An examination of stage theory of grief among individuals bereaved by natural and violent causes: a meaning-oriented contribution

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

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

Mourning in the time of coronavirus: Examining how grief differs in those who lost loved ones to COVID-19 vs. natural causes in Iran

OBJECTIVES

Our study aimed to analyze and compare the grief experiences of individuals in Iran who lost family members to COVID-19 and those who lost loved ones to other natural causes.

METHODS

In this study, telephone interviews were conducted with 640 first-degree relatives, and finally, a total of 395 people remained in the research. Participants answered the Prolonged Grief Questionnaire (PG-13-R) and Grief Experience Questionnaire.

RESULTS

The results showed that the most common symptoms and features of grief were feeling guilt, searching for an explanation, somatic reactions, and rejection, with no significant difference observed between the 2 death groups. However, the average scores for these symptoms were higher in the COVID-19 death group. Moreover, the majority of bereaved reported signs and symptoms of prolonged grief, with a higher percentage in the COVID-19 death group, although there was no significant difference between the 2 death groups in terms of the distribution of symptoms and signs of prolonged grief. These findings suggest that the bereavement process can be challenging, and losing a loved one to COVID-19 may lead to more intense experiences of grief.

SIGNIFICANCE OF RESULTS

The study reveals high levels of guilt, searching for meaning, somatic reactions, and rejection among COVID-19 grievers. Losing loved ones to the pandemic appears linked to more intense, prolonged grief symptoms.

Ambivalence Resolution in Meaning Reconstruction Grief Therapy: An Exploratory Study

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.

Ambiguous loss in organ donor families: A constructivist grounded theory

AIMS AND OBJECTIVES

Explore families' experiences when being approached for organ donation authorisation after brainstem death.

BACKGROUND

The complexities of potential organ donor families' experiences include challenges related to emotional distress, coping with the loss and the organ donation decision-making process, and support needed. A lack of conceptual clarity was found concerning families' experiences when being approached for organ donation authorisation, which guided the study.

DESIGN

Constructivist grounded theory.

METHODS

Seventy-one participants, including healthcare professionals and families, were recruited from two large hospitals in Chile between 2017 and 2019. Field notes, documents (n = 80), interviews (n = 27) and focus groups (n = 14) were collected and analysed following Charmaz's constructivist grounded theory principles and practices until theoretical saturation was reached. The study is reported using the COREQ checklist.

RESULTS

A third type of ambiguous loss of bereaved families' experience was developed as a fourfold process: (1) impending loss, (2) confirming loss, (3) ambiguous loss and organ donation decision-making and (4) organ donation as a third type of ambiguous loss. This grounded theory expands the concepts of ambiguous loss by Boss, dying by Glaser and Strauss and grief by Brinkmann, enabling explanation of families' experiences.

CONCLUSION

Families of potential organ donors develop a highly complex grieving process, which may play a significant role in the organ donation decision-making process. Ambiguity is embedded in how donor families reframe the existence of the donor through the act of giving life.

RELEVANCE TO CLINICAL PRACTICE

The findings shed light on families' experiences on the organ donation process after brainstem death. The study can be used in nursing practice, education and to inform policy nationally and globally, mainly due to the current focus on quantitative measures and legislative changes fostering individual decision-making.

PATIENT OR PUBLIC CONTRIBUTION

Families contributed through their first-hand experiences of the organ donation process.

Revising ruling discourses: The griefwork evidence-to-practice gap and the mental health workforce

Elisabeth Kübler-Ross' pioneering work focused on dying, yet some clinicians persist in prescribing it as a path through grief. We surveyed 964 mental health clinicians who completed a five-section mixed methods survey: two sections assessed knowledge with multiple choice questions and a case study to assess clinicians' knowledge-base and approach to grief/loss in practice. Analysis of four items related to Kübler-Ross' model and 66/962 case studies indicates ongoing use of "stages" and Kübler-Ross' model. Only 330 (34.2%) of the clinicians were deemed knowledgeable; 462 (47.9%) were questionable; and 172 (17.9%) were misinformed, continuing to use Kübler-Ross' stage theory for grief.

