple regression was used to examine the influence of the ability to perform daily activities (WSAS), self-efficacy (GSE-SF), social support (CSS), and symptoms of prolonged grief (PG-13) on the outcome variable of post-traumatic growth (PTGI-SF). Reflexive thematic analysis was applied to analyze the qualitative data. Finally, we integrated the results of the survey and the interviews.

Results

For items measuring post-traumatic growth, parents scored highest on the item “I discovered that I’m stronger than I thought I was” and lowest on the item “I am able to do better things with my life.” Self-efficacy and social support had a statistically significant relation with post-traumatic growth. Two themes were generated from the interviews: (I) new perspectives on life and (II) new paths in life. Even though the “New Possibilities” subscale had the lowest mean score for the PTGI-SF, new paths in life were important for many of the interviewed parents.

Discussion

Parents described traumatic stressors associated with having a child who uses narcotics and hence experienced positive changes even before losing their child. We argue that on an individual level, the consequences of spillover stigma, low self-efficacy, and intrusive rumination can hinder potential post-traumatic growth. On a group level, enhancing network support may increase post-traumatic growth experiences. Hence, parents who have experienced a DRD can benefit from help to activate their social networks and strengthen their self-efficacy.

Are empathy profiles and perceived social support associated with depressive and grief-related symptoms in suicide survivors?

OBJECTIVE

To investigate the link between empathy, perceived social support, and depressive and grieving symptoms in suicide survivors.

METHODS

Scores on the Beck Depression Inventory (BDI), Inventory of Complicated Grief (ICG), Prolonged Grief Disorder (PGD), Interpersonal Reactivity Index (IRI), and the Social Support section of the Interpersonal Questionnaire were collected from 265 survivors. Relations were tested via multivariate regression models.

RESULTS

Lower Perspective Taking (PT) was related with higher levels of BDI score, and higher Personal Distress (PD) was associated with higher BDI, ICG, and PGD scores. Higher levels of Social Support were related with higher BDI and ICG (but not PGD) scores.

CONCLUSION

Empathic PD and PT, and perceived social support are differently associated with depression and grief-related symptoms. Empathy-focused psychotherapies and empowerment of social support may reduce symptoms in suicide survivors.

Grief and growth among Chinese parents who lost their only child: the role of positive and negative experiences of social support from different sources

BACKGROUND

In China, bereaved parents who have lost their only child are known as Shidu parents, and they tend to present high levels of prolonged grief reactions. To date, a widespread focus has been placed on positive social support, while potential negative experiences have been relatively neglected. Additionally, the role of social support from different sources (i.e. close family members [partner, siblings, grandchildren], peers, and others [relatives, friends, colleagues]) has not been examined thoroughly.

OBJECTIVE

The present study investigated whether social support from different sources has a differential impact on postloss adaptation (i.e. prolonged grief and growth). The loss-orientated and restoration-orientated coping strategies of the dual process model were also tested for their mediating roles.

METHODS

A total of 277 Chinese Shidu parents were recruited to complete a series of questionnaires including social support from different sources, prolonged grief symptoms, posttraumatic growth, and dual process coping strategies. Correlation analyses, paired sample t tests and structural equation modelling were conducted.

RESULTS

More positive support were related to less prolonged grief symptoms and more posttraumatic growth, while more negative support was only related to more prolonged grief. Positive support from close family members and others was significantly related to prolonged grief/growth, and negative support from these sources was significantly positively associated with prolonged grief. Positive or negative support from people who shared a similar experience was unrelated to prolonged grief/growth. Positive and negative support were related to prolonged grief and growth through loss-oriented coping strategies.

CONCLUSION

Overall, the present study indicated that positive and negative support experiences from different sources functioned differently in the recovery of Chinese Shidu parents and that loss-oriented coping played a mediating role. These findings highlight the importance of differentiating social support by traits in coping with grief and the crucial mediating role of loss-oriented coping.

HIGHLIGHTS

More positive support correlated with less prolonged grief and more growth, while more negative support correlated with more prolonged grief.Support from family members and friends was more potent than that from peers.Social Support correlated with prolonged grief/growth through loss-oriented coping.

Anxiety, resilience and local conditions: A cross-cultural investigation in the time of Covid-19

The spread of Covid‐19 is a worldwide phenomenon, unprecedented in modern times. Differences among countries in such matters are of interest as they provide a unique window to understand human behaviour and culture. The aim of this study is to examine cross‐cultural differences in state anxiety, and any moderating role of resilience and social contact. Participants from three countries were recruited: Ireland (n = 449), Italy (n = 324) and Spain (n = 471). While these countries share many characteristics, it was anticipated that their experiences might differ because of pronounced differences in governmental measures and the local severity and history of the pandemic at the time of data collection. Results indicated that: (a) Resilience was negatively related to state anxiety both bivariately and multivariately; (b) number of hours outside per week did not predict state anxiety but was negatively correlated with fear of contagious diseases in the essential workers from the Irish sample; (c) national measures had a moderating role in the relationship between resilience and state anxiety; and (d) social contact, in terms of numbers of written, audio or visual interactions, was not a statistically significant predictor of state anxiety. These results may help to understand the adverse impact on mental health.

