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Rueger MS, Steil R, Lubik S, Roll SC, Lechner-Meichsner F. A comprehensive investigation of comorbidities of prolonged grief disorder in a bereaved inpatient psychiatric sample. J Psychiatr Res 2024; 177:185-193. [PMID: 39029160 DOI: 10.1016/j.jpsychires.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/03/2024] [Accepted: 07/10/2024] [Indexed: 07/21/2024]
Abstract
Prolonged Grief Disorder (PGD) was recently added to ICD-11 and DSM-5-TR. Depression and Posttraumatic Stress Disorder (PTSD) are frequent comorbidities, but findings regarding comorbid somatoform disorder and personality disorders remain mixed and studies with severely impaired patients are scarce. It was therefore the objective of the present study to examine comorbidities of PGD in a bereaved inpatient psychiatric sample. We assessed N = 101 bereaved inpatients in a psychiatric hospital with clinical interviews and self-report questionnaires. We calculated differences between patients with and without a PGD-diagnosis in number and type of comorbid disorders as well as associations between the severity of PGD and comorbid disorders. On average, patients had 2.53 comorbid psychiatric diagnoses. Patients with and without a PGD-diagnosis did not differ in their number of comorbid diagnoses, and there was no association between number of comorbid diagnoses and PGD-severity. However, patients with PGD, had significantly more comorbid diagnoses belonging to neurotic-, stress-related and somatoform disorders of the ICD-10. Patients with PGDICD-11 also had significantly higher scores in self-reported depressive, PTSD-, and somatoform symptoms, as well as the negative affectivity personality domain than those without a PGD diagnosis. To the best of our knowledge, this is the first study to provide insights into comorbidities of PGD in a bereaved inpatient psychiatric sample. It highlights the importance of considering PGD symptoms as part of the complaints of bereaved patients to achieve a tailored treatment approach. Future longitudinal studies are needed to unveil relationships between pre-existing mental disorders and PGD.
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Affiliation(s)
- Mirjam Sophie Rueger
- Goethe-University Frankfurt am Main, Department Clinical Psychology & Psychotherapy, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Germany.
| | - Regina Steil
- Goethe-University Frankfurt am Main, Department Clinical Psychology & Psychotherapy, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Germany
| | - Silke Lubik
- varisano Klinikum Frankfurt Höchst, Klinik für psychische Gesundheit, Gotenstraße 6-8, 65929, Frankfurt am Main, Germany
| | - Sibylle C Roll
- varisano Klinikum Frankfurt Höchst, Klinik für psychische Gesundheit, Gotenstraße 6-8, 65929, Frankfurt am Main, Germany
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Rheingold AA, Williams JL, Bottomley JS. Prevalence and Co-Occurrence of Psychiatric Conditions Among Bereaved Adults. JAMA Netw Open 2024; 7:e2415325. [PMID: 38842805 PMCID: PMC11157353 DOI: 10.1001/jamanetworkopen.2024.15325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/05/2024] [Indexed: 06/07/2024] Open
Abstract
Importance Rates of grief-related psychiatric conditions, such as prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD), among bereaved adults in the US are largely unknown due to limited studies that leverage national samples. Objective To assess risk factors for and prevalence rates and co-occurrence of PGD, PTSD, and MDD among bereaved adults in the US. Design, Setting, and Participants Data for this survey study were collected from a large US panel sample between October 10 and 28, 2022, using a web-based survey. Participants were aged 18 years or older and were proficient in English. Data analysis was conducted between March and June 2023. Main Outcomes and Measures Probable psychiatric conditions were assessed with validated measures that used conservative cutoff scores, duration, and impairment criteria. These measures included the revised Prolonged Grief Disorder scale for PGD, the PTSD Checklist for DSM-5 for PTSD, and the Patient Health Questionnaire-9 for MDD. Data were analyzed using basic descriptives and logistic regression. Results A total of 2034 adults (n = 1529 and 505 in the bereaved and comparison groups, respectively) completed the study. Respondents had a mean (SD) age of 40.7 (15.9) years; the majority were women (1314 [64.6%]) and had at least some college experience (1394 [68.5%]). With regard to race and ethnicity, 392 respondents (19.3%) were Black, 138 (6.8%) were Hispanic, and 1357 (66.7%) were White. Among bereaved adults, 312 (20.4%), 518 (33.9%), and 461 (30.2%) met criteria for a presumptive diagnosis of PGD, PTSD, and MDD, respectively. Comorbidities were common, with 441 participants (28.8%) meeting criteria for at least 2 co-occurring disorders. Comorbid PGD, PTSD, and MDD were more common than any 2 co-occurring or isolated disorders; the presence of co-occurring conditions was more likely among respondents who reported a traumatic loss. Age and educational attainment were associated with the risk of psychiatric conditions; less time since the index death, loss of a psychologically close other, and a traumatic loss experience were associated with increased risk of PGD, PTSD, and MDD or their co-occurrence. Conclusions and Relevance In this study, the majority of bereaved adults did not meet presumptive criteria for PGD, PTSD, or MDD. Nevertheless, PGD, PTSD, and MDD were highly prevalent and comorbid, particularly among those who experienced traumatic loss. These findings underscore the need for integrated psychological care that leverages transdiagnostic mechanisms of evidence-based practice.
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Affiliation(s)
- Alyssa A. Rheingold
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Joah L. Williams
- Department of Psychology, University of Memphis, Memphis, Tennessee
| | - Jamison S. Bottomley
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
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Hopf D, Eckstein M, Ditzen B, Aguilar-Raab C. Still With Me? Assessing the Persisting Relationship to a Deceased Loved-One - Validation of the "Continuing Bonds Scale" in a German Population. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:623-648. [PMID: 35302429 PMCID: PMC11100273 DOI: 10.1177/00302228221076622] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Continuing the bond (CB) to a deceased loved one plays a clinically significant role in grief. We validated the Continuing Bonds Scale (CBS) examining externalized CB (illusions and hallucinations) versus internalized CB (use of the deceased as a secure base) in relation to risk factors of complicated grief and bereavement-related adjustment. Data from 364 bereaved German participants on CBS, Inventory of Complicated Grief (ICG), and Posttraumatic Personal Growth Inventory (PPGI) entered an exploratory factor analysis. This yielded a two-factor-solution representing externalized and internalized CB (KMO = .89, χ2 = 2100.5, df = 120). Both factors demonstrated high internal consistency (Cronbach's α = .87). ICG and PPGI highly correlated with externalized and internalized CB. Cause of death and feelings of responsibility were associated with externalized CB. In the future, the use of the CBS could help predict problems in grief processing and consequently implement early interventions.
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Affiliation(s)
- Dora Hopf
- Institute of Medical Psychology, Heidelberg University Hospital, Heidelberg, Germany
- Ruprecht-Karls University, Heidelberg, Germany
| | - Monika Eckstein
- Institute of Medical Psychology, Heidelberg University Hospital, Heidelberg, Germany
- Ruprecht-Karls University, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Heidelberg University Hospital, Heidelberg, Germany
- Ruprecht-Karls University, Heidelberg, Germany
| | - Corina Aguilar-Raab
- Institute of Medical Psychology, Heidelberg University Hospital, Heidelberg, Germany
- Ruprecht-Karls University, Heidelberg, Germany
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Çiftci N, Yildiz M, Uçar M. Relationship Between Posttraumatic Stress Disorder, Death Anxiety, and Insomnia in Adults After the Earthquake. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241256267. [PMID: 38785216 DOI: 10.1177/00302228241256267] [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: 05/25/2024]
Abstract
This study aimed to determine the relationship between posttraumatic stress disorder, death anxiety, and insomnia in adults after the earthquake. This study, designed in a relational-cross-sectional-descriptive model, was conducted with 624 adult individuals living in a province affected by the earthquake that occurred in Turkey on February 6, 2023. The study data were collected using a personal information form, Posttraumatic Stress Disorder Checklist, Turkish Death Anxiety Scale, and Bergen Insomnia Scale. The analysis of the study data was performed by using SPSS 25.0, AMOS 24.0, and G*Power 3.1 Statistical package software. A significant positive correlation was found between posttraumatic stress disorder and Insomnia and Death Anxiety (p < .05). There was a significant positive correlation between Death Anxiety and Insomnia (p < .05). It was determined that Death Anxiety has a mediating role in the impact of posttraumatic stress disorder on insomnia (95% Confidence Interval: 0.572/1.407) (p < .05). It was determined that the model created in line with the hypotheses was compatible and the model fit indices were within the desired limits, with x2/df = 1.795, RMSEA = 0.03, CFI = 0.95, GFI = 0.946, AGFI = 0.93, IFI = 0.95. It was determined that posttraumatic stress disorder increased death anxiety and insomnia after the earthquake. Conducting longitudinal studies on the post-earthquake period is recommended.
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Affiliation(s)
- Necmettin Çiftci
- Department of Nursing, Faculty of Health Sciences, Muş Alparslan University, Muş, Turkey
| | - Metin Yildiz
- Department of Midwifery, Faculty of Health Sciences, Sakarya University, Sakarya, Turkey
| | - Mehmet Uçar
- Department of Medical Services and Techniques, Varto Vocational School, Muş Alparslan University, Muş, Turkey
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Krauss BJ. To Calm and to Commend: Veterans' Musical Preferences Anticipating End of Life. Mil Med 2024:usae216. [PMID: 38788152 DOI: 10.1093/milmed/usae216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Since World War 1, physicians have noted the calming effects of music for military personnel experiencing "shell shock," Post Traumatic Stress Disorder (PTSD), or stress. Researchers have documented that stress or PTSD-like symptoms re-emerge for veterans at the end of life, triggered by hospital-like settings, co-occurring conditions, and debilitation. Dying veterans also face integration of their service and combat experiences into summations of their lives. In response, there has been a national movement for bedside ceremonies, often with music, to honor veterans. MATERIALS AND METHODS The project elicited veterans' musical preferences for calming and for music for honor services, using non-hospitalized veterans as surrogates for veterans in hospice. Respondent-driven sampling protected confidentiality and likely resulted in participants being representative of US veterans in terms of ethnicity, gender, and military branch. Recruitment materials contained all elements of informed consent, with consent collected in the introduction to the online survey. The survey had embedded links to musical performances, as well as write-in musical choices, and allowed US veterans from the Army, Air Force, Marines, and Navy to note their preferences both for music that was calming and music to be used in honor ceremonies. Online queries also asked about stress during service, usual coping strategies for stress, and current or past symptoms of PTSD. Links to hot lines were provided. The study was approved by the University of Arizona Institutional Review Board. RESULTS Listening to music was the most prevalent of the 20 coping mechanisms for stress in this sample of 30 veterans. Musical preferences were stable across age groups. For calming, music at resting heartbeat rhythms was chosen. Music from early adulthood or from the timelessness of the classics was selected most often. Modern music with lyrics has themes of duty, affirmation, gratitude, and relief. The nearly universal soothing effects of lullabies were recognized. For music for honor ceremonies, desires were often independent of the military branch. Patriotic songs, or songs recognizing multiple service branches, or with themes of peace and affirmation were more often chosen than music from a particular service branch. CONCLUSION Listening to music is a frequent coping strategy for veterans. While themes representing classical music choices are readily available in anthologies, other music chosen by this sample is not; the veterans' preferred music is rarely found in compilations of popular, movie, and TV music. Hospice and hospital intakes that document and communicate veterans' musical preferences to music therapists and therapeutic musicians may better support service men and women. Further research may examine veterans' preference for live or recorded music at end of life given the importance of meaning-making and the presence of others documented in the literature.