Construction of Meaning in Pregnancy Loss: Qualitative Study with Brazilian Couples

Abstract We investigated the process of meaning construction in pregnancy loss in 11 Brazilian couples. The reports were submitted to inductive and deductive thematic analysis using the categorization system from the integrative model of meaning construction in grief. Regarding the original dimensions of the model (Sense-making of death, benefit from the experience of loss, and identity change), there was a lack of meaning for death, perception of strengthened bonds within the couple as a benefit, and parenting as an identity project. We propose an additional dimension (Meaning-making process) that includes gender differences, lack of social recognition, and emotional intensity of the experience. As for coping strategies, spirituality and the search for peers were identified, especially in social media. After a pregnancy loss, the process of meaning construction proved similar to that of other types of loss, validating this experience. We discuss the implications of the category system used in this study.

Psychometric properties, stability, and predictive validity of the Korean version of the Prolonged Grief Disorder Scale (PG-13-K): A longitudinal study among bereaved Koreans

This study aims to investigate the psychometric properties, stability, and predictive validity of the PG-13-K. Two subsamples were used: the first subsample (N = 153), participated at Time 1 only, and the second subsample (N = 184) participated at both Time 1 and Time 2. At each time point, reliability, test-retest reliability, and validity were adequate, and the hypothesized two-factor model indicated good to excellent fit. Moreover, the PG-13-K was able to predict the correlation between prolonged grief disorder (PGD) and negative psychological factors. The PG-13-K is a useful and valid instrument for measuring PGD symptoms in Korean settings.

Embodied meaning making: Memorial tattoos as a visual expression of grief

Memorial tattoos are an increasingly prevalent response to the death of a loved one. This study explored the role of memorial tattoos as an active response to loss and a visual expression of grief. Twenty-two people with memorial tattoos volunteered to be interviewed and to have photographs taken of their tattoos. Through a grounded theory analysis, the core category emerged that memorial tattoos were an expression of embodied meaning making in the grief experience. Under this core category, the themes of creating permanence, constructing control, and symbolizing the bond further elucidated the meaning making process represented in memorial tattoos.

"Everything Changes": Listening to Homicidally Bereaved Individuals' Practice and Intervention Needs

This study sought to understand how individuals bereaved through homicide (murder or manslaughter) describe their postevent experiences to inform clinical needs and promote mechanisms for change. A total of 21 participants (18 females) between the ages of 29 and 66 (M age = 47.81 years, SD = 8.99) took part in this study. They were all participating in a residential program for homicidally bereaved individuals and were all residents in the United Kingdom. The sample comprised of 12 parents, five siblings, one partner, one daughter, one friend, and one grandmother of the deceased. The length of time since the bereavement varied from 12 months to 18 years (M = 2.48, SD = 1.80). Thematic analysis was used to analyze the narratives collected. Three central themes emerged, namely (a) uniqueness of the experience, (b) changed self and world, and (c) mixed experiences of support. The uniqueness of the individuals' experiences was associated with the nature of the homicide event and the consequences that are unlikely to occur in "normal" deaths (e.g., judiciary). A sense of a changed self (e.g., ongoing emotional/mental and physical responses, coping) and world (e.g., changed beliefs regarding safety and criminal activity) seemed to be contributing to different shades of (mal)adjustment. Adaptive and protective strategies were identified. The current study with a large qualitative sample generated a unique, rich description/integration about individuals' journeys following an experience of homicidal bereavement. Findings are likely to inform policy and clinical practice by considering individuals' voices.

