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.

The Health Service Model for Promoting Good Death in Critically Ill End-of-Life Patients in the Emergency Department: A Qualitative Study

Good death is one of the important outcomes of end-of-life care service delivery. The initial management of critically ill patients in the Emergency Department (ED) for promoting good death often challenging since it requires a focus on human dignity and equity at the end of life. A qualitative approach was used included eight bereaved family members who loss of their loved one in the ED and 25 emergency staff, including 11 emergency physicians and 14 emergency nurses of a super tertiary hospital in Thailand. Semi-structured, face-to-face interviews were conducted from February to August 2021. All the interviews were transcribed verbatim for content analysis. The result identified four distinct scenarios and seven core themes of end-of-life patient characteristics in the ED. To promote a good death in the ED, health care provider should consider the unique service deliver for each critically end-of-life patients and their family members.

Views of Psychologists About Their Role in Hastened Death

Hastened death practices are legal in several countries. Psychologists are increasingly taking a more active role in end-of-life issues, but the role of psychologists in requests to hasten death is not established. This study aims to contribute guidance for psychological practice in the context of requests to hasten death. We conducted a cross-sectional and cross-cultural study with Psychologists from Portugal and Luxembourg who answer closed and open questions to provide views about their role in hastened death. Psychological assessment, psychological support to patient and family, the exploration of patient decision-making and reorientation of patients were viewed as roles for psychologists. However, these roles may differ depending whether the patient has a terminal or non-terminal illness.

Continuing Bonds in the Existential, Phenomenological, and Cultural Study of Grief: Prolegomena

The essay makes the case that continuing bonds is a useful perspective for bereavement studies based in existential, phenomenological, and cultural philosophy. First, the idea of continuing bonds has explanatory power for many phenomena in individual and family grief and in the multiple interactions between individual/family grief and larger social/cultural dynamics. Second, in the study of continuing bonds we find concepts that are akin to those in phenomenology and existentialism. Using some of my own scholarship and the scholarship of many others, the essay is structured by themes Edith Marie Steffen and I found in our 2018 anthology on developments in the continuing bonds model in the two decades after it was introduced: Continuing bonds (1) are inter-subjective, (2) are central in constructing meaning, (3) raise questions about the ontological status of our interactions with the dead, and (4) are best understood within their cultural setting.

End of Life in Patients With Advanced Non-curable Cancer: Patient Considerations Around the Moment of Death

There is limited knowledge regarding Colombian patients with advanced cancer preferences regarding their final moments, place of death, and post-death wishes. To better understand these preferences, we conducted 23 in-depth interviews with patients between the ages of 28 and 78 receiving treatment at two academic hospitals and the National Cancer Institute. While many participants desired a peaceful death, few were comfortable discussing the topic of death directly. Some younger participants expressed an interest in euthanasia but had not received any guidance or support. While several participants preferred a home death, some expressed a desire to die in a hospital due to better symptom control. Additionally, when discussing post-death wishes, some participants expressed frustration about being unable to have these conversations with their loved ones and their preferences for funeral arrangements. Socioeconomic and geographical factors significantly impacted the wishes and preferences expressed, with many individuals hesitant to initiate difficult conversations.

Death Anxiety and Interment Stress Family Interventions for Filipino Older Adults

The overall intent of this research is to determine the preferred death anxiety and interment stress family interventions for Filipino older adults. 214 Filipino respondents (18-75 years old) participated in this conjoint analysis study. Results showed that cognitive state (23.272%) is most important and spiritual state (17.256%) as least important family intervention. Part-worth of the attributes shows medical routines and procedures (.342) as most preferred for physical state; mental health awareness (.266) for cognitive state; livelihood trainings (.051) for social state; family therapy (.022) for psychological state; and church activities (.017) for spiritual state. Spiritual state, age, and number of children have marked associations. Respondents aged 60-75 with a higher number of children in the family, cope with death anxiety and interment stress through spirituality. Significant findings of this study will greatly contribute to the knowledge base of geriatric mental health care; including caregivers and family members of older adults.

