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Larsson AL, Beck I, Janlöv AC, Einberg EL. Nurse assistants' experiences of encountering patients in grief due to the death of a loved one - a qualitative study in municipal health and social care. Int J Qual Stud Health Well-being 2024; 19:2330116. [PMID: 38493488 PMCID: PMC10946262 DOI: 10.1080/17482631.2024.2330116] [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: 10/27/2023] [Accepted: 03/08/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE The aim was to explore nurse assistants´ experiences of paying attention to and encountering patients receiving municipal health and social care, who are in grief due to the death of a loved one. METHODS A qualitative study with focus group interviews (n = 6) was conducted with nurse assistants (NAs) (n = 28) in municipal health and social care (n = 5) in southern Sweden. The data were analysed inductively using qualitative content analysis. RESULTS Three categories (1) Noticing changes in the patient, (2) Using different strategies to create a dialogue with the patient, (3) Experiencing challenges when encountering patients in grief, included eight sub-categories were identified. The result is captured in the theme of Having to be attentive to signs of grief after patients´ loss of loved ones, sensing the right time to approach and comfort, while having to cope with emotional challenges. CONCLUSIONS The NAs encountered expressions of strong emotions from patients in grief, and even expressions of a desire to end their lives. Additionally, the NAs had to deal with their own emotions that were evoked when meeting patients in grief. These challenges indicate the need for enhanced conditions in the work culture, and improved training and supervision in health and social care.
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Affiliation(s)
- Anne-Lie Larsson
- The Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
| | - Ingela Beck
- The Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - Ann-Christin Janlöv
- The Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
| | - Eva-Lena Einberg
- The Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
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2
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Champion MJ, Kilcullen M. Complicated Grief Following the Traumatic Loss of a Child: A Systematic Review. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231170417. [PMID: 37169347 DOI: 10.1177/00302228231170417] [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: 05/13/2023]
Abstract
Complicated grief is a disabling condition that occurs when the natural grief process is disturbed or prolonged. Research demonstrates that complicated grief is more prevalent following the sudden or violent loss of a child. Despite the high incidence of accidental death worldwide, little research has focused on parental grief trajectories following this form of traumatic loss. A systematic review was conducted to explore parental bereavement outcomes following accidental death. Studies were included if they specifically examined complicated grief in parents bereaved by the accidental death of their child. A total of 767 articles were identified and seven studies met the eligibility criteria for review. Poorer outcomes were identified in relation to the mode of death, relationship type, time post-loss, perceived support, perceived justice and comorbidities. Results of the current study may be used to inform the development of clinical practice guidelines for the treatment of complicated grief.
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Affiliation(s)
| | - Meegan Kilcullen
- College of Healthcare Sciences, James Cook University, Townsville, QLD Australia
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3
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Larsen LH, Guldberg A, Kring V. A Group Therapy Program for Parentally Bereaved Young Adults With Grief Complications: Rationale, Method and Case Examples. OMEGA-JOURNAL OF DEATH AND DYING 2023; 86:1212-1234. [PMID: 33818158 DOI: 10.1177/0030222821997705] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Considerable effort has gone into studying bereavement in children, adults and the elderly, but few studies have investigated the effects of bereavement or grief interventions in young adults. Even fewer studies have reported on the effect of interventions for young adults with grief complications. The present study seeks to help fill this gap by describing a Danish treatment program specially developed for young adults with complicated grief reactions. The dual process model of coping with bereavement, psychodynamic theory, and a narrative approach provide the foundation for the treatment. In addition, it utilizes an eclectic use of techniques and a group treatment modality that involves providing individual therapy within a group context. The core elements of the treatment are discussed and then exemplified in two case studies.
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Affiliation(s)
| | | | - Villy Kring
- Danish National Center for Grief, Copenhagen K, Denmark
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4
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Labek K, Sittenberger E, Kienhöfer V, Rabl L, Messina I, Schurz M, Stingl JC, Viviani R. The gradient model of brain organization in decisions involving “empathy for pain”. Cereb Cortex 2022; 33:5839-5850. [PMID: 36537039 DOI: 10.1093/cercor/bhac464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 12/24/2022] Open
Abstract
Abstract
Influential models of cortical organization propose a close relationship between heteromodal association areas and highly connected hubs in the default mode network. The “gradient model” of cortical organization proposes a close relationship between these areas and highly connected hubs in the default mode network, a set of cortical areas deactivated by demanding tasks. Here, we used a decision-making task and representational similarity analysis with classic “empathy for pain” stimuli to probe the relationship between high-level representations of imminent pain in others and these areas. High-level representations were colocalized with task deactivations or the transitions from activations to deactivations. These loci belonged to 2 groups: those that loaded on the high end of the principal cortical gradient and were associated by meta-analytic decoding with the default mode network, and those that appeared to accompany functional repurposing of somatosensory cortex in the presence of visual stimuli. These findings suggest that task deactivations may set out cortical areas that host high-level representations. We anticipate that an increased understanding of the cortical correlates of high-level representations may improve neurobiological models of social interactions and psychopathology.