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Affiliation(s)
- Beatrice J Krauss
- Casa de la Luz Hospice at the Hacienda, Tucson, AZ 85718, USA
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
- City University of New York Graduate School of Public Health and Health Policy, New York, NY 10027, USA
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Kgadima PN, Leburu GE. COVID-19 Ruptures And Disruptions on Grieving And Mourning Within an African Context: Lessons For Social Work Practice. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:191-206. [PMID: 35103534 PMCID: PMC8814609 DOI: 10.1177/00302228211070149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Losing a significant other through death is a tragic experience worsened by the novel coronavirus disease 2019 (COVID-19). To curb this massive increase of deaths, the South African government introduced various rules to regulate the burial process. However, these COVID-19 regulations have caused major ruptures and disruptions on how bereaved families observe and practice cultural rites and customs following death within an African context. Consequently, many bereaved family members, particularly Black Africans, struggle with adhering to the regulations and funerals have been coined 'super spreaders' of the virus. The concerns raised in this article are twofold, namely, the impact of the Covid-19 regulations on how Black Africans grieve and mourn, as well as the involvement of social workers in formulating regulations that ought to be adhered to. This article explores the fissures and bricolages brought about by COVID-19, ultimately suggesting possible ways of dealing the losses ascribed to the pandemic.
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Affiliation(s)
- Phuti N. Kgadima
- Department of Social Work, School of Social Sciences, University of South Africa, Pretoria, South Africa
| | - Goitseone E. Leburu
- Department of Social Work, School of Social Sciences, University of South Africa, Pretoria, South Africa
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Bırni G, Deniz ME, Karaağaç ZG, Erişen Y, Kaya Y, Satıcı SA. Rebuilding wellbeing: Understanding the role of self-criticism, anger rumination, and death distress after the February 6, 2023, Türkiye Earthquake. DEATH STUDIES 2024; 48:511-521. [PMID: 37534943 DOI: 10.1080/07481187.2023.2241401] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
This study investigated self-criticism, anger rumination, and death distress in wellbeing after one of the most devastating natural disasters of this century. The study included 399 participants from 56 different cities across Türkiye. Participants were from 3 groups: those who themselves or one of their nuclear families are earthquake survivors (group 1), those who had a loved one other than a nuclear family member who was an earthquake survivor (group 2), and those who were deeply affected by the earthquake through media networks (group 3). Results showed that women experienced higher death distress and anger rumination and lower mental wellbeing compared to men post-earthquake. Individuals in group 1 had significantly lower mental wellbeing and higher death distress than groups 2 and 3. However, the effect size of this significant differentiation depending on earthquake experience was small. Moreover, anger rumination and death distress fully mediated the link between self-criticism and mental wellbeing.
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Affiliation(s)
- Gaye Bırni
- Department of Psychological Counselling, Yıldız Technical University, Istanbul, Türkiye
| | - M Engin Deniz
- Department of Psychological Counselling, Yıldız Technical University, Istanbul, Türkiye
| | - Zahide Gül Karaağaç
- Department of Psychological Counselling, Yıldız Technical University, Istanbul, Türkiye
| | - Yavuz Erişen
- Department of Educational Sciences, Yıldız Technical University, Istanbul, Türkiye
| | - Yağmur Kaya
- Department of Psychological Counselling, Yıldız Technical University, Istanbul, Türkiye
| | - Seydi Ahmet Satıcı
- Department of Psychological Counselling, Yıldız Technical University, Istanbul, Türkiye
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Redican E, Hyland P, Shevlin M, Martsenkovskyi D, Karatzias T, Ben-Ezra M. Prevalence and correlates of ICD-11 prolonged grief disorder among adults living in Ukraine during the war with Russia. Acta Psychiatr Scand 2024; 149:425-435. [PMID: 38491862 DOI: 10.1111/acps.13678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Although high rates of bereavement are evident in war-affected populations, no study has investigated the prevalence and correlates of probable ICD-11 prolonged grief disorder (PGD) under these circumstances. METHODS Participants were 2050 adults who participated in a nationwide survey exploring the effects of the Ukraine-Russia war on the daily lives and mental health of Ukrainian people. RESULTS Of the total sample, 87.7% (n = 1797) of people indicated a lifetime bereavement. In the full sample, 11.4% met the diagnostic requirements for probable ICD-11 PGD, and amongst those with a lifetime bereavement, the conditional rate of probable ICD-11 PGD was 13.0%. Significant risk factors of ICD-11 PGD included the recent loss of a loved one (6 months to a year ago), being most affected by a partner or spouse's death, loved one dying in the war, no recent contact with the deceased prior to their death, and meeting depression and anxiety diagnostic requirements. CONCLUSION The study reveals that a significant percentage of Ukrainian bereaved individuals have probable ICD-11 PGD, and identifying risk factors, particularly war-related losses, will aid in the development of intervention and prevention programs for bereaved adults.
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Affiliation(s)
- Enya Redican
- School of Psychology, Ulster University, Coleraine, UK
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, UK
| | - Dmytro Martsenkovskyi
- Department of Psychiatry and Narcology, Bogomolets National Medical University, Kyiv, Ukraine
- SI "Institute of Psychiatry, Forensic Psychiatric Examination and Drug Monitoring of Ministry of Health of Ukraine", Kyiv, Ukraine
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
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Ben-Shlomo S, Oreg A, Cohen N. Families of organ donors between Jews and Arabs in Israel during a military operation: Constructing meaning through participation in an epistemic Community - Media analysis of two cases. DEATH STUDIES 2024:1-10. [PMID: 38635693 DOI: 10.1080/07481187.2024.2341881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
This study explores how bereaved families of organ donors become participants in an 'imagined epistemic community' of organ donor families, amidst a national conflict between Jews and Arabs in Israel. Utilizing a media case study approach, we identified factors contributing to the creation of this bi-national community and examined what the families received in return for their part. Additionally, we explored the reasons behind the community splitting into two separate entities. Based on the media reports, we suggest that entry into the community is conditional on donating organs during wartime, granting these families a special moral status in return, resonating messages of altruism, solidarity and coexistence. Further to this, we propose that when the Arab family felt they did not receive the expected recognition, they withdrew from the common community in favor of a separate national community.
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Affiliation(s)
- Shirley Ben-Shlomo
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Israel
| | - Ayelet Oreg
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Israel
| | - Noaz Cohen
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Israel
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Lebel S, Lépine O, Brillon P. Mental Health of Homicidally Bereaved Individuals: A Systematic Review of Post-Homicide Factors. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241245751. [PMID: 38584454 DOI: 10.1177/00302228241245751] [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: 04/09/2024]
Abstract
Experiencing the homicide of a loved one has a substantial impact on the mental health of family members and friends who must survive their loved one's tragic death. This systematic review aims to synthesize the current findings on post-homicide factors and identify the factors most frequently related to the mental health of homicidally bereaved individuals (HBI). Four databases were searched (PsycINFO, SCOPUS, Sociological Abstract, PubMed). The selection of studies was based on a peer review process conducted by two independent researchers to ensure interrater reliability. The articles were screened to ensure the presence of homicidally bereaved adults, resulting in a total of 35 eligible papers to be considered in the current review. Factors were organized into categories, with the criminal justice system-related factors (n = 18), social factors (n = 17), and coping factors (n = 13) being the most prevalent. This review identifies clinical avenues for preventing distress and fostering the well-being of HBI.
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Affiliation(s)
- Sarah Lebel
- Psychology Department, Université du Québec à Montréal, Montreal, QC, Canada
| | - Olivier Lépine
- Psychology Department, Université du Québec à Montréal, Montreal, QC, Canada
| | - Pascale Brillon
- Psychology Department, Université du Québec à Montréal, Montreal, QC, Canada
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Andriessen K, Snir J, Krysinska K, Rickwood D, Pirkis J. Supporting Adolescents Bereaved by Suicide or Other Traumatic Death: The Views of Counselors. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241246031. [PMID: 38581106 DOI: 10.1177/00302228241246031] [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: 04/08/2024]
Abstract
Adolescents bereaved by suicide and other traumatic death may experience strong grief reactions and increased risks of mental health problems and suicidal behaviour. As timely access to professional help can be critical, it is essential to understand how counselors perceive suicide bereavement in adolescents and how they work with this population. This study aimed to examine the perspectives of counselors (N = 34). Eleven participated in an individual semi-structured interview and 23 others in group interviews. Thematic analysis yielded three themes: (1) Building a relationship with the bereaved adolescent, (2) Offering support tailored to the needs of the grieving adolescent, and (3) Offering strengths-based and sustainable support. Counselors' skills, attitudes, content-related expertise, and approaching the adolescent's grief within their developmental context were deemed essential for building a therapeutic relationship and offering viable support. The findings may inform good practices in counseling bereaved adolescents to facilitate positive mental health outcomes.
