1
|
Krijnen LJG, van Eldik WM, Mooren TTM, van Rooijen B, Boelen PA, van Baar AL, Spuij M, Verhoeven M, Egberts MR. Factors associated with mental health of young children during the COVID-19 pandemic in the Netherlands. Child Adolesc Psychiatry Ment Health 2023; 17:136. [PMID: 38093365 PMCID: PMC10720157 DOI: 10.1186/s13034-023-00686-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic and accompanying societal measures have impacted children and their families all over the world. Little is known about the factors associated with mental health outcomes in young children (i.e., 1 to 6 years old) during the pandemic. The current study aimed to examine associations with potential risk and protective factors, i.e., direct COVID-19 exposure factors as well as within-family characteristics. METHODS Caregivers of children aged 1-6 years old were recruited in the Netherlands to participate in an ongoing longitudinal research project. In the current study, baseline data-collected during the 1st year of the pandemic-are reported. The final sample consisted of 2762 caregivers who answered questionnaires assessing negative and positive dimensions of their children's mental health (i.e., anxiety, depressive symptoms, anger, sleep problems, positive affect, and self-regulation). Furthermore, caregivers provided information regarding: (1) Direct COVID-19 related factors, i.e., parental infection and death of a family member or close friend due to COVID-19, (2) Family related COVID-19 factors, i.e., parental perceived impact of the pandemic and COVID-19 related parent-child emotion regulation strategies (i.e., active, avoidant and information-focused strategies), (3) General caregiver's distress, i.e., parental mental health, parental feelings of rejection towards their child. Regression analyses were used to examine associations with children's mental health. RESULTS Direct COVID-19 related factors were not associated with more mental health problems in the children, though parental COVID-19 infections were related with less anger in children. Family related COVID-19 factors and caregiver's distress were related with children's mental health. Higher parental perceived negative impact of the pandemic, lower parental perceived positive impact of the pandemic, more avoidant as well as more active and information-focused parent-child emotion regulation strategies, more caregiver's mental health problems and more parental feelings of rejection towards their child were related with more mental health problems in the child. CONCLUSION Direct exposure to COVID-19 was not related with more mental health problems in the child. Family related COVID-19 factors and caregiver's distress appear to play a more important role for young children's mental health. Findings may inform prevention and intervention programs for potential future global crises as well as other stressful events.
Collapse
Affiliation(s)
- L J G Krijnen
- Child and Adolescent Studies, Utrecht University, Utrecht, Netherlands.
| | - W M van Eldik
- Youz, Parnassia Psychiatric Institution, The Hague, The Netherlands
| | - T T M Mooren
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - B van Rooijen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - P A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - A L van Baar
- Child and Adolescent Studies, Utrecht University, Utrecht, Netherlands
| | - M Spuij
- Child and Adolescent Studies, Utrecht University, Utrecht, Netherlands
- TOPP-Zorg, Driebergen, The Netherlands
| | - M Verhoeven
- Child and Adolescent Studies, Utrecht University, Utrecht, Netherlands
| | - M R Egberts
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Ingeborg Douwes Centrum, Centre for Psycho-Oncology, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Lenferink LIM, Eisma MC, Buiter MY, de Keijser J, Boelen PA. Online cognitive behavioral therapy for prolonged grief after traumatic loss: a randomized waitlist-controlled trial. Cogn Behav Ther 2023; 52:508-522. [PMID: 37341432 DOI: 10.1080/16506073.2023.2225744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023]
Abstract
Prolonged grief disorder, a condition characterized by severe, persistent, and disabling grief, is newly included in ICD-11 and DSM-5-TR. Prolonged grief symptoms can be effectively treated with face-to-face or internet-delivered cognitive behavioral therapy. Traumatic losses may elicit higher prevalence of severe grief reactions. While face-to-face cognitive behavioral therapy appears efficacious in treating prolonged grief symptoms in traumatically bereaved individuals, it is not yet clear if internet-based cognitive behavioral therapy is efficacious for this population. Therefore, we investigated the efficacy of a 12-week internet-delivered cognitive behavioral therapy for people bereaved through traffic accidents in a randomized waitlist-controlled trial (registration number: NL7497, Dutch Trial Register). Forty adults bereaved though a traffic accident were randomized to internet-based cognitive behavioral therapy (n = 19) or a waitlist control condition (n = 21). Prolonged grief, post-traumatic stress, and depression symptoms were assessed at baseline, post-treatment, and 8-week follow-up. Dropout in the treatment condition was relatively high (42%) compared to the control condition (19%). Nevertheless, multilevel analyses showed that internet-based cognitive behavioral therapy strongly reduced prolonged grief, post-traumatic stress, and depression symptoms relative to the control condition at post-treatment and follow-up. We conclude that internet-based cognitive behavioral therapy appears a promising treatment for traumatically bereaved adults.