Dealing with loss: food and eating in women with ovarian cancer on parenteral nutrition

BACKGROUND

Malignant bowel obstruction is a common complication of ovarian cancer, resulting in limited oral intake. Home parenteral nutrition (HPN) may be offered to patients in this condition to meet nutritional requirements. However, it is not known how they experience being unable to eat. The present study reports how patients related to food when receiving HPN.

METHODS

The investigation was a qualitative study underpinned by phenomenology with women with advanced ovarian cancer in bowel obstruction receiving parenteral nutrition. Interview transcripts were analysed thematically guided by the techniques of Van Manen.

RESULTS

We recruited 20 women to the study. Participants were interviewed a maximum of four times and a total of 39 in-depth longitudinal interviews were conducted. Participants could tolerate minimal amounts of food, if they had a venting gastrostomy. Not being able to eat engendered a sense of sadness and loss, and most women found it challenging to be in the presence of others eating. They adopted strategies to cope, which included fantasising about food and watching cookery programmes. These approaches were not a long-term solution; either participants came to terms with their loss or the strategies became less effective in providing relief.

CONCLUSIONS

Home parenteral nutrition meets the nutritional requirements of patients with malignant bowel obstruction but cannot replace the non-nutritive functions of food. Healthcare professionals can offer a patient-centred approach by acknowledging the difficulties that patients may face and, wherever possible, encourage them to focus on the positive benefits of interacting with people rather than the loss of eating on social occasions.

Differential Associations of Coping Strategies With Grief and Depression in Young Adults: The Role of Cause of Death and Relationship to the Deceased

Introduction: The impact of loss by death in young adults has been underinvestigated, although higher rates of traumatic deaths are reported at this developmental stage. This study examined the relative differential consequences of bereavement-related factors for Persistent Complex Bereavement Disorder (PCBD) and depression. In addition, coping strategies predicting the study outcomes were examined as a function of bereavement-related factors.

Methods: The study included 580 bereaved young adults with up to 5-year post loss. They were administered a battery of valided tools measuring PCBD symptoms, normal acute grief reactions as measured by the Core Bereavement Items scale, depressive symptoms, coping strategies, and bereavement-related characteristics. Covariance and regression analyses were used.

Results: We found that the dimensions of PCBD and depressive symptoms were differentially associated with the bereavement-related factors. More specifically, the death of an immediate family member was associated with higher levels of PCBD-separation distress, whereas the traumatic death of a friend and romantic partner was more associated with PCBD-social and identity disruption. Furthermore, the study revealed differential associations between PCBD severity, depressive symptoms, and coping strategies as functions of bereavement-related factors.

Discussion: The study has provided better understanding of clinical manifestations of PCBD as a function of etiologic risk factors. The results clarifying risk and protective factors are especially useful for improving effective bereavement-health counseling interventions among bereaved young adults.

A Body of Evidence: Barriers to Family Viewing After Death by Gun Violence

BACKGROUND

Gun violence remains a staggering public health care crisis. Although viewing the victim's body is essential to the grieving process, this practice is not universally practiced in the trauma bay and may not be supported by nurses. This study investigates how trauma nurses perceive bereavement and the potential barriers to family viewing after death by gun violence.

METHODS

A survey designed to assess demographics, current practices, knowledge of policies, and personal beliefs regarding family viewing after violent crime was sent electronically to members of the Society of Trauma Nurses. Participants were asked to rank the importance of 14 viewing barriers. Descriptive analysis and perception of barriers between those who did and did not permit viewing were compared using Mann-Whitney tests. *P < 0.05 is considered significant.

RESULTS

Of the 212 participants, the majority were white, female nurses (86%), aged 30 to 60 y who worked in an urban or suburban setting (58% and 30%). Only 15% had a written hospital policy with the majority not knowing if the police (68%) or medical examiner (74%) had written policies. Despite lack of guidelines, viewings did routinely occur (68%), but only 37% permitted touching. Nurses who did not permit viewing were more likely to rank legal concerns and trauma bay environment as significant barriers.