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Affiliation(s)
- Karl Andriessen
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jessica Snir
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Karolina Krysinska
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Debra Rickwood
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Jane Pirkis
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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12
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Hasson-Ohayon I, Horesh D. A unique combination of horror and longing: Traumatic grief in post-October 7, 2023, Israel. J Trauma Stress 2024; 37:348-351. [PMID: 38487945 DOI: 10.1002/jts.23026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 04/04/2024]
Abstract
On October 7, 2023 (10/7), Hamas militants brutally attacked Israeli towns and villages surrounding the Gaza Strip, resulting in the killing of more than 1100 people, most of whom were civilians slaughtered in their own homes. The killings occurred under highly traumatic circumstances, including shooting, the burning of homes, hunting down people who attempted to escape, and severe sexual assault. Thus, many Israelis today experience a unique mix of both posttraumatic and severe grief reactions. Traumatic grief (TG) is often defined as a condition that results from the death of a significant other and includes symptoms similar to posttraumatic stress disorder (PTSD) that are specifically related to the deceased, such as intrusive thoughts and memories about the deceased and hypervigilance expressed by constantly looking for them or cues associated with them. However, whereas definitions, phenomenological descriptions, and clinical illustrations of PTSD are abundant and widely validated, TG has yet to receive formal diagnostic status. In this paper, we aim to reexamine TG in the context of post-10/7 Israel. We argue that TG is a critical concept for clinicians working in Israel and other conflict-exposed areas of the world today, as it accurately captures the painful mix of grief- and trauma-related symptoms. We also suggest potential explanations for the lack of acknowledgment of TG as a formal diagnosis and discuss the possible role of historical events in the formation of new, relevant psychiatric diagnoses.
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Affiliation(s)
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York, USA
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Aguiar A, Pinto M, Duarte R. Urgent Attention Needed for Mental Health Challenges Arising from Prolonged Grief During and in the Aftermath of COVID-19. ACTA MEDICA PORT 2024; 37:305-307. [PMID: 38484777 DOI: 10.20344/amp.20993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/24/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Ana Aguiar
- EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR). Porto; Estudo das Populações. Instituto de Ciências Biomédicas Abel Salazar (ICBAS). Universidade do Porto. Porto. Portugal
| | - Marta Pinto
- Faculdade de Psicologia e Ciências da Educação. Universidade do Porto. Porto. Portugal
| | - Raquel Duarte
- EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR). Porto; Estudo das Populações. Instituto de Ciências Biomédicas Abel Salazar (ICBAS). Universidade do Porto. Porto. Portugal
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14
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Saltzman LY, Terzis L. Psychological predictors of the time perspective: The role of posttraumatic stress disorder, posttraumatic growth, and temporal triggers in a sample of bereaved adults. PLoS One 2024; 19:e0298445. [PMID: 38427669 PMCID: PMC10906841 DOI: 10.1371/journal.pone.0298445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/23/2024] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION The process of coping with loss and trauma is inextricably linked with subjective experiences and perceptions of time. The Time Perspective Framework, suggests that temporal frames influence an individual's actions, judgements, and the decisions that they make. Similarly, time perspective has been linked with psychosocial outcomes of trauma and loss (e.g. posttraumatic stress disorder). The aim of this study is to identify factors that may influence survivor's time perspective in order to determine if posttraumatic stress disorder (PTSD), posttraumatic growth (PTG), and temporal triggers (MIT) influenced different time perspective orientations. METHODS Data was collected via Qualtrics survey between July 2019 and July 2020. Measures included basic demographic characteristics, posttraumatic stress disorder checklist, posttraumatic growth inventory, an assessment of temporal triggers, and the Zimbardo time perspective inventory. A series of OLS regression analyses were estimated. RESULTS PTG was positively associated with future time perspective scores, whereas PTSD was associated with an increase in past negative orientation. The endorsement of temporal triggers like markers in time was negatively associated with present hedonistic scores and positively associated with future time perspective scores. Interestingly, PTSD, PTG and the endorsement of MIT were not associated with present time perspective scores. DISCUSSION AND IMPLICATIONS Identifying the relationship between PTSD, PTG, marker in time, and time perspective may offer important insights into treatment modalities that can improve outcomes for bereaved individuals. We discuss limitations of the current analysis and make recommendations for future research.
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Affiliation(s)
- Leia Y. Saltzman
- School of Social Work, Tulane University, New Orleans, LA, United States of America
| | - Lauren Terzis
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
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Wesemann U, Renner KH, Rowlands K, Köhler K, Hüttermann N, Himmerich H. Incidence of mental disorders in soldiers deployed to Afghanistan who have or have not experienced a life-threatening military incident-a quasi-experimental cohort study. Front Public Health 2024; 12:1357836. [PMID: 38584933 PMCID: PMC10995976 DOI: 10.3389/fpubh.2024.1357836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/09/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction There is very good international research on deployment-related mental disorders in military personnel. The incidence rates show a very wide range. A new strategy is therefore proposed in order to achieve better standardization and thus better comparability of the studies. In addition to a non-deployed comparison group, we propose to compare deployed soldiers with and without critical military incidents during the deployment. This additional distinction makes it possible to differentiate between the influencing variables of actual threat and general deployment stress. Methods N = 358 male combat soldiers deployed to Afghanistan were included in the study. Clinical interviews were conducted several days before deployment and after deployment. Of them, n = 80 soldiers suffered a life-threatening military incident during deployment, whereas 278 soldiers did not. Odds ratios (OR) were calculated for the groups with and without critical military incidents and the new onset for PTSD, anxiety disorders and depressive disorders. Results When comparing both groups, we found significantly higher 1-year incidence rates in the group with critical military incidents: 6.4% vs. 1.1% (OR 6.2) for post-traumatic stress disorder (PTSD); 7.0% vs. 1.1% (OR 6.5) for depression; and 15.9% vs. 2.8% (OR 6.6) for anxiety disorders. The 1-year incidence rate of mental multimorbidity (PTSD with anxiety or depression) was 4.8% vs. 0.4% (OR 12.0). Discussion These results indicate that life-threatening military incidents during military deployment are important to mental health. As the different threat levels of the various missions are taken into account, additional predictors could be determined more precisely in further research.
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Affiliation(s)
- Ulrich Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Karl-Heinz Renner
- Faculty of Human Sciences, Institute of Psychology, Bundeswehr University Munich, Neubiberg, Germany
| | - Katie Rowlands
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom
| | - Kai Köhler
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Nils Hüttermann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Hubertus Himmerich
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom
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Bolaséll LT, Castro da Cruz Oliveira V, Frimm VC, Menda CC, Maria Rodrigues CS, Kristensen CH. "I Have No Words": A Qualitative Study About the Traumatic Experience of Violent Death. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:1136-1152. [PMID: 34911403 DOI: 10.1177/00302228211051532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Individuals bereaved by violent death have a higher risk of developing psychopathology. Consistent data concerning the subjective experience during the traumatic event of the death are still scarce. This study aimed to explore the traumatic experience of the violent death of a loved one. Nine reports of patients bereaved by violence were selected and transcribed. Reports were analyzed using Bardin's Content Analysis. Two final categories were generated. It was observed that most participants remembered details about the traumatic event or the time they were told about the violent death. There were two factors described as important when coping with the loss, social support during the traumatic event, and receiving detailed information from the authorities and others present in that moment. This study provides relevant data for future interventions during violent situations by health and security professionals.
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Affiliation(s)
- Laura Teixeira Bolaséll
- Department of Psychology, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
- Center of Study and Research in Traumatic Stress, PUCRS, Porto Alegre, Brazil
| | - Vitoria Castro da Cruz Oliveira
- Department of Psychology, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
- Center of Study and Research in Traumatic Stress, PUCRS, Porto Alegre, Brazil
| | - Vitor Corrêa Frimm
- Department of Psychology, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
- Center of Study and Research in Traumatic Stress, PUCRS, Porto Alegre, Brazil
| | - Cynthia Castiel Menda
- Department of Psychology, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
- Center of Study and Research in Traumatic Stress, PUCRS, Porto Alegre, Brazil
| | - Caroline Santa Maria Rodrigues
- Department of Psychology, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
- Center of Studies in Families and Individuals (CEFI), Porto Alegre, Brazil
| | - Christian Haag Kristensen
- Department of Psychology, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
- Center of Study and Research in Traumatic Stress, PUCRS, Porto Alegre, Brazil
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Fahmy C, Testa A, Woodward K, Jackson DB. Depression among incarcerated persons following the death of a loved one: Does social support mitigate grief? DEATH STUDIES 2024; 48:79-94. [PMID: 36931234 DOI: 10.1080/07481187.2023.2188620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
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.
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Affiliation(s)
- Chantal Fahmy
- Department of Criminology & Criminal Justice, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Alexander Testa
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Krista Woodward
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dylan B Jackson
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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18
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Nijborg LC, Kunst MJ, Westerhof GJ, de Keijser J, Lenferink LI. Grief and delivering a statement in court: a longitudinal mixed-method study among homicidally bereaved people. Eur J Psychotraumatol 2024; 15:2297541. [PMID: 38285899 PMCID: PMC10826785 DOI: 10.1080/20008066.2023.2297541] [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: 07/29/2023] [Accepted: 12/02/2023] [Indexed: 01/31/2024] Open
Abstract
Background: Participating in a criminal trial may increase the likelihood of developing psychopathology. In 2021, people bereaved by a plane disaster (flight MH17) had the opportunity to deliver a victim personal statement (VPS) in Dutch court.Objective: This longitudinal mixed-method study examined different aspects of 84 bereaved people's experiences with VPS delivery.Method: Motivations to deliver, or not deliver, an oral VPS were examined qualitatively using thematic content analysis. Whether background and loss-related variables were related to the decision to deliver a VPS was examined using binary logistic regression analyses. Between-group (delivered VPS vs. did not) and within-group (pre- vs. post-VPS) comparisons were made regarding prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression levels using t-tests and paired t-tests.Results: Bereaved people were most frequently motivated to deliver an oral VPS to describe the impact of the incident, while those who did not deliver an oral VPS commonly wanted to protect themselves from the perceived emotional burden. None of the correlates - i.e. biological sex, age, level of education, number of losses, and (closest) relationship to the deceased - were related to the decision to deliver a VPS. Lastly, significantly higher PGD, PTSD, and depression levels were reported by people who delivered a VPS than those who did not, before and after the court hearing. No significant within-group differences were found over time.Conclusions: Professionals may provide emotional support to bereaved people who want to deliver a VPS and manage their expectations if they want to deliver a VPS for the purpose of symptom reduction. Future research may benefit from examining other ways in which VPS delivery might have beneficial or detrimental effects for specific individuals. Overall, implementing VPS delivery in court on the basis of emotional restoration remains empirically unsupported, if defined as a reduction in psychopathological levels.
