Complicated Grief in the Aftermath of Homicide: Spiritual Crisis and Distress in an African American Sample

Religious/spiritual struggles and whole person functioning among Colombian university students: Longitudinal evidence of mutual influence

This prospective study examined the primary, secondary and complex conceptual models of religious/spiritual struggles with 18 indicators of whole person functioning across five domains: psychological well-being, psychological distress, social well-being, physical well-being and character. We used three waves of longitudinal data (Wave 1: August/September 2021, Wave 2: October/November 2021, Wave 3: February 2022) from Colombian university students (N = 2878, Mage = 20.88 ± 4.05 years). Adjusting for covariates assessed in Wave 1, our primary analysis applied the analytic templates for outcome-wide and lagged exposure-wide designs to estimate two sets of lagged linear regression models. Religious/spiritual struggles in Wave 2 were associated with a small-to-medium-sized decline in subsequent functioning on 17/18 indicators in Wave 3, and worse functioning on 16/18 indicators in Wave 2 was associated with very small-to-medium-sized increases in subsequent religious/spiritual struggles in Wave 3. The results provided evidence in favour of the complex conceptual model for 16/18 indicators of whole person functioning. Our findings extend existing evidence on the reciprocal association between religious/spiritual struggles and individual functioning to a wide range of indicators, reinforcing the need for practitioners to consider the dynamic interplay between religious/spiritual struggles and individual functioning as they work with younger populations.

Mental Health of Homicidally Bereaved Individuals: A Systematic Review of Post-Homicide Factors

Experiencing the homicide of a loved one has a substantial impact on the mental health of family members and friends who must survive their loved one's tragic death. This systematic review aims to synthesize the current findings on post-homicide factors and identify the factors most frequently related to the mental health of homicidally bereaved individuals (HBI). Four databases were searched (PsycINFO, SCOPUS, Sociological Abstract, PubMed). The selection of studies was based on a peer review process conducted by two independent researchers to ensure interrater reliability. The articles were screened to ensure the presence of homicidally bereaved adults, resulting in a total of 35 eligible papers to be considered in the current review. Factors were organized into categories, with the criminal justice system-related factors (n = 18), social factors (n = 17), and coping factors (n = 13) being the most prevalent. This review identifies clinical avenues for preventing distress and fostering the well-being of HBI.

A qualitative phenomenological exploration of prolonged grief in New Delhi, India

Prolonged grief disorder (PGD) is a condition characterized by difficulty in coping effectively with the loss of loved ones. The proposed diagnostic criteria for PGD have been based predominantly on research from developed Western nations. The cultural variations associated with experience and expression of grief and associated mourning rituals have not been considered comprehensively. The current study aimed to understand the experience of prolonged grief in India through a qualitative enquiry with mental health professionals (focus group discussions) and affected individuals (key informant interviews). Several novel findings diverging from the current understanding of manifestation and narratives of PGD emerged from the study, including differences in the social contexts of bereavement and culture-specific magico-religious beliefs and idioms of distress. The findings point to limitations of existing diagnostic systems for PGD. The results of this study suggest that the assumption of content equivalence for psychiatric disorders across cultures may not be justified and that there is a need to develop culturally sensitive diagnostic criteria and assessment scales for PGD.

Recollections of Childhood Sexual Abuse: Complexities of Religious Coping and Muslim Religious and Psychological Adjustment in Afghanistan

Religious coping is a double-edged sword. Clarification of the psychological benefits for positive religious coping requires statistical controls for negative religious coping and vice versa. This study sought to further explore the complexities of Muslim religious coping by extending the analysis to Afghans who coped with the sufferings associated with recollections of childhood and adolescent sexual abuse. Two hundred Dari Persian-speaking Afghan university students (122 identified having experience of childhood sexual abuse) self-reported on variables that measure religious orientation, religious coping, Muslim experiential religiousness, mental health, and child abuse. Results showed that negative religious coping interfered with the possibly beneficial effects of positive religious coping on mental health and child abuse. After controlling for negative religious coping, the associations of positive religious coping became obvious. In addition, Muslim spirituality moderated the associations of religious coping with mental health outcomes and child abuse: for people with higher Muslim spirituality, positive religious coping associated with better mental health, and negative religious coping associated with less child abuse. Implications for religious coping and combating trauma in a religious context are discussed.