CONCLUSIONS

Although family viewing after gun violence frequently occurs in the trauma bay, there are significant barriers that are compounded by lack of formal policies. Collaboration with police and medical examiners could mitigate these fears while promoting a safe and more family-centered experience.

I am surrounded by death: death as a defining psychic issue within a relational psychoanalytic engagement and the impact of the therapist's relationship with death

Taking inspiration from Frommer, this paper is part of a shift towards incorporating death as a defining psychic issue. With a sense that I am surrounded by death, the author presents two brief vignettes of clinical cases to illustrate the impact of the therapist’s relationship with death on the therapeutic process. Each case shows a different level of engagement with the client when the focus is on death-talk, and reflects, on the one hand, the therapist’s ability and readiness to work with death as an object of analysis, and on the other hand, the therapist’s lack of processing of experiences of death of others, and the resultant failure to successfully work with death in analysis. The one case is arguably more successful therapeutically than the other, and highlights some issues that come into play in the light of the therapist’s relationship with death. These issues are: i) the importance of the therapist’s development with regards to processing experiences of death and dying cannot be underestimated when working with death as an object of scrutiny; ii) empathy remains core to the process and getting in touch with how the client experiences the death of the other. Without recognition, however, no (grief) work can begin. The therapist needs to psychologically recognise the other to be able to connect to, and empathize with, the clients process; iii) the impact of the death of the other often transforms into the work of the impact of the death of self; iv) if clients have a sense that the therapist knows what they are speaking about because the therapist has done some of the work of making meaning of death, clients may feel more confident in working with death as an object of analysis.

Meaning Reconstruction in Bereaved Family Caregivers of Person's With Alzheimer's Disease: A Mixed-Methods Study

The purpose of this descriptive study was to identify whether meaning reconstruction was associated with indicators of bereavement adaptation in 66 spouses and adult child caregivers of person's with Alzheimer's disease. A cross-sectional mixed-methods design was used. Hierarchical regression models were used to examine whether meaning making predicted grief, depression, and positive and states of mind in the sample. Qualitative interviews were conducted to gain further knowledge about ways in which Alzheimer's disease caregivers construct meaning during bereavement. The majority of participants reported experiencing positive aspects of meaning reconstruction. Benefit-finding and identity change contributed to reductions in grief, and benefit-finding contributed to positive states of mind. Being a spouse and female gender contributed to increased grief and depression. Bereaved caregivers who are at risk for high levels of grief should be targeted for grief therapy interventions that foster meaning making.

Psychometric evaluation of the Texas revised inventory of grief in a sample of bereaved family caregivers

The Texas Revised Inventory of Grief (TRIG) was developed to measure the intensity of grief after the death of a close person. It consists of two scales: TRIG I (past behaviors) and TRIG II (present feelings). Because of inconsistencies in previous validations, the instrument needs to be further validated, hence the aim of this study was to evaluate the psychometric properties of the TRIG in a sample of bereaved family caregivers in Sweden. The TRIG was translated to Swedish according to standard principles, and 129 bereaved family caregivers completed the questionnaire. Parallel analysis was used to decide the number of factors to extract, followed by confirmatory factor analysis. An ordinal version of Cronbach's alpha was used to evaluate the internal consistency of the scales. Construct validity was tested against the Hospital Anxiety and Depression Scale (HADS). The factor analyses resulted in one factor being retained for both scales. The internal consistency was excellent (α > 0.9) for both scales. Construct validity was supported by strong correlations between TRIG I and TRIG II as well as moderate correlations between the TRIG scales and HADS. In conclusion, the TRIG has sound psychometric qualities and the two scales should be treated as unidimensional measures of grief. Hence, the instrument is suited to be used in the context of palliative care.