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Affiliation(s)
- Lieke C.J. Nijborg
- Department of Psychology, Health, and Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, the Netherlands
| | - Maarten J.J. Kunst
- Institute for Criminal Law and Criminology, Faculty of Law, Leiden University, Leiden, the Netherlands
| | - Gerben J. Westerhof
- Department of Psychology, Health, and Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, the Netherlands
| | - Jos de Keijser
- Department of Clinical Psychology, Faculty of Behavioural, and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - Lonneke I.M. Lenferink
- Department of Psychology, Health, and Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, the Netherlands
- Department of Clinical Psychology, Faculty of Behavioural, and Social Sciences, University of Groningen, Groningen, the Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
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Liang HJ, Xiong Q, Remawi BN, Preston N. Taiwanese family members' bereavement experience following an expected death: a systematic review and narrative synthesis. BMC Palliat Care 2024; 23:14. [PMID: 38212776 PMCID: PMC10782629 DOI: 10.1186/s12904-024-01344-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Bereavement experience is shaped by cultural and social contexts. No systematically constructed reviews were identified to explore the bereavement experience for people who are influenced by Chinese culture valuing filial piety and mutual dependence. This review aimed to systematically review the bereavement experience of Taiwanese family members living in Taiwan following an expected death. METHODS MEDLINE, PsycINFO, CINAHL, China Academic Journal Database, and Chinese Electronic Periodical Services were searched with no date restrictions from inception to 20 October 2022. The methodological rigour of studies was assessed using Hawker's appraisal tool. A narrative synthesis approach using Popay's work was employed to synthesise the findings of the studies. Studies investigating Taiwanese family members' bereavement experiences were included. We excluded papers studying bereavement through the death of a child. RESULTS Searches retrieved 12,735 articles (after de-duplication), 17 of which met the inclusion criteria and were included for synthesis: English [9] and Chinese [8], published between 2006 and 2021. The studies varied in quality with scores ranging from 22 to 33 out of 36. The studies differed in the relationship between participants and the deceased, the bereaved time frames, and the definitions of bereavement. Most studies focussed on family members of cancer patients receiving specialist palliative care. Three bereavement theories and four tools were used. Risk factors of bereavement outcomes included family members feeling less prepared for death and deaths where palliative sedative therapy was used. Protective factors were higher caregiving burden and longer caregiving periods. Four themes regarding Taiwanese bereavement experience were generated: multiple impacts of death; problem-based coping strategies; importance of maintaining connections; influential religious beliefs and rituals. CONCLUSION Continuing the relationship with the deceased is a key element of Taiwanese bereavement experience and it is influenced by religious and cultural beliefs. Suppressing or hiding emotions during bereavement to connect with the deceased and maintain harmonious relationships needs to be acknowledged as culturally acceptable and encouraged by some religions in Taiwan. The findings could be potentially relevant for other Chinese populations, predominantly Buddhist countries or other East Asian societies. The role of preparing for death in bereavement outcomes is little understood and requires further research.
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Affiliation(s)
- Hui-Ju Liang
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster, LA1 4AT, UK.
| | - Qian Xiong
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster, LA1 4AT, UK
| | - Bader Nael Remawi
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster, LA1 4AT, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster, LA1 4AT, UK
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20
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Braga C, Batista J, Ferreira H, Sousa I, Gonçalves MM. Ambivalence Resolution in Meaning Reconstruction Grief Therapy: An Exploratory Study. OMEGA-JOURNAL OF DEATH AND DYING 2023; 88:732-748. [PMID: 34870509 DOI: 10.1177/00302228211051527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In psychotherapy, ambivalence may be conceptualized as a conflict between two distinct motivations: one that is favorable to change (pro-change) and another that favors the maintenance of a problematic pattern (pro status quo). Previous studies identified two processes by which clients resolve this conflict: imposing the innovative part and silencing the problematic one (dominance), and establishing negotiations between the innovative and the pro status quo parts (negotiation). The present exploratory study examined ambivalence resolution in a sample of clients diagnosed with complicated grief. Results revealed that, in recovered cases, negotiation increases and dominance decreases from the beginning until the middle sessions of therapy and the opposite tendency is observed from the middle to the final sessions. Unchanged cases reveal an overall high proportion of dominance and an overall low proportion of negotiation. These results are partially divergent from those reported in previous studies with samples of clients diagnosed with major depression.
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Affiliation(s)
- Cátia Braga
- CIPsi - Psychology Research Centre, School of Psychology, University of Minho, Campus de Gualtar Braga, Portugal
| | - João Batista
- CIPsi - Psychology Research Centre, School of Psychology, University of Minho, Campus de Gualtar Braga, Portugal
| | - Helena Ferreira
- CIPsi - Psychology Research Centre, School of Psychology, University of Minho, Campus de Gualtar Braga, Portugal
| | - Inês Sousa
- Department of Mathematics and Applications, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Miguel M Gonçalves
- CIPsi - Psychology Research Centre, School of Psychology, University of Minho, Campus de Gualtar Braga, Portugal
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21
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Forero SA, Ophir AG. Bonding against the odds: Male prairie vole response to the "widow effect" among females. Behav Processes 2023; 213:104968. [PMID: 37984679 DOI: 10.1016/j.beproc.2023.104968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023]
Abstract
Although pair bonding is the preferred mating tactic among socially monogamous prairie voles, naturalistic observations have demonstrated many males remain non-bonded. Moreover, although males readily re-bond after the loss of a partner, females do not (i.e., the "widow effect'). Few studies have attempted to address why so many males remain non-bonded or if a reluctance of re-bonding in females contributes to this outcome. We investigate how female bonding history impacts male pair bond formation. Specifically, we test two alternative hypotheses for how sexually naïve males will behave when paired with widow females. The fecundity hypothesis predicts males will avoid bonding with widow females and be more receptive to novel bond-naïve females. The preference to bond hypothesis predicts males will choose to bond and express a partner preference, irrespective of if a pair-mate is a widow or sexually naïve. Our results demonstrated that males expressed a partner preference for females regardless of their social history. These data support the preference to bond hypothesis and suggest natural variation in bonding may not be strongly due to males forgoing bonding opportunities.
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Lovik A, González-Hijón J, Hoffart A, Fawns-Ritchie C, Magnúsdóttir I, Lu L, Unnarsdóttir AB, Kähler AK, Campbell A, Hauksdóttir A, Chourpiliadis C, McCartney DL, Thordardóttir EB, Joyce EE, Frans EM, Jakobsdóttir J, Trogstad L, Andreassen OA, Magnus P, Johnson SU, Sullivan PF, Aspelund T, Porteous DJ, Ask H, Ebrahimi OV, Valdimarsdóttir UA, Fang F. Elevated symptoms of depression and anxiety among family members and friends of critically ill COVID-19 patients - an observational study of five cohorts across four countries. THE LANCET REGIONAL HEALTH. EUROPE 2023; 33:100733. [PMID: 37953992 PMCID: PMC10636287 DOI: 10.1016/j.lanepe.2023.100733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 11/14/2023]
Abstract
Background Little is known regarding the mental health impact of having a significant person (family member and/or close friend) with COVID-19 of different severity. Methods The study included five prospective cohorts from four countries (Iceland, Norway, Sweden, and the UK) with self-reported data on COVID-19 and symptoms of depression and anxiety during March 2020-March 2022. We calculated prevalence ratios (PR) of depression and anxiety in relation to having a significant person with COVID-19 and performed a longitudinal analysis in the Swedish cohort to describe temporal patterns. Findings 162,237 and 168,783 individuals were included in the analysis of depression and anxiety, respectively, of whom 24,718 and 27,003 reported a significant person with COVID-19. Overall, the PR was 1.07 (95% CI: 1.05-1.10) for depression and 1.08 (95% CI: 1.03-1.13) for anxiety in relation to having a significant person with COVID-19. The respective PRs for depression and anxiety were 1.15 (95% CI: 1.08-1.23) and 1.24 (95% CI: 1.14-1.34) if the patient was hospitalized, 1.42 (95% CI: 1.27-1.57) and 1.45 (95% CI: 1.31-1.60) if the patient was ICU-admitted, and 1.34 (95% CI: 1.22-1.46) and 1.36 (95% CI: 1.22-1.51) if the patient died. Individuals with a significant person with hospitalized, ICU-admitted, or fatal COVID-19 showed elevated prevalence of depression and anxiety during the entire year after the COVID-19 diagnosis. Interpretation Family members and close friends of critically ill COVID-19 patients show persistently elevated prevalence of depressive and anxiety symptoms. Funding This study was primarily supported by NordForsk (COVIDMENT, 105668) and Horizon 2020 (CoMorMent, 847776).
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Affiliation(s)
- Anikó Lovik
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Methodology and Statistics Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Juan González-Hijón
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Asle Hoffart
- Department of Psychology, University of Oslo, Oslo, Norway
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Chloe Fawns-Ritchie
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland
- Division of Psychology, University of Dundee, Dundee, Scotland
| | - Ingibjörg Magnúsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Li Lu
- Health Management and Policy Institute, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Anna Bára Unnarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Anna K. Kähler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Archie Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland
| | - Arna Hauksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Charilaos Chourpiliadis
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Daniel L. McCartney
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland
| | - Edda Björk Thordardóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Mental Health Services, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Emily E. Joyce
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Emma M. Frans
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Lill Trogstad
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Ole A. Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Sverre Urnes Johnson
- Department of Psychology, University of Oslo, Oslo, Norway
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Patrick F. Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- The Icelandic Heart Association, Kopavogur, Iceland
| | - David J. Porteous
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland
| | - Helga Ask
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Omid V. Ebrahimi
- Department of Psychology, University of Oslo, Oslo, Norway
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Unnur Anna Valdimarsdóttir
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Kim JH, Chung S. Validation of the Korean version of the Utrecht Grief Rumination Scale and its relationship with COVID-related hypochondriasis among healthcare workers who witnessed patient deaths. Brain Behav 2023; 13:e3203. [PMID: 37667549 PMCID: PMC10570490 DOI: 10.1002/brb3.3203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION This study aimed to examine the reliability and validity of the Korean version of the Utrecht Grief Rumination Scale (UGRS) among healthcare workers who witnessed patient deaths. We also examined whether grief rumination may impact the cognitive-behavioral model of hypochondriasis. METHODS This study was conducted via an anonymous online survey targeting healthcare workers who had worked at a tertiary hospital and had witnessed patient deaths over the previous 2 years. Demographic data and responses to the UGRS, the Pandemic Grief Scale (PGS) for healthcare workers, the Stress and Anxiety to Viral Epidemic-9 (SAVE-9), the Obsession with COVID-19 Scale (OCS), and the Coronavirus Reassurance-Seeking Behaviors Scale (CRBS) were collected by requesting participants to recall their emotional state during the 2 weeks after witnessing a patient's death. RESULTS The Korean version of the UGRS is reliable (Cronbach's alpha = 0.941) and valid (comparative fit index = 0.920, Tucker-Lewis index = 0.900, root-mean-square-error of approximation = 0.102, standardized root-mean-square residual = 0.050) for measuring grief rumination in healthcare workers. The OCS was predicted by CRBS (β = 0.19, p < 0.001), SAVE-9 (β = 0.45, p < 0.001), UGRS (β = 0.16, p = 0.010), and PGS (β = 0.16, p = 0.010, adjusted R2 = 0.49, F = 52.9, p < 0.001). In mediation analysis, grief rumination directly influenced coronavirus preoccupation; the relationship was mediated by viral anxiety and coronavirus reassurance-seeking behavior. CONCLUSION Grief rumination of healthcare workers who witnessed patient death requires further exploration as it may influence hypochondriacal responses.