The relational landscape of bereavement after anticipated death: An interpretive model

To complement existing literature and better capture the diversity of factors influencing grief, a more interpersonal understanding is required. Thus, we used the relational landscape's concept and empirical investigation to clarify the roles of individuals surrounding the bereaved. Sixteen interviews with bereaved individuals by euthanasia or natural death were analyzed using Interpretive Description. We present a model describing five types of actors in the environment of the bereaved and their ways of "being with" or giving space. We also include four lived landscapes in our model, with the purpose of describing how bereavement can be experienced within the social environment.

What is good grief support? Exploring the actors and actions in social support after traumatic grief

Social support seems to enhance wellbeing and health in many populations. Conversely, poor social support and loneliness are a social determinant of poor health outcomes and can adversely affect physical, emotional, and mental well-being. Social support is especially important in traumatic grief. However, the ways in which grieving individuals interpret and define social support is not well understood, and little is known about what specific behaviours are perceived as helpful. Using qualitative description and content analysis, this study assessed bereaved individuals’ satisfaction of social support in traumatic grief, using four categories of social support as a framework. Findings suggest inadequate satisfaction from professional, familial, and community support. Pets emerged with the most satisfactory ratings. Further, findings suggest that emotional support is the most desired type of support following traumatic loss. Implications for supporting bereaved individuals within and beyond the context of the COVID-19 pandemic are discussed.

Symptoms of Prolonged Grief and Self-Reported Health Among Bereaved Family Members of Persons Who Died From Sudden Cardiac Arrest

Sudden cardiac arrest is common and is one of the leading causes of death in the western world, and the sudden loss following cardiac arrest may have a significant impact on bereaved family members' health. Therefore, the aim of this study was to describe symptoms of prolonged grief and self-reported health among bereaved family members of persons who died from sudden cardiac arrest, with comparisons between spouses and non-spouses. This was a cross-sectional observation study with 108 adult family members who completed a questionnaire. A fifth of the family members reported prolonged grief, and problems with self-reported health were common, especially regarding anxiety. Spouses reported more problems with prolonged grief and self-reported health compared with non-spouses. The risk of these family members developing prolonged grief and health problems should be recognized, and professional support should be offered.

Social Support, Attachment Closeness, and Self-Esteem Affect Depression in International Students in China

With an increase in the number of international students in China, there has been a simultaneous increase in their emotional problems, such as depression, as well as the importance of their emotional well-being. This study aimed to investigate the influence of social support on depression and the mediation and moderation mechanisms of this relationship in international students. In total, 349 international students in China responded to a questionnaire survey comprising the Social Support Rating Scale, Self-rating Depression Scale, Adult Attachment Scale, and Self-Esteem Scale. The results showed that: (1) attachment closeness had a significant direct predictive effect on depression; (2) attachment closeness played a mediating role in the relationship between social support and depression; and (3) the direct effect of social support on depression and the mediating effect of attachment and closeness are regulated by self-esteem. Therefore, interventions aimed at improving the social support, attachment closeness, and self-esteem of international students in China can be effective in reducing their depressive symptoms.

Do interpersonal events buffer or worsen depressive and grief related symptoms in people bereaved through suicide?

Life events can heighten emotional suffering related to the loss of a close relative or friend by suicide, while supportive social relationships may promote coping. We investigated the impact of stressful events and perceived social support on depressive and grief symptoms in 378 help-seeking Italians bereaved through suicide. While we did not observe a significant effect of interpersonal stressors, perceived social support did have a buffering role on the intensity of depressive symptoms but not of grief-related suffering. Focusing on expanding and capitalizing on clients' perceived social networks could strengthen postvention programs. Further research on the role of interpersonal factors is needed.

The association of loneliness after sudden bereavement with risk of suicide attempt: a nationwide survey of bereaved adults

PURPOSE

We aimed to test the hypothesis that among people who experience sudden bereavement, loneliness is associated with post-bereavement suicide attempt and post-bereavement suicidal ideation, even when adjusting for network size.

METHODS

We analysed cross-sectional data collected in the 2010 UCL Bereavement Study, to identify 3193 respondents who had experienced sudden bereavement. We used multivariable logistic regression to test for an association between loneliness (using a newly-developed eight-item loneliness measure) and post-bereavement suicide attempt and suicidal ideation, adjusting for socio-demographic factors, pre-bereavement depression and self-harm, and network size.

RESULTS

Among bereaved adults, loneliness was significantly associated with probability of post-bereavement suicide attempt (AOR 1.19; 95% CI 1.14-1.25) and of post-bereavement suicidal ideation (AOR 1.24; 95% CI 1.20-1.28), with estimates unchanged by adding perceived stigma of the bereavement to adjusted models. There was no association between suicide bereavement and loneliness (adjusted coefficient 0.22; 95% CI - 0.12 to 0.45; p = 0.063). The association of loneliness and suicide attempt risk was similar whether participants were bereaved by suicide or not.

CONCLUSIONS

People who report feeling lonely after sudden bereavement are more likely to make a suicide attempt after their loss, even when taking into account their network size and the perceived stigma of the sudden bereavement. There is no evidence that the effects of loneliness on suicidality are specific to suicide bereavement. This work identifies loneliness as a potential target for suicide prevention interventions among bereaved people. It also fuels interest in longitudinal research investigating loneliness as a putative mediator of suicide risk.