Different Trajectories of Prolonged Grief in Bereaved Family Members After Terror

Family Coping With COVID-19: Unexpected Parental Loss and Surviving Parent Coping, Grief and Posttraumatic Growth Outcomes Based on Child Age

Guided by the conceptual framework of widowed parenting, the current study takes a relational approach to understand more about how the characteristics of parents of young and adult children relate to coping following the unexpected death of a partner due to COVID-19, and how these variables predict complicated grief and posttraumatic growth. A sample of 81 widowed parents completed self-report measures examining parenting self-efficacy, relationship uncertainty, coping, complicated grief, and posttraumatic growth. Results of hierarchical regression analyses suggest that, when controlling for time since death (1) relationship uncertainty and avoidant coping significantly predict complicated grief for parents in the sample with adult children, and (2) widowed parenting self-efficacy and both problem-focused and emotion-focused coping significantly predict posttraumatic growth for parents in the sample with young children. Results of the current study may inform future practices (e.g., use of Emotionally Focused Family Therapy) to aid families grieving an unexpected loss.

Long-term bereavement outcomes in family members of those who died in acute care hospitals before and during the first wave of COVID-19: A cohort study

BACKGROUND

Severe grief is highly distressing and prevalent up to 1 year post-death among people bereaved during the first wave of COVID-19, but no study has assessed changes in grief severity beyond this timeframe.

AIM

Understand the trajectory of grief during the pandemic by reassessing grief symptoms in our original cohort 12-18 months post-death.

DESIGN

Prospective matched cohort study.

SETTINGS/PARTICIPANTS

Family members of decedents who died in an acute care hospital between November 1, 2019 and August 31, 2020 in Ottawa, Canada. Family members of patients who died of COVID (COVID +ve) were matched 2:1 with those who died of non-COVID illness (COVID -ve) during pandemic wave 1 or immediately prior to its onset (pre-COVID). Grief was assessed using the Inventory of Complicated Grief (ICG).

RESULTS

Follow-up assessment was completed by 92% (111/121) of family members in the initial cohort. Mean ICG score on the 12-18-month assessment was 19.9 (SD = 11.8), and severe grief (ICG > 25) was present in 28.8% of participants. One-third (33.3%) had either a persistently high (>25) or worsening ICG score (⩾4-point increase between assessments). Using a modified Poisson regression analysis, persistently high or worsening ICG scores were associated with endotracheal intubation in the deceased, but not cause of death (COVID +ve, COVID -ve, pre-COVID) or physical presence of the family member in the final 48 h of life.

CONCLUSIONS

Severe grief is a substantial source of psychological morbidity in the wake of the COVID-19 pandemic, persisting more than a year post-death. Our findings highlight an acute need for effective and scalable means of addressing severe grief.

Grief and delivering a statement in court: a longitudinal mixed-method study among homicidally bereaved people

Background: Participating in a criminal trial may increase the likelihood of developing psychopathology. In 2021, people bereaved by a plane disaster (flight MH17) had the opportunity to deliver a victim personal statement (VPS) in Dutch court.Objective: This longitudinal mixed-method study examined different aspects of 84 bereaved people's experiences with VPS delivery.Method: Motivations to deliver, or not deliver, an oral VPS were examined qualitatively using thematic content analysis. Whether background and loss-related variables were related to the decision to deliver a VPS was examined using binary logistic regression analyses. Between-group (delivered VPS vs. did not) and within-group (pre- vs. post-VPS) comparisons were made regarding prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression levels using t-tests and paired t-tests.Results: Bereaved people were most frequently motivated to deliver an oral VPS to describe the impact of the incident, while those who did not deliver an oral VPS commonly wanted to protect themselves from the perceived emotional burden. None of the correlates - i.e. biological sex, age, level of education, number of losses, and (closest) relationship to the deceased - were related to the decision to deliver a VPS. Lastly, significantly higher PGD, PTSD, and depression levels were reported by people who delivered a VPS than those who did not, before and after the court hearing. No significant within-group differences were found over time.Conclusions: Professionals may provide emotional support to bereaved people who want to deliver a VPS and manage their expectations if they want to deliver a VPS for the purpose of symptom reduction. Future research may benefit from examining other ways in which VPS delivery might have beneficial or detrimental effects for specific individuals. Overall, implementing VPS delivery in court on the basis of emotional restoration remains empirically unsupported, if defined as a reduction in psychopathological levels.