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Affiliation(s)
- Karin Labek
- University of Innsbruck Institute of Psychology, , Universitätsstraße 5-7, 6020 Innsbruck , Austria
| | - Elisa Sittenberger
- University of Ulm Psychiatry and Psychotherapy Clinic III, , Leimgrubenweg 12, 89075 Ulm , Germany
| | - Valerie Kienhöfer
- University of Innsbruck Institute of Psychology, , Universitätsstraße 5-7, 6020 Innsbruck , Austria
- University of Ulm Psychiatry and Psychotherapy Clinic III, , Leimgrubenweg 12, 89075 Ulm , Germany
| | - Luna Rabl
- University of Innsbruck Institute of Psychology, , Universitätsstraße 5-7, 6020 Innsbruck , Austria
- University of Ulm Psychiatry and Psychotherapy Clinic III, , Leimgrubenweg 12, 89075 Ulm , Germany
| | - Irene Messina
- University of Ulm Psychiatry and Psychotherapy Clinic III, , Leimgrubenweg 12, 89075 Ulm , Germany
- Scienze e Tecniche Psicologiche,Universitas Mercatorum , Piazza Mattei 10, 00186 Rome , Italy
| | - Matthias Schurz
- University of Innsbruck Institute of Psychology, , Universitätsstraße 5-7, 6020 Innsbruck , Austria
- University of Innsbruck Digital Science Center (DiSC), , Innrain 15, 6020 Innsbruck , Austria
| | - Julia C Stingl
- University Clinic Aachen Clinical Pharmacology, , Wendlingweg 2, 52074 Aachen , Germany
| | - Roberto Viviani
- University of Innsbruck Institute of Psychology, , Universitätsstraße 5-7, 6020 Innsbruck , Austria
- University of Ulm Psychiatry and Psychotherapy Clinic III, , Leimgrubenweg 12, 89075 Ulm , Germany
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5
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Blair NOP, Cohen AD, Ward BD, Claesges SA, Agarwal M, Wang Y, Reynolds CF, Goveas JS. Ventral striatal subregional dysfunction in late-life grief: Relationships with yearning and depressive symptoms. J Psychiatr Res 2022; 156:252-260. [PMID: 36272343 DOI: 10.1016/j.jpsychires.2022.10.031] [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: 06/09/2022] [Revised: 09/07/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
Bereaved older adults experiencing high grief in the first year after an attachment loss is at increased risk for prolonged grief disorder (PGD) via unknown mechanisms. Yearning, a core grief symptom, is linked to the ventral striatal (VS) brain function, but the role of this neuronal system in late-life grief is poorly understood. As a first step, we examined the VS subregional abnormalities associated with multidimensional symptoms in bereaved elders during the first year post-loss. Sixty-five bereaved elders completed clinical assessments within 13 months post-loss. Ventral caudate (VCau) and nucleus accumbens (NAcc) functional connectivity (FC) was assessed using seed-based resting-state functional MRI. VCau and NAcc FC differences between high (inventory of complicated grief [ICG] score≥30; n = 35) and low (ICG score<30; n = 30) grief, and the relationships between ventral striatal subregional FC and clinical measures (yearning and depressive symptoms) were assessed after covariate adjustments (α < 0.05; 3dClustSim corrected). Relative to low grief participants, those with high grief showed higher FC between VCau and the medial prefrontal, orbitofrontal, and subgenual cingulate cortices. VCau FC abnormalities positively correlated with yearning (r2 = 0.24, p < 0.001). In contrast, FC between VCau and temporoparietal junction negatively correlated with depressive symptoms, a commonly co-occurring symptom (r2 = 0.37, p < 0.001). The FC between NAcc and insula/striatum positively correlated with yearning (r2 = 0.35, p < 0.001); no other NAcc FC findings were seen in the full sample. In women, higher FC between the NAcc and bilateral posterior cingulate, precuneus, and visual areas were found in those with high, relative to low grief symptoms. Distinct VS subregional abnormalities associate with yearning and depressive symptoms in bereaved elders. Whether ventral striatal dysfunction correlates with PGD development and/or worsening depression remains to be elucidated.
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Affiliation(s)
- Nutta-On P Blair
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Alexander D Cohen
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - B Douglas Ward
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Stacy A Claesges
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Mohit Agarwal
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Yang Wang
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Joseph S Goveas
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
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6
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Gerber K, Brijnath B, Lock K, Bryant C, Hills D, Hjorth L. 'Unprepared for the depth of my feelings' - Capturing grief in older people through research poetry. Age Ageing 2022; 51:6547546. [PMID: 35284925 PMCID: PMC9171723 DOI: 10.1093/ageing/afac030] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background Older people are more likely to experience bereavements than any other age group. However, in healthcare and society, their grief experiences and support needs receive limited attention. Through innovative, arts-based research poetry, this study aimed to capture older people’s bereavement stories and the effects of grief on their physical and mental health. Method Semi-structured in-depth interviews with 18 bereaved older adults were analysed using thematic and poetic narrative analysis, following a five-step approach of immersion, creation, critical reflection, ethics and engagement. Results Research poems were used to illustrate three themes of bereavement experiences among older adults: feeling unprepared, accumulation of losses and ripple effects of grief. While half of participants reported that the death of their family member was expected, many felt unprepared despite having experienced multiple bereavements throughout their life. Instead, the accumulation of losses had a compounding effect on their health and well-being. While these ripple effects of grief focussed on emotional and mental health consequences, many also reported physical health effects like the onset of a new condition or the worsening of an existing one. In its most extreme form, grief was connected with a perceived increased mortality risk. Conclusions By using poetry to draw attention to the intense and often long-lasting effects of grief on older people’s health and well-being, this article offers emotional, engaging and immersive insights into their unique bereavement experiences and thereby challenges the notion that grief has an expiry date.