Collapse
Affiliation(s)
- L I M Lenferink
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, Groningen 9712, The Netherlands
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, Utrecht 3508, The Netherlands
- Department of Psychology, Health, & Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Drienerlolaan 5, Enschede 7522, The Netherlands
| | - M C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, Groningen 9712, The Netherlands
| | - M Y Buiter
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, Groningen 9712, The Netherlands
| | - J de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, Groningen 9712, The Netherlands
| | - P A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, Utrecht 3508, The Netherlands
- ARQ National Psychotrauma Centre, Nienoord 5, Diemen 1112, The Netherlands
- Foundation Centrum '45, Nienoord 5, Diemen 1112, The Netherlands
| |
Collapse
|
3
|
Reitsma L, Boelen PA, de Keijser J, Lenferink LIM. Self-guided online treatment of disturbed grief, posttraumatic stress, and depression in adults bereaved during the COVID-19 pandemic: A randomized controlled trial. Behav Res Ther 2023; 163:104286. [PMID: 36906949 PMCID: PMC9985540 DOI: 10.1016/j.brat.2023.104286] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
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.
Collapse
Affiliation(s)
- L Reitsma
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, the Netherlands.
| | - P A Boelen
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, the Netherlands; ARQ National Psychotrauma Centre, Nienoord 5, 3508 TC, Diemen, the Netherlands
| | - J de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands
| | - L I M Lenferink
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, the Netherlands; Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands; Department of Psychology, Health & Technology, Faculty of Behavioural Management and Social Sciences, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
| |
Collapse
|
4
|
Lenferink LIM, Boelen PA. DSM-5-TR prolonged grief disorder levels after natural, COVID-19, and unnatural loss during the COVID-19 pandemic. J Affect Disord Rep 2023; 12:100516. [PMID: 36938562 PMCID: PMC10007714 DOI: 10.1016/j.jadr.2023.100516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023] Open
Abstract
Background and objectives A rise in prolonged grief disorder (PGD) levels was expected due to COVID-19 deaths. We tested this assumption, by comparing PGD-severity among people who experienced a death of a loved one during the pandemic caused by a natural (e.g., illness), COVID-19, or unnatural (e.g., accidents, suicides, homicides) loss on average 8 months earlier and in a subgroup of people bereaved ≥12 months earlier. Design and methods Self-rated DSM-5-TR (acute) PGD levels (using the Traumatic Grief Inventory-Self Report plus) were compared among Dutch adults who experienced a natural (N = 1036), COVID-19 (N = 76), or unnatural loss (N = 271) during the pandemic. Analyses of covariance were used. Results About two-thirds of the participants scored above the cut-off for (acute) probable PGD. Significantly higher acute PGD-severity was found in people after unnatural loss compared with COVID-19 (B = -2.44 (SE=0.87), p = .005) or natural loss (B = -1.78 (SE=0.45), p<.001). No significant differences in acute PGD-severity was found between people who experienced a natural or COVID-19 loss (B = 0.66 (SE=0.80), p = .413). PGD levels did not differ between the three groups for people who lost their loved one ≥12 months earlier (N = 380). Conclusions We found that acute PGD-severity was significantly higher following unnatural deaths than after COVID-19 deaths or natural causes, but no differences were found for people who experienced a loss ≥12 months earlier.
