Surviving grief: An analysis of the exchange of hope in online grief communities

Grieving the Loss of a Child and the Use of Online Social Support: An Exploratory Survey Study

PURPOSE

To describe social media online grief supports, accessing behaviors, psychosocial variables, and feelings of support among individuals grieving the loss of a child aged <18 years.

METHOD

This online survey study recruited 26 adults grieving the loss of a child using social media. Dependent variables included feelings of support and frequency of access. Independent variables included sleep disturbance, cognitive function, depression, anxiety, and self-efficacy to manage emotions (SEMA). Data were collected from May to September 2018.

RESULTS

Participants' T scores were higher in level of sleep disturbance (mean = 59.4, SD = 6.1), depression (mean = 62.1, SD = 6.1), and anxiety (mean = 62.8, SD = 7.9), and lower in cognitive function (mean = 37.4, SD = 7.3) and SEMA (mean = 39.3, SD = 5.7). SEMA showed a positive correlation with feeling emotionally supported (p = 0.034). Participants who were accessing online grief supports more frequently reported higher levels of emotional support (F = 9.31, p = 0.006).

CONCLUSION

Current findings will help guide the design of online grief support interventions for individuals grieving the loss of a child. [Journal of Psychosocial Nursing and Mental Health Services, 62(8), 47-55.].

How are Conversations via an On-Demand Peer-To-Peer Emotional Well-Being App Associated with Emotional Improvement?

Non-clinical, on-demand peer-to-peer (PtP) support apps have become increasingly popular over the past several years. Although not as pervasive as general self-help apps, these PtP support apps are usually free and instantly connect individuals through live texting with a non-clinical volunteer who has been minimally trained to listen and offer support. To date, there is little empirical work that examines whether and how using an on-demand PtP support app improves emotional well-being. Applying regression and multilevel models to N = 1000+ PtP conversations, this study examined whether individuals experience emotional improvement following a conversation on a PtP support app (HearMe) and whether dyadic characteristics of the conversation - specifically, verbal and emotional synchrony - are associated with individuals' emotional improvement. We found that individuals reported emotional improvement following a conversation on the PtP support app and that verbal (but not emotional) synchrony was associated with the extent of individuals' emotional improvement. Our results suggest that online PtP support apps are a viable source of help. We discuss cautions and considerations when applying our findings to enhance the delivery of support provision on PtP apps.

Sharing is Caring: A Realist Evaluation of a Social Support Group for Individuals Who Have Been Bereaved by Suicide

AIM

To understand the experiences and perceived impact on the wellbeing of individuals attending a suicide bereavement social support group.

DESIGN

A qualitative study guided by a realist evaluation framework.

METHODS

Data were collected from May-July 2020 using online semistructured individual interviews with participants (N = 6), from the North West of England recruited from a suicide bereavement support group's social media. Data were analysed using thematic analysis informed by the realist framework.

RESULTS

Effective social support includes the prioritisation of building meaningful connections with like-minded individuals, providing a safe space for authentic self-expression aiding personal relationship maintenance. Contextual factors included: Societal and cultural stigma of suicide, self-stigma and gender norms. Mechanisms influencing support seeking include: Not wanting to burden loved ones due to judgement, and a lack of understanding.

IMPACT

Policymakers can reduce demand on healthcare systems by developing tailored support groups to suit individual needs.

Grieving in community: Accompanying bereaved parents

This study explored relational grieving in community by examining how community members grieve with bereaved parents after the death of a child. Three bereaved parent couples and their community members were interviewed together using the qualitative action-project method to examine their shared grieving actions. Data was analyzed through top-down and bottom-up processes to understand the shared intentions of their grieving actions together. The findings of this research elicited thick descriptions of relational grieving at a community level. Four main assertions of how communities grieve with bereaved parents emerged, and include: (a) selflessly offering emotional and practical support, (b) engaging in and honouring vulnerability, (c) holding the complexity of grieving, and (d) fostering remembrance of the deceased child together. The novel descriptions of relational grieving in community contributed to the growing area of relational bereavement research. The theoretical, empirical, and clinical implications of this study are discussed.