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Affiliation(s)
- Katrin Gerber
- National Ageing Research Institute Melbourne Ageing Research Collaboration, , Melbourne, Australia
- University of Melbourne Melbourne School of Psychological Sciences, , Melbourne, Australia
| | - Bianca Brijnath
- National Ageing Research Institute Melbourne Ageing Research Collaboration, , Melbourne, Australia
- Curtin University School of Allied Health, , Perth, Australia
- University of Western Australia School of Social Sciences, , Perth, Australia
| | - Kayla Lock
- National Ageing Research Institute Melbourne Ageing Research Collaboration, , Melbourne, Australia
| | - Christina Bryant
- University of Melbourne Melbourne School of Psychological Sciences, , Melbourne, Australia
| | - Danny Hills
- Federation University School of Health, , Ballarat, Australia
| | - Larissa Hjorth
- School of Media and Communication, RMIT University , Melbourne, Australia
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7
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Harvey AR. Integrated neuroimmune processing of threat, injury, and illness: An ecological framework mapping social alienation onto lifetime health vulnerability. Brain Behav Immun Health 2021; 18:100349. [PMID: 34723222 PMCID: PMC8531850 DOI: 10.1016/j.bbih.2021.100349] [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: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/23/2022] Open
Abstract
Social alienation is a pre-eminent ecological threat for humans. In clinical and social care settings its impact is acknowledged in conditions as diverse as severe mood disturbance, chronic pain, and metabolic non-communicable diseases. An integrated psychoneuroimmune perspective shows how threat, injury, healing, and recovery follow through as a continuous process, but accepted cultural and clinical paradigms separating mental from physical illness provide little common ground on which to analyse and apply this continuum in practice. By reviewing the ecological relationships between emotional threat, tissue dyshomeostasis and injury, infection, pain, and mood this article explores not only how primeval somatic responses underpin the evolutionary foundations of depression and somatisation, but also links them to escalating physical non-communicable disease through archived socioeconomic adversity (allostatic load). Social alienation (in the absence of trauma) may prime and activate this ancient repertoire in which sensitised responses lay the foundation for persistent maladaptive states of aversive sensory misinterpretation, behavioural avoidance, anhedonia, and neuroinflammation presenting as widespread non-nociceptive pain, non-pain somatisation, and severe depression. The ecological perspective illuminates perverse clinical presentations, shows how some approaches to care may facilitate self-reinforcement in maladaptive syndromes, and offers pointers for inclusive rehabilitative clinical and social care.
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Affiliation(s)
- Andrew R. Harvey
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, LS2 9JT, UK
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8
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De Stefano R, Muscatello MRA, Bruno A, Cedro C, Mento C, Zoccali RA, Pandolfo G. Complicated grief: A systematic review of the last 20 years. Int J Soc Psychiatry 2021; 67:492-499. [PMID: 32972293 DOI: 10.1177/0020764020960202] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Grief is a common reaction to the feeling of loss and it is considered a physiological and instinctive response. The 'normal' grief evolves into an 'integrated' phase within 1 year from death, and it is a non-pathological condition, that do not require specific therapeutic interventions. When this 'integrated phase' does not occur, the subject could reach pathological manifestations related to the grief. The Persistent Complex Bereavement Disorder (PCBD) is a new DSM5 clinical category characterized by symptoms related to the detachment and to the post-traumatic distress and it differs from normal and uncomplicated grief, for the disability caused by these reactions and their persistence and pervasiveness. AIM The purpose of this work is the analysis of the pathways that led to this new definition, through a review of the main studies published in the last 20 years, with the aim to clarify the clinical utility of this new diagnostic category. METHOD Relevant publications done in the last 20 years were identified via electronic searches of Pubmed, Embase, and Elsevier databases using the terms 'complicated grief' AND 'persistent', according to PRISMA guideline and PICO study design. RESULTS PCBD results a new important clinical category showing specific symptoms, diagnostic criteria, and treatment. It presents many differences with other pathologies, that goes into differential diagnosis with PCBD, and it and can be treated with targeted therapeutic approaches. Diagnostic criteria for PCBD could allow an early diagnosis and a correct treatment avoiding underdiagnosis and misdiagnosis. CONCLUSION Further researches could focus on the evaluation of more neurobiological aspects, new psychometric tools, for assessing susceptibility to this pathology, and on the cultural aspects that may influence mourning reactions, in an ethno-psychiatric perspective.