Collapse
Affiliation(s)
- L I M Lenferink
- Department of Psychology, Health, & Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, The Netherlands
| | - P A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, The Netherlands
- ARQ Centrum'45, Nienoord 5, 1112 XE, Diemen, The Netherlands
- ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE, Diemen, The Netherlands
| |
Collapse
|
5
|
Van Dijk I, Boelen PA, de Keijser J, Lenferink LIM. Assessing DSM-5-TR and ICD-11 prolonged grief disorder in children and adolescents: development of the Traumatic Grief Inventory - Kids - Clinician-Administered. Eur J Psychotraumatol 2023; 14:2197697. [PMID: 37078208 PMCID: PMC10120442 DOI: 10.1080/20008066.2023.2197697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Around 10% of bereaved youths experience symptoms of prolonged grief disorder (PGD). Recently, PGD was included in the two main classification systems for mental disorders: the ICD-11 and DSM-5-TR. Assessing PGD symptoms in youth is currently hindered by the lack of instruments for ICD-11 and DSM-5-TR criteria. To fill this gap, we developed an instrument to assess PGD symptoms in children and adolescents, the Traumatic Grief Inventory - Kids - Clinician-Administered (TGI-K-CA), based on input of grief experts and bereaved children. METHODS Five experts rated the items on alignment with DSM-TR and ICD-11 PGD symptoms and comprehensibility. The adjusted items were then presented to seventeen bereaved youths (Mdnage = 13.0 years, range = 8-17 years). Using the Three-Step Test Interview (TSTI), children were asked to verbalize their thoughts while answering the items. RESULTS Issues raised by experts were mostly related to alignment with the DSM-5-TR/ICD-11 symptom, ambiguous formulation of the items, or low comprehensibility for children and adolescents. Items raising fundamental issues according to experts were adjusted. The TSTI showed that children encountered relatively few problems with the items. Frequently reported problems with some of the items (e.g. regarding comprehensibility) led to final adjustments. CONCLUSION With input from grief experts and bereaved youths, an instrument to assess PGD symptoms as defined in DSM-5-TR and ICD-11 in bereaved youths was finalized. Further quantitative research is currently undertaken to evaluate the instrument's psychometric qualities.
Collapse
Affiliation(s)
- I Van Dijk
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
| | - P A Boelen
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
- ARQ National Psychotrauma Centre, Diemen, the Netherlands
| | - J de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - L I M Lenferink
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
- Department of Psychology, Health & Technology, Faculty of Behavioural Management and Social Sciences, University of Twente, Enschede, the Netherlands
| |
Collapse
|
6
|
Buiter MY, Boelen PA, Kunst M, Gerlsma C, de Keijser J, Lenferink LIM. The mediating role of state anger in the associations between intentions to participate in the criminal trial and psychopathology in traumatically bereaved people. Int J Law Psychiatry 2022; 85:101840. [PMID: 36274496 DOI: 10.1016/j.ijlp.2022.101840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Victims of crimes have been granted increasing procedural rights to participate in the juridical process since the mid 1990s. However, knowledge about the (anti)-therapeutic effect of participation is limited. We examined the associations between symptom levels of persistent complex bereavement disorder (PCBD), posttraumatic stress disorder (PTSD), and depression and the intention to participate in a criminal trial. Furthermore, we investigated the mediating role of state anger in these associations. People who lost loved ones after a plane disaster with flight MH17 (N = 203) completed questionnaires within three weeks before the start of the criminal trial. Mediation analyses indicated that people, who did not intend to actively participate in the trial by delivering a written or oral victim statement, were less likely to experience anger, which is, in turn, associated with attenuated psychopathology levels. State anger explains 68% of the effect of the intention to exercise the right to speak on PCBD levels. An important limitation is the cross-sectional study design, which precludes conclusions about temporal associations. More research is needed to improve preparation and support of bereaved people when they intend to exercise their victim rights during a criminal trial.