A Systematic Review of Barriers and Facilitators to Implementing Assisted Dying: A Qualitative Evidence Synthesis of Professionals' Perspectives

Assisted dying is a divisive topic and draws both lamenting and approving commentary from political, medical, legal, and philosophical domains. This systematic review and qualitative evidence synthesis aims to identify the factors that healthcare professionals experience when working within assisted dying frameworks. PRISMA guidelines for systematic reviews were followed. Search results yielded 15,426 papers with 39 papers meeting inclusion criteria for this review. Remaining papers were subjected to critical appraisal and a thematic synthesis. Eight themes fell under the domain of 'barrier' and represented different personal and professional factors that hinder professionals from delivering assisted dying healthcare. Five themes came under the domain of 'facilitators' and represent factors that contribute to the smooth implementation and delivery of assisted dying services. Health professionals experience a range of factors that both impede and propel delivery of assisted dying frameworks.

Preferred Place of Death Discussions: Are They Informing and Empowering Patients and their Family Caregivers?

Factors influencing preferred place of death (PPoD) are variable between individuals. However, there is little understanding of how these preferences are formed and how consistent they are in the final months of life. In particular, the expectation and responsibility of family caregivers to provide unpaid caregiving support to their dying loved one in the home is often overlooked. There is a need for clinicians to take an individualised approach to PPoD conversations that is inclusive of the needs of both the patient and the family caregiver. More Good Deaths - A Change Programme responds to this gap in care by advancing the skills of clinicians having PPoD conversations with patients and their family caregivers. This paper describes the programme, providing insight into its benefits to advanced care planning and communication, as well as to our newest service - Cottage Hospice.

Spanish Version of the Death Attitude Profile-Revised. Translation and Validation Into Spanish

The Death Attitude Profile-Revised (DAP-R) was developed in English-speaking cultures with the aim of measuring attitudes towards death. This measure consists of 32 items, grouped into five factors (Fear of Death, Avoidance of Death, Neutral Acceptance, Approach Acceptance, and Escape Acceptance). The DAP-R was translated and adapted to Spanish (DAP-RSp), and the psychometric properties were analyzed accross a general sample. The face validity was evaluated by 20 experts in palliative care. N = 417 (X = 39.06 years) took part in the validation. DAP-RSp showed adequate internal consistency (Cronbach's alpha ranging from 0.67 for Neutral Acceptance to 0.95 for Escape a Acceptance, and 0.88 for the total), a multitrait scaling analysis and a confirmatory factor analysis reproduced the five dimensions of the original scale. The Spanish version of the DAP-R can be used as a valid scale to assess attitudes towards death in Spanish speaking population.

Adjustment Disorder in the Face of COVID-19 Outbreak: The Impact of Death Anxiety, Media Exposure, Fear of Contagion and Hypochondriasis Symptoms

Based on the theoretical view of Terror Management Theory, the current research examines whether higher levels of death anxiety symptoms, in the face of the COVID-19 outbreak, increase the extent to which participants are exposed to information regarding the spread of the pandemic, as well as the fear of contagion and symptoms of hypochondriasis, which all in turn increase symptoms of adjustment disorder. A total number of 302 participants filled out self-report questionnaires regarding death anxiety, adjustment disorder, the extent of exposure to information regarding COVID-19, fear of contagion, hypochondriasis, and demographic information. Structural Equation Modeling analysis indicated a very good fit of the theoretical model with the data, confirming the mediation effect of exposure to information, fear of contagion, and symptoms of hypochondriasis on the association between death anxiety and adjustment disorder symptoms. Implications for practice are discussed.