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Affiliation(s)
- Rosa De Stefano
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Maria Rosaria Anna Muscatello
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Antonio Bruno
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Clemente Cedro
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Carmela Mento
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Rocco Antonio Zoccali
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Gianluca Pandolfo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
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9
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Chen G, Ward BD, Claesges SA, Li SJ, Goveas JS. Amygdala Functional Connectivity Features in Grief: A Pilot Longitudinal Study. Am J Geriatr Psychiatry 2020; 28:1089-1101. [PMID: 32253102 PMCID: PMC7483593 DOI: 10.1016/j.jagp.2020.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/18/2020] [Accepted: 02/28/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Acute grief, in an important minority of older adults, can become protracted, intense, and debilitating, leading to the development of complicated grief (CG). However, the neurobiologic mechanisms underlying a maladaptive grief response after an attachment loss are unknown. The current study aimed to examine the amygdala brain network features that cross-sectionally explain the symptom variance and longitudinally relate to grief symptom trajectories after an attachment loss. METHODS Baseline amygdala functional connectivity (Fc) was assessed using a seed-based resting-state functional magnetic resonance imaging method in 35 adults who were within 1-year after death of a loved one and 21 healthy comparison (HC) participants. Magnetic resonance imaging scans were obtained at baseline, and clinical assessments, including the inventory of complicated grief (ICG) were completed at weeks 0, 8, 16, and 26 (endpoint). RESULTS Relative to HC participants, grief participants showed increased amygdala Fc in the posterior default mode (bilateral medial temporal lobes and left precuneus) and thalamus. Amygdala Fc in the default mode and ventral affective regions positively correlated with ICG scores at baseline. Furthermore, increased baseline amygdala functional connections with the dorsal frontal executive control and salience network regions correlated with worsening ICG scores over time. These longitudinal findings persisted after controlling for covariates, including baseline depressive and anxiety symptoms. CONCLUSION These results provide novel preliminary evidence suggesting amygdala-based brain network measures to cross-sectionally explain symptom variance and longitudinally correlate with grief symptom trajectories in grievers. Amygdala brain network function measures may have the potential to serve as biomarkers of CG.
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Affiliation(s)
- Gang Chen
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin,Department of Biophysics, Medical College of Wisconsin
| | | | - Stacy A. Claesges
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin
| | - Shi-Jiang Li
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin,Department of Biophysics, Medical College of Wisconsin
| | - Joseph S. Goveas
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin,Institute for Health and Equity, Medical College of Wisconsin
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10
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Kakarala SE, Roberts KE, Rogers M, Coats T, Falzarano F, Gang J, Chilov M, Avery J, Maciejewski PK, Lichtenthal WG, Prigerson HG. The neurobiological reward system in Prolonged Grief Disorder (PGD): A systematic review. Psychiatry Res Neuroimaging 2020; 303:111135. [PMID: 32629197 PMCID: PMC7442719 DOI: 10.1016/j.pscychresns.2020.111135] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 12/21/2022]
Abstract
Prolonged Grief Disorder (PGD) is a debilitating condition affecting between 7% and 10% of bereaved individuals. Past imaging and psychological studies have proposed links between PGD's characteristic symptoms - in particular, profound yearning - and the neural reward system. We conducted a systematic review to investigate this connection. On December 19, 2019, we searched six bibliographic databases for data on the neurobiology of grief and disordered grief. We excluded studies of the hypothalamic-pituitary-adrenal (HPA) axis, animal studies, and reviews. After abstract and full-text screening, twenty-four studies were included in the final review. We found diverse evidence for the activation of several reward-related regions of the brain in PGD. The data reviewed suggest that compared to normative grief, PGD involves a differential pattern of activity in the amygdala and orbitofrontal cortex (OFC); likely differential activity in the posterior cingulate cortex (PCC), rostral or subgenual anterior cingulate cortex (ACC), and basal ganglia overall, including the nucleus accumbens (NAc); and possible differential activity in the insula. It also appears that oxytocin signaling is altered in PGD, though the exact mechanism is unclear. Our findings appear to be consistent with, though not confirmative of, conceptualizing PGD as a disorder of reward, and identify directions for future research.
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Affiliation(s)
- S E Kakarala
- Cornell Center for Research on End-of-life Care, Weill Cornell Medicine, 420 E. 70th St., New York, NY 10021, USA
| | - K E Roberts
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA
| | - M Rogers
- Cornell Center for Research on End-of-life Care, Weill Cornell Medicine, 420 E. 70th St., New York, NY 10021, USA
| | - T Coats
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA
| | - F Falzarano
- Cornell Center for Research on End-of-life Care, Weill Cornell Medicine, 420 E. 70th St., New York, NY 10021, USA
| | - J Gang
- Cornell Center for Research on End-of-life Care, Weill Cornell Medicine, 420 E. 70th St., New York, NY 10021, USA
| | - M Chilov
- Medical Library, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA
| | - J Avery
- Department of Radiology, Weill Cornell Medicine, 1305 York Ave., New York, NY 10021, USA
| | - P K Maciejewski
- Cornell Center for Research on End-of-life Care, Weill Cornell Medicine, 420 E. 70th St., New York, NY 10021, USA; Department of Radiology, Weill Cornell Medicine, 1305 York Ave., New York, NY 10021, USA
| | - W G Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA; Department of Psychiatry, Weill Cornell Medicine, 525 E. 68th St., New York, NY 10065, USA
| | - H G Prigerson
- Cornell Center for Research on End-of-life Care, Weill Cornell Medicine, 420 E. 70th St., New York, NY 10021, USA; Department of Medicine, Weill Cornell Medicine, 1320 York Ave., New York, NY 10021, USA.