Collapse
Affiliation(s)
- M Y Buiter
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712, TS, Groningen, the Netherlands
| | - P A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, 3508, TC, Utrecht, the Netherlands; Foundation Centrum' 45, Nienoord 5, 1112 XE Diemen, the Netherlands; ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE Diemen, the Netherlands
| | - M Kunst
- Institute for Criminal Law and Criminology, Faculty of Law, Leiden University, P.O. Box 9520, 2300, RA, Leiden, the Netherlands
| | - C Gerlsma
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712, TS, Groningen, the Netherlands
| | - J de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712, TS, Groningen, the Netherlands
| | - L I M Lenferink
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712, TS, Groningen, the Netherlands; Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, 3508, TC, Utrecht, the Netherlands; Department of Psychology, Health & Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands.
| |
Collapse
|
7
|
Snijdewind MC, de Keijser J, Casteelen G, Boelen PA, Smid GE. "I lost so much more than my partner" - Bereaved partners' grief experiences following suicide or physician-assisted dying in case of a mental disorder. BMC Psychiatry 2022; 22:454. [PMID: 35799148 PMCID: PMC9261256 DOI: 10.1186/s12888-022-04098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/23/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND There is a lack of existing research on grief following the intentional death of people suffering from a mental disorder. Our study aims to provide insight into grief experiences and social reactions of bereaved persons who lost their life partners, who were suffering from a mental disorder, to physician-assisted dying (PAD) or suicide. METHODS For this mixed-methods research, we conducted a survey and in-depth interviews with 27 persons living in the Netherlands and bereaved by the death of their life partners. The deceased life partners suffered from a mental disorder and had died by physician-assisted dying (n = 12) or suicide (n = 15). Interviews explored grief experiences and social reactions. In the survey we compared self-reported grief reactions of partners bereaved by suicide and PAD using the Grief Experience Questionnaire. RESULTS Compared to suicide, physician-assisted dying was associated with less severe grief experiences of the bereaved partners. Participants reported that others rarely understood the suffering of their deceased partners and sometimes expected them to justify their partners' death. Following physician-assisted dying, the fact that the partner's euthanasia request was granted, helped others understand that the deceased person's mental suffering had been unbearable and irremediable. Whereas, following suicide, the involvement of the bereaved partners was sometimes the focus of judicial inquiry, especially, if the partner had been present during the death. CONCLUSION When individuals suffering from a mental disorder die by suicide or PAD, their bereaved partners may experience a lack of understanding from others. Although both ways of dying are considered unnatural, their implications for bereaved partners vary considerably. We propose looking beyond the dichotomy of PAD versus suicide when studying grief following the intentional death of people suffering from a mental disorder, and considering other important aspects, such as expectedness of the death, suffering during it, and partners' presence during the death.
Collapse
Affiliation(s)
- M. C. Snijdewind
- ARQ Centrum’45, Nienoord 5, 1112 XE, Diemen, The Netherlands ,grid.5650.60000000404654431Department of Ethics, Law and Humanities, Amsterdam UMC, Academic Medical Centre, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - J. de Keijser
- grid.4830.f0000 0004 0407 1981Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - G. Casteelen
- Expertisecentrum Euthanasie, P.O. Box 13480, 2501 EL Den Haag, The Netherlands
| | - P. A. Boelen
- ARQ Centrum’45, Nienoord 5, 1112 XE, Diemen, The Netherlands ,grid.491097.2ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE, Diemen, The Netherlands ,grid.5477.10000000120346234Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands
| | - G. E. Smid
- ARQ Centrum’45, Nienoord 5, 1112 XE, Diemen, The Netherlands ,grid.491097.2ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE, Diemen, The Netherlands ,grid.449771.80000 0004 0545 9398Department of Humanistic Chaplaincy Studies, University of Humanistic Studies, Kromme Nieuwegracht 29, 3512 HD Utrecht, the Netherlands
| |
Collapse
|
8
|
Killikelly C, Smid GE, Wagner B, Boelen PA. Responding to the new International Classification of Diseases-11 prolonged grief disorder during the COVID-19 pandemic: a new bereavement network and three-tiered model of care. Public Health 2021; 191:85-90. [PMID: 33556639 DOI: 10.1016/j.puhe.2020.10.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
The field of bereavement research and care is at a tipping point. The introduction of prolonged grief disorder (PGD) in the International Classification of Diseases (ICD-11) has ignited clinical interest in this new disorder, along with debate over challenges in validating and implementing these new criteria. At the same time, the global COVID-19 pandemic has launched several local and international efforts to provide urgent support and comfort for individuals and communities suffering from grief. Recently, grief experts have called for a collective response to these complicated bereavements and possible increase in PGD due to COVID-19. Here we outline a new European network that aims to unite a community of grief researchers and clinicians to provide accessible, evidence-based support particularly during times of unprecedent crisis. The Bereavement Network Europe (BNE) has been developed with two main aims. Firstly, to develop expert agreed, internationally acceptable guidelines for bereavement care through a three-tiered approach. Secondly, to provide a platform for researchers and clinicians to share knowledge, collaborate, and develop consensus protocols to facilitate the introduction of PGD to diverse stakeholders. This article outlines the current status and aims of the BNE along with the plans for upcoming network initiatives and the three-tiered bereavement care guidelines in response to the COVID-19 pandemic.