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Affiliation(s)
- Jeong Hye Kim
- Department of Clinical NursingUniversity of UlsanSeoulSouth Korea
| | - Seockhoon Chung
- Department of Psychiatry, ASAN Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
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Williamson V, Lamb D, Hotopf M, Raine R, Stevelink S, Wessely S, Docherty M, Madan I, Murphy D, Greenberg N. Moral injury and psychological wellbeing in UK healthcare staff. J Ment Health 2023; 32:890-898. [PMID: 36883341 DOI: 10.1080/09638237.2023.2182414] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 12/13/2022] [Accepted: 01/28/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Potentially morally injurious events (PMIEs) can negatively impact mental health. The COVID-19 pandemic may have placed healthcare staff at risk of moral injury. AIM To examine the impact of PMIE on healthcare staff wellbeing. METHODS Twelve thousand nine hundred and sixty-five healthcare staff (clinical and non-clinical) were recruited from 18 NHS-England trusts into a survey of PMIE exposure and wellbeing. RESULTS PMIEs were significantly associated with adverse mental health symptoms across healthcare staff. Specific work factors were significantly associated with experiences of moral injury, including being redeployed, lack of PPE, and having a colleague die of COVID-19. Nurses who reported symptoms of mental disorders were more likely to report all forms of PMIEs than those without symptoms (AOR 2.7; 95% CI 2.2, 3.3). Doctors who reported symptoms were only more likely to report betrayal events, such as breach of trust by colleagues (AOR 2.7, 95% CI 1.5, 4.9). CONCLUSION A considerable proportion of NHS healthcare staff in both clinical and non-clinical roles report exposure to PMIEs during the COVID-19 pandemic. Prospective research is needed to identify the direction of causation between moral injury and mental disorder as well as continuing to monitor the longer term outcomes of exposure to PMIEs.
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Affiliation(s)
- Victoria Williamson
- Institute of Psychology, Psychiatry and Neuroscience, King's Centre for Military Health Research, King's College London, London, UK
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, UK
| | - Danielle Lamb
- Department of Applied Health Research, NIHR ARC North Thames, UCL, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, NIHR ARC North Thames, UCL, London, UK
| | - Sharon Stevelink
- Institute of Psychology, Psychiatry and Neuroscience, King's Centre for Military Health Research, King's College London, London, UK
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Mary Docherty
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas' NHS Trust and King's College London, London, UK
| | - Dominic Murphy
- Institute of Psychology, Psychiatry and Neuroscience, King's Centre for Military Health Research, King's College London, London, UK
- Combat Stress, Tyrwhitt House, Leatherhead, UK
| | - Neil Greenberg
- Institute of Psychology, Psychiatry and Neuroscience, King's Centre for Military Health Research, King's College London, London, UK
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Kalsås ØR, Titlestad KB, Dyregrov K, Fadnes LT. Needs for help and received help for those bereaved by a drug-related death: a cross-sectional study. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:463-481. [PMID: 37969900 PMCID: PMC10634386 DOI: 10.1177/14550725221125378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2023] Open
Abstract
Background and aims: Individuals bereaved after sudden and unexpected deaths can benefit from professional help to cope after the loss, and the bereaved call for proactive, early and flexible help from professional services. Most drug-related deaths (DRDs) happen suddenly and unexpectedly. DRDs are a significant public health issue, yet few studies have examined DRD-bereaved people's needs and experiences with professional help. This article investigates the needs for help and received help reported by DRD-bereaved family members and friends, and suggests improvements in services based on the findings. Data and method: A heterogeneous convenience sample of DRD-bereaved family members and close friends (n = 255) were recruited for a survey from February to December 2018. Descriptive analyses were conducted for experiences with professional help, chi-square analyses to find predictors for help needs and received help, and logistic regression analysis to find predictors for satisfaction with the help provided. Results: Most DRD-bereaved individuals reported a need for professional help after the death regardless of family relation to the deceased, and about half of the participants received help. Nearly half of them were satisfied with the help. Our results indicated higher satisfaction with help among older bereaved, and the participants who received help from a crisis team or psychotherapist. The latter was particularly stated for younger participants. Few participants with children in the family reported that the children had received help, and less than one-third were satisfied with this help. Conclusion: The study shows that younger age groups and children need particular recognition, and a family perspective from services is essential. When assessing the help needs of the DRD-bereaved, relations of both psychological and biological closeness should be recognised. Help efforts should be tailored according to established knowledge of the provided help that bereaved populations deem effective.
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Affiliation(s)
- Øyvind Reehorst Kalsås
- Department of Welfare and Participation, Western Norway University of Applied Sciences, Norway
| | - Kristine Berg Titlestad
- Department of Welfare and Participation, Western Norway University of Applied Sciences, Norway
| | - Kari Dyregrov
- Department of Welfare and Participation, Western Norway University of Applied Sciences, Norway
| | - Lars Thore Fadnes
- Department of Global Public Health and Primary Care, University of Bergen, Norway
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Thiemann P, Street AN, Heath SE, Quince T, Kuhn I, Barclay S. Prolonged grief disorder prevalence in adults 65 years and over: a systematic review. BMJ Support Palliat Care 2023; 13:e30-e42. [PMID: 33707297 DOI: 10.1136/bmjspcare-2020-002845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/03/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Prolonged grief disorder (PGD) is a recently recognised mental health disorder with an estimated prevalence of 10% in the bereaved adult population. This review aims to appraise and summarise evidence relating to PGD in older adults (≥65 years), a growing population group, most likely to experience bereavement and often assumed to cope well. METHOD Literature from Medline, PsycINFO, CINAHL, Cochrane Library and Web of Science was searched. Epidemiological and non-epidemiological studies including data on frequency of PGD in older adults bereaved by mainly natural causes were included and a descriptive analysis undertaken. RESULTS From 2059 records, three epidemiological and six non-epidemiological studies were included. Most studies had good internal but not external validity. Conditional prevalence for PGD ranged between 3.2% and 48.8%. Heterogeneity in sample characteristics and study methodology contributed to this variability resulting in a descriptive analysis. The prevalence rate of 9.1% by Kersting et al was the best available estimate for PGD in older adults for western countries. The small number of epidemiological studies and the use of varying PGD-constructs which did not match International Classification of Diseases 11th Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria were the main limiting factors. CONCLUSION This first review on PGD prevalence in older adults suggests that, despite studies' methodological short comings, a similar proportion of older adults experience PGD as the general bereaved adult population (1:10). With older adults forming the largest subgroup among the bereaved, health and social care systems need to adapt their provision of care to address the specific needs of older adults.
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Affiliation(s)
- Pia Thiemann
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Anna Naomi Street
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sarah Eleanor Heath
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thelma Quince
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Isla Kuhn
- Medical Library, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Hennemann S, Killikelly C, Hyland P, Maercker A, Witthöft M. Somatic symptom distress and ICD-11 prolonged grief in a large intercultural sample. Eur J Psychotraumatol 2023; 14:2254584. [PMID: 37767693 PMCID: PMC10540649 DOI: 10.1080/20008066.2023.2254584] [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: 12/19/2022] [Accepted: 07/12/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Grief is a multi-faceted experience including emotional, social, and physical reactions. Research in ICD-11 prolonged grief disorder (PGD) in different cultural contexts has revealed different or potentially missing grief symptoms that may be relevant.Objective: This study thus aimed to explore the prevalence of somatic symptom distress and its associations with grief and negative affect in a culturally diverse sample of bereaved individuals with symptoms of PGD.Methods: Based on cross-sectional survey data from the Measurement and Assessment of Grief (MAGIC) project, this study included 1337 participants (mean age 23.79 yrs, 76.1% female) from three regions (USA: 62.3%, Turkey/Iran: 24.2%, Cyprus/Greece: 13.5%), who experienced a loss of a significant other. Associations between somatic symptom distress (Somatic Symptom Scale, SSS-8), symptoms of PGD (International Prolonged Grief Disorder Scale, IPGDS-33), anxiety (Generalized Anxiety Disorder Questionnaire, GAD-7), depression (Patient Health Questionnaire, PHQ-9) as well as demographic and loss related characteristics were investigated. Three hundred and thirteen participants (23.4%) scored above the proposed cut-off for clinically severe PGD.Results: 'High' or 'very high' levels of somatic symptom distress were more frequent in a possible PGD group (58.2%), than in a non-PGD group (22.4%), p < .001, as divided per cut-off in the IPGDS. In a multiple regression analysis, PGD symptoms were significantly but weakly associated with somatic symptom distress (β = 0.08, p < .001) beyond demographics, loss-related variables, and negative affect. Negative affect (anxiety and depression) mediated the relationship of PGD symptoms with somatic symptom distress and the indirect effect explained 58% of the variance.Conclusions: High levels of somatic symptom distress can be observed in a substantial proportion of bereaved across cultures. Our findings suggest that PGD is related to somatic symptom distress partly and indirectly through facets of negative affect.
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Affiliation(s)
- Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Clare Killikelly
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
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Shin S, Ahn S, Joung J, Kim S. Parents' lived experiences of losing adolescent children in the Korean Ferry Sewol disaster: Lessons through a qualitative meta-synthesis. DEATH STUDIES 2023; 48:584-599. [PMID: 37672392 DOI: 10.1080/07481187.2023.2253764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
This study meta-synthesized qualitative studies on the parents' experiences of losing their adolescent children due to the human-made disaster, Ferry Sewol disaster in Korea, 2014. Five Korean and five international electronic databases were searched. Twenty-one studies were selected and critically appraised. Thematic analysis was employed. Four themes (with 10 subthemes) were derived: screaming in excruciating pain at the unbelievable deaths of children, family love evolving amidst pain and deepening into higher value, relationships collapsed and reformed while experiencing various social perspectives, and transitioning from a life of holding on to a life of progress. Bereaved parents experience psychological, physical, social pain for a long time, but gradually tried not to waste their children's death, forming new values and life goals. There is pressing need to devise sustained recovery strategies that account for distinct characteristics and needs of affected population groups.