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11
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Abstract
The definition of traumatic brain injury (TBI) has expanded to include mild TBI and postconcussive syndrome. This evolution has resulted in difficulty disentangling the physical trauma of mild TBI from the emotional trauma of posttraumatic stress disorder (PTSD). Advances in stress neurobiology and knowledge of brain injury at the macroscopic, microscopic, biochemical, and molecular levels call for a redefinition of TBI that encompasses both physical and emotional TBI. Conceptualizing a spectrum of TBI with both physical and emotional causation resolves the irreconcilable tangle between diagnostic categories and acknowledges overlapping forms of brain injury and shared systemic effects due to hormonal and inflammatory mediators. Recognizing emotional TBI shifts the interpretation of emotional trauma from a confound to a comorbid, related cause of brain injury. The mechanism of emotional TBI includes the intricate actions of stress hormones on diverse brain functions due to changes in synaptic plasticity, where chronically elevated hormone levels reduce neurogenesis, resulting in dendritic atrophy and impaired cognition. The overlapping effects of physical and emotional trauma are seen in neuropathology (ie, reduction of hippocampal volume in TBI and PTSD); fMRI (similar regional activations in physical and emotional pain); and systemic sequelae, including changes in proinflammatory cytokine levels and immune cell function. Accumulating evidence favors a change in the definition of TBI to encompass emotional TBI. The definition of TBI will be strengthened by the inclusion of both physical and emotional trauma that result in diverse and overlapping forms of brain injury with sequelae for physical and mental health.
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12
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Ghesquiere A, Bagaajav A, Ito M, Sakaguchi Y, Miyashita M. Investigating associations between pain and complicated grief symptoms in bereaved Japanese older adults. Aging Ment Health 2020; 24:1472-1478. [PMID: 31002011 DOI: 10.1080/13607863.2019.1594166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: About 10% of those who lose a loved one in hospice or palliative care settings will experience a mental health condition characterized by severe, prolonged grief responses. Criteria for this condition have evolved; we refer to this condition as Complicated Grief (CG) because it is one of the more common names. While there are some indications of associations between CG and poor physical health, explorations of the association between CG and pain is limited. The main objective of this study was to explore whether pain levels are higher in those with CG than those without, using a large population-based samples of Japanese older adults.Method: The study analyzed data from the Japan HOspice and Palliative care Evaluation (J-HOPE) study, a cross sectional study conducted in 2008 that examined the experiences and outcomes among adults throughout Japan who had lost a loved one within a palliative department or hospice setting, via self-report survey. We examined a subsample sample of 324 individuals aged 50 and above who completed a measure of CG.Results: Family members with high pain group had statistically significantly higher CG symptoms than those with low pain group (M = 66.95 vs. M = 52.05), an association which remained when controlling for demographic and loss-related factors.Conclusion: We found preliminary evidence of an association between CG symptoms and pain, which should be explored in additional samples. Should this finding be replicated, the mechanism of this association could be explored and treatment could potentially address both CG and pain.
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Affiliation(s)
- Angela Ghesquiere
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, New York, USA
| | - Ariunsanaa Bagaajav
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, New York, USA
| | - Masaya Ito
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, New York, USA
| | - Yukihiro Sakaguchi
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, New York, USA
| | - Mitsunori Miyashita
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, New York, USA
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Bourassa KJ, Cornelius T, Birk JL. Bereavement is associated with reduced systemic inflammation: C-reactive protein before and after widowhood. Brain Behav Immun 2020; 88:925-929. [PMID: 32283288 PMCID: PMC7415735 DOI: 10.1016/j.bbi.2020.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Bereavement is associated with poorer health and early mortality. Increased systemic inflammation is one pathophysiological pathway thought to explain this health risk. However, few studies have examined systemic inflammation before and after widowhood. PURPOSE The current study examined the associations between inflammation and widowhood status before and after bereavement in a sample of married adults who became widowed between assessments in the English Longitudinal Study of Ageing. METHODS We examined levels and change over time in systemic inflammation, as assessed by C-reactive protein (CRP), among participants who became bereaved (n = 199). We then compared these results to a sample of participants whose spouse remained living, selected using a propensity score matching algorithm (n = 199). RESULTS Contrary to expectations, widowed participants' CRP decreased following bereavement, d = -0.29, p < 0.001. Change in CRP was not associated with pre-loss depression levels, caregiving status, marital quality, number of chronic diseases, prescribed medications, body mass index, age, or sex. Compared to continuously married participants, widowed participants' evidenced a significantly greater decrease in CRP after their spouse's death, β = -0.14, p < 0.001. CONCLUSIONS Widowed adults' systemic inflammation decreased significantly following bereavement, both as a group and compared to people who remained married. We discuss possible explanations for this counterintuitive finding, including the measure of inflammation used in the study and the timing of the study measurements.