Collapse
Affiliation(s)
- C Killikelly
- Department of Psychology, University of Zurich, Switzerland.
| | - G E Smid
- University of Humanistic Studies, the Netherlands; ARQ National Psychotrauma Centre, Diemen, the Netherlands
| | - B Wagner
- MSB Medical School Berlin, Germany
| | - P A Boelen
- ARQ National Psychotrauma Centre, Diemen, the Netherlands; Department of Clinical Psychology, Utrecht University, Netherlands
| |
Collapse
|
9
|
van Ee E, Lenferink LIM, Eidhof MB, Boelen PA. [Mourning together: on social support for bereaved people during the COVID-19 pandemic]. Tijdschr Psychiatr 2021; 63:13-15. [PMID: 33537968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background In the Netherlands over 9,400 people have died from the consequences of the COVID-19 virus. Aim To describe possible consequences of the COVID-19 pandemia and the measures to control the spread of the virus, for the experiences of loss and mourning and to describe what is needed to prevent grief problems. Method Discussion of selected literature and consideration. Results The COVID-19 measures have an impact on the experiences of loss and mourning of bereaved people. The possibilities to appeal to social relationships have been limited due to the isolation measurements. Therefore, bereaved people might have a heightened risk to develop grief problems. Even though social support is of crucial interest in the processing of a loss, grief can also interfere with the possibilities to use social relationships. Research demonstrated a negative relationship between grief and social problem-solving skills. Thereby bereaved people face an additional challenge, to develop new goals, roles and attachment relationships under the current COVID-19 measurements of social isolation. Conclusion In times of COVID-19 society should pay more attention to experiences of loss and grief in order to activate social support for people bereaved during the COVID-19 pandemic. Tijdschrift voor Psychiatrie 63(2021)1, 13-15.
Collapse
|
10
|
Lenferink LIM, van den Munckhof MJA, de Keijser J, Boelen PA. DSM-5-TR prolonged grief disorder and DSM-5 posttraumatic stress disorder are related, yet distinct: confirmatory factor analyses in traumatically bereaved people. Eur J Psychotraumatol 2021; 12:1-14. [PMID: 34912501 PMCID: PMC8667936 DOI: 10.1080/20008198.2021.2000131] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Prolonged grief disorder (PGD) is newly included in the text revision of the DSM-5 (DSM-5-TR). So far, it is unknown if DSM-5-TR PGD is distinguishable from bereavement-related posttraumatic stress disorder (PTSD). Prior research examining the distinctiveness of PTSD and pathological grief focused on non-traumatic loss samples, used outdated conceptualizations of grief disorders, and has provided mixed results. OBJECTIVE In a large sample of traumatically bereaved people, we first evaluated the factor structure of PTSD and PGD separately and then evaluated the factor structure when combining PTSD and PGD symptoms to examine the distinctiveness between the two syndromes. METHODS Self-reported data were used from 468 people bereaved due to the MH17 plane disaster (N = 200) or a traffic accident (N = 268). The 10 DSM-5-TR PGD symptoms were assessed with the Traumatic Grief Inventory-Self Report Plus (TGI-SR+). The 20-item Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) was used to tap PTSD symptoms. Confirmatory factor analyses were conducted. RESULTS For PTSD, a seven factor, so-called 'Hybrid' model yielded the best fit. For PGD, a univariate factor model fits the data well. A combined model with PGD items loading on one factor and PTSD items on seven factors (associations between PGD and PTSD subscales r ≥ .50 and ≤.71), plus a higher-order factor (i.e. PTSD factors on a higher-order PTSD factor) (association between higher-order PTSD factor and PGD factor r = .82) exhibited a better fit than a model with all PGD and PTSD symptom loading on a single factor or two factors (i.e. one for PGD and one for PTSD). CONCLUSIONS This is the first study examining the factor structure of DSM-5-TR PGD and DSM-5 PTSD in people confronted with a traumatic loss. The findings provide support that PGD constitutes a syndrome distinguishable from, yet related with, PTSD.