Genetic counselors' response types to prenatal patient deferring or attributing religious/spiritual statements: An exploratory study of US genetic counselors

Research shows religiosity and spirituality (R/S) influence genetic counseling patients' and families' risk perception, decision-making, and coping. No published studies have examined how genetic counselors respond to patient-initiated R/S statements. This exploratory study examined genetic counselors' response types and reasons for their responses to two prenatal patient's R/S statements. Genetic counselors (n = 225) recruited through a National Society of Genetic Counselors eblast completed a survey containing two hypothetical scenarios regarding a prenatal patient's receipt of a trisomy 18 diagnosis. Scenarios were identical except for the last patient statement: "God makes everything possible…we leave things in his hands" (a deferring statement) or "I feel like God is punishing me for something I did" (an attributing statement). Imagining they were the counselor, participants wrote a response to each scenario and provided reasons for their response. Responses were analyzed using the Helping Skills Verbal Response System. MANOVA and chi-square tests, examining differences in response type based on patient statement (deferring or attributing), participant comfort with R/S, and years of experience, yielded a significant multivariate effect for scenario (p < 0.001). Responses to the deferring statement scenario contained a greater proportion of content statements (p < 0.001), closed questions (p < 0.001), and information-giving (p < 0.001). Responses to the attributing statement scenario contained a greater proportion of open questions (p = 0.05), influencing statements (p < 0.001), and affective statements (p = 0.006). Neither comfort with R/S nor genetic counseling experience significantly affected response type. Thematic analysis of reasons for responses yielded nine themes. Most prevalent were exploration (of the patient's statement), validation, correction (of patient's beliefs), and reassurance. The findings reflect stylistic differences in how and why genetic counselors respond to patients.

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

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

Acknowledging bereavement, strengthening communities: Introducing an online compassionate community initiative for the recognition of pandemic grief

Despite public health measures and collective efforts, millions of individuals have unfortunately died from COVID-19 complications worldwide, leaving several million family members at risk of developing bereavement complications. In the Canadian province of Quebec, where substantial deaths were associated with COVID-19, we established an online support community for bereaved caregivers who lost a loved one during the pandemic. We explain how we created a community that recognized pandemic grief and advocated for its wider acknowledgment. We discuss "compassionate communities," the theoretical underpinning of our initiative, as a means to foster solidarity, normalize finitude, create and maintain a safe social space through group sharing, and challenging capitalist principles. We then describe the eight areas of activities inspired by the Charter of Pallium Canada: education and training, hospices and nursing homes, media and social media, commemoration, celebrations, artistic practices and storytelling, marginalized populations, and review and evaluate. We propose that online communities constitute a powerful space for community members to gather and advocate for greater awareness of the inequities found in end-of-life care and bereavement services, to denounce abusive situations experienced by many individuals who died from COVID-19 complications, and to fight against the lack of recognition experienced by numerous caregivers.

Adding a Facebook Support Group to an Online Yoga Randomized Trial for Women Who Have Experienced Stillbirth: A Feasibility Study

Objectives: Women who experience stillbirth are more likely to develop post-traumatic stress disorder (PTSD), and anxious and depressive symptoms than those who deliver live healthy babies. Participants in a recent study of online yoga (OY) reported a desire for more social support, which may help reduce PTSD related to grief and aid in coping. Facebook (FB) has been used successfully to deliver support for online interventions, but little is known about its use in conjunction with OY. The purpose of this study was to examine the feasibility of a FB support group in conjunction with an 8-week OY intervention. Design: Randomized parallel feasibility trial with a 1:1 study group allocation ratio. Setting/Location: Online. Subjects: Women (N = 60) who experienced stillbirth within the past 3 years. Interventions: Participants were recruited nationally to participate and randomized into one of two groups: OY only (n = 30) or online yoga with Facebook (OYFB) (n = 30). Both groups were asked to complete 60 min of OY per week. Women in the OY group were asked to log on to a FB page at least once per week. Outcome measures: Acceptability (i.e., satisfaction) and demand (i.e., attendance), PTSD, anxiety, depressive symptoms, social support. Results: Participants were satisfied with and enjoyed OY, and 8/13 FB acceptability benchmarks were met. There were no significant differences between groups in minutes of yoga per week. Conclusions: The addition of a FB group to an OY intervention for women who have experienced stillbirth is feasible, although more research is needed to increase its efficacy. Trial registration: NCT04077476. Registered September 4, 2019. Retrospectively registered (https://clinicaltrials.gov/ct2/show/NCT04077476).