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Affiliation(s)
- Soyoung Shin
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Suyoun Ahn
- Department of Nursing, Seoyeong University, Paju, South Korea
| | - Jaewon Joung
- College of Nursing, Research Institute of Nursing Science, Jeonbuk National University, Jeonju, South Korea
| | - Sungjae Kim
- College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, South Korea
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29
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Carlsson N, Årestedt K, Alvariza A, Axelsson L, Bremer A. Factors Associated With Symptoms of Prolonged Grief and Psychological Distress Among Bereaved Family Members of Persons Who Died From Sudden Cardiac Arrest. J Cardiovasc Nurs 2023; 38:454-461. [PMID: 35953072 DOI: 10.1097/jcn.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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30
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Katz NT, Coleman C, Corbett C. 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. Am J Hosp Palliat Care 2023; 40:999-1003. [PMID: 36322963 DOI: 10.1177/10499091221137744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
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.
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Affiliation(s)
- Naomi T Katz
- Palliative Care Service, Alfred Health, Melbourne, VIC, Australia
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Chloe Coleman
- Palliative Care Service, Alfred Health, Melbourne, VIC, Australia
| | - Cathy Corbett
- Palliative Care Service, Alfred Health, Melbourne, VIC, Australia
- General Medicine Unit, Alfred Health, Melbourne, VIC, Australia
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31
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Bottomley JS, Campbell KW, Titlestad KB, Feigelman W, Rheingold AA. Predictors of Stigma, Guilt, and Shame among Adults Bereaved by Fatal Overdose. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231194208. [PMID: 37553120 DOI: 10.1177/00302228231194208] [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: 08/10/2023]
Abstract
With the spectacular rise of US overdose deaths, bereavement for these affected families has become a matter of increasing concern. Qualitative research has highlighted the role of stigmatization as well as guilt and shame among this population. However, the magnitude and pre-death predictors of stigmatization, guilt, and shame have yet to be assessed quantitatively. In the current study, we assess the magnitude of stigmatization, guilt, and shame among 115 adults bereaved by overdose by drawing comparisons with 185 adults bereaved by suicide. Results revealed no significant differences regarding overall levels of stigmatization, guilt, and shame between the overdose and suicide bereaved. Among the overdose bereaved, regression models indicated a number of pre-death factors associated with stigmatization, guilt, and shame, such as the frequency of the decedent's drug use, family drug use severity, and interpersonal conflict between the bereaved and the decedent. Implications and future directions for research are discussed.
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Affiliation(s)
- Jamison S Bottomley
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, USA
| | | | - Kristine B Titlestad
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Alyssa A Rheingold
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, USA
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Bhaskaran J, Afifi TO, Sareen J, Vincent N, Bolton JM. A cross-sectional examination of sudden-death bereavement in university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1696-1704. [PMID: 34469263 DOI: 10.1080/07448481.2021.1947298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/27/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
ObjectivesThe objective of this research was to determine the unique contributions of sudden death bereavement to the mental health of university students compared to non-sudden death bereaved university students. Methods: We surveyed 1047 bereaved university students (retention rate 92%) and compared the non-sudden death bereaved university student population to the sudden death bereaved university population on outcomes including mental health symptomatology, and complicated grief using logistic regressions. Results: Sixty two percent of the sample reported sudden death bereavement. There were no differences on measures of PTSD, generalized anxiety disorder, depression, suicidal ideation, and at-risk drinking behavior across types of bereavement. However, sudden death bereavement compared to general bereavement was associated with increased likelihood of complicated grief. Conclusions: Sudden death bereavement in university students is associated with elevated risk of complicated grief. These findings confirm previous research and provide more insight into the unique needs of university student coping with sudden loss.
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Affiliation(s)
- Joanna Bhaskaran
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Tracie O Afifi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Jitender Sareen
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Norah Vincent
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
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33
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Hillow MA, Atwoli L, Kwobah EK. "Association between Traumatic Life Events and Psychosis: A case-control study in western Kenya". Heliyon 2023; 9:e18144. [PMID: 37483688 PMCID: PMC10362348 DOI: 10.1016/j.heliyon.2023.e18144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/16/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023] Open
Abstract
Globally close to 70% of the general population has experienced at least one traumatic life event (TLE). Although child and adulthood exposure to TLEs is considered a risk factor for the subsequent development of psychosis, few studies have examined the association between trauma and psychosis in the African population. We sought to explore the association between TLEs and psychosis in patients with psychotic disorders (N = 254) and individuals without (N = 254). The participants were matched by age and sex. The study was conducted at a national referral hospital, the Life Events Checklist for DSM-5 (LEC-5) was used to obtain data on TLEs, and ethical approval was obtained from the ethics committee. The proportion of those who experienced TLEs was equal among the cases and controls at about 80%. However, more cases reported that the TLEs happened to them (cases 60.3, p = 0.004). After multivariate analysis, the following specific TLEs remained statistically significant.: Physical assault (aOR = 3.66, 95% CI 2.28-5.48), assaults with a weapon (aOR = 5.26, 95% CI 2.15-10.48), sexual assault (aOR = 4.55, 95% CI 1.08-10.48). The sudden death of a loved one (aOR = 2.33, 95% CI 1.15-4.70) and serious injury/harm to others (aOR = 10.53, 95% CI 1.47-89.37).
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Affiliation(s)
| | - Lukoye Atwoli
- Department of Internal Medicine, Medical College East Africa, Brain and Mind Institute Aga Khan University, Aga Khan University, Karachi, Pakistan
| | - Edith Kamaru Kwobah
- Mental Health Department, MOI TEACHING AND REFERRAL HOSPITAL, Eldoret, Kenya
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Maltais D, Cherblanc J, Cadell S, Bergeron-Leclerc C, Pouliot E, Fortin G, Généreux M, Roy M. Factors Associated with Complicated Grief Following a Railway Tragedy. ILLNESS, CRISES, AND LOSS 2023; 31:467-487. [PMID: 37323654 PMCID: PMC10265305 DOI: 10.1177/10541373221088393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
On July 6, 2013, a train with 72 crude oil tank cars derailed in the heart of Lac-Mégantic, a small municipality of 6,000 inhabitants located in Québec (Canada). This tragedy killed 47 people. Technological disasters are rarely studied in bereavement research, and train derailments even less. The goal of this article is to increase our understanding of the bereavement consequences of technological disasters. Specifically, we aim to identify the factors that lead to the experience complicated grief and distinguish from the protective factors. A representative population-based survey was conducted among 268 bereaved people, three and a half years after the train accident. Of these, 71 people (26.5%) experienced complicated grief. People with complicated grief (CG) differ significantly from those without CG in terms of psychological health, perception of physical health, alcohol use and medication, as well as social and professional relationships. Hierarchical logistic regression analysis identified four predictive factors for CG: level of exposure to the disaster, having a negative perception of the event, as well as having a paid job and low-income increase the risk of CG. The importance of having health and social practitioners pay attention to these factors of CG are discussed along with future directions for research.
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Affiliation(s)
- Danielle Maltais
- Department of Human and Social Sciences, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Jacques Cherblanc
- Department of Human and Social Sciences, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Susan Cadell
- School of Social Work, Renison University College, University of Waterloo
| | | | - Eve Pouliot
- Department of Human and Social Sciences, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Geneviève Fortin
- Department of Human and Social Sciences, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Mélissa Généreux
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mathieu Roy
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Zhang N, Sandler I, Thieleman K, Wolchik S, O'Hara K. Self-Compassion for Caregivers of Children in Parentally Bereaved Families: A Theoretical Model and Intervention Example. Clin Child Fam Psychol Rev 2023; 26:430-444. [PMID: 36920631 PMCID: PMC10866557 DOI: 10.1007/s10567-023-00431-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
Family-based bereavement interventions have shown promises to prevent problem outcomes and promote resilience in parentally bereaved children. Evidence of the broad range of mental and physical health problems following the death of a parent supports the need for a transdiagnostic approach that promotes adaptation and reduces multiple problem outcomes for parentally bereaved families. We discuss self-compassion as a promising framework for a transdiagnostic approach. We argue that three elements of self-compassion-mindfulness (vs. over-identification), self-kindness (vs. self-judgment), and common humanity (vs. isolation)-can facilitate loss-oriented coping, restoration-oriented coping, and the oscillation process between the two. This sets the foundation for individual and family processes that support bereavement adjustment. To explain how self-compassion promotes adjustment outcomes in parentally bereaved families, we review the extant literature with a focus on parental emotion regulation and effective parenting and propose a conceptual model with testable hypotheses to guide more research in this area. The model suggests that caregivers' self-compassion is a resilience resource for multiple adaptive outcomes for themselves and for their child through its positive impacts on emotion regulation and effective parenting. We illustrate the utility of the framework with an example of a family-based bereavement prevention program that integrated self-compassion training. Future directions for research are discussed.