The associations of grief-related rumination with prolonged grief and posttraumatic stress symptoms: A longitudinal study of bereaved after the 2011 terror attack in Norway

After the sudden and violent death of a loved one, many bereaved experience symptoms of prolonged grief (PG) and posttraumatic stress (PTS). The present study investigated the cross-sectional and longitudinal associations of grief-related rumination with PG and PTS symptoms among bereaved parents and siblings after the Utøya terror attack in Norway on 22 July 2011 (N = 110, Mage  = 43.2 years, 59.1% female). Participants' responses on the Rumination Scale, the Inventory of Complicated Grief and the Impact of Event Scale-Revised 28, 40 and 102 months after the loss were analysed. Cross-sectionally and longitudinally, grief-related rumination was positively and strongly linked with PG and PTS symptoms. When controlling for the baseline levels of PG and PTS symptoms and demographics of the sample, grief-related rumination predicted PG symptoms after 12 months but not after 74 months. Further, grief-related rumination predicted significantly the PTS symptoms of avoidance after 12 and 74 months and hyperarousal after 74 months beyond sample demographics and baseline symptoms. The results suggest that grief-related rumination is an important factor in PG and PTS symptoms after traumatic bereavement.

Latent trajectories of DSM-5-TR-based Prolonged Grief Disorder: findings from a data pooling project MARBLES

Background: With the release of the text revision of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5-TR), criteria for Prolonged Grief Disorder (PGD) were included. This necessitates studying grief trajectories based on these criteria.Objective: This is the first study examining latent trajectories of DSM-5-TR-based PGD symptom levels and testing whether specific risk factors (e.g. cause of death) predicted PGD trajectories.Method: We evaluated latent DSM-5-TR PGD trajectories using pooled existing data collected at 6-12, 13-24, and 25-60 months post-loss in Danish and Dutch bereaved adults (N = 398). Latent Growth Mixture Modelling (LGMM) was employed to determine the trajectories. Multinomial logistic regression analyses were used to examine which risk factors predicted class membership.Results: The four-class LGMM solution with a quadratic term was best-fitting the data. This solution represented four trajectories: High stable PGD (6%), High PGD quick recovery (10%), High PGD slow recovery (35%), and Low PGD symptoms (49%). Participants with a higher educational level were more likely to be assigned to the Low PGD symptoms trajectory compared to High stable PGD and High PGD slow recovery trajectories. Unnatural causes of death increased the likelihood of being in the High stable PGD and High PGD slow recovery trajectories compared to the Low PGD symptoms trajectory.Conclusions: Consistent with prior research, the Low PGD symptoms trajectory was the most common. A significant minority experienced high and stable levels of PGD within five years after the loss. About one-third of participants experienced high acute grief levels that decreased slowly; how slow decreasing symptoms relate to an individual's functioning requires further attention. This study demonstrates that a significant minority of bereaved people develop acute PGD symptomatology that does not diminish within five years post-loss, emphasizing the need for early screening for PGD to prevent long-lasting complaints.

Comorbid Prolonged Grief, PTSD, and Depression Trajectories for Bereaved Family Surrogates

Importance

Family surrogates of patients who die in an intensive care unit (ICU) are at risk of cooccurring prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depressive disorder during bereavement, but symptom trajectories are often explored individually.

Objectives

To simultaneously examine and determine co-occurrence of PGD, PTSD, and depressive symptom trajectories.