Psychosocial trajectories before and after spousal loss: Does gender matter?

RATIONALE

Prior studies have suggested that spousal loss can have negative impacts on widowed persons' lives. However, few studies have examined whether time since spousal loss is related to changes in psychosocial outcomes and there are gender differences in psychosocial trajectories in response to spousal loss.

OBJECTIVE

This study examines the psychosocial trajectories (depressive symptoms and social engagement) of widowed individuals before and after spousal death. This study also investigates whether psychosocial adjustment trajectories, among individuals who experienced spousal loss, are gendered.

METHODS

This study uses data from 685 middle- and older-aged adults over seven waves (4284 person-observations) of the Korean Longitudinal Study of Ageing spanning 12 years between 2006 and 2018. This study estimates fixed effects models to account for observed and unobserved individual-level heterogeneity. Gender-stratified fixed effects regression models are used to investigate whether psychosocial changes associated with spousal loss differ by gender.

RESULTS

Psychosocial adjustment to spousal loss is strikingly gendered. Among men, depressive symptoms began to increase within the first year following spousal loss and continued through the fourth and subsequent years. In contrast, depressive symptoms among widows did not change significantly during and after bereavement. Similar patterns were found for social engagement. Among men, a decrease in frequency of social interactions and participation in social activities was found from the first year of spousal loss to the fourth and subsequent years. No such patterns were found for women.

CONCLUSION

Spousal loss is a life event that spurs tremendous psychosocial changes for widowed people. This study suggests that spousal loss-associated psychosocial changes occur over a long period of time and are greater in men than in women.

Grief Iconography between Italians and Americans: A Comparative Study on How Mourning Is Visually Expressed on Social Media

As an innovative way to express grief, social media posts about the deceased have become fairly common. However, few studies have examined commonly posted grief photos. The purpose of the present study was to examine such pictures, as well as the motivations and reactions of those who posted them, among Italians and Americans. Surveys were sent to both Italian and US participants. The US group yielded 262 responses (mean age = 22 years; 81% female), and the Italian group yielded 51 (mean age = 32 years; 82% female). Several key issues emerged, such as the need for social media users to receive empathic support from other users, the desire to maintain continuing bonds, the wish to remember the deceased, and the desire to share beauty and symbolic pictures. The images were analyzed using content analysis. Both samples posted photos to remember, and to enhance their posts. A strong preference for pictures with a positive emotional connotation appeared, depicting the deceased in a conjoint appearance with the participant. The results suggest that the imagery used for the expression of grief in social media sites, an “iconography of grief”, is a popular means of expression for grievers across the two cultures.

Strategies to Cope With the COVID-Related Deaths Among Family Members

The extraordinary circumstances of deaths during COVID-19 pandemic have been challenging for the deceased's families. This contribution aims to describe some spontaneous strategies that family members may adopt to cope with the loss of a relative for COVID-19. The present reflection derives from the experience of a clinical psychology unit of one of the biggest public hospital in Milan, Italy, which supported 246 families of COVID-19 victims in the 1st days after the loss. Spontaneous strategies used by family members to deal with such a unique mourning process involved: creating alternative good-bye rituals, normalizing the loss, addressing faith and hope, highlighting the perks of isolation, supporting others in need, and delivering the bad news to others. These observed strategies may suggest how to assess and support a "normal" bereavement process during the extraordinary COVID-19 circumstances, in order to prevent further psychological distress.

Integration of palliative care into COVID-19 pandemic planning

The COVID-19 pandemic is expected to surpass the healthcare system’s capacity to provide intensive care to all patients who deteriorate as a result of the disease. This poses a unique challenge to healthcare teams of rationing care during pandemic when resources are scarce. Healthcare providers will need to acquire new skills in care decision making and effective symptom control for patients who do not receive life-saving measures. In this review, we describe some of the important palliative care considerations that need to be incorporated into COVID-19 pandemic planning. The main aspects to be considered include decision algorithms for rationing care, training on effective symptoms management, alternative delivery methods of palliative care services such as telemedicine and finally death and bereavement support for surviving family members who are likely to be isolated from their loved one at the moment of death.