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

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

Complicated grief: recent developments in diagnostic criteria and treatment

Although grief is a natural response to loss among human beings, some people have a severe and prolonged course of grief. In the 1990s, unusual grief persisting with a high level of acute symptoms became known as 'complicated grief (CG)'. Many studies have shown that people who suffer from CG are at risk of long-term mental and physical health impairments and suicidal behaviours; it is considered a pathological state, which requires clinical intervention and treatment. DSM-5 (2013 Diagnostic and statistical manual of mental disorders, 5th edn) proposed 'persistent complex bereavement disorder' as a psychiatric disorder; it is similar to CG in that it is a trauma- and stress-related disorder. In recent years, there has been considerable research on the treatment of CG. Randomized controlled trials have suggested the efficacy of cognitive behavioural therapy including an exposure component that is targeted for CG. However, experts disagree about the terminology and diagnostic criteria for CG. The ICD-11 (International classification of diseases, 11th revision) beta draft proposed prolonged grief disorder as a condition that differs from persistent complex bereavement disorder with respect to terminology and the duration of symptoms. This divergence has arisen from insufficient evidence for a set of core symptoms and the biological basis of CG. Future studies including biological studies are needed to reach consensus about the diagnostic criteria for CG.This article is part of the theme issue 'Evolutionary thanatology: impacts of the dead on the living in humans and other animals'.

In one’s own time: Contesting the temporality and linearity of bereavement

This article explores the experience and meaning of time from the perspective of caregivers who have recently been bereaved following the death of a family member. The study is situated within the broader cultural tendency to understand bereavement within the logic of stages, including the perception of bereavement as a somewhat predictable and certainly time-delimited ascent from a nadir in death to a ‘new normal’ once loss is accepted. Drawing on qualitative data from interviews with 15 bereaved family caregivers we challenge bereavement as a linear, temporally bound process, examining the multiple ways bereavement is experienced and how it variously resists ideas about the timeliness, desirability and even possibility of ‘recovery’. We posit, on the basis of these accounts, that the lived experience of bereavement offers considerable challenges to normative understandings of the social ties between the living and the dead and requires a broader reconceptualization of bereavement as an enduring affective state.

Dialogical space in grief work: Integrating the alterity of loss

Research on grief is moving away from stage and task-oriented models. Instead, loss is reconceptualized as an event that will change mourners' identity over time. The authors envision dynamic grief work as flowing from a dialogical engagement with loss, death, and illness; a terrain in which to begin a conversation with soul. A soul perspective challenges the prevailing call for efficiency, engages the voice of loss, and aims to bring value to the experience more than resolution. The process of rebecoming following bereavement is assisted by creating image-rich narratives that attend to and allow grief to express itself.

Supporting Family Members to View the Body after a Violent or Sudden Death: A Role for Social Work

Supporting family members to view the body of their relative after a traumatic death is a critical role for social workers in hospital and morgue settings; however, this role has had little attention in the literature. In-depth interviews with 48 bereaved family members explored their experiences of helpful and unhelpful aspects of support when viewing the body of their deceased relative. A central theme of "support as a relational interaction" was identified. Aspects of the connection and communication valued by participants within this relational interaction included: "permissions and possibilities," "information and preparation," "presenting with care," "time and timing," and "tuning to family." These results are considered with grief practice and theory, to suggest the need for social workers to actively engage with working in the interface between the deceased body and the grieving family. This includes advocating a private location for time with the body and using interpersonal skills to provide paced and dosed information for preparation to view that is consistent with the capacities and needs of the individual and family.