Religious/spiritual struggles and psychological distress: A test of three models in a longitudinal study of adults with chronic health conditions

OBJECTIVE

This study tested three conceptual explanatory models that have been theorized to account for the linkages between religious/spiritual (R/S) struggles and psychological distress: the primary model (i.e., R/S struggles lead to psychological distress), the secondary model (i.e., psychological distress leads to R/S struggles), and the complex model (i.e., R/S struggles and psychological distress reciprocally exacerbate each other).

METHODS

Using prospective data from a sample of US adults living with chronic health conditions (n = 302), we performed a cross-lagged panel analysis with three timepoints to test for evidence of potential causal relations between R/S struggles and psychological distress.

RESULTS

Consistent with the complex conceptual model of R/S struggles, we found evidence of positive reciprocal associations between R/S struggles and psychological distress.

CONCLUSION

The findings highlight the importance of attending to the dynamic interplay between R/S struggles and psychological distress when working with adults who have chronic health conditions.

Evaluation of Religious Coping in Tunisian Muslim Women with Newly Diagnosed Breast Cancer

Studies evaluating religious coping in Arab-Muslim populations are few. We aimed to evaluate religiosity and religious coping in a sample of breast cancer women, and to analyze the association between religiosity, religious coping, depression, anxiety, cancer clinical data, and sociodemographic data in our patients. A cross-sectional and descriptive study was conducted over a 4-month period in 61 newly diagnosed breast cancer women. We used the following scales: The Depression Anxiety Stress Scales (DASS-21), the Arabic-Brief Religious Coping Scale (A-BRCS) and the Arabic Religiosity Scale. The majority of participants (98.4%) had a moderate to high level of religiosity. A weak correlation was found between religious coping scores and stress, depression, and anxiety scores. Our patients had high scores of positive religious coping, with a mean score of 26.13 out of 28 and used more positive coping than negative coping to cope with the cancerous disease. High levels of affective religiosity were the main predictive factor of positive religious coping. Therapies should reinforce the positive religious coping patterns of breast cancer patients, and detect a possible resort to negative religious coping that may negatively affect the patients' quality of life.

Signs of Traumatic Grief, Lack of Justice, Magnitude of Loss, and Signs of Resilience Following the Homicidal Loss of Their Adult Child Among Caribbean Black Mothers

This study examined the aftermath of adult homicide on Trinidadian mothers. This is an understudied population, and the ability of these mothers to cope with the aftermath of such a tragedy needs to be fully acknowledged in order to understand their mental health status after the traumatic death of an adult child. This study utilized a narrative analysis approach to interview 20 mothers and used NVIVO 12 software to analyze the data. The findings highlight that factors such as multiple deaths, the scale of loss, and attempts to seek justice complicated the grief process. Although none of the mothers interviewed were diagnosed with a grief disorder, it was evident that their grief was indeed traumatic. It took more than a year for some mothers to find ways and opportunities for resilience, while others continue to struggle in the aftermath. Homicidally bereaved mothers are a distinct population that should be studied as they have the experiential knowledge and are willing to share the feelings and trauma-related needs after their loss.

Association Between Prolonged Grief and Attitudes Toward Reconciliation in Bereaved Survivors of the Khmer Rouge Regime in Cambodia

BACKGROUND

During the Khmer Rouge regime in Cambodia, about a quarter of the population died, resulting in many individuals losing close relatives. Still today, many individuals are suffering from the psychological consequences of these losses, which might also affect the process of reconciliation within the Cambodian society. The aim of this paper is therefore to investigate the association between symptoms of prolonged grief and attitudes toward reconciliation.

METHODS

A sample of 775 survivors of the Khmer Rouge regime who lost relatives during the conflict were interviewed about their losses and traumatic events, prolonged grief (PG; Complicated Grief Assessment Self-Report, CGA-SR), posttraumatic stress disorder (PTSD Checklist - Civilian Version) and attitudes toward reconciliation (Readiness to Reconcile Inventory, RRI).