Expressions of Grief in Online Discussion Forums-Linguistic Similarities and Differences in Pet and Human Bereavement

We compared online discussion forum posts related to pet loss to those related to human bereavement. Posts (N = 401) were analyzed using the Linguistic Inquiry and Word Count software for frequencies of word use relevant to bereavement. Words related to anger, sadness, and negative emotions were used at similar frequencies for all grief. Sibling loss was associated with using first person pronouns at higher frequencies, and positive emotion words at lower frequencies than other categories of loss. There were some similarities in partners and pets in the word use related to friends and social connectedness. Words related to religion were highest when writing about losing a child and lowest when losing a pet. Our results highlight the similarities in the vocabulary in pet and human bereavement. Findings demonstrate the importance of online discussion forums for understanding the process of grief and specific relationship types.

Latent profiles of physical and psychological outcomes of bereaved parents in China who lost their only child

Background: Along with the implementation of the one-child policy in China, a special group of bereaved parents called 'shiduer' (), meaning parents bereaved by the loss of their only child, emerged. Although previous research has examined the physical and psychological health of this population, individual differences in physical and psychological outcomes are still not well understood. Objective: This study aimed to identify heterogenous subgroups of Chinese bereaved parents who lost their only child based on the physical and psychological health of this population as well as the predictive factors of each subgroup. Method: Latent profile analysis was used to explore underlying patterns of physical and psychological indicators including subjective physical health, negative psychological outcomes (i.e. depression, post-traumatic stress disorder and prolonged grief disorder) and positive psychological outcomes (i.e. post-traumatic growth) among a sample of Chinese bereaved parents who lost their only child (N = 536). A three-step approach was used to examine the effects of covariates including quality of spousal relationship and recruitment channels on psychological and physical outcomes. Results: A three-profile model identified severity-based groupings of a 'resilient' subgroup (n = 153), a 'coping' subgroup (n = 338) and a 'dysfunctional' subgroup (n = 45). Less satisfaction with spousal relationship and recruitment from institutions in the community and online self-help groups (vs. offline support groups) are associated with the membership of the 'coping' or 'dysfunctional' subgroup compared to the 'resilient' subgroup. Conclusions: There is heterogeneity regarding the physical and psychological health of Chinese parents after losing their only child. The predictive effects of the quality of spousal relationship and the recruitment channels could provide directions for professional intervention.

Peer Support Services for Bereaved Survivors: A Systematic Review

This systematic literature review assesses the evidence regarding benefits of peer support services for bereaved survivors of sudden or unexpected death. Reports were included that addressed peer support services for adults who experienced death of a family member, close friend, or coworker. Of the 32 studies meeting all inclusion criteria, most showed evidence that peer support was helpful to bereaved survivors, reducing grief symptoms and increasing well-being and personal growth. Studies also showed benefits to providers of peer support, including increased personal growth and positive meaning in life. Several studies addressed the growing trend of Internet-based peer support programs, finding that these are beneficial in part due to their easy accessibility. Peer support appears to be especially valuable for survivors of suicide loss, a result that may be related to stigma and lack of support from family and friends experienced by many suicide survivors. The reviewed studies provide consistent evidence that peer support is beneficial to bereaved survivors.

The mental health of visitors of web-based support forums for bereaved by suicide

BACKGROUND

Persons bereaved by suicide are reluctant to ask for social support when they experience feelings of guilt and blame. A web-based peer forum may provide a safe and anonymous place for mutual support.

AIMS

This study examined the mental health changes of visitors of two online support forums for persons bereaved by suicide and their experiences with the forum over 1 year.

METHOD

Visitors of two forums completed self-report measures at baseline and at 6 and 12 months' follow-up. Repeated measures analyses were used to study changes in well-being, depressive symptoms, and complicated grief. Additionally, participants were interviewed about their experiences with the forum.

RESULTS

The 270 participants were mostly female, low in well-being, with high levels of depressive symptoms and complicated grief. Suicidal risk was high for 5.9%. At 12 months, there were small to medium-sized significant improvements in well-being and depressive symptoms (p < .001) and nearly as much for grief (p = .08). About two thirds reported benefit from visiting the forum. Because of the pre-post design we cannot determine whether a causal relationship exists between the form and changes in mental health.

CONCLUSION

After 1 year some positive changes but a large group was still struggling with their mental health. Interviews indicate that the forum was valued for finding recognition.