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Affiliation(s)
- Na Zhang
- Department of Human Development and Family Sciences, University of Connecticut, 1 University Place, Stamford, CT, USA.
| | - Irwin Sandler
- REACH Institute, Arizona State University, Tempe, AZ, USA
| | - Kara Thieleman
- REACH Institute, Arizona State University, Tempe, AZ, USA
| | | | - Karey O'Hara
- REACH Institute, Arizona State University, Tempe, AZ, USA
- School of Social and Behavioral Sciences, Arizona State University, Phoenix, AZ, USA
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36
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Ottaviani G, Ramos SG. Autopsy for Medical Diagnostics: Finding the Cause of Sudden Unexpected Death through Investigation of the Cardiac Conduction System by Serial Sections. Diagnostics (Basel) 2023; 13:diagnostics13111919. [PMID: 37296771 DOI: 10.3390/diagnostics13111919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Sudden unexpected death (SUD) is a fatal event that occurs in an apparently healthy subject in a way that such an abrupt outcome could have not been predicted. SUD-including sudden intrauterine unexplained death (SIUD), sudden neonatal unexpected death (SNUD), sudden infant death syndrome (SIDS), sudden unexpected death of the young (SUDY), and sudden unexpected death in the adult (SUDA)-occurs as the first manifestation of an unknown underlying disease or within a few hours of the presentation of a disease. SUD is a major unsolved, shocking form of death that occurs frequently and can happen at any time without warning. For each case of SUD, a review of clinical history data and performance of a complete autopsy, particularly focused on the study of the cardiac conduction system, were carried out according to the necropsy protocol devised by the Lino Rossi Research Center, Università degli Studi di Milano, Italy. Research cases collected and selected for this study were represented by 75 SUD victims that were subdivided into 15 SIUD, 15 SNUD, 15 SUDY, and 15 SUDA victims. After a routine autopsy and clinical history analysis, death remained unexplained, and hence a diagnosis of SUD was assigned to 75 subjects, which included 45 females (60%) and 30 (40%) males ranging in age from 27 gestational weeks to 76 years. Serial sections of the cardiac conduction system disclosed frequent congenital alterations of the cardiac conduction system in fetuses and infants. An age-related significant difference in distribution among the five age-related groups was detected for the following anomalies of the conduction system: central fibrous body (CFB) islands of conduction tissue, fetal dispersion, resorptive degeneration, Mahaim fiber, CFB cartilaginous meta-hyperplasia, His bundle septation, sino-atrial node (SAN) artery fibromuscular thickening, atrio-ventricular junction hypoplasia, intramural right bundle branch, and SAN hypoplasia. The results are useful for understanding the cause of death for all SUD cases that were unexpected and would have otherwise remained unexplained, so as to motivate medical examiners and pathologists to perform more in-depth studies.
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Affiliation(s)
- Giulia Ottaviani
- Lino Rossi Research Center, Anatomic Pathology, Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy
| | - Simone G Ramos
- Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, Brazil
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Janus SA, King S, Lam VC, Anderson GS. Impacts of the COVID-19 Pandemic on the Bereaved. ILLNESS, CRISIS & LOSS 2023. [PMCID: PMC9895293 DOI: 10.1177/10541373221151105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The COVID-19 pandemic has killed millions across the world in only two years. Government health restrictions aimed at preventing transmission have impacted typical mourning practices such as funeral gatherings and in-person grief support services. This research examines the potential impacts that the pandemic may have had on people's ability to grieve. We employed a mixed methods study design to ask those who have lost a loved one during this time to reflect on their mourning practices with an anonymous survey. Our results present themes of complicated grief, the uncertainty of who to blame for frustrations, and common needs requested by the bereaved to help them mourn during these unprecedented times. These findings may help inform grief support and bereavement services during current and future mass death and pandemic health concerns.
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Affiliation(s)
- Soraya A. Janus
- School of Criminology, Centre for Forensic Research, Simon Fraser University, Burnaby, Canada
| | - Steff King
- School of Criminology, Centre for Forensic Research, Simon Fraser University, Burnaby, Canada
| | - Vienna C. Lam
- School of Criminology, Centre for Forensic Research, Simon Fraser University, Burnaby, Canada
| | - Gail S. Anderson
- School of Criminology, Centre for Forensic Research, Simon Fraser University, Burnaby, Canada
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Adena M, Hamermesh D, Myck M, Oczkowska M. Home Alone: Widows' Well-Being and Time. JOURNAL OF HAPPINESS STUDIES 2023; 24:813-838. [PMID: 36694477 PMCID: PMC9851896 DOI: 10.1007/s10902-023-00622-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
UNLABELLED 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.
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Affiliation(s)
- Maja Adena
- Wissenschaftszentrum Berlin (WZB), 10785 Berlin, Germany
| | - Daniel Hamermesh
- University of Texas at Austin, Austin, TX 78712 USA
- Institute for the Study of Labor, 53113 Bonn, Germany
- National Bureau of Economic Research, Cambridge, USA
| | - Michał Myck
- Institute for the Study of Labor, 53113 Bonn, Germany
- Centre for Economic Analysis, Cyfrowa 2, 71441 Szczecin, Poland
- University of Greifswald, 17489 Greifswald, Germany
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39
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Eli B, Chen Y, Zhang J, Huang X, Wang Q, Ma Z, Yv Y, Liu Z. Time course of attentional bias and its relationship with PTSD symptoms in bereaved Chinese parents who have lost their only child. Eur J Psychotraumatol 2023; 14:2235980. [PMID: 37493173 PMCID: PMC10599259 DOI: 10.1080/20008066.2023.2235980] [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: 08/14/2022] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 07/27/2023] Open
Abstract
Background: The death of a child is a highly traumatic event for parents and often leads to posttraumatic stress disorder (PTSD). Attentional bias has been demonstrated in the onset and maintenance of PTSD symptoms.Objective: This study aimed to investigate the time course of attentional bias among bereaved Chinese parents who have lost their only child (Shidu parents), and to examine its relationship with PTSD symptoms and symptom clusters.Methods: Shidu parents (n = 38; 50-72 years of age) completed a dot-probe task with negative (trauma-related), positive, and neutral images at four stimulus presentation times (250, 500, 750, and 1250 ms). PTSD symptoms were measured by the PTSD Checklist for DSM-5 (PCL-5).Results: We observed difficulty in disengaging from both negative and positive stimuli at 750 ms and attentional bias away from negative stimuli at 1250 ms. At 1250 ms, attentional avoidance of trauma-related stimuli was positively correlated with PCL-5 total and intrusion scores. Difficulty in disengaging from positive stimuli was negatively correlated with PCL-5 total and intrusion scores as well as negative alterations in cogniti and mood scores.Conclusions: These findings enhance our understanding of attentional bias and cognitive-affective processing in PTSD. This study provides evidence that attentional bias (difficulty in disengaging from positive stimuli and bias away from negative stimuli) are correlated with PTSD symptoms and certain symptom clusters.
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Affiliation(s)
- Buzohre Eli
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, P.R. China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, P.R. China
| | - Yaru Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, P.R. China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, P.R. China
| | - Jing Zhang
- Gengdan Institute of Beijing University of Technology, Beijing, P.R. China
| | - Xin Huang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, P.R. China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, P.R. China
| | - Qian Wang
- Beijing Key Laboratory of Behavior and Mental Health, Clinical and Health Psychology Department, School of Psychological and Cognitive Sciences, Peking University, Beijing, P.R. China
| | - Zhujiang Ma
- Beijing Wisdom Spirits Technology Co., Ltd, Beijing, P.R. China
| | - Yang Yv
- Yv Yang Psychological Service Center, Economic and Technological Development Zone, Huai'an, Jiangsu Province, P.R. China
| | - ZhengKui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, P.R. China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, P.R. China
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40
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Dickerson MGA, Conlon D, Raeburn T. Ars Moriendi: An Overview of Approaches to the Art of Dying, Grief and Loss for Nurses Working in Mental Health. Issues Ment Health Nurs 2023; 44:27-34. [PMID: 36206035 DOI: 10.1080/01612840.2022.2128125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This historical discussion paper is an overview for nurses working in mental health of medieval and Early Modern texts known as Ars Moriendi literature, which focuses on the art of dying, grief and loss. Primary and secondary historical documents are used to describe Ars Moriendi literature and how historical understandings of death and dying were shaped within a spiritual context. Ars Moriendi concepts are compared with modern Western secularised and medicalised notions to prompt reflection on historical versus modern approaches to dying, grief and loss.
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Affiliation(s)
- Meagan G A Dickerson
- School of Nursing & Midwifery, The University of Notre Dame, Darlinghurst, NSW, Australia
| | - Darren Conlon
- School of Nursing & Midwifery, The University of Notre Dame, Darlinghurst, NSW, Australia
| | - Toby Raeburn
- School of Nursing & Midwifery, The University of Notre Dame, Darlinghurst, NSW, Australia
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Keloharju M, Knüpfer S, Tåg J. CEO health. THE LEADERSHIP QUARTERLY 2023. [DOI: 10.1016/j.leaqua.2022.101672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Fjærestad A, Kristensen P, Dyregrov A, Hjelen Stige S. Grief trajectories among bereaved parents after the 2011 Utøya terror attack: A qualitative analysis. DEATH STUDIES 2023; 47:847-860. [PMID: 36259509 DOI: 10.1080/07481187.2022.2135045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
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.
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Affiliation(s)
- Anita Fjærestad
- Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Pål Kristensen
- Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Atle Dyregrov
- Centre for Crisis Psychology, University of Bergen, Bergen, Norway
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43
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McGill G, Mann E, Moreland M, Osborne A, Kiernan MD, Wilson-Menzfeld G. Bereaved Military Families: Relationships and Identity. JOURNAL OF LOSS & TRAUMA 2022. [DOI: 10.1080/15325024.2022.2127678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Gill McGill
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Emily Mann
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Mary Moreland
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Alison Osborne
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Matthew Donal Kiernan
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Gemma Wilson-Menzfeld
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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44
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Selman LE, Farnell DJJ, Longo M, Goss S, Torrens-Burton A, Seddon K, Mayland CR, Machin L, Byrne A, Harrop EJ. Factors Associated With Higher Levels of Grief and Support Needs Among People Bereaved During the Pandemic: Results from a National Online Survey. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221144925. [PMID: 36542774 DOI: 10.1177/00302228221144925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
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).
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Affiliation(s)
- Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Mirella Longo
- Marie Curie Research Centre, Cardiff University, Cardiff, UK
| | - Silvia Goss
- Marie Curie Research Centre, Cardiff University, Cardiff, UK
| | - Anna Torrens-Burton
- PRIME Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | - Catriona R Mayland
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Anthony Byrne
- Marie Curie Research Centre, Cardiff University, Cardiff, UK
| | - Emily J Harrop
- Marie Curie Research Centre, Cardiff University, Cardiff, UK
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45
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Moreira D, Azeredo A, Sá Moreira D, Fávero M, Sousa-Gomes V. Why Does Grief Hurt? EUROPEAN PSYCHOLOGIST 2022. [DOI: 10.1027/1016-9040/a000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract. Grief is a major physical and psychological health concern for adults, as well as a key risk factor for depression. The direct and indirect costs of depression in adults place heavy burdens on societal resources. Indeed, bereavement is a stressful and profound life experience, with the grieving process combining reactions to a loss that may originate in complications for bereaved individuals. The goal of this systematic review is to synthesize the findings regarding depression and grief. Studies related to the topic were obtained from multiple databases through rigorous exclusion and inclusion criteria. Only empirical studies with quantitative methodologies were included. Objectives, sample (type of sample, % male, and age), instruments, and main conclusions were extracted from each study. Overall, there are personality and contextual factors that, in addition to affecting depressive reactions following a loss, may also interface with one’s ability to grieve. Furthermore, after the patient’s death, there was a decrease in depressive symptoms over time, indicating that these symptoms are dynamic. Individuals who experience prolonged grief exhibit depressive symptoms, and those who suffer a loss may have depressive symptoms, but in a natural and non-pathological way, that is, sadness and not depression. Depression tends to decrease over time, with the existence of more children and a focus on occupation.