Design, Setting, and Participants

This cohort study was conducted in ICUs of 2 Taiwanese medical centers from January 2018 to March 2020, with follow-up through July 2022. Participants included surrogates responsible for decision-making who provided data 6 to 24 months after the death of their loved one. Data were analyzed from August to December 2022.

Main Outcomes and Measures

PGD was assessed with the 11 grief symptom items of the PG-13; PTSD, the Impact of Event Scale-Revised; and depressive symptoms, the depression subscale of the Hospital Anxiety and Depression Scale at 6, 13, 18, and 24 months after the death. Latent growth mixture modeling was conducted to identify distinct trajectories, and joint latent class analysis was used to assess joint patterns of trajectories.

Results

A total of 303 participants were included, with most younger than 56 years (207 participants [68.3%]), female (177 participants [58.4%]), and married (228 participants [75.2%]), and their relationship with the patient was mostly spouse (88 participants [29.0%]) or adult child (166 participants [54.8%]). Three trajectories were identified each for PGD, PTSD, and depressive symptoms. A resilience trajectory was predominant across PGD (253 participants [83.5%]), PTSD (250 participants [82.5%]), and depressive (200 participants [66.0%]) symptoms. Second most common was a recovery trajectory identified for PGD (36 participants [11.9%]) and PTSD (41 participants [13.5%]) symptoms, while for depressive symptoms, a moderate trajectory (72 participants [23.8%]) signified persistent moderate distress. A chronic trajectory characterized by persistently high distress was identified for PGD (14 participants [4.6%]) and depressive (31 participants [10.2%]) symptoms, whereas a unique delayed-onset trajectory (12 participants [4.0%]) was identified for PTSD symptoms. Most family surrogates (228 participants [75.2%]) experienced cooccurring PGD, PTSD, and depressive symptom trajectories, but multiple patterns were discordant. Symptom trajectories cooccurred in joint patterns: resilient (247 participants [81.5%]), recovered (43 participants [14.1%]), and distressed (14 participants [4.5%]). These patterns were characterized by high conditional probabilities for the resilience (PGD, 0.999; PTSD, 0.999; depressive, 0.804), recovery (PGD, 0.854; PTSD, 0.890; depressive, 0.588), and chronic (PGD, 0.921; PTSD, 0.789; depressive, 0.980) symptom trajectories.

Conclusions and Relevance

In this cohort study, grief-related psychological symptoms evolved in complex ways during ICU bereavement, as characterized by heterogeneous trajectories. Some ICU bereaved surrogates experienced persistent elevated PGD, PTSD, and depressive symptoms individually or conjointly, underscoring the importance of early screening to identify this population at high risk of comorbid psychological distress trajectories.

Self-guided online treatment of disturbed grief, posttraumatic stress, and depression in adults bereaved during the COVID-19 pandemic: A randomized controlled trial

OBJECTIVE

This randomized-waitlist controlled trial is the first study examining short-term effects of a self-guided online grief-specific cognitive behavioral therapy (CBT) in reducing early persistent complex bereavement disorder (PCBD), posttraumatic stress disorder (PTSD), and depression symptoms in adults bereaved during the COVID-19 pandemic.

METHOD

Sixty-five Dutch adults, bereaved at least three months earlier during the pandemic, with clinically-relevant PCBD, PTSD, and/or depression symptoms, were allocated to a treatment (n = 32) or waitlist condition (n = 33). Telephone interviews were conducted to assess PCBD, PTSD, and depression symptoms (using validated instruments) at baseline, post-treatment, and post-waiting period. Participants received an eight-week self-guided online grief-specific CBT including exposure, cognitive restructuring, and behavioral activation assignments. Analyses of covariance were performed.

RESULTS

Intention-to-treat analyses indicated that people in the intervention condition showed significantly lower PCBD (d = 0.90), PTSD (d = 0.71), and depression (d = 0.57) symptom-levels post-treatment relative to waitlist controls post-waiting, while taking baseline symptom-levels and use of professional psychological co-intervention into account.