Cautioning Health-Care Professionals

Science and practice seem deeply stuck in the so-called stage theory of grief. Health-care professionals continue to "prescribe" stages. Basically, this perspective endorses the idea that bereaved people go through a set pattern of specific reactions over time following the death of a loved one. It has frequently been interpreted prescriptively, as a progression that bereaved persons must follow in order to adapt to loss. It is of paramount importance to assess stage theory, not least in view of the current status of the maladaptive "persistent complex bereavement-related disorder" as a category for further research in DSM-5. We therefore review the status and value of this approach. It has remained hugely influential among researchers as well as practitioners across recent decades, but there has also been forceful opposition. Major concerns include the absence of sound empirical evidence, conceptual clarity, or explanatory potential. It lacks practical utility for the design or allocation of treatment services, and it does not help identification of those at risk or with complications in the grieving process. Most disturbingly, the expectation that bereaved persons will, even should, go through stages of grieving can be harmful to those who do not. Following such lines of reasoning, we argue that stage theory should be discarded by all concerned (including bereaved persons themselves); at best, it should be relegated to the realms of history. There are alternative models that better represent grieving processes. We develop guidelines to enhance such a move beyond the stage approach in both theory and practice.

Adult separation anxiety disorder in complicated grief: an exploratory study on frequency and correlates

INTRODUCTION

Complicated grief (CG) has been the subject of increasing attention in the past decades but its relationship with separation anxiety disorder (SEPAD) is still controversial. The aim of the current study was to explore the prevalence and clinical significance of adult SEPAD in a sample of help-seeking individuals with CG.

METHODS

151 adults with CG, enrolled in a randomized controlled trial comparing the effectiveness of (CG) treatment to that of interpersonal therapy, were assessed by means of the Inventory of Complicated Grief (ICG), the Structured Clinical Interview for DSM-IV, the Hamilton Rating Scale for Depression (HAM-D), the Work and Social Adjustment Scale (WSAS), the Adult Separation Anxiety Questionnaire (ASA-27), the Grief Related Avoidance Questionnaire (GRAQ), the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), and the Impact of Events Scale (IES).

RESULTS

104 (68.9%) individuals with CG were considered to have SEPAD (ASA-27 score ≥22). Individuals with SEPAD were more likely to have reported a CG related to the loss of another close relative or friend (than a parent, spouse/partner or a child) (p=.02), as well as greater scores on the ICG (p=<.001), PDEQ (p=.004), GRAQ (p<.001), intrusion (p<.001) and avoidance (p=<.001) IES subscales, HAM-D (p<.001) and WSAS (p=.006). ASA-27 total scores correlated with ICG (p<.0001), PDEQ (p<.001) GRAQ (p<.0001) scores and both the IES intrusion (p<.0001) and IES avoidance (p<.0001) subscale scores. People with SEPAD had higher rates of lifetime post-traumatic stress disorder (PTSD) (p=.04) and panic disorder (PD) (p=.01).

CONCLUSIONS

SEPAD is highly prevalent among patients with CG and is associated with greater symptom severity and impairment and greater comorbidity with PTSD and PD. Further studies will help to confirm and generalize our results and to determine whether adult SEPAD responds to CG treatment and/or moderates CG treatment response.

Event Centrality and Bereavement Symptomatology: The Moderating Role of Meaning Made

The centrality of a loss to a bereaved individual’s identity is associated with greater symptomatology, whereas meaning made of a loss is associated with positive outcomes. This article examines meaning made as a moderator of the relationship between event centrality and symptomatology. Our sample consisted of 204 bereaved undergraduate university students. Centrality was assessed using the Centrality of Events Scale, meaning made was assessed using the Integration of Stressful Life Experiences Scale, and symptomatology was assessed using the posttraumatic stress disorder Checklist-Civilian and Inventory of Complicated Grief-Revised. Meaning made had a significant moderating effect on the relationship between centrality and both measures of symptomatology. At lower levels of meaning made, centrality had a strong and positive association with symptomatology; at higher levels of meaning made, this association became weaker. These results suggest that meaning made is the key to understanding how centrality affects bereavement outcomes.

Reliability generalization of the Texas Revised Inventory of Grief (TRIG)

While grief is a universal experience, this phenomenon is experienced in a variety of ways largely dependent upon one's cultural schema. To consider the potential problems inherent in generalizing the results of an assessment tool across cultures, this study explores the notion of generalizability in assessment by evaluating the reliability of the Texas Revised Inventory of Grief (TRIG) using a meta-analytic technique called reliability generalization. The TRIG demonstrated strong reliability with mean Cronbach's alphas of .90 and .82 for the present and past subscales, respectively. Overall, the TRIG, especially the present subscale, appears to produce reliable scores even across cultures.