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Affiliation(s)
- Diana Moreira
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Portugal
- Centre for Philosophical and Humanistic Studies, Faculty of Philosophy and Social Sciences, Universidade Católica Portuguesa, Portugal
- Institute of Psychology and Neuropsychology of Porto – IPNP Health, Portugal
- Centro de Solidariedade de Braga/Projecto Homem, Portugal
| | - Andreia Azeredo
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Portugal
| | - Diana Sá Moreira
- Institute of Psychology and Neuropsychology of Porto – IPNP Health, Portugal
- Social and Behavioral Sciences Department, University Institute of Maia, Portugal
| | - Marisalva Fávero
- Social and Behavioral Sciences Department, University Institute of Maia, Portugal
- Unit I&D of the Justice and Governance Research Center of the Law School, University of Minho (JusGov/UM), Portugal
| | - Valéria Sousa-Gomes
- Institute of Psychology and Neuropsychology of Porto – IPNP Health, Portugal
- Social and Behavioral Sciences Department, University Institute of Maia, Portugal
- Unit I&D of the Justice and Governance Research Center of the Law School, University of Minho (JusGov/UM), Portugal
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46
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Nordström EEL, Thimm JC, Kaltiala R, Kristensen P. Prolonged grief, post-traumatic stress, and functional impairment in parents and siblings 8 years after the 2011 Utøya terror attack. Eur J Psychotraumatol 2022; 13:2152930. [PMID: 38872603 PMCID: PMC9754049 DOI: 10.1080/20008066.2022.2152930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Research on bereavement after terrorism is limited and primarily aiming on short-term consequences.Objective: To better understand the long-term health consequences of terrorism, we studied bereaved parents and siblings eight years after the Utøya terrorist attack in Norway. We examined the participants' symptom levels of prolonged grief (PG) and post-traumatic stress (PTS), as well as their psychosocial functioning and employment status.Method: Bereaved parents (n = 88) and siblings (n = 34) aged 19 and above (mean age = 49.7 years, SD = 13.8 years, 59.8% female) completed the Inventory of Complicated Grief (ICG), the Impact of Event Scale-Revised (IES-R), and the Work and Social Adjustment Scale (WSAS) to assess PG, PTS, and functional impairment, respectively. In addition, information about employment status was obtained. The proportion of participants scoring above recommended thresholds on the ICG, IES-R, and WSAS was calculated. Differences between parents and siblings and gender differences on these measures were examined.Results: In total, 62.3% of the participants had scores on the ICG indicating a risk for prolonged grief, while 45.9% scored over cutoff on the IES. There was a high overlap between symptoms of PG and PTS. Females had significantly higher scores on both the ICG and the IES compared to males. There were no differences between parents and siblings regarding PG and PTS symptoms. One out of three showed severe functional impairment on the WSAS. Approximately 30% of all the bereaved were outside the labour force, and one third of the parents had become unable to work after the terrorist attack.Conclusion: Many bereaved parents and siblings, following the Utøya terror attack, report long-lasting health consequences with symptoms of PG and PTS and functional impairment. The results suggest a need for follow up of bereaved after a terror attack and identify family members in need of health services.
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Affiliation(s)
| | - Jens C Thimm
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
- Department of Psychology, UiT The arctic University of Norway, Tromsø, Norway
| | - 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
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Carlsson N, Alvariza A, Axelsson L, Bremer A, Årestedt K. Grief reactions in relation to professional and social support among family members of persons who died from sudden cardiac arrest: A longitudinal survey study. Resusc Plus 2022; 12:100318. [PMID: 36299826 PMCID: PMC9589205 DOI: 10.1016/j.resplu.2022.100318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/23/2022] [Accepted: 10/02/2022] [Indexed: 12/23/2022] Open
Abstract
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.
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Affiliation(s)
- Nina Carlsson
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden,Corresponding author at: Faculty of Health and Life Sciences, Linnaeus University, SE-39182 Kalmar, Sweden.
| | - Anette Alvariza
- Department of Health Care Sciences/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden,Capio, Palliative Care, Dalen Hospital, Stockholm, Sweden
| | | | - Anders Bremer
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden,Department of Ambulance Service, Region Kalmar County, Kalmar, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden,Department of Research, Region Kalmar County, Kalmar, Sweden
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Gajewski AJ, Zhang H, Abu-Hamad S, Pollio W, McDonald K, Pollio DE, North CS. Making Meaning of Surviving the Oklahoma City Bombing Seven Years Later. Psychiatry 2022; 86:42-52. [PMID: 36190776 PMCID: PMC9992151 DOI: 10.1080/00332747.2022.2120309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
Objective: No previous studies examined how survivors made meaning (i.e. interpreted the personal significance) of a disaster experience after seven years. This qualitative study follows up on a previously published analysis of 182 directly-exposed survivors of the Oklahoma City bombing, assessed after six months had elapsed for bombing-related psychopathology and meaning-making processes. The current study examines how 113 survivors (62% follow-up rate) made meaning of their bombing experience after seven years. Method: Survivors answered questions about the effects of the bombing on their beliefs and perspectives. Their responses were hand recorded by interviewers and transcribed. Content was coded into themes, allowing codes of multiple themes. Excellent interrater reliability was obtained (Cohen's kappa≥.8). Results: The survivors were 50% (57/113) male, 93% (105/113) Caucasian, 34% (38/113) college educated, and 71% (80/113) married with a mean (SD) age of 42.5 (10.6) (range = 19-69) years at the time of the bombing. Eight themes emerged and indicated that survivors matured in personal goals and character, interpersonal relationships, and philosophical thought (e.g., reconsideration of human nature and religion). More than one third of the comments included negative remarks about personal harm, especially psychological effects. Conclusions: Nearly two thirds of the material was positive in tone and consistent between six months and seven years. Negative content was entirely new relative to six-month baseline interview responses, suggesting many survivors incorporate greater reflection on negative outcomes in meaning-making processes over time. After several years, clinicians could encourage survivors to integrate positive and negative consequences as meaning. Longer-term studies are needed.
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Affiliation(s)
| | - Helena Zhang
- Medical School, The University of Texas Southwestern Medical Center, Dallas, USA
| | - Samir Abu-Hamad
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, USA
| | - Whitney Pollio
- Colledge of Nursing, The University of South Florida, USA
| | - Katy McDonald
- The Altshuler Center for Education & Research at Metrocare Services, Dallas, USA; and Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, USA
| | | | - Carol S. North
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, USA
- The Altshuler Center for Education & Research at Metrocare Services, Dallas, USA; and Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, USA
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"I don't go to funerals anymore": how people who use opioids grieve drug-related death in the US overdose epidemic. Harm Reduct J 2022; 19:110. [PMID: 36183109 PMCID: PMC9526383 DOI: 10.1186/s12954-022-00693-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Opioid-related overdose death is a public health epidemic in much of the USA, yet little is known about how people who use opioids (PWUO) experience overdose deaths in their social networks. We explore these experiences through a qualitative study of opioid-related overdose death bereavement among PWUO. METHODS We recruited 30 adults who inject opioids from a syringe service program in the Midwestern USA and interviewed them using a semi-structured guide that addressed experiences of opioid use, opioid-related overdose, and overdose reversal via the medication naloxone. Interviews were transcribed verbatim and analyzed thematically. FINDINGS Participants described overdose death as ever-present in their social worlds. Most (approximately 75%) reported at least one overdose death in their social network, and many came to consider death an inevitable end of opioid use. Participants described grief shaped by complex social relations and mourning that was interrupted due to involvement with social services and criminal legal systems. They also reported several ways that overdose deaths influenced their drug use, with some increasing their use and others adopting safer drug use practices. Despite the high prevalence of overdose deaths in their social networks, only one participant reported receiving grief support services. DISCUSSION Findings underscore the need for interventions that not only maintain life, such as naloxone distribution, but also improve quality of life by attending to grief related to overdose death bereavement. We discuss policies and practices with the potential to address the unique psychological, social, and structural challenges of grief for this population.
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Tay DL, Thygesen LC, Kozlov E, Ornstein KA. Serious Mental Illness Exacerbation Post-Bereavement: A Population-Based Study of Partners and Adult Children. Clin Epidemiol 2022; 14:1065-1077. [PMID: 36164496 PMCID: PMC9508997 DOI: 10.2147/clep.s372936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The death of a close family member is commonly accompanied by intense grief, stress, and loss of social support. We hypothesized that recent bereavement would be associated with an increase in symptom exacerbations among adults with serious mental illness (SMI) whose partners or parents had died. Patients and Methods Adults whose partners and parents had died in Denmark between January 1, 2010, and June 30, 2016, were identified using linked population-based registries. History of SMI was defined as having a diagnosis of schizophrenia and schizoaffective disorders, major depression, and bipolar disorder in the five years preceding their family member's death in the Danish Psychiatric Central Research Register using International Classification of Diseases-10 codes. The odds of SMI exacerbation (ie, attempt or completion of suicide or psychiatric hospitalization) among partners and children in the first two years after death in 3-month intervals were estimated with generalized estimating equations. Results 12.8% of partners and 15.0% of adult children with a history of SMI experienced any SMI exacerbation two years after bereavement. Among bereaved partners, older age (80+ years) was associated with a lower risk of experiencing an SMI exacerbation compared with partners aged 18-49 years (ORadj=0.29, [0.18-0.45]). Partners with a history of SMI had significantly increased odds of SMI exacerbations three months after their partners' death compared to prior to their partners' death (ORadj = 1.43, [1.13-1.81]). There was no evidence that adult children with SMI experience increased SMI exacerbations after the death of their parents compared to prior to death. Conclusion Adults with a history of SMI whose partners had died are at increased risk for an SMI exacerbation post bereavement. Additional bereavement resources and support should be provided to those with a history of SMI, especially in the period immediately after death.
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Affiliation(s)
- Djin L Tay
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Elissa Kozlov
- Department of Health Behavior, Society and Policy, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
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