CONCLUSIONS

The online CBT proved to be an effective intervention, reducing PCBD, PTSD, and depression symptoms. Pending replication of these findings, early online interventions may be widely implemented in practice to improve treatments for distressed bereaved people.

Online One-Stop Shop for Disaster Response Services After the MH17 Airplane Crash: An Evaluation Study

Background

A one-stop shop for disaster response services provides a central location for information and advice in an accessible way. Yet little is known about its organization and outcomes. After the MH17 airplane crash, the one-stop shop concept was realized through a digital environment called the Information and Referral Center (IRC). The aim of this study was to evaluate the experiences of users and providers in regard to the IRC and to identify improvement points for future IRCs.

Method

Data was collected among affected ones as well as involved organizations, using interviews, focus groups, surveys and online user information. Existing evaluation and quality models were combined to design the study and analyze the data.

Results

First, affected ones and a variety of organizations involved were positive about the merits of the IRC. Affected ones indicated they perceived the IRC as a reliable source of information and appreciated the referral possibilities. Second, the feature of the IRC to serve as a community where affected ones could meet, share experiences and support each other was hardly used according to participants. Lastly, tracking evolving psychosocial needs and problems through the IRC was hampered due to difficulty in accessing relevant data.

Conclusions

The IRC helped organizations to structure and align their services. Affected ones were positive about its reliability and accessibility. An IRC has to be embedded within the established care structures. Future research could indicate whether an IRC is useful in other event types and population contexts as well.

Symptoms Description of Family Post Traumatic Stress Disorder of the Mount Merapi Eruption Disaster Victims during Covid19

BACKGROUND: Volcano disaster can cause psychological problems such as Post Traumatic Stress Disorder (PTSD). PTSD is an anxiety disorder caused by a scary or frightening, unpleasant and challenging event or experience with physical abuse or threatened feeling. AIM: The purpose of this study was to describe the symptoms of PTSD experienced by families after the volcanic eruption disaster in Magelang Regency. METHODOLOGY: This research was conducted with a descriptive-analytic strategy. The research population was community aged 15–64 years, with a total of 574 people, and 86 respondents were selected as samples using a quota sampling technique. RESULTS: The results show that the majority of respondents experience symptoms of PTSD in the mild category as many as 60 respondents with a percentage of 68.9%. However, there are two respondents included in the severe category. The results of this study are expected to be the basis for the community and other institutions to pay attention to the symptoms of PTSD. CONCLUSION: Respondents who are categorized as experiencing weight PTSD symptoms are expected to conduct further examinations at health services immediately; therefore, PTSD can be handled.

Grief: Aetiology, Symptoms and Management

Grief is a process provoked as a response to different losses, such as death, loss of job, relationship breakdown, some unexpected life events and changes, etc. The experiences of loss and bereavement are very individual. Even though loss is expected, the person feels traumatized, especially if death is provoked by violence, natural disasters, or war. This pandemic, like other disasters (wars, tsunami, earthquakes, floods, etc.) has provoked intensive reactions of grief, reactions that could persist for years. The core symptoms of grief are described in the ICD-11 and DSM-5 manuals. The term "complicated grief" in the medical sense refers to a superimposed process that alters grief and modifies its course for the worse. Prolonged grief disorder (PGD) is characterized by normal grief symptoms, but these are symptoms that remain too intense for too long of a period. This article is a review of the manifestations and duration of grief in different occasions, and it is based on over 50 published papers, and discoveries in the Medline and Psych-Net databases. Commonly described reactions to grief are: shock, disbelief or denial, a high level of anxiety, distress, anger, sadness, insomnia, and a loss of appetite. As predictors for a high/slow decreasing trajectory of grief process are: female gender, reported symptoms of depression before the traumatic event, and higher scores on avoidance. However, grief is transient, even as we are is in the midst of its clutches. People should expect to fluctuate between moments of sadness and mourning, and moments of acceptance, or even happiness for being alive. Researchers suppose that when a crisis passes; most people will be able to bounce back and move on with their lives.