Medical Stress and Fear of Death and Dying in a Medical Patient Population

We explored the relationship between medical illness-related stress and fear of death and dying in a population of individuals with self-reported medical illnesses. Medically ill participants identified their level of stress related to their medical condition, their level of fear of death and dying, and what treatments they would most prefer for addressing any fear of death and dying as well as their medical illness-related stress. Participants' medical illness-related stress levels were high with an average endorsed score of 7.23 out of 10 (most extreme stress). The majority (70%) of participants endorsed "some," "a little," or "no fear" of death and dying. Overall, reported medical illness-related stress was not significantly correlated with fear of death and dying. Seventy-five percent of participants reported preferring psychotherapy or mindfulness interventions for addressing their stress. Psychotherapy, anti-anxiety medications, and meditation were the top three choices for addressing fear of death and dying.

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.

Predicting Attrition Among Hospice Volunteers

To explore those factors predicting continued involvement among hospice volunteers, this study collected data from questionnaires distributed among 53 individuals who were hospice volunteers, to include personal demographics and measures of locus of control, burnout, hospice self-efficacy, spirituality, and death anxiety. Participants were then contacted between 6 and 8 months later to assess whether they were still actively volunteering for hospice. Those who remained in hospice reported less burnout when adjusting for previous volunteer experience, age, education, and duration of volunteering and a combination of burnout, spirituality, and hospice self-efficacy accurately predicted group membership (completers vs. dropouts) in 82% of the cases. The implications of these exploratory findings for the retention of hospice volunteers are discussed in the context to carefully screening persons before they enter the hospice volunteer role and providing hospice volunteer training for them.

The End of Life Within Social Work Literature: A Conceptual Review

The current conceptual review sought to identify and describe how the end of life was conceptualized and operationalized in top-ranking, peer-reviewed social work journals considering the highly individualized and multidimensional experience of dying put forth by modern scholars and social work practitioners. An iterative content analysis of included articles (N = 103) revealed six themes within reported definitions and four themes within eligibility criteria. Definitions (n = 66) related to treatment responsiveness, the death process, dying, prognosis, admission to specific services, and old age. Eligibility criteria (n = 18) related to proxy assessment, diagnosis, prognosis, and functional ability assessments. Over one-third of included articles did not define what was meant by the end of life (36%; n = 37) and the majority did not include eligibility criteria (83%; n = 85). In conclusion, the complex lived experience of dying was not manifest within included articles raising important implications for research (e.g., measurement, meta-analysis) and social work practice (viz. service eligibility).

Coping With Imminent Death: Thematic Content Analysis on Narratives by Japanese Soldiers in World War II

Coping affects somatic and psychological outcomes. This article explores narratives in a book, Kamikaze Diaries: Reflections of Japanese Student Soldiers, which report on the ways of coping used by each kamikaze participant before and during military service. The purpose of this study is to observe the possibility of a trend in coping strategies and consider how these trends inform us about other populations facing imminent death. This study analyzed data and extracted meaning from the narratives in the book (thematic content analysis). Within the thematic content analysis, the Ways of Coping scale was used, which describes the coping strategies people use when facing problems. The most frequently used coping strategies before they entered the military were "Accept Responsibility," "Endurance/Obedience/Effort," and "Self-Control," while once in the military, they were "Accept Responsibility" and "Endurance/Obedience/Effort." All the coping strategies used by kamikaze pilots appeared to focus on the passive self, which may be the type of coping in other populations facing death.

Religious Preference and Hospice Choice

This article will employ a database from a large hospice provider with offices in 16 states to examine the impact of religious preference on hospice choice. Little work has been done on this issue, even though religion is the only social institution that specifically addresses the end of life. Hospice work, in particular, has drawn little attention despite it effecting millions of patients and their families. Of all the medical subspecialties, hospice is one of the most effected by society's views on death and religious views of dying. It is also the only government-funded medical service that requires religious support be made available to patients. Our hypothesis is that certain religious groups have a predisposition against end-of-life interventions and will be less likely to utilize hospice. This impacts a multibillion dollar a year industry that supplies hospice service to millions of patients, and our research points to one major religious group not accessing their hospice benefit at the same rate as other denominations.