Collapse
Affiliation(s)
- L I M Lenferink
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.,Department of Psychology, Health, & Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, The Netherlands
| | - M J A van den Munckhof
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - J de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - P A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.,Foundation Centrum '45, Diemen, the Netherlands.,ARQ National Psychotrauma Centre, Diemen, the Netherlands
| |
Collapse
|
11
|
Reitsma L, Boelen PA, de Keijser J, Lenferink LIM. Online treatment of persistent complex bereavement disorder, posttraumatic stress disorder, and depression symptoms in people who lost loved ones during the COVID-19 pandemic: study protocol for a randomized controlled trial and a controlled trial. Eur J Psychotraumatol 2021; 12:1987687. [PMID: 34868479 PMCID: PMC8635653 DOI: 10.1080/20008198.2021.1987687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Losing a loved one during the COVID-19 pandemic is a potentially traumatic loss that may result in symptoms of persistent complex bereavement disorder (PCBD), posttraumatic stress disorder (PTSD), and depression. To date, grief-specific cognitive-behavioural therapy (CBT) has mostly been delivered through individual face-to-face formats, while studies have shown that online treatment also yields promising results. Offering treatment online is now more than ever relevant during the pan demic and may offer important benefits compared with face-to-face CBT, such as lower costs and higher accessibility. Our expectation is that grief-specific online CBT is effective in reducing PCBD, PTSD, and depression symptoms. OBJECTIVE Our aim is to evaluate the short-term and long-term effectiveness of grief-specific online CBT in reducing PCBD, PTSD, and depression symptom-levels for adults who lost a loved one during the COVID-19 pandemic. METHOD This study consists of two parts. In part 1, a two-armed (unguided online CBT versus waitlist controls) randomized controlled trial will be conducted. In part 2, a two-armed (guided online CBT versus unguided online CBT) controlled trial will be conducted. Symptoms of PCBD, PTSD, and depression will be assessed via telephone interviews at pre-treatment/pre-waiting period, post-treatment/post-waiting period, and six months post-treatment. Potential participants are people who lost a loved one at least three months earlier during the COVID-19 pandemic with clinically relevant levels of PCBD, PTSD, and/or depression. Analysis of covariance and multilevel modelling will be performed. DISCUSSION This is one of the first studies examining the effectiveness of online grief-specific CBT. More research is needed before implementing online grief-specific CBT into clinical practice.