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Affiliation(s)
- Kyle J. Bourassa
- Duke University Medical Center, Center for the Study of Aging and Human Development
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center
| | - Jeffrey L. Birk
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center
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Abstract
OBJECTIVE Low social integration and divorce/widowhood are chronic psychosocial stressors that may affect health. When assessed after cancer diagnosis, they have been associated with poorer survival, but their role in cancer development, particularly ovarian cancer (OvCA), is less understood. We investigated whether social integration and marital status were related to OvCA risk in a large population-based study. METHODS Women from the Nurses' Health Study completed the Berkman-Syme Social Network Index and reported their marital status every 4 years starting in 1992 (N = 72,206), and were followed up until 2012 (20-year follow-up period). Multivariate Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of OvCA risk, considering relevant potential confounders, in lagged analyses whereby psychosocial indicators were assessed 4 to 8 years (n = 436 cases) and 8 to 12 years (n = 306 cases) before diagnosis to account for the effects of prediagnostic symptoms on social measures. Secondary analyses evaluated the stability of and cumulative exposure to these social factors on OvCA risk. RESULTS Being socially isolated versus integrated was related to an increased OvCA risk 8 to 12 years later (HR = 1.51, 95% CI = 1.07-2.13), but not 4 to 8 years later. Compared with married women, OvCA risk was significantly higher in widowed but not in separated/divorced individuals, with both time periods (e.g., 8-12 years later: HRwidowed = 1.57 [95% CI = 1.15-2.14] versus HRseparated/divorced = 1.13 [95% CI = 0.74-1.72]). Estimates were comparable or stronger when investigating stability in and cumulative effects of social indicators. CONCLUSIONS Results suggest higher OvCA risk among socially isolated and widowed women, particularly when such psychosocial stressors were experienced a decade before diagnosis or were sustained over time.
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Labek K, Berger S, Buchheim A, Bosch J, Spohrs J, Dommes L, Beschoner P, Stingl JC, Viviani R. The iconography of mourning and its neural correlates: a functional neuroimaging study. Soc Cogn Affect Neurosci 2018; 12:1303-1313. [PMID: 28449116 PMCID: PMC5597887 DOI: 10.1093/scan/nsx058] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 04/02/2017] [Indexed: 12/30/2022] Open
Abstract
The present functional neuroimaging study focuses on the iconography of mourning. A culture-specific pattern of body postures of mourning individuals, mostly suggesting withdrawal, emerged from a survey of visual material. When used in different combinations in stylized drawings in our neuroimaging study, this material activated cortical areas commonly seen in studies of social cognition (temporo-parietal junction, superior temporal gyrus, and inferior temporal lobe), empathy for pain (somatosensory cortex), and loss (precuneus, middle/posterior cingular gyrus). This pattern of activation developed over time. While in the early phases of exposure lower association areas, such as the extrastriate body area, were active, in the late phases activation in parietal and temporal association areas and the prefrontal cortex was more prominent. These findings are consistent with the conventional and contextual character of iconographic material, and further differentiate it from emotionally negatively valenced and high-arousing stimuli. In future studies, this neuroimaging assay may be useful in characterizing interpretive appraisal of material of negative emotional valence.
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Affiliation(s)
- Karin Labek
- Institute of Psychology, University of Innsbruck, Tyrol, Austria
| | - Samantha Berger
- Institute of Psychology, University of Innsbruck, Tyrol, Austria
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Tyrol, Austria
| | - Julia Bosch
- Department of Psychiatry and Psychotherapy III, University of Ulm, Baden-Württemberg, Germany
| | - Jennifer Spohrs
- Department of Psychiatry and Psychotherapy III, University of Ulm, Baden-Württemberg, Germany
| | - Lisa Dommes
- Department of Psychiatry and Psychotherapy III, University of Ulm, Baden-Württemberg, Germany.,Psychosomatic and Psychotherapy Clinic, University of Ulm, Baden-Württemberg, Germany
| | - Petra Beschoner
- Psychosomatic and Psychotherapy Clinic, University of Ulm, Baden-Württemberg, Germany
| | - Julia C Stingl
- Federal Institute for Drugs and Medical Devices, Bonn, Germany.,Center for Translational Medicine, University of Bonn Medical School, Bonn, Germany
| | - Roberto Viviani
- Institute of Psychology, University of Innsbruck, Tyrol, Austria.,Department of Psychiatry and Psychotherapy III, University of Ulm, Baden-Württemberg, Germany
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16
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Lee SM, Han H, Jang KI, Huh S, Huh HJ, Joo JY, Chae JH. Heart rate variability associated with posttraumatic stress disorder in victims' families of sewol ferry disaster. Psychiatry Res 2018; 259:277-282. [PMID: 29091829 DOI: 10.1016/j.psychres.2017.08.062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 11/26/2022]
Abstract
Posttraumatic stress disorder (PTSD), which is caused by a major traumatic event, has been associated with autonomic nervous function. However, there have been few explorations of measuring biological stress in the victims' family members who have been indirectly exposed to the disaster. Therefore, this longitudinal study examined the heart rate variability (HRV) of the family members of victims of the Sewol ferry disaster. We recruited 112 family members of victims 18 months after the disaster. Sixty-seven participants were revisited at the 30 months postdisaster time point. HRV and psychiatric symptoms including PTSD, depression and anxiety were evaluated at each time point. Participants with PTSD had a higher low frequency to high frequency ratio (LF:HF ratio) than those without PTSD. Logistic regression analysis showed that the LF:HF ratio at 18 months postdisaster was associated with a PTSD diagnosis at 30 months postdisaster. These results suggest that disrupted autonomic nervous system functioning for longer than a year after trauma exposure contributes to predicting PTSD vulnerability. Our finding may contribute to understand neurophysiologic mechanisms underlying secondary traumatic stress. Future studies will be needed to clarify the interaction between autonomic regulation and trauma exposure.