RESULTS

A higher symptom severity of PG was significantly associated with readiness to reconcile even when controlling for other relevant variables (β = -0.22; p <.001). Persons who met caseness criteria for PG were significantly less ready to reconcile, t(773) = 5.47, p <.001, than persons who did not meet caseness for PG.

CONCLUSION

PG seems to be a relevant mental health correlate of attitudes toward reconciliation. The results of the current study underline the importance of also considering PG with regard to the reconciliation process in Cambodia and possibly also in other post-conflict regions.

Religious/Spiritual Struggles and Life Satisfaction among Young Roman Catholics: The Mediating Role of Gratitude

An extensive review of the psychological literature shows that interactions between religious/spiritual (R/S) struggles and other aspects of human functioning are complex and affected by “third” factors. Still, we have only a few studies that confirm R/S struggles as a source of well-being and indicate the ways in which it happens. In the present study, we aimed to verify whether the relationship between R/S struggles and life satisfaction was mediated by dispositional gratitude that seems to offer protection in times of adversity and turmoil. The sample consisted of 440 Roman Catholics (331 women) from Poland aged between 18 and 40. We applied the Religious Comfort and Strain Scale, the Satisfaction with Life Scale, and the Gratitude Questionnaire. In line with our hypotheses, it was confirmed that respondents with higher life satisfaction were more likely to display a higher sense of trust in God. They also declared a lower fear/guilt and perception of God as abandoning people. Gratitude correlated positively and significantly with religious comfort, and negatively with emotions towards God and social interactions surrounding religion. Moreover, it can be affirmed that dispositional gratitude mediated the relationship between three of four dimensions of religious strain and life satisfaction: religious comfort, negative emotions towards God, and negative social interactions surrounding religion.

Positive and negative religious coping as predictors of distress among minority older adults

OBJECTIVES

The study replicated and extended previous findings by investigating relationships between positive and negative religious coping and psychological distress in minority older adults.

METHODS

Older adults were evaluated during screening and baseline procedures of a psychotherapy clinical trial for late-life worry and anxiety. Participants were age 50 years or older and recruited from low-income and predominantly minority neighborhoods. Participants screening positive for worry (PSWQ-A ≥ 23) with no significant cognitive impairment (Six-Item Screener for cognitive impairment ≤2) completed a diagnostic interview and baseline assessments. Positive and negative religious coping were assessed with the positive and negative coping subscales of the Brief Religious Coping scale. Psychological distress was assessed with measures of depression, anxiety, and worry. A set of multiple linear regression models were used to evaluate the relationship between religious coping and each measure of psychological distress.

RESULTS

Negative religious coping was associated with greater anxiety, worry, and depression. Positive and negative religious coping interacted such that positive religious coping buffered the effects of negative religious coping on anxiety and depression. Significant main effects and interactions remained after controlling for age, gender, race, years of education, and study.

CONCLUSIONS

The findings of this study are consistent with prior work showing that negative religious coping is associated with greater psychological distress. This study replicates previous findings that positive religious coping may buffer the harmful effects of negative religious coping and extends understandings of the specific psychological impacts that positive and negative religious coping may have on older, minority adults.

A systematic review and meta-analysis of correlates of prolonged grief disorder in adults exposed to violent loss

Background: Violent loss (i.e. loss through homicide, suicide, or accident) is associated with high levels of prolonged grief disorder (PGD). Objective: The current meta-analysis aims at identifying correlates of PGD in adults exposed to violent loss. Method: We conducted a systematic literature search in PsycINFO, PsycARTICLES, PubMed, Web of Science, and Scopus. We used the Pearson correlation coefficient r as an effect size measure and a random effects model was applied to calculate effect sizes. Results: Thirty-seven eligible studies published between 2003 and 2017 (N = 5911) revealed 29 potential correlates. Most studies used a cross-sectional design. Analyses revealed large significant effect sizes for comorbid psychopathology (r = .50-.59), suicidality (r = .41, 95% confidence interval [CI] [.30; .52]), and rumination (r = .42, 95% CI [.31; .52]), while medium effect sizes were found for exposure to traumatic events and factors concerning the relationship to the deceased. Small effect sizes emerged for sociodemographic characteristics, multiple loss, physical symptoms, and religious beliefs. Ten variables did not show a significant association with PGD. Heterogeneity and a small number of studies assessing certain correlates were observed. Conclusions: The associations with psychological disorders may indicate shared mechanisms of psychopathology. Moreover, we recommend that clinicians carefully assess suicidal ideation among individuals with PGD who have been exposed to violent loss. Further research is warranted using longitudinal study designs with large sample sizes to understand the relevance of these factors for the development of PGD.

