Loneliness in Bereavement: Measurement Matters

The role of loneliness in the bereavement experience has been reported as substantial, with the death of a close person leaving a considerable void in the life of the bereaved. Yet, there is lack of agreement about its precise role and, notably, whether loneliness should be included as a core symptom for diagnosis of grief complications. The ongoing threat of heightened social isolation due to the COVID-19 pandemic underlines the need to understand the impact of loneliness, and to accurately chart its prevalence, intensity, duration, and associated difficulties in the context of bereavement. Assessment issues are central to this endeavor. In this article, we review the scientific literature to examine how loneliness after bereavement has been operationalized and measured. Sixty-three articles analyzing 51 independent datasets were reviewed. Results show major disparities: approximately half of the projects assessed loneliness by means of one of two validated scales (spanning different versions); the remainder included only single- or few-item measures. Diverse instructions, content and answer categories were used. While one size does not fit all, awareness of assessment options and dis/advantages may aid selection of the most appropriate measure, to suit the goals of a particular study and the specific groups under investigation. Our conclusion is that, in selecting a loneliness measure, health care professionals should come to their own well-informed decision, aided by the information provided in our review.

[Photographs of deceased newborn infants as documentation and as aid in mourning process for parents]

The death of a newborn infant is an extremely emotional event for relatives. Many hospitals provide the parents with support, and in some cases a mourning protocol is available. Some hospitals offer parents photographs of infants which have died around birth. The photographs are often taken by a nurse or doctor on the maternity or paediatric ward. It is advisable to draw up a mourning protocol which allows professional studio photographs to be taken. As a photograph is often the only concrete memento that parents have of their baby, it is important for it to be of good quality. The parents decide what they would prefer, but it is important to point out to them that their wishes and needs immediately following the death may differ to those in the longer term.

Western conceptualizations and Eastern experience: a cross-cultural study of traumatic stress reactions among Tibetan refugees in India

This study investigated the nature and impact of traumatic experiences among Tibetan refugees in India. It explored the applicability of western conceptualizations of reactions to traumatic events among this cultural group. A randomly selected sample of refugee camp students was assessed on measures of psychological and physical complaints, and on impact as well as severity of traumatic experiences. Respondents had experienced multiple traumatic events. The majority reported ongoing health problems. More than half demonstrated symptoms of intrusion-avoidance. Those with more traumatic experiences reported more symptoms of anxiety and depression (psychologically and, particularly, somatically manifested). Cultural differences in types of experienced traumatic events and manifestations of distress are discussed, as are implications for cross-cultural trauma research using western conceptualizations and instruments.

New directions in bereavement research: exploration of gender differences

Psychological research on the phenomena of bereavement has moved from a concern to establish the range and severity of mental and physical health consequences, to the examination of factors that make particular persons or subgroups especially vulnerable, to most recently an investigation of ways of coping with loss that may influence the course of recovery and adjustment. This trend is illustrated by exploring gender differences in reactions to spousal bereavement. Both males and females are vulnerable to ailments and illnesses on becoming bereaved, but research has shown that widowers have even more excessive detrimental consequences than widows. A new framework that has been developed to help understanding of such processes in coping with loss is outlined.

Intervention for the bereaved: gender differences in the efficacy of two counselling programmes

This article describes an investigation of emotion-focused versus problem-focused intervention for widowers (N = 23) and widowers (N = 23) who were suffering elevated levels of distress 11 months after their loss. They were randomly assigned to an intervention condition and improvement (on the General Health Questionnaire) was compared with non-intervention controls (N = 59). Two alternative hypotheses were considered: (1) men, since they focus less on their emotions, would benefit from problem-focused counselling, while women, focusing more on their emotions, would benefit from emotion-focused intervention; (2) each gender, having been comparatively unsuccessful in coping through these usual strategies, would benefit more from intervention directed towards the less familiar strategy. Results supported the second hypothesis: widowers benefited more from emotion-focused, widows from problem-focused interventions. Implications for supporting widows and widowers are discussed.

Cross-modality grief therapy: description and assessment of a new program

A recently developed program for extensive inpatient grief therapy in groups, administered on a time-limited basis, is outlined, an illustrative case study is described, and empirical assessment of the program's efficacy is provided. During a 3-month stay in a Dutch Health Care Centre, a combined treatment program was offered that integrated behavior and art therapy [so-called Cross-Modality Grief Therapy, (CMGT)]. Assessment (levels of symptomatology on the General Health Questionnaire) was made at pretest, post-test, and follow-up and was compared with levels at comparable time points among participants in a more traditional program. Systematic advantages were found for CMGT. Discussion focuses on the identification of elements within CMGT that were responsible for its effectiveness.