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Affiliation(s)
- Sang Min Lee
- Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Institute of Biomedical Industry, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyesung Han
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Kuk-In Jang
- Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Institute of Biomedical Industry, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Huh
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Hyu Jung Huh
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Ji-Young Joo
- Institute of Biomedical Industry, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong-Ho Chae
- Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Institute of Biomedical Industry, The Catholic University of Korea, Seoul, Republic of Korea; Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea.
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17
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Abstract
Affect and emotion are defined as “an essential part of the process of an organism's interaction with stimuli.” Similar to affect, the immune response is the “tool” the body uses to interact with the external environment. Thanks to the emotional and immunological response, we learn to distinguish between what we like and what we do not like, to counteract a broad range of challenges, and to adjust to the environment we are living in. Recent compelling evidence has shown that the emotional and immunological systems share more than a similarity of functions. This review article will discuss the crosstalk between these two systems and the need for a new scientific area of research called affective immunology. Research in this field will allow a better understanding and appreciation of the immunological basis of mental disorders and the emotional side of immune diseases.
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Affiliation(s)
- Fulvio D'Acquisto
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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18
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D'Acquisto F. Affective immunology: where emotions and the immune response converge. DIALOGUES IN CLINICAL NEUROSCIENCE 2017; 19:9-19. [PMID: 28566943 PMCID: PMC5442367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Affect and emotion are defined as "an essential part of the process of an organism's interaction with stimuli." Similar to affect, the immune response is the "tool" the body uses to interact with the external environment. Thanks to the emotional and immunological response, we learn to distinguish between what we like and what we do not like, to counteract a broad range of challenges, and to adjust to the environment we are living in. Recent compelling evidence has shown that the emotional and immunological systems share more than a similarity of functions. This review article will discuss the crosstalk between these two systems and the need for a new scientific area of research called affective immunology. Research in this field will allow a better understanding and appreciation of the immunological basis of mental disorders and the emotional side of immune diseases.
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Affiliation(s)
- Fulvio D'Acquisto
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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19
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Lai C, Luciani M, Galli F, Morelli E, Moriconi F, Penco I, Aceto P, Lombardo L. Persistent complex bereavement disorder in caregivers of terminally ill patients undergoing supportive-expressive treatment: a pilot study. J Ment Health 2016; 26:111-118. [DOI: 10.3109/09638237.2016.1167855] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Carlo Lai
- Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy,
| | - Massimiliano Luciani
- Psychiatry and Psychology Institute, Catholic University of Sacred Heart, Rome, Italy,
| | | | | | - Federica Moriconi
- Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy,
| | | | - Paola Aceto
- Department of Anaesthesiology and Intensive Care, Catholic University of Sacred Heart, Rome, Italy
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20
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Lai C, Luciani M, Galli F, Morelli E, Cappelluti R, Penco I, Aceto P, Lombardo L. Attachment Style Dimensions Can Affect Prolonged Grief Risk in Caregivers of Terminally Ill Patients With Cancer. Am J Hosp Palliat Care 2015; 32:855-860. [DOI: 10.1177/1049909114547945] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Objective: The aim of the present study was to evaluate the predictive role of attachment dimensions on the risk of prolonged grief. Sixty caregivers of 51 terminally ill patients with cancer who had been admitted in a hospice were selected. Methods: Caregivers were interviewed using Attachment Scale Questionnaire, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Prolonged Grief Disorder 12 (PG-12). Results: The consort caregivers showed higher PG-12 level compared to the sibling caregivers. Anxiety, depression, need for approval, and preoccupation with relationships levels were significantly correlated with PG-12 scores. Conclusion: Female gender, high levels of depression, and preoccupation with relationships significantly predicted higher levels of prolonged grief risk.
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Affiliation(s)
- Carlo Lai
- Dynamic and Clinical Psychology, Sapienza University, Rome, Italy
| | - Massimiliano Luciani
- Psychiatry and Psychology Institute, Catholic University of Sacred Heart, Rome, Italy
| | | | | | | | - Italo Penco
- Fondazione Roma, Hospice-SLA-Alzheimer, Rome, Italy
| | - Paola Aceto
- Department of Anaesthesiology and Intensive Care, Catholic University of Sacred Heart, Rome, Italy
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21
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Disrupted prefrontal activity during emotion processing in complicated grief: An fMRI investigation. Neuroimage 2015; 124:968-976. [PMID: 26434802 DOI: 10.1016/j.neuroimage.2015.09.054] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 08/27/2015] [Accepted: 09/26/2015] [Indexed: 11/20/2022] Open
Abstract
Complicated Grief, marked by a persistent and intrusive grief lasting beyond the expected period of adaptation, is associated with a relative inability to disengage from idiographic loss-relevant stimuli (O'Connor and Arizmendi, 2014). In other populations, functional magnetic resonance imaging (fMRI) studies investigating the neural networks associated with this bias consistently implicate the anterior cingulate cortex (ACC) during emotion regulation. In the present study, twenty-eight older adults were categorized into three groups based on grief severity: Complicated Grief (n=8), Non-Complicated Grief (n=9), and Nonbereaved, married controls (n=11). Using a block design, all participants completed 8 blocks (20 stimuli per block) of the ecStroop task during fMRI data acquisition. Differences in neural activity during grief-related (as opposed to neutral) stimuli across groups were examined. Those with Complicated Grief showed an absence of increased rostral ACC (rACC) and fronto-cortical recruitment relative to Nonbereaved controls. Activity in the orbitofrontal cortex (x=6, y=54, z=-10) was significantly elevated in the Non-Complicated Grief group when compared to Nonbereaved controls. Post hoc analysis evidenced activity in the dorsal ACC in the Complicated Grief and Nonbereaved groups late in the task. These findings, supported by behavioral data, suggest a relative inability to recruit the regions necessary for successful completion of this emotional task in those with Complicated Grief. This deficit was not observed in recruitment of the orbitofrontal cortex and the rACC during processing of idiographic semantic stimuli in Non-Complicated Grief.