Grief and Risk of Depression in Context

We investigated the relationships of grief and depression to cancer caregiving in early bereavement. We began with three expectations: (a) each outcome would reflect different situational predictors, (b) grief would be more directly related to such predictors, and (c) components of grief would relate differently to the caregiving context and depressed mood. We conducted telephone interviews with family caregivers of incurable cancer patients from two hospitals. A total of 199 family caregivers were interviewed at the time of the patient’s diagnosis and reinterviewed 3 months after the patient’s death. Results showed grief severity was predicted by caregiving circumstances, but bereavement depressed mood was largely unrelated to caregiving. Grief was the main predictor of depressed mood and mediated almost all other effects. We conclude that while grief may trigger depression, the dissimilar connection to context means that the two emotional states should not be equated based purely on similarity of expression.

Exploring the genetic counselor's role in facilitating meaning-making: rare disease diagnoses

The main goal of the constructivist meaning-making framework is to encourage grief adaptation through the search for meaning in loss. Strategies to help patients construct meaning from their experiences may lead to positive adaptation. This strategy has been used in contemporary grief counseling, but it may also be beneficial in the genetic counseling scenario. The diagnosis of a rare genetic disorder often has considerable psychosocial impact as patients and families describe feelings of isolation and hopelessness. Negative experiences with healthcare providers often reinforce these feelings. Genetic counselors continue to provide education and psychosocial support to patients and families with rare genetic disorders, and meaning-making strategies may provide a framework for which to help patients and families adapt to these challenging diagnoses. In this paper I explore the background of meaning-making counseling strategy and describe an experience in which it was used for counseling a family with a child with Mowat-Wilson syndrome. I show how a meaning-making framework can help families explore and construct meaning from their experiences and encourage positive adaptation. I also address the possible limitations of this strategy and the need to share additional experiences with this counseling framework. Meaning-making can be another tool for genetic counselors to help guide families in their grief and adaptation to rare disease diagnoses. I also describe qualities and aspects of counseling through the lens of meaning-making and stress the importance of addressing psychosocial dimensions of rare disease diagnoses.

The (Half) Truth about Grief

The recent critique of the bereavement field offered by author Ruth Davis Konigsberg takes grief theorists and researchers to task for perpetuating self-serving stage-based models of mourning that ignore the resilience of most bereaved people, while promulgating a form of grief counseling that is neither necessary nor effective. In this commentary I underscore the truth embedded in her analysis, but also the half-truths that result from its simplification and neglect of broader considerations.

Factorial validity of the Texas Revised Inventory of Grief-Present scale among bereaved older adults

The Texas Revised Inventory of Grief-Present scale (TRIG-Present) is one of the most widely used grief measures; however, researchers have only empirically examined the validity and underlying factor structure of TRIG-Present scores in a few studies. Hence, in the present investigation, we sought to examine the factorial validity of the TRIG-Present (those scores that index current grief) among 2 samples of bereaved older adults--a community-dwelling sample of 162 individuals who experienced a diverse set of losses in terms of relationship to the deceased and time since loss, and a recently widowed sample of 212 individuals who were assessed at 2-months and 12-months postloss. Across both samples, we found support for a 3-factor model, composed of clusters of items representing Emotional Response, Thoughts, and Nonacceptance regarding a loss. Additionally, this 3-factor model exhibited significant invariance from 2-months to 12-months postloss in the recently widowed sample. Analyses examining the convergent validity of these 3 factors also suggest that this conceptualization of the TRIG-Present could have practical advantages and potentially influence the way in which clinicians and/or researchers assess grief and evaluate bereavement interventions.