Content Analysis of Select YouTube Postings: Comparisons of Reactions to the Sandy Hook and Aurora Shootings and Hurricane Sandy

This study details an innovative and methodical content analysis of 2,207 YouTube comments from four different YouTube videos (e.g., breaking news or memorials) related to the 2012 Sandy Hook Elementary School and Aurora theater mass shootings and the catastrophic Hurricane Sandy. As expected, YouTube comments associated with the Sandy Hook shootings (particularly those from a memorial video) were especially likely to feature compassion and grief with lessened hostility. This study highlights differing online contexts by which individuals show grief and related emotions following man-made and natural calamities and how-even in an online environment-powerful situational contexts greatly guide behavior.

"Please Know That You Are Not Alone with Your Pain": Responses to Newcomer Posts in an Online Grief Support Forum

In an effort to better understand how the Internet can provide support to bereaved individuals, this discourse analysis study examined the responses to 107 initial posts in an online grief support group to understand how newcomers' bids for group membership were taken up by current members. Discursive features included validation and empathy through second stories, constructing grief through descriptions, and accepting bids for membership through advice giving and invitations to return to the group. These features illustrate how grief and being a griever are constructed in an online context and how they deviate from the "normal" grief expectations in the offline world.

Grieving online: newcomers' constructions of grief in an online support group

Research into peer conversations in online grief support groups remains scarce. The authors used discourse analysis to examine 107 initial posts to one such group to examine how newcomers constructed their initial posts to display their eligibility for membership. The authors identified three discursive features: formulating unusual stories of loss, describing uncontrollable emotional and physical states, and engaging in "troubles telling." These discursive patterns illustrate how grief is constructed in ways that may simultaneously conform to and resist norms around grief that exist offline. Implications for practitioners include the need to support individuals through validation of their "nonnormal" grief.

Exploiting Loss?: Ethical Considerations, Boundaries, and Opportunities for the Study of Death and Grief Online

More people are turning to the Internet to communicate about dying, death, and grief experiences. This theoretical article explores the ethical dilemmas, challenges, and opportunities presented to researchers interested in exploring how death and grief are communicated online. Weaving together the literatures of computer-mediated communication and thanatology (dying and death), we discuss the ways in which many common ethical dilemmas uniquely manifest related to death and grief. We also explore the emotional impact studying death and grief online has on researchers and the importance of thinking about researcher emotions on scholars who study these issues. We end with recommendations of how to move forward in the dialogue about ethics and studying death and grief online.

A Parent's Tears: Primary Results from the Traumatic Experiences and Resiliency Study

This study examined health/mental health status, family functioning, and resiliency among a sample of bereaved parents ( N = 503). Participants were recruited from an online support community to complete an online survey instrument (response rate = 51.75%). The questionnaire contained an array of self-report instruments, such as the Hopkins Symptoms Checklist-25 (HSCL-25), the Impact of Event Scale-Revised (IES-R), and the Family Assessment Device (FAD), as well as open-ended questions. Many respondents scored over the clinical cut-off for the HSCL-25 (51.3%, n = 258) and IES-R (42.3%, n = 213). IES-R scores were negatively correlated with years-since loss ( r = −0.24, p < .05). In narrative responses, participants described a wide range of deeply impactful mental and physical health problems. The results indicate significant clinical distress in this sample of bereaved parents, with many reporting enduring psychological, familial, and health consequences following the death of a child.

What Do the Bereaved by Suicide Communicate in Online Support Groups?

Background: Every year, more than six million people lose a loved one through suicide. These bereaved by suicide are at relatively high risk for mental illnesses including suicide. The social stigma attached to suicide often makes it difficult to talk about grief. Participating in online forums may be beneficial for the bereaved by suicide, but it is unknown what they communicate in these forums. Aims: What do the bereaved by suicide communicate in online forums? We examined which self-help mechanisms, grief reactions, and experiences with health-care services they shared online. Method: We conducted a content analysis of 1,250 messages from 165 members of two Dutch language forums for the bereaved by suicide. Results: We found that sharing personal experiences featured most prominently in the messages, often with emotional expressions of grief. Other frequently used self-help mechanisms were expressions of support or empathy, providing advice, and universality (recognition), while experiences with health-care services featured only occasionally. Compared with previous studies about online forums for somatic illnesses, the bereaved by suicide communicated more personal experiences and engaged much less in chitchat. Conclusion: Online forums appear to have relevant additional value as a platform for talking about grief and finding support.