Childhood bereavement: The role of the surviving parent and the continuing bond with the deceased

This study investigated the relationship between the role of the surviving parent in the child's grieving process, the continuing bond with the deceased parent and biopsychosocial functioning and active grief in adulthood. A survey of 135 adults, parentally bereaved in childhood, indicated that the surviving parent's role in facilitating the grieving process promoted a positive continuing bond with the deceased in childhood as well as general functioning in adulthood. The continuing bond with the deceased had a weak association with both better general functioning and relational active grief.

Complicated spiritual grief II: a deductive inquiry following the loss of a loved one

Recent studies have revealed an association between complicated grief-a severe, prolonged response to the loss of a loved one-and complicated spiritual grief-a spiritual crisis following loss. Furthermore, bereavement research has benefitted from a number of studies using qualitative inquiry as a means of examining the experiences of individuals grieving a variety of types of losses. However, a gap in the literature remains in terms of the qualitative investigation of spiritual struggle following loss. Thus, using participants' written responses to open-ended questions along with systematic exploration of this topic with a five-member focus group, we designed this qualitative study to better understand the firsthand experiences of bereaved individuals who have suffered a crisis of faith after the death of a loved one. Specifically, our directed content analysis of bereaved focus group members' responses revealed 17 different common and salient themes subsumed in an overarching narrative of resentment and doubt toward God, dissatisfaction with the spiritual support received, and substantial changes in the bereaved person's spiritual beliefs and behaviors. Thus, our study clarified the construct of complicated spiritual grief, and laid the groundwork for development of more specific assessment and treatment of this condition.

Complicated spiritual grief I: relation to complicated grief symptomatology following violent death bereavement

Losing a loved one to violent death has been associated with poor mental health outcomes, including posttraumatic stress disorder, depression, and complicated grief (CG), a protracted, debilitating, and sometimes life-threatening reaction to loss. In addition, recent research suggests that traumatic loss can violate mourners' basic assumptive worldviews, and can precipitate a spiritual crisis following loss, also known as complicated spiritual grief (CSG). The present cross-sectional study investigated these multidimensional outcomes in a diverse sample of 150 grievers. The authors found that (a) violently bereaved individuals reported greater CG and CSG than did individuals bereaved by natural death; (b) CG and CSG were correlated across the larger sample, and yet are theoretically different constructs; and (c) specific cause of death (natural anticipated, natural sudden, homicide, suicide, or fatal accident) differentially predicted levels of CG and CSG. Implications of these findings for a clearer understanding of spiritual coping in the wake of troubling loss are noted, as well as for intervention with mourners struggling with clinical complications.

Inventory of complicated spiritual grief: development and validation of a new measure

Although spirituality often has been associated with better outcomes following bereavement, it can be significantly challenged by loss as well. Studies have shown that some bereaved individuals suffer profoundly not only in relation to the death of their loved one but also in their relationship with God and their faith community, a condition known as complicated spiritual grief (CSG). However, to date, in the absence of a simple, multidimensional, and well-validated measure of spiritual crisis following loss, investigators have measured CSG with nongrief-specific instruments. In this study, the authors tested the reliability and validity of a newly developed measure of CSG, called the Inventory of Complicated Spiritual Grief (ICSG). With 2 diverse samples of bereaved adult Christians (total n = 304), the authors found that the ICSG had strong internal consistency, and high test-retest reliability for both subscales in a subsample of participants. Analyses of both samples supported a 2-factor model, with one factor measuring Insecurity with God and the other assessing Disruption in Religious Practice. Analyses further supported the convergent and incremental validity of the 18-item ICSG relative to other theoretically similar instruments and measures of poor bereavement outcome, suggesting its usefulness in clinical research and practice.