Collapse
Affiliation(s)
- L Reitsma
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - P A Boelen
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - J de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - L I M Lenferink
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.,Department of Psychology, Health & Technology, Faculty of Behavioural Management and Social Sciences, University of Twente, Enschede, The Netherlands
| |
Collapse
|
12
|
van Heemstra HE, Scholte WF, Haagen JFG, Boelen PA. 7ROSES, a transdiagnostic intervention for promoting self-efficacy in traumatized refugees: a first quantitative evaluation. Eur J Psychotraumatol 2019; 10:1673062. [PMID: 31681464 PMCID: PMC6807946 DOI: 10.1080/20008198.2019.1673062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/27/2019] [Accepted: 09/02/2019] [Indexed: 11/24/2022] Open
Abstract
Objective: Due to traumatic experiences and highly prevalent post-migration stressors, refugees are vulnerable for developing psychopathology. To date, research has mainly evaluated trauma-focused therapies, targeting post traumatic stresss symptoms. Treatments targeting post-migration stressors are relatively understudied. The present cohort study evaluated the potential effectiveness of 7ROSES, a transdiagnostic intervention that aims to increase self-efficacy among treatment-seeking refugees in dealing with post-migration stressors. Because it can be applied by non-specialist health care workers, it can be disseminated on a large scale, thereby increasing options for psychosocial support for refugees. Method: Forty-nine refugees (65% male, average age: 36.02 years, SD = 8.52) with psychopathology were included. Before and after participation in 7ROSES, self-efficacy was measured using the General Self-Efficacy Scale (GSES), and general psychopathology using the Brief Symptom Inventory (BSI). Results: Completers analysis yielded a significant increase in GSES scores (Z = -2.16, p = .03) and significant decrease in BSI scores (Z = -2.05, p = .04) with medium-small effects (both r = -.28). Intent-to-treat analysis, using predictive mean matching imputation, yielded significant results for the GSES (p = .012) but not for the BSI (p = .14) with small effects (GSES r = .14, BSI r = .12). Reliable change indices established negative change in 3%, no change in 70%, and positive change in 27% based on the GSES; percentages were 11.5%, 65.5%, and 23%, respectively, based on the BSI. Conclusion: Findings provide preliminary evidence that 7ROSES could improve self-efficacy and general mental health in refugees with psychopathology.
Collapse
Affiliation(s)
- Henriette E van Heemstra
- ARQ Centrum'45, Diemen, Diemen, Netherlands.,ARQ National Psychotrauma Centre, Utrecht University, Diemen, Netherlands.,department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
| | - W F Scholte
- ARQ Centrum'45, Diemen, Diemen, Netherlands.,ARQ National Psychotrauma Centre, Utrecht University, Diemen, Netherlands.,Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - J F G Haagen
- ARQ National Psychotrauma Centre, Utrecht University, Diemen, Netherlands.,Impact, Dutch Knowledge and Advice Center for Psychosocial Care and Safety Concerning Critical Incidents, Diemen, Netherlands
| | - P A Boelen
- ARQ National Psychotrauma Centre, Utrecht University, Diemen, Netherlands.,department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
13
|
Hanssen I, Regeer EJ, Schut D, Boelen PA. Ruminative and dampening responses to positive affect in bipolar disorder and major depressive disorder. Compr Psychiatry 2018; 85:72-77. [PMID: 30005179 DOI: 10.1016/j.comppsych.2018.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Although previous research has focused on distinguishing cognitive styles between Bipolar Disorder (BD) and Major Depressive Disorder (MDD), little is known about differences in positive affect regulation between these affective groups. The aim of the present study was to extend previous research by investigating such differences between BD and MDD, and between the bipolar subtypes (BD-I vs. BD-II and predominant polarities), using large, clinical, outpatient samples. METHODS In total, 298 participants (96 BD-I, 27 BD-II, and 175 MDD) were included. All completed the Responses to Positive Affect (RPA) questionnaire. Mood symptoms in BD patients were clinically assessed by means of the Clinical Global Impression for Bipolar Disorders (CGI-BP), while depressive symptom severity in MDD patients were assessed by means of the Inventory of Depressive Symptomatology (IDS-SR). RESULTS Results showed differences between affective groups and bipolar subtypes. The most salient finding was that both BD-I and BD-II patients were more likely to ruminate about positive affect than MDD patients, while MDD patients were more likely to engage in dampening responses to positive affect. CONCLUSIONS Differentiation of responses to positive affect between BD and MDD may have relevant clinical implications in terms of symptomatology, course, and treatment.
Collapse
Affiliation(s)
- I Hanssen
- Altrecht Institute for Mental Health Care, Utrecht, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
| | - E J Regeer
- Altrecht Institute for Mental Health Care, Utrecht, the Netherlands
| | - D Schut
- Altrecht Institute for Mental Health Care, Utrecht, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - P A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands; Arq Psychotrauma Expert Group, Diemen, the Netherlands
| |
Collapse
|