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22
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Saavedra Pérez HC, Ikram MA, Direk N, Prigerson HG, Freak-Poli R, Verhaaren BFJ, Hofman A, Vernooij M, Tiemeier H. Cognition, structural brain changes and complicated grief. A population-based study. Psychol Med 2015; 45:1389-1399. [PMID: 25363662 DOI: 10.1017/s0033291714002499] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Several psychosocial risk factors for complicated grief have been described. However, the association of complicated grief with cognitive and biological risk factors is unclear. The present study examined whether complicated grief and normal grief are related to cognitive performance or structural brain volumes in a large population-based study. METHOD The present research comprised cross-sectional analyses embedded in the Rotterdam Study. The study included 5501 non-demented persons. Participants were classified as experiencing no grief (n = 4731), normal grief (n = 615) or complicated grief (n = 155) as assessed with the Inventory of Complicated Grief. All persons underwent cognitive testing (Mini-Mental State Examination, Letter-Digit Substitution Test, Stroop Test, Word Fluency Task, word learning test - immediate and delayed recall), and magnetic resonance imaging to measure general brain parameters (white matter, gray matter), and white matter lesions. Total brain volume was defined as the sum of gray matter plus normal white matter and white matter lesion volume. Persons with depressive disorders were excluded and analyses were adjusted for depressive symptoms. RESULTS Compared with no-grief participants, participants with complicated grief had lower scores for the Letter-Digit Substitution Test [Z-score -0.16 v. 0.04, 95% confidence interval (CI) -0.36 to -0.04, p = 0.01] and Word Fluency Task (Z-score -0.15 v. 0.03, 95% CI -0.35 to -0.02, p = 0.02) and smaller total volumes of brain matter (933.53 ml v. 952.42 ml, 95% CI -37.6 to -0.10, p = 0.04). CONCLUSIONS Participants with complicated grief performed poorly in cognitive tests and had a smaller total brain volume. Although the effect sizes were small, these findings suggest that there may be a neurological correlate of complicated grief, but not of normal grief, in the general population.
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Affiliation(s)
- H C Saavedra Pérez
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - M A Ikram
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - N Direk
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - H G Prigerson
- Department of Psychiatry,Brigham and Women's Hospital,Boston,MA,USA
| | - R Freak-Poli
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - B F J Verhaaren
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - A Hofman
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - M Vernooij
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - H Tiemeier
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
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23
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Abstract
PURPOSE OF REVIEW Although there is much evidence for the construct of prolonged grief, there was much controversy over the proposal to introduce a prolonged grief diagnosis into Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), and it was finally rejected as a diagnosis in DSM-5. This review outlines the evidence for and against the diagnosis, and highlights the implications of the DSM-5 decision. RECENT FINDINGS Convergent evidence indicates that prolonged grief characterized by persistently severe yearning for the deceased is a distinct construct from bereavement-related depression and anxiety, is associated with marked functional impairment, is responsive to targeted treatments for prolonged grief, and has been validated across different cultures, age groups, and types of bereavement. Although DSM-5 has rejected the construct as a formal diagnosis, evidence continues to emerge on related mechanisms, including maladaptive appraisals, memory and attentional processes, immunological and arousal responses, and neural circuitry. SUMMARY It is most likely that the International Classification of Diseases (ICD-11) will introduce a diagnosis to recognize prolonged grief, even though DSM-5 has decided against this option. It is probable that the DSM-5 decision may result in more prolonged grief patients being incorrectly diagnosed with depression after bereavement and possibly incorrectly treated. The DSM-5 decision is unlikely to impact on future research agendas.
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Lai C, Luciani M, Morelli E, Galli F, Cappelluti R, Penco I, Aceto P, Lombardo L. Predictive role of different dimensions of burden for risk of complicated grief in caregivers of terminally ill patients. Am J Hosp Palliat Care 2013; 31:189-93. [PMID: 23689368 DOI: 10.1177/1049909113490227] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to test whether high levels of caregiver burden, as other confirmed predictors, are associated with the risk of prolonged grief disorder in caregivers of terminally ill patients. A predictive study was carried out in order to test the hypothesis. A demographic schedule, the Prolonged Grief 12 (PG-12), the Toronto Alexithymia Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and Caregiver Burden Inventory were administered to 60 caregivers of 51 patients who were admitted in Hospice. In the regression analysis, difficulty in recognizing emotions, total burden, depression, and developmental burden dimension were significant predictors of PG-12 levels. Findings showed that feeling of deprivation of existential expectations represents the greater risk factor for the prolonged grief disorder, among the burden dimensions.
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Affiliation(s)
- Carlo Lai
- 1Dynamic and Clinical Psychology Department, Sapienza University of Rome, Rome, Italy
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