A Cross-Sectional View of Fear of Death and Dying Among Skydivers

The literature lacks a consistent pattern on the relationship between attitudes toward death and dying across occupations and recreational pursuits. The present cross-sectional study categorized a group of individuals engaging in a high-risk recreational activity (i.e., skydivers) on the basis of experience and classified them into student, intermediate, and experts. There were more negative attitudes of death and dying among student skydivers compared with more experienced skydivers. It was also found that expert skydivers had more negative attitudes toward death and dying on some of the measures compared with the intermediate level experienced skydivers. It may be the case that factors such as perceived personal control, overconfidence, and metacognition may be related to these observed differences between the two more experienced groups of skydivers. The possibility of the factors playing a role in skydivers' attitudes toward death and dying should be taken into consideration in the training programs for skydiving.

Death Is Not the End: A Register-Based Study of the Effect of Parental Death on Adult Children's Childbearing Behavior in Sweden

Macro-level studies have shown that rapid increases in mortality can affect fertility rates. Parental death has also been linked to negative psychological and physical outcomes, reduced relationship quality, and making bereaved children attach more importance to their families. No prior study has examined whether parental death influences adult children's fertility at the microlevel. This study applies event history techniques to Swedish multigeneration registers listing 1.5 million individuals with micro data on mortality and fertility to investigate short-term (first birth risk) and long-term (childlessness at age 45) effects of parental death on adult children's fertility. The principal finding is that parental death during reproductive age affects children's fertility and this effect is mainly short term. The effects differ to some degree between men and women and depend on the stage of the life course in which the bereavement occurs. Younger individuals experiencing a parental death have a significantly higher first birth risk after the parental death compared with peers who did not experience a parental death. Individuals older than 23 who experience a parental death have no or lower first birth risk after the parental death compared with baseline. Men, compared with women, are more likely to end childless if they experience a parental death.

Soldiers' Preferences Regarding Sperm Preservation, Posthumous Reproduction, and Attributes of a Potential "Posthumous Mother"

We present study results regarding soldiers' willingness to conduct posthumous reproduction. Two hundred twelve Israeli soldiers filled in a questionnaire designed to examine their willingness to cryopreserve sperm and evaluate in which familial circumstances they would consent to posthumous reproduction. They ranked the desirability of 46 attributes of a potential mother and a life partner. Findings indicate a relatively high predisposition in favor of posthumous-assisted reproduction; the wishes of soldiers' parents had much more influence on soldiers' willingness to pursue this technology than those of a partner. Soldiers preferred "feminine" jobs for a potential mother that would allow her to dedicate herself to child-rearing. The desired traits of such a mother were rated similarly to partner preferences; however, significant differences were found in attributes that are most related to the potential mother's devotion to maternity. Interpretations of these findings are contextualized in relation to ethical and bereavement considerations.

"Keep All Thee 'Til the End": Reclaiming the Lifeworld for Patients in the Hospice Setting

St Christopher's Hospice, London, was founded to provide specialist care to the incurably ill. We studied the dimensions of difference that set St Christopher's Hospice apart from hospital care of the dying, focusing on physical space and social organization. Material from 1953 to 1980 from the Cicely Saunders Archive was analyzed qualitatively. Through thematic analysis, quotes were found and analyzed using open coding. Five themes were developed. Themes identified were home/homelike, community, consideration of others, link with outside world, and privacy. The hospice philosophy functioned as the catalyst for the development of the physical environment of St Christopher's Hospice. Taking Habermas' concept of lifeworld, it seems that, in contrast to acute care, the need for hospice to formulate their own lifeworld to support and fully engage patients was central. As lifeworlds are culture sensitive, this underlines the need for variation in design and organization